Criteria For Alcohol Use Disorder Research Articles

Mental and physical health morbidity among people in prisons: an umbrella review

People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre-registered with PROSPERO, CRD42023404827. Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9-12·8) for major depression, 9·8% (6·8-13·2) for post-traumatic stress disorder, and 3·7% (3·2-4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0-26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5-46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0-20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small-study effects. People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health. Research Foundation-Flanders, Wellcome Trust, National Institutes of Health.

A preliminary analysis of clinical characteristics of patient with alcohol use disorder and suicidal ideation

IntroductionSuicidal behaviors are frequently observed among patients with substance use disorder, including suicidal ideation (SI) (1). Alcohol use disorder (AUD) is one of the most prevalent addictions and may be related to suicidal behaviors (2,3). However, the association between AUD and SI requires a deeper analysis which includes several clinical features observed among AUD patients.ObjectivesTo analyze the clinical characteristics and features associated with lifetime SI among patients who had AUD.MethodsThis is a cross-sectional study performed in an outpatient center for addiction treatment in patients seeking treatment who met the criteria for AUD between 01/01/2010 and 12/31/2021. Patients were evaluated with an ad-hoc questionnaire and the European addiction severity index (EuropASI). SI was evaluated by using the item for SI in EuropASI.ResultsFrom a potential sample of n=3729 patients, only n=1082 (73.8% males; mean age 42.82±12.51) met inclusion criteria and had data for the current analysis. Lifetime SI was present in 50.9% of the AUD patients. Several clinical features were related to SI, including: sex differences, any type of lifetime abuse, polyconsumption, benzodiazepine use disorder, any psychiatric diagnosis aside of SUD, and higher addiction severity according to the EuropASI (See table)Image:ConclusionsSI among AUD patients is related to several clinical features which indicate a higher addiction severity, more polyconsumption, and a higher prevalence of psychiatric comorbidities. These findings may contribute to the understanding of suicidal behaviors in AUD patients but it is required further investigations, including longitudinal studies.REFERENCES1. Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-445. doi:10.1016/j.psychres.2017.09.022. MacKillop J, et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers. 2022;8(1):80. doi:10.1038/s41572-022-00406-1 3. Darvishi N, et al. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis [published correction appears in PLoS One. 2020;15(10):e0241874]. PLoS One. 2015;10(5):e0126870. doi:10.1371/journal.pone.0126870Disclosure of InterestR. Palma-Alvarez Speakers bureau of: RFPA has received speaker honorariums from Angelini, Cassen Recordati, Exeltis, Lundbeck, MSD, Rubió, Servier, and Takeda., A. Rios-Landeo: None Declared, G. Ortega-Hernandez Speakers bureau of: GOH has received speaker honorariums from Rubió., E. Ros-Cucurull Speakers bureau of: ERC has received speaker honorariums from Janssen-Cilag, Lundbeck, Otsuka, Pfizer, Lilly, Servier, Rovi, Juste., C. Daigre: None Declared, M. Perea-Ortueta: None Declared, L. Grau-Lopez Speakers bureau of: LGL has received fees to give talks for Janssen-Cilag, Lundbeck, Servier, Otsuka, and Pfizer., J. Ramos-Quiroga Speakers bureau of: JARQ has been on the speakers’ bureau and/or acted as consultant for Janssen-Cilag, Novartis, Shire, Takeda, Bial, Shionogi, Sincrolab, Novartis, BMS, Medice, Rubió, Uriach and Raffo.

A preliminary analysis of clinical characteristics of patient with alcohol use disorder and suicidal ideation

