Continued Alcohol Use Research Articles

Insomnia and Alcohol Use in Assisted Living

Insomnia and Alcohol Use in Assisted Living

Quality of Life, Functioning, and Coping in HCV Patients Continuing Versus Ceasing Alcohol Use.

The purpose of this study was to compare quality of life, functioning, and coping among hepatitis C virus (HCV) patients who continued versus ceased alcohol use in the past year. HCV patients (n = 291) were recruited from three liver and infectious disease clinics. Student's t test was used to compare HCV patients who were former and active users of alcohol. The majority of HCV patients were male, African American, and without a high school degree. Compared to former users of alcohol, active users of alcohol self-reported lower ratings on home life, personal leisure, and overall quality of life. In the area of functioning, active users of alcohol self-reported lower ratings on home life, close relationships, sex life, and overall functioning. The two groups did not differ on coping. Most HCV clinicians advise HCV patients to avoid alcohol completely because of its adverse biological effects on the liver. Despite this important advice by their HCV clinicians, most HCV patients continue to use alcohol. HCV clinicians can additionally consider advising these patients that continued alcohol use is associated with lower quality of life and functioning as further evidence to convince these patients to avoid alcohol or to participate in alcohol cessation treatment.

Patterns, perceptions and their association with changes in alcohol consumption in cancer survivors

Continued consumption of alcohol after a cancer diagnosis is associated with poorer outcomes. We evaluated whether perceptions of the effects of continued alcohol use and receiving information on moderating alcohol reduced alcohol consumption in adult cancer survivors. A total of 509 cancer survivors were cross-sectionally surveyed at follow-up for their alcohol use before and after cancer diagnosis and perceptions of continued drinking. Multivariable logistic regression models evaluated factors associated with changes in alcohol consumption after diagnosis. Among 299 patients who were drinking alcohol at diagnosis (13% exceeding gender-specific guidelines), 52% reduced/ceased alcohol consumption 1year after diagnosis. Patients perceiving that alcohol worsened their own (a) quality of life, (b) cancer-related fatigue or (c) overall survival were more likely (aORs=2.43-3.35, p<0.002) to reduce (moderating or quitting) their alcohol use 1year after diagnosis. Only 14% of individuals currently drinking regularly recalled receiving information/counselling from healthcare providers on alcohol consumption (7% from oncologists). However, there was a significant fourfold to sixfold increase in cessation with such information/counselling (p<0.01). Similar trends were observed in patients exceeding gender-specific guidelines. Perception of negative effects of alcohol use on their health by cancer survivors was associated with reducing harmful alcohol consumption. Counselling, especially from the oncologist, may play a significant role for reducing consumption.

Neural response to errors is associated with problematic alcohol use over time in combat-exposed returning veterans: An event-related potential study

BackgroundCurrently, we do not have biomarkers to help identify individuals at-risk for chronic, problematic alcohol use, especially among veteran populations, who have notoriously high rates of alcohol use. One biomarker that may predict individuals at risk for chronic, problematic alcohol use is error-related brain activity. We examined longitudinal associations between the error-related negativity (ERN), an event-related potential observed following the commission of errors, and problematic alcohol use among U.S. military veterans returning from recent conflicts in Iraq and Afghanistan. MethodsForty-six military veterans, aged 18–55 years, completed a well-validated flanker task known to elicit the ERN at baseline. Problematic alcohol use and other clinically relevant variables were assessed at baseline, 3-, 6-, 9-, 12-, 15-, 18-, 21-months, and 2 years. ResultsResults indicated that the ERN magnitude was associated with problematic alcohol use over time, even after controlling for relevant clinical variables. Specifically, veterans with a smaller ERN magnitude evidenced a decline in problematic alcohol use over time, while veterans with a larger ERN magnitude had no change in their problematic alcohol use across the follow-up. In addition, exploratory analyses found that treatment engagement during the study did not moderate these relationships. ConclusionsOur findings provide preliminary evidence that ERN can be used as a predictor of problematic alcohol use over time. Therefore, neural response to errors could help to identify individuals at risk for continued problematic alcohol use for intervention efforts and suggests that error processing may be an important therapeutic target within Alcohol Use Disorder intervention efforts.