IntroductionSuicidal behaviors are frequently observed among patients with substance use disorder, including suicidal ideation (SI) (1). Alcohol use disorder (AUD) is one of the most prevalent addictions and may be related to suicidal behaviors (2,3). However, the association between AUD and SI requires a deeper analysis which includes several clinical features observed among AUD patients.ObjectivesTo analyze the clinical characteristics and features associated with lifetime SI among patients who had AUD.MethodsThis is a cross-sectional study performed in an outpatient center for addiction treatment in patients seeking for treatment who met the criteria for AUD between 01/01/2010 and 12/31/2021. Patients were evaluated with an ad-hoc questionnaire and the European Addiction Severity Index (EuropASI), SI was evaluated using the item for SI in EuropASI.ResultsFrom a potential sample of n=3729 patients, only n=1082 (73.8% males; mean age 42.82±12.51) met inclusion criteria and had data for the current analysis. Lifetime SI was present in 50.9% of the AUD patients. Several clinical features were related to SI, including: sex differences, any type of lifetime abuse, polyconsumption, benzodiazepine use disorder, any psychiatric diagnosis aside from SUD, and higher addiction severity according to the EuropASI.Image:ConclusionsSI among AUD patients is related to several clinical features which indicate a higher addiction severity, more polyconsumption, and a higher prevalence of psychiatric comorbidities. These findings may contribute to the understanding of suicidal behaviors in AUD patients but it is required further investigations, including longitudinal studies.REFERENCES1 Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-445. doi:10.1016/j.psychres.2017.09.0212. MacKillop J, et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers. 2022;8(1):80. doi:10.1038/s41572-022-00406-13.Darvishi N, et al. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis [published correction appears in PLoS One. 2020;15(10):e0241874]. PLoS One. 2015;10(5):e0126870. doi:10.1371/journal.pone.0126870Disclosure of InterestNone Declared

"Everybody needs to find the best path for them": Insights into recovery strategies of people who have not used specialty treatment for alcohol use disorder.

Most people with alcohol use disorder (AUD) do not use treatment services, yet the majority ultimately resolve their AUD. As the phenomenon of untreated recovery remains poorly understood, we investigated the strategies used for recovery without treatment. We conducted semi-structured interviews with 65 adults (27 women, 37 White) with resolved AUD and no history of using specialty services (e.g., inpatient or outpatient rehabilitation, medication-assisted treatment). Using both inductive and deductive coding, we identified and elaborated themes and meanings. We verified our findings through nine member-check sessions with interviewers and interview participants. Majorities of interview participants met criteria for severe lifetime AUD (84.6%), were in long-term recovery (>5 years; 81.5%), and indicated abstinence was their recovery goal (56.9%). Close to half (41.5%) had attended mutual-help groups (e.g., Alcoholics Anonymous). We identified five active strategies (Changing Contexts, Social Connections. Activities, Substitution, and Other Strategies) and four additional factors (Mutual-help Groups, Self-Reliance, Spirituality, and Aging/Maturing) that contributed to their recovery. Most participants employed multiple strategies and were intentional in adopting the ones that best suited them. By far, the two most common strategies were Changing Contexts (reported by 69.2% of participants) whereby people reduced their alcohol exposure by modifying social networks or physical settings and relying on Social Connections (reported by 67.7%), especially connections to people with similar lived experiences and struggles. Notably, Social Connections and Mutual-Help groups were the themes most often discussed jointly. Among other contributing factors mentioned, Spirituality appeared to play an important, but not universal, role as it was invoked by approximately half (49.2%) of participants. Our study confirms that recovery without specialty treatment is possible, and that multiple strategies and contributing factors help to achieve it. These findings may inform novel interventions to support recovery among people unwilling or unable to obtain treatment for AUD.

Different measures of alcohol use as predictors of DSM-5 alcohol use disorder among adolescents – A cohort study from Sweden

Background and aimsThis study addresses a significant gap in existing research by investigating the longitudinal relationship between various measures of alcohol use and the development of alcohol use disorders (AUDs) in a cohort of Swedish adolescents. MethodsA prospective longitudinal survey was conducted on 3999 adolescents in Sweden who were in 9th grade in 2017 and were followed up in 2019. Baseline assessments included lifetime alcohol use, recent use (past 30 days), risky drinking (AUDIT-C), and heavy episodic drinking (HED). Follow-up assessments comprised eleven items measuring DSM-5 AUD criteria. The study explores prospective associations between these diverse alcohol use measures and the occurrence of AUD, while also calculating population attributable fractions (PAF). FindingsThe proportion of alcohol consumers who met the criteria for AUD at follow-up was 31.8%. All baseline measures of alcohol use exhibited associations with subsequent AUD. Notably, the HED group demonstrated the highest prevalence of AUD at 51.4% (p<.001). However, when calculating PAFs, any lifetime alcohol use emerged as the most substantial contributor, accounting for 10.8% of all subsequent AUD cases. ConclusionsThis study underscores that alcohol use during mid-adolescence heightens the risk of developing AUD in late adolescence. Among the various measures, heavy episodic drinking presents the highest risk for later AUD. From a public health perspective, preventing any alcohol use emerges as the most effective strategy to mitigate the population-level burden of disease of AUD.