From Defect to Dangerous: Has the Door Opened for Recognition of an Addiction-Based Defence in Canadian Criminal Law?

For purposes of liability assessment, Canadian criminal law proceeds on a simplistic conceptualization of addiction. It presumes that the continued use of drugs or alcohol on the part of an addict is willed and deliberate, without regard to the potential impact of neurobiological vulnerabilities or concomitant mental disorders that impair volition and self-control. Not surprisingly, as a result, there is no accommodation within the law of criminal responsibility for the clinical realities of accused persons with these conditions. Significantly, in its 2011 decision in R v Bouchard-Lebrun, the Supreme Court of Canada signalled a willingness to vary this approach. It suggested that, if there were a risk of future dangerousness on the part of the accused by reason of addiction, resort might be had to the defence of not-criminally-responsible-by-reason-of-mental-disorder (“NCRMD”), and the accused might then be diverted from the correctional system to the forensic psychiatric system. It is perhaps obvious that a treatment-oriented response in a health care setting would benefit individuals seeking to overcome addiction. Moreover, to the extent that substance use and criminality are linked, public safety surely would be enhanced through the supervision of recovering addicts under the terms of Part XX.1 of the Criminal Code. Care must nonetheless be taken. It would be a matter of serious concern if the defence of NCRMD came to be used – unwittingly perhaps – as an alternative pathway for the preventive detention of addict populations.

Marijuana use in the context of alcohol interventions for mandated college students

ObjectiveConcurrent use of marijuana and alcohol among college students is highly prevalent and associated with negative consequences. It remains unclear whether marijuana use is influenced by or lessens the efficacy of alcohol interventions delivered within a stepped-care approach. MethodParticipants were 530 college students who violated campus alcohol policy and were mandated to an alcohol-focused brief advice (BA) session. Participants who reported continued risky alcohol use (4+ heavy drinking episodes and/or 5+ alcohol-related consequences in the past month) six weeks following the BA session were randomized to a brief motivational intervention (BMI; n=211) or assessment only (AO; n=194) condition. Follow-up assessments were conducted 3, 6, and 9months' post-intervention. ResultsMultiple regression analyses revealed that marijuana user status did not influence drinking outcomes following the BA session. However, hierarchical linear models suggested that marijuana users who were randomized to BMI or AO reported higher levels of binge drinking, pBAC and consequences compared to non-users, regardless of condition. Despite this, heavy drinking marijuana users and nonusers had equivalent reductions on alcohol use outcomes following the BMI sessions. Marijuana users who received a BMI did not significantly reduce marijuana use frequency compared to participants in the AO group. ConclusionUse of marijuana did not lessen the efficacy of the BA session on alcohol use or consequences. Findings suggest that marijuana users respond similarly to alcohol interventions as do non-users and can benefit from brief or more intensive alcohol interventions. A marijuana-focused intervention may be warranted to facilitate changes in marijuana use.

Alcohol consumption among adults in Bangladesh: Results from STEPS 2010.

Background Alcohol use is a risk factor for the development of noncommunicable diseases. National data are needed to assess the prevalence of alcohol use in the Bangladeshi population. The objective of this study was to describe the prevalence and patterns of alcohol use among men and women of rural and urban areas of Bangladesh. Additionally, predictors of ever alcohol use were also identified. Methods A nationally representative cross-sectional survey (STEPS 2010) was conducted on 9275 adults between November 2009 and April 2010. Participants were selected using multi-stage random cluster sampling. Data on several risk factors for noncommunicable diseases, including alcohol use, were collected by an interviewer-administered questionnaire. Results Among the total population, 5.6% (n = 519) reported to have ever drunk alcohol and 94.4% (8756) were lifetime abstainers; 2.0% (n = 190) of participants reported to have drunk alcohol within the last 12 months. Of these, 94.7% (n = 180) were men. Only 0.9% (n = 87) of the total population had drunk alcohol within the last 30 days and were categorized as current drinkers. Among current drinkers, 77.0% (n = 67) were defined as binge drinkers, having had at least one episode of heavy drinking in this time period; 92.0% (n = 80) were current smokers and 59.8% (n = 52) had either no formal education or less than primary school education. Ever alcohol use was more common among men, those who live in urban areas and smokers. Conclusion Alcohol use is low in Bangladesh; however, those who do use alcohol frequently binge drink, which is a public health concern. Targeted efforts should be made on these specific groups, to control and prevent the continued use of alcohol in Bangladesh.