Converging Effects of Chronic Pain and Binge Alcohol Consumption on Anterior Insular Cortex Neurons Projecting to the Dorsolateral Striatum in Male Mice.

Chronic pain and alcohol use disorder (AUD) are highly comorbid, and patients with chronic pain are more likely to meet the criteria for AUD. Evidence suggests that both conditions alter similar brain pathways, yet this relationship remains poorly understood. Prior work shows that the anterior insular cortex (AIC) is involved in both chronic pain and AUD. However, circuit-specific changes elicited by the combination of pain and alcohol use remain understudied. The goal of this work was to elucidate the converging effects of binge alcohol consumption and chronic pain on AIC neurons that send projections to the dorsolateral striatum (DLS). Here, we used the Drinking-in-the-Dark (DID) paradigm to model binge-like alcohol drinking in mice that underwent spared nerve injury (SNI), after which whole-cell patch-clamp electrophysiological recordings were performed in acute brain slices to measure intrinsic and synaptic properties of AIC→DLS neurons. In male, but not female, mice, we found that SNI mice with no prior alcohol exposure consumed less alcohol compared with sham mice. Electrophysiological analyses showed that AIC→DLS neurons from SNI-alcohol male mice displayed increased neuronal excitability and increased frequency of miniature excitatory postsynaptic currents. However, mice exposed to alcohol prior to SNI consumed similar amounts of alcohol compared with sham mice following SNI. Together, our data suggest that the interaction of chronic pain and alcohol drinking have a direct effect on both intrinsic excitability and synaptic transmission onto AIC→DLS neurons in mice, which may be critical in understanding how chronic pain alters motivated behaviors associated with alcohol.

A CROSS-SECTIONAL STUDY OF PSYCHOSIS AND PERSONALITY PROFILE IN PATIENTS DIAGNOSED WITH ALCOHOL USE DISORDER

Objectives: The objectives of the study are (1) to study personality profile in patients diagnosed with alcohol use disorder (AUD) and (2) to study incidence of psychosis in patients with AUD. Methods: This was a cross-sectional study conducted in the department of psychiatry of a tertiary care medical college. 70 patients presenting with a history of alcohol intake underwent diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for AUD were enrolled in the study on the basis of pre-defined inclusion and exclusion criteria. Post a 2-week detoxification period, psychiatric symptoms encompassing depression, anxiety, hallucinations, and unusual behavior were assessed using the brief psychiatric rating scale (BPRS), while personality profiles were evaluated with the NEO Personality Inventory-3. Alcohol dependence levels were measured using the Severity of Alcohol Dependence Questionnaire. Results: There were 60 (85.71%) males and 10 (14.29%) females. There was a significant male preponderance in studied cases with M:F ratio of 1:0.16. Highest number of patients, i.e., 63 (90%) patients were married, followed by 4 (5.71%) patients were unmarried and 3 (4.29%) patients were divorced. Among 70 studied cases, 5 (7.14%) patients were found to have some or the other degree of psychotic symptoms. There was a significant correlation between being unskilled worker and having low literacy or low income and AUD (p&lt;0.05). There was no statistically significant association between severity of AUD and education (p=0.70), occupation (p=0.94), income (p=0.84), and family history of alcohol consumption (p=0.58). Participants have mild severity shown low to average score on neuroticism, average scores on extraversion, very low to low scores on openness, high to very high scores on agreeableness, and high to very high scores on conscientiousness. Conclusion: We found a significant correlation of AUD with increasing age, male gender, early alcohol initiation, and prolonged dependence. Lower education and unskilled occupations were also linked to AUD. Personality trait analysis revealed distinct patterns based on the severity of physical dependency.

Clinical characteristics and 6-month follow-up of adults with and without alcohol use disorder who self-harm.

Alcohol use disorder (AUD) is associated with suicidal behavior, but prospective clinical studies are lacking. To compare clinical characteristics and 6-month outcomes in persons with and without AUD who self-harm. 804 adults (mean age 33, age range 18-95, 541 women and 263 men, 666 with suicide attempts and 138 with non-suicidal self-injuries at index) at three Swedish university hospitals took part in a research interview that included the Mini International Neuropsychiatric Interview (MINI). Subsequent non-fatal suicidal behavior within six months was identified by record review; suicides were identified by national register. At index, 39% of the men and 29% of the women had AUD. Over two thirds of these cases (69%) were identified by the MINI, but not by clinical AUD diagnosis. While trait impulsivity was more common among persons with AUD than those without (56% vs 36%, P adj = <.001), impulsivity in connection with the index attempt was noted in half of the participants in each group (48% vs 52%, P adj = 1). Subsequent suicidal behavior (fatal/non-fatal) occurred in 67 persons with AUD (26%) and in 98 without AUD (18%), a 60% higher risk among persons with AUD (OR = 1.60, 95% [CI 1.13-2.28], P = .009). Four persons with AUD (2%) and six without (1%) died by suicide within 6 months. Almost a third of patients presenting at psychiatric emergency settings after self-harm fulfilled criteria for AUD, but clinicians often missed this diagnosis. Risk for subsequent suicidal behavior was elevated in patients with AUD. Educational interventions to improve recognition of alcohol use disorder may aid clinicians in the assessment and management of patients who present with self-harm.

Associations between alcohol use disorder polygenic score andremission in participants from high-risk families and the Indiana Biobank.

In the United States, ~50% of individuals who meet criteria for alcohol use disorder (AUD) during their lifetimes do not remit. We previously reported that a polygenic score for AUD (PGSAUD ) was positively associated with AUD severity as measured by DSM-5 lifetime criterion count, and AUD severity was negatively associated with remission. Thus, we hypothesized that PGSAUD would be negatively associated with remission. Individuals of European (EA) and African ancestry (AA) from the Collaborative Study on the Genetics of Alcoholism (COGA) who met lifetime criteria for AUD, and two EA cohorts ascertained for studies of liver diseases and substance use disorders from the Indiana Biobank were included. In COGA, 12-month remission was defined as any period of ≥12 consecutive months without meeting AUD criteria except craving and was further categorized as abstinent and non-abstinent. In the Indiana Biobank, remission was defined based on ICD codes and could not be further distinguished as abstinent or non-abstinent. Sex and age were included as covariates. COGA analyses included additional adjustment for AUD severity, family history of remission, and AUD treatment history. In COGA EA, PGSAUD was negatively associated with 12-month and non-abstinent remission (p ≤ 0.013, βs between -0.15 and -0.10) after adjusting for all covariates. In contrast to the COGA findings, PGSAUD was positively associated with remission (p = 0.004, β = 0.28) in the Indiana Biobank liver diseases cohort but not in the Indiana Biobank substance use disorder cohort (p = 0.17, β = 0.15). PGSAUD was negatively associated with 12-month and non-abstinent remission in COGA EA, independent of behavioral measures of AUD severity and family history of remission. The discrepant results in COGA and the Indiana Biobank could reflect different ascertainment strategies: the Indiana Biobank participants were older and had higher rates of liver disease, suggesting that these individuals remitted due to alcohol-related health conditions that manifested in later life.

Predictors of symptom course in alcohol use disorder.

Symptoms often play an important role in the scientific inquiry of psychological disorders and have been theorized to play a functional role in the disorders themselves. However, little is known about the course of specific symptoms and individual differences in course. Understanding the course of specific symptoms and factors influencing symptom course can inform psychological theory and future research on course and treatment. The current study examined alcohol use disorder (AUD) criteria to explore how etiologically relevant covariates differentially affected the course of individual criteria. The study examined 34,653 participants from Wave 1 (2001-2002) and Wave 2 (2003-2004) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), to analyze the extent to which AUD symptom course is predicted by alcohol consumption patterns, family history of alcoholism, the presence of internalizing and externalizing disorders, and race. The course of all AUD criteria was significantly influenced by these predictors, with the magnitude of the influence varying across different criteria and different aspects of the course (i.e., onset, persistence, recurrence). The strength of the relationship is partially related to the theoretical proximity of a given covariate to AUD symptomatology, with heavy drinking being the strongest and family history of AUD being the weakest. The course of all criteria was strongly associated with the prevalence of the criterion in the overall sample. The course of AUD criteria is heterogeneous, appearing to be influenced by conceptually proximal predictors, the prevalence of the criterion, and perhaps an underlying common factor. Diagnostic accuracy may be improved by including a criterion related to alcohol consumption. Future work should include exploring the interchangeability of criteria and alternative operationalization of them.