FRI-310 - Hair ethyl glucuronide is a highly accurate and objective biomarker of continued alcohol use in patients with alcoholic cirrhosis

FRI-310 - Hair ethyl glucuronide is a highly accurate and objective biomarker of continued alcohol use in patients with alcoholic cirrhosis

Alcohol-dose-dependent DNA methylation and expression in the nucleus accumbens identifies coordinated regulation of synaptic genes

Alterations in DNA methylation have been associated with alcohol exposure and proposed to contribute to continued alcohol use; however, the molecular mechanisms involved remain obscure. We investigated the escalating effects of alcohol use on DNA methylation, gene expression and predicted neural effects in the nucleus accumbens of rhesus macaques that self-administered 4% alcohol for over 12 months. Using an exploratory approach to identify CpG-rich regions, followed by bisulfite sequencing, the methylation levels of 2.7 million CpGs were compared between seven low-binge drinkers and nine heavy–very heavy drinking subjects. We identified 17 significant differential methylation regions (DMRs), including 14 with methylation levels that were correlated with average daily alcohol consumption. The size of the DMRs ranged from 29 to 158 bp (mean=63.7), included 4–19 CpGs per DMR (mean=8.06) and spanned a range of average methylation values from 5 to 34%. Eight of the DMRs mapped to genes implicated in modulating synaptic plasticity. Six of the synaptic genes have not previously been linked to alcohol use. Validation studies of these eight DMRs using bisulfite amplicon sequencing and an expanded set of 30 subjects confirmed the significant alcohol-dose-associated methylation of the DMRs. Expression analysis of three of the DMR-associated genes, LRP5, GPR39 and JAKMIP1, revealed significant correlations between DMR methylation and whole-gene or alternative transcript expression, supporting a functional role in regulating gene expression. Together, these studies suggest that alcohol-associated synaptic remodeling may be regulated and coordinated at the level of DNA methylation.

Management of alcohol misuse in patients with liver diseases

Excessive alcohol use not only causes alcoholic liver disease (ALD) but also increases the risk of liver-related mortality in patients who already have other chronic liver diseases. Screening for alcohol...

Position statement on cannabis.

There is an ongoing national debate around cannabis policy. This brief position statement by the Executive Committee of the Central Drug Authorityoutlines some of the factors that have contributed to this debate, delineates reduction strategies, summarises the harms and benefits ofmarijuana, and provides recommendations. These recommendations emphasise an integrated and evidence-based approach, the need forresources to implement harm reduction strategies against continued and chronic use of alcohol and cannabis, and the potential value of afocus on decriminalisation rather than the legalisation of cannabis.

Residential environments, alcohol advertising, and initiation and continuation of alcohol consumption among adolescents in urban Taiwan: A prospective multilevel study