Some DSM‐5 criteria for AUD appear to confer greater risk of problems

Researchers who have completed a new cohort study involving alcohol users have suggested that evaluating alcohol use disorder (AUD) based on the severity of the various diagnostic criteria might offer a clearer picture than an approach that simply counts the number of criteria an individual endorses.

A - 138 Using the Federal Interagency Traumatic Brain Injury Research (FITBIR) Informatics System to Understand Complex Associations between Traumatic Brain Injury and Alcohol or Substance Use.

Associations between traumatic brain injury (TBI) and alcohol or substance use are complex and likely bidirectional. The purpose of this project was to conduct a proof-of-concept study demonstrating our ability to compile patient-level TBI data from shared studies in the Federal Interagency Traumatic Brain Injury Research (FITBIR) Informatics System to improve our understanding of key TBI outcomes. We searched the FITBIR database for shared studies reporting alcohol or substance use among participants with TBI. We merged and harmonized data across the relevant studies to determine rates of alcohol or substance use by TBI severity. In the alcohol use sample (N = 1539), 82% of participants had a history of mild TBI and 46% met criteria for alcohol use disorder (AUD). Participants with a history of mild TBI had 1.34 greater odds of screening positive for AUD (95% CI: 0.98, 1.82) and males had 2.48 increased odds of screening positive for AUD (95% CI: 1.67, 3.68). Unfortunately, due to limited data on substance use we were unable to conduct the intended analyses for this outcome. Data support research and theory suggesting that rates of AUD are higher among individuals with mild TBI versus those without, particularly among males. Additionally, this proof-of-concept study established methods, created data harmonization and analysis code, and provided the TBI-SUD meta dataset back to FITBIR for dissemination. Further, numerous additional datasets have been shared with the FITBIR platform since the time of these analyses, which will allow our team and others to extend these analyses over time.

Characterization of quality of life among individuals with current treated, untreated, and past alcohol use disorder

ABSTRACTBackground: Understanding health-related quality of life (HRQOL) among those who seek treatment for their alcohol use disorder (AUD) and those not seeking AUD treatment is critical to decreasing morbidity and mortality, yet HRQOL in these groups has been little characterized.Objectives: Characterize HRQOL among those who meet diagnostic criteria for AUD, both receiving and not receiving treatment.Methods: This analysis used the NESARC-III database (n = 36,309; female = 56.3%), a nationally representative survey of US adults, to compare four groups: those treated for current AUD; those untreated for current AUD; those with past AUD only; and those who never met criteria for AUD. Multiple regression analysis was used to account for differences in sociodemographic and other behavioral factors across these groups. HRQOL was operationalized using annual quality-adjusted life years (QALYs).Results: Patients treated for past-year AUD had a deficit of 0.07 QALYs/year compared to those who never met criteria for AUD (P < .001). They retained a still clinically meaningful 0.03 QALYs/year deficit after controlling for concomitant psychiatric disorders and other behavioral health factors (P < .001). Those with past-year untreated AUD or past AUD had a near-zero difference in QALYs compared with those who never met criteria for AUD.Conclusion: These findings suggest that previously-reported differences in HRQOL associated with AUD may be due to the problems of the relatively small sub-group who seek treatment. Clinicians seeking to treat those with currently untreated AUD may do better to focus on the latent potential health effects of AUD instead of current HRQOL concerns.

Preventing alcohol use post-bariatric surgery: patient perspectives on a technology-based approach.