BackgroundResearch indicates that place characteristics and the media environment are important contextual determinants of underage drinking behaviors in Western countries, but it is unknown whether these exposures influence adolescent alcohol consumption outside Western contexts, including in Asia׳s emerging global alcohol markets. Guided by the social ecological framework, we prospectively investigated the influences of place characteristics and alcohol advertising on initiation and continuation of alcohol consumption among adolescents in Taipei, Taiwan. MethodsData on individual-level characteristics, including alcohol use behaviors and perceived exposure to alcohol advertising, were obtained from two waves of a longitudinal school-based study through a stratified probability sampling method in 2010 (Grade 7/Grade 8, aged 13-14 years old) and 2011-2012 (Grade 9, aged 15 years old) from 1795 adolescents residing in 22 of 41 districts in Taipei. Data on district-level characteristics were drawn from administrative sources and Google Street View virtual audit to describe districts where adolescents lived at baseline. Hierarchical generalized linear models tested hypotheses about the associations of place characteristics and perceived alcohol advertising with underage drinking, with stratification by baseline lifetime alcohol consumption. ResultsAmong alcohol-naïve adolescents, lower district-level economic disadvantage, a higher proportion of betel nut kiosks (a relatively unregulated alcohol source) compared to off-premises alcohol outlets, and exposure to television-based alcohol advertising predicted increased likelihood of alcohol initiation at one-year follow-up. Among alcohol-experienced adolescents, greater spatial access to off-premises alcohol outlets, and lower access to metro rapid transportation (MRT) and to temples were found to predict a subsequent increased likelihood of continued alcohol use. Parental drinking moderated the relationship between district-level violent crime and initiation of alcohol consumption. ConclusionsThese findings suggest that local social economic status, alcohol access, and institutional resource and individual media exposure affect underage drinking behaviors in Taiwan. We discuss potential public health implications for place-based interventions. Future research on place, media, and adolescent alcohol consumption in Asian contexts is warranted.

Translational Research on Habit and Alcohol.

Habitual actions enable efficient daily living, but they can also contribute to pathological behaviors that resistant change, such as alcoholism. Habitual behaviors are learned actions that appear goal-directed but are in fact no longer under the control of the action's outcome. Instead, these actions are triggered by stimuli, which may be exogenous or interoceptive, discrete or contextual. A major hallmark characteristic of alcoholism is continued alcohol use despite serious negative consequences. In essence, although the outcome of alcohol seeking and drinking is dramatically devalued, these actions persist, often triggered by environmental cues associated with alcohol use. Thus, alcoholism meets the definition of an initially goal-directed behavior that converts to a habit-based process. Habit and alcohol have been well investigated in rodent models, with comparatively less research in non-human primates and people. This review focuses on translational research on habit and alcohol with an emphasis on cross-species methodology and neural circuitry.

End-of-life care in a case of severe anorexia nervosa and end-stage liver disease

This article reviews a Court of Protection case involving a woman, Ms X, with two severe medical conditions: anorexia nervosa and end-stage liver cirrhosis due to alcohol dependence. Each of these conditions alone warranted end-of-life care planning. When combined, they provided a far more unique and complex presentation because of the way they were intertwined. Ms X's life was in imminent danger. The Court implemented methodically the principles of the Mental Capacity Act 2005. Ms X was assessed as lacking capacity to make decisions in relation to treatment for her anorexia. However, she retained capacity to make decisions regarding treatment for her liver disease and the continued harmful use of alcohol. The Court ruled that it was not in Ms X's best interests to be subject to further compulsory treatment for her anorexia, even though this may have prolonged her life. It was also in her best interests and lawful not to provide nutrition and hydration with which she did not comply.

Comparing and contrasting White and African American participants' lived experiences in drug court

ABSTRACTDrug courts are designed to offer treatment in lieu of incarceration for nonviolent offenders who have substance use disorders. Recent evidence has suggested the African American participants are less likely to graduate drug court than their White counterparts. This qualitative study interviewed 38 participants from a midwestern drug court to compare and contrast Whites' (n = 22) and African Americans' (n = 16) lived experiences in the program in order to learn about the factors that may contribute to racial disparities in outcomes. Findings suggest that both White and African American participants felt that the drug court team was supportive and compassionate and wanted them to succeed in the program. White participants found managing the demands of drug court with other obligations they had to be a noticeable challenge, and they also reported continued alcohol use in the program even though the program required total abstinence. African Americans were most critical of the quality of substance abuse treatment they received and felt that they were forced to accept culturally incompetent labels. Findings have implications for drug court practice and future research.

Alcohol-induced dysregulation of stress-related circuitry: The search for novel targets and implications for interventions across the sexes.

While the ability to process fermented fruits and alcohols was once an adaptive trait that improved nutrition and quality of life, the availability and prevalence of high potency alcoholic drinks has contributed to alcohol abuse disorders in a vulnerable portion of the population. Although the neural reward systems take part in the initial response to alcohol, negative reinforcement and stress, which are normally adaptive responses, can intersect to promote continued alcohol use at all stages of the addiction cycle. Eventually a point is reached where these once adaptive responses become dysregulated resulting in uncontrolled intake that constitutes a clinically important condition termed alcohol use disorder (AUD). Current research is targeted at both the behavioral and molecular adaptations in AUDs in an effort to better develop novel approaches to intervention. In this review, historical context is provided demonstrating the societal burden of alcohol use and abuse disorders. The importance of gender in the mechanism of action of alcohol is discussed. Finally, the impact of alcohol on stress-related circuitry, uncovered by preclinical research, is outlined to provide insight into potential novel pharmacological approaches to the treatment of AUD.

Effects of genetic variants of ADH1B and ALDH2 and social network on continued alcohol drinking among young adolescents in Taiwan

BackgroundThis study aimed (i) to evaluate the effects of genetic variants of ADH1B and ALDH2 and social network position on continued alcohol use in early adolescence, and (ii) to explore possible moderating role of pubertal development on genetic effects. MethodsThe sample comprised 496 children who ever drank alcohol before the ages of 10–12. Information pertaining to sociodemographic background, pubertal development, parental drinking, alcohol and tobacco use, alcohol-metabolizing genes, and nominated best friends was collected in four waves of assessment. Polymorphisms of ADH1B (rs1229984) and ALDH2 (rs671) were genotyped. The latent class analysis was first used to characterize longitudinal alcohol use pattern, followed by the multinomial logistic regression analyses to assess its association with genes, pubertal development, and social network. ResultsThree distinct classes of alcohol users (i.e. ex-drinkers, sporadic drinkers, and continued drinkers) were derived from alcohol-experienced children. Both alcohol-metabolizing genes appear to have protective effects, yet such relationships were only significant for youngsters in pre-to-early pubertal stage: the adjusted odds ratio (aOR) of ADH1B fast-genotype for sporadic drinkers was 0.46 and that of ALDH2 slow-genotype for both sporadic and continued drinkers was 0.47 and 0.42, respectively. Children having the bridge position in their peer network were more likely to be sporadic drinkers (aOR=4.15) and continued drinkers (aOR=3.16). ConclusionsOur results illustrate a potential moderating effect of pubertal development on the protective influence of alcohol-metabolizing genes on subsequent alcohol use among alcohol-experienced children as well as the independent contribution of early life's social network to their alcohol involvement.

Alcohol and tobacco consumption affects bacterial richness in oral cavity mucosa biofilms.

BackgroundToday there are more than 2 billion alcohol users and about 1.3 billion tobacco users worldwide. The chronic and heavy use of these two substances is at the heart of numerous diseases and may wreak havoc on the human oral microbiome. This study delves into the changes that alcohol and tobacco may cause on biofilms of the human oral microbiome. To do so, we used swabs to sample the oral biofilm of 22 subjects; including 9 control-individuals with no or very low consumption of alcohol and no consumption of tobacco, 7 who were chronic and heavy users of both substances and 6 active smokers that reported no significant alcohol consumption. DNA was extracted from swabs and the V1 region of the 16S rRNA gene was PCR amplified and sequenced using the Ion Torrent PGM platform, generating 3.7 million high quality reads. DNA sequences were clustered and OTUs were assigned using the ARB SILVA database and Qiime.ResultsWe found no differences in species diversity and evenness among the groups. However, we found a significant decrease in species richness in only smokers and in smokers/drinkers when compared to controls. We found that Neisseria abundance was significantly decreased in both groups when compared to controls. Smokers had significant increases in Prevotella and Capnocytophaga and reductions in Granulicatella, Staphylococcus, Peptostreptococcus and Gemella when compared to the two other groups. Controls showed higher abundance of Aggregibacter, whilst smokers/drinkers had lower abundances of Fusobacteria. Samples from only smokers clustered closer together than to controls and smokers/drinkers, and also had a significant reduction in inter-group dissimilarity distances, indicating a more homogenous group than controls.ConclusionsOur results indicate that the continued use of tobacco or alcohol plus tobacco significantly reduces bacterial richness, which apparently leads to a reduction in inter-group variability, turning the respective biofilms into a more homogenous microenvironment in terms of bacterial community composition, with possible consequences for human oral diseases.Electronic supplementary materialThe online version of this article (doi:10.1186/s12866-014-0250-2) contains supplementary material, which is available to authorized users.