Nearly two-thirds of patients engage in alcohol use after bariatric surgery, while a substantial number meet criteria for alcohol use disorder after their procedure. Given that pre-surgical education may not be sufficient, alternative methods of preventing post-surgical drinking are needed. We sought feedback on a proposed technology-based intervention to reduce alcohol use for individuals who have undergone bariatric surgery. Twenty patients who consumed alcohol post-surgery completed qualitative interviews where they provided opinions on sample intervention content, delivery method, timing, and other aspects of a two-session web-based intervention followed by tailored text messaging for 6 months. Interviews were recorded, transcribed, and coded using thematic analysis principles. Participants strongly endorsed using technology to deliver an alcohol intervention, citing the interactivity and personal tailoring available in the proposed software. Education about the effects of post-surgical drinking and learning new coping strategies for social situations were the two most salient themes to emerge from questions about intervention content. Throughout the interviews, participants strongly highlighted the importance of measuring patient readiness to change alcohol use and matching intervention content to such motivation levels. Respondents felt that text messages could extend what they had learned, but also requested additional non-alcohol content (e.g., recipes, exercise tips). Most participants agreed that an online forum consisting of peers and professionals with whom they could ask questions and interact would be useful. Web- and text message-based interventions may be an acceptable approach to prevent alcohol use post-bariatric surgery.

Ethnic Discrimination, Sexual Orientation Discrimination, and DSM-5 Alcohol Use Disorder Among U.S. Latino or Hispanic Adults

ABSTRACT We aimed to assess the probability of past-year DSM-5 alcohol use disorder (AUD) and past-year moderate-to-severe DSM-5 AUD as a function of past-year ethnic discrimination among U.S. Latino/Hispanic adults and as a function of past-year discrimination types among Latino/Hispanic sexual minorities (SM). We used data from the 2012–2013 National Epidemiological Survey on Alcohol and Related Conditions-III (n = 36,309 U.S. adults aged ≥18 years). Our sample consisted of 6,954 Latino/Hispanic adults. Multivariable logistic regression analyses estimated the association of past-year ethnic discrimination with past-year AUD and past-year moderate-to-severe AUD among the overall Latino/Hispanic population. We tested the association between discrimination types (i.e. none, ethnic or sexual orientation discrimination, both) with AUD and moderate-to-severe AUD among Latino/Hispanic SM adults. Among Latino/Hispanic adults, 13.4% met criteria for past-year AUD and 6.4% met criteria for past-year moderate-to-severe AUD. Ethnic discrimination was significantly associated with AUD (AOR = 1.09, 95% CI = 1.07–1.12) and moderate-to-severe AUD (AOR = 1.10, 95% CI = 1.06–1.13). Latino/Hispanic SMs who experienced both ethnic and sexual orientation discrimination were more likely to meet criteria for AUD (AOR = 3.44, 95% CI = 1.97–6.03) and moderate-to-severe AUD (AOR = 2.69, 95% CI = 1.25–5.82) compared to those who did not experience discrimination. Discrimination is a risk factor for AUD and moderate-to-severe AUD among Latino/Hispanic overall and SM populations.

Effects of alcohol problem discrepancy on relationship adjustment: The moderating role of conflict negotiation among couples with alcohol use disorder and intimate partner violence.

Alcohol use disorder (AUD) has well-known negative effects on romantic relationship functioning, including the occurrence of intimate partner violence (IPV). A separate literature focused on community couples indicates that relationship functioning is more likely to suffer when partners report greater discrepancies in alcohol consumption. It is important to expand this literature to couples with AUD and to examine the role of impactful AUD domains in dyadic functioning. Furthermore, few studies have examined adaptive, treatment-malleable factors that could potentially offset the negative impact of alcohol discrepancies on relationship functioning. This study examined the association between couples' alcohol problem discrepancies and relationship adjustment, as well as the moderating effect of self-reported adaptive conflict negotiation behaviors. Participants were 100 couples (N = 200 individual participants) with intimate partner violence wherein at least one partner met diagnostic criteria for AUD. Actor-Partner Interdependence Models indicated that greater alcohol problem discrepancy was associated with lower dyadic adjustment. Moderation analyses revealed that the highest level of relationship adjustment was observed among couples with lower alcohol problem discrepancy and greater negotiation behaviors, while relationship adjustment was similar for couples with larger alcohol problem discrepancy, regardless of negotiation behaviors. Although further study is needed to clarify under what specific conditions adaptive negotiation behaviors are most helpful, they appear to be beneficial for some couples in this sample. We found no evidence that negotiation behaviors may be harmful among these high-risk couples.

Do personality characteristics predict future alcohol problems after considering current demography, substance use, and alcohol response?

Several personality traits predict future alcohol problems but also relate to demographic and substance-related variables that themselves correlate with later adverse alcohol outcomes. Few prospective studies have evaluated whether personality measures predict alcohol problems after considering current demographic and substance-related variables. Data from 414 drinkers without alcohol use disorder (AUD) from the Collaborative Study on the Genetics of Alcoholism (average age 20, 44% male) were followed over an average of 9 years. Time 1 (baseline) demography, AUD family history (FH), substance use and problems, and psychiatric histories were gathered using a standardized interview; the Level of Response (LR) to alcohol was measured by the Self-Report of the Effects of alcohol (SRE) questionnaire; and seven personality dimensions were extracted from the NEO Five-Factor Personality, Barratt, and Zuckerman scales. Analyses involved product-moment correlations of each baseline measure with the highest number of DSM-IV AUD criteria endorsed in any follow-up period, and hierarchical regression analyses evaluated whether the personality domains added significantly to the prediction of the outcome after adjusting for other baseline variables. Significant correlations with the outcome were observed for baseline age, sex, length of follow-up, AUD family history, past cannabis use, and all alcohol-related baseline variables, including SRE-based LR, but not prior mood or anxiety disorders. All personality characteristics except extraversion also correlated with outcomes. Ahierarchical regression analysis that included all relevant personality scores together demonstrated significant contributions to the prediction of future alcohol problems for demographics in Step 1; demographics and most baseline alcohol items, including response level, in Step 2; and cannabis use in Step 3; after which demographics, LR, baseline alcohol problems, cannabis use, and higher sensation seeking added significantly in Step 4. Regression for each personality domain separately revealed significant contributions to Step 4 for all personality domains except openness. Lower levels of response to alcohol added significantly to all regression analyses. Most tested personality scores and lower levels of response to alcohol contributed to predictions of later alcohol problems even after considering baseline demographic and substance use measures.

Commentary on Hyland et al.: Digital treatment for alcohol use disorders - challenges and opportunities.

Hyland and colleagues found no significant effects of an internet-delivered cognitive behavioral therapy intervention (iCBT) as addendum to treatment as usual in individuals with moderate alcohol use disorders. While findings can be attributed partially to methodological issues, future studies should focus upon patient preferences and include potential side effects of internet-based interventions. In the field of problematic alcohol consumption, digital interventions have shown promise in non-clinical populations [1]; however, little is known about their efficacy in clinical populations fulfilling criteria for alcohol use disorders (AUDs). Internet-delivered treatment has rapidly evolved as an option for various mental disorders. First meta-analyses show positive effects when compared to non-active controls in disorders such as depression and agoraphobia [2-4], but also for addictive disorders, especially behavioural addictions [5] and tobacco smoking [6]. Given that disorders due to alcohol and/or drugs are highly stigmatized, internet-delivered interventions might be a relevant tool for narrowing the treatment gap in the field. In their excellently conducted randomized controlled trial (RCT), Hyland and colleagues [7] found only weak evidence for an internet-delivered cognitive behavioral therapy (iCBT) intervention as addendum to treatment as usual (TAU) in individuals with AUDs compared to TAU. However, it has to be taken into account that, as comparator in this study, TAU included far more evidence-based components than would usually be expected in most treatment systems world-wide. The high rate of participants willing to take (and receiving) medication is particularly impressive: data from the United States show that only 16.3% of all speciality treatment programmes for alcohol use disorders offered any single medication for AUD treatment [8]. Furthermore, as all participants in the Hyland et al. study were self-selected, the initial motivation to change already might have produced strong effects, especially if we consider the high rates of unassisted recovery that are common in alcohol use disorders [9]. Another encouraging finding is that overall treatment initiation and completion rates are relatively high compared to digital self-help interventions in the field of affective and anxiety disorders [10], where efficacy of these interventions has already been demonstrated. There is no evidence that guided or unguided internet-delivered interventions for AUDs are associated with lower rates of treatment uptake compared to face-to-face delivery. A prior study from the research group of Hyland et al. on a therapist-guided iCBT intervention compared to therapist-delivered CBT showed no differences in uptake numbers between the two conditions, and both interventions did not differ on outcomes [11]. Another RCT on iCBT as a stand-alone intervention for individuals with AUDs [12] even showed that retention rates were better in the iCBT condition compared to therapist-delivered CBT, and that both conditions were superior compared to TAU (which included lower doses of treatment compared to the Hyland et al. study). Given that internet-delivered treatment requires a high level of patient engagement, future studies should take into account the interaction between type of treatment and patient preferences. Internet-delivered interventions might be a good option for some, but certainly not for all, patients suffering from AUDs. A systematic review on effects of matching patient preferences to treatment in the field of substance use disorders suggests that treatment effects might be improved, although findings were inconsistent [13]. Patient preferences have become increasingly important for the development of clinical interventions, and they could play an important role for improving treatment uptake and outcomes by affected individuals [14]. Finally, only recently have studies on the efficacy of treatment assessed potential side effects. A potential risk of digital interventions is that these interventions might incorrectly be viewed as sufficient by some individuals who otherwise would be willing to engage in other evidence-based treatments. The significant difference between the conditions in the Hyland et al. study regarding receipt of medication shows the need for further rigorous, well-conducted studies. For a more detailed understanding on processes of change in newly developed interventions, mixed-methods studies that include the experiences of patients are warranted. GB conceptualized and wrote the manuscript. None.