Efficacy of motivational enhancement therapy on alcohol use disorders in patients with chronic hepatitis C: a randomized controlled trial.

To determine the efficacy of motivational enhancement therapy (MET) on alcohol use in patients with the hepatitis C virus (HCV) and an alcohol use disorder (AUD). Randomized, single-blind, controlled trial comparing MET to a control education condition with 6-month follow-up. Patients were recruited from hepatitis clinics at the Minneapolis, Minnesota and Portland, Oregon Veterans Affairs Health Care Systems, USA. Patients with HCV, an AUD and continued alcohol use (n = 139) were randomized to receive either MET (n = 70) or a control education condition (n = 69) over 3 months. Data were self-reported percentage of days abstinent from alcohol and number of standard alcohol drinks per week 6 months after randomization. At baseline, subjects in MET had 34.98% days abstinent, which increased to 73.15% at 6 months compared to 34.63 and 59.49% for the control condition. Multi-level models examined changes in alcohol consumption between MET and control groups. Results showed a significant increase in percentage of days abstinent overall (F(1120.4) = 28.04, P < 0.001) and a significant group × time effect (F(1119.9) = 5.23, P = 0.024) with the MET group showing a greater increase in percentage of days abstinent at 6 months compared with the education control condition. There were no significant differences between groups for drinks per week. The effect size of the MET intervention was moderate (0.45) for percentage of days abstinent. Motivational enhancement therapy (MET) appears to increase the percentage of days abstinent in patients with chronic hepatitis C, alcohol use disorders and ongoing alcohol use.

Factors influencing women's decisions to drink alcohol during pregnancy: findings of a qualitative study with implications for health communication.

BackgroundDespite Australian guidelines advising abstinence from alcohol during pregnancy, a relatively high number of Australian women continue to drink alcohol while pregnant. While some call for greater advocacy of the need for abstinence, others have expressed concern that abstinence messages may be harmful to pregnant women and their unborn babies due to the anxiety they could provoke. We present findings on women's deliberations over drinking alcohol during pregnancy, particularly their emotional dimensions, to inform debates about public health messages and practitioner-patient discussions regarding alcohol use during pregnancy.MethodsSemi-structured face-to-face interviews were conducted with 40 women in their homes. Our sample comprised women aged 34–39, drawn from the Australian Longitudinal Study on Women’s Health, living in the Greater Brisbane Area who were pregnant, or had recently given birth, in 2009. An inductive qualitative framework analysis approach was used to identify and interpret themes explaining why pregnant women choose to drink or not.ResultsWomen generally described drinking small amounts of alcohol during pregnancy as being a low risk activity and talked about the importance of alcohol to their social lives as a reason for continuing to drink or finding abstinence a burden; sensitisation to the judgements of others was not widespread. Women predominantly assessed the risk of their drinking in terms of the kinds of alcoholic beverages consumed rather than alcohol content. In reflecting on the advice they recalled receiving, women described their healthcare practitioners as being relaxed about the risks of alcohol consumption.ConclusionsThe significance of alcohol to women’s identity appeared to be an important reason for continued alcohol use during pregnancy among otherwise risk averse women. Anxiety about alcohol consumption during pregnancy was not widespread. However, obstetricians were an important mediator of this. Health messages that dispel the notion that wine is a “healthy” choice of alcoholic beverage, that provide women with strategies to help them avoid drinking, that advise the broader public not to pressure women to drink if they do not want to, and educate women about the effects of ethanol on maternal and fetal bodies, should be considered.