Strategies to maintain recovery from alcohol problems during the COVID-19 pandemic: Insights from a mixed-methods national survey of adults in the United States.

The COVID-19 pandemic has been associated with poorer mental health and, in some cases, increased alcohol consumption; however, little is known about the pandemic's effects on people in recovery from alcohol use disorder (AUD), especially how they have coped with novel stressors. Our mixed-methods study investigated strategies used to maintain recovery during the pandemic, with attention to variation by gender. We analyzed data obtained in fall 2020 from an online US national survey of adults with resolved AUD (n = 1,492) recruited from KnowledgePanel, a probability-based cohort of non-institutionalized adults maintained by Ipsos for internet-based research. Participants endorsed possible coping strategies on a 19-item choose-all-that-apply list, which were analyzed using chi-square tests. In addition, 1,008 participants provided text responses to an open-ended question about their strategies to maintain recovery during the pandemic, which were coded and analyzed using an inductive, thematic approach. The majority of our sample met criteria for severe lifetime AUD (72.9%), reported being in recovery more than five years (75.5%), and had never used specialty AUD services or mutual-help groups (59.7%). The ordering of the coping strategies was quite similar for women and men; however, the top strategy (talking with family and friends by phone, text, or video) was endorsed more frequently by women than men (49.7% vs. 36.1%; p < .001). Among qualitative themes, "staying connected" was the most common. It was dominated by statements about family, with women mentioning children more often than men. Among other themes, "cognitive strategies" mirrored established therapeutic modalities, and "active pursuits" aligned with many recent recommendations for service providers working with substance-using populations during the pandemic. A minority of participants invoked "willpower" for recovery or stated that pandemic restrictions helped by reducing exposure to relapse risks. These findings shed light on recovery mechanisms during the COVID-19 pandemic and suggest potential intervention targets to support recovery during other catastrophic events, such as natural disasters.

Alcohol Use and Alcoholism Among Individuals with Schizophrenia in the North of Iran

Background: Alcohol consumption is one of the most common problematic issues globally that usually causes high costs for the health system. Also, schizophrenia is a chronic psychiatric disorder responsible for a heavy burden on healthcare providers. Objectives: This study aimed to investigate alcohol use and alcoholism in schizophrenia in Iran. Methods: A cross-sectional (descriptive-analytical) study was conducted on 400 individuals with schizophrenia referred to the psychiatry hospital of Mazandaran University of Medical Sciences. History of alcohol consumption and the criteria of alcohol use disorder according to DSM-5-TR were sought during the interviews using the Alcohol Use Disorder Identification Test (AUDIT). Results: Of the patients, 45.5% had drunk alcohol at some point in their lives, 23% had low-risk alcohol consumption, and 10% experienced high-risk consumption. In addition, 1.5% of our sample suffered from alcoholism, according to the AUDIT. Conclusions: The results of our study in Iran regarding alcohol use in schizophrenia are more similar to those of Western countries than eastern countries. The ratio of alcohol use in schizophrenia compared with the general population was even higher in our study than in western countries.