Disorders Identification Test-Consumption Research Articles

Incidence of Hospitalizations Involving Alcohol Withdrawal Syndrome in a Primary Care Population.

Alcohol withdrawal syndrome (AWS) is an important cause and complication of hospitalizations. Although common and preventable, the incidence of AWS during hospitalizations is poorly described. To evaluate the incidence and proportional incidence of hospitalizations involving AWS in an adult primary care population overall and across patient characteristics. This retrospective cohort study used electronic health records and insurance claims from Kaiser Permanente Washington (KPWA) between July 1, 2018, and June 30, 2022. The study included adults with 1 or more primary care visits during this period or the year prior, where primary care included annual standardized alcohol screening using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Age, sex, race, Hispanic ethnicity, AUDIT-C scores, and comorbid diagnoses. Hospitalizations involving AWS were defined by diagnosis codes documented during hospitalizations (incidence numerator). Time enrolled in KPWA determined person-enrolled-years (incidence denominator). Proportional incidence was calculated as the incidence of hospitalizations involving AWS divided by the incidence of all-cause hospitalizations. Proportional incidence was also estimated for hospitalizations involving other common chronic conditions (chronic obstructive pulmonary disease, diabetes, heart failure, and hypertension), which were also defined using hospital diagnosis codes. Among 544 825 adults engaged in primary care (mean [SD] age, 47.0 [17.9] years; 310 069 [56.9%] female; 3656 [0.7%] American Indian or Alaska Native, 55 206 [10.1%] Asian, 25 406 [4.7%] Black, 5204 [1.0%] Native Hawaiian or Other Pacific Islander, 365 780 [67.1%] White, 19 791 [3.6%] multiracial, 15 963 [2.9%] other races, and 53 819 [9.9%] unknown race; 33 987 [6.2%] Hispanic, 414 269 [76.0%] not Hispanic, and 96 569 [17.7%] unknown ethnicity), incidence of hospitalizations involving AWS was 169 (95% CI, 159-179) per 100 000 person-enrolled-years overall but as high as 15 347 (95% CI, 13 502-17 331) in patients with other alcohol-attributable diagnoses. The proportional incidence of hospitalizations involving AWS was 2.3% overall, with variation by age, sex, and AUDIT-C scores (eg, 9%-11% in male patients aged 30-49 years and 23%-44% in patients with high-risk AUDIT-C scores of 7-12 points). In most cases, among adults younger than 60 years, proportional incidence of hospitalizations involving AWS matched or surpassed that of other common chronic conditions (chronic obstructive pulmonary disease, diabetes, heart failure, and hypertension). In this cohort study of a large primary care population served by an integrated health system, AWS hospitalizations were common, especially in male patients, younger age groups, and individuals with high-risk alcohol use. During hospitalizations, the burden of AWS was similar to or exceeded complications of other chronic diseases that receive greater medical attention.

Alcohol consumption in cancer patients receiving psycho-oncologic care analysis of socio-demographic, health-related and cancer-related factors.

The carcinogenic effects of alcoholic beverages and the negative impact of alcohol consumption on cancer progression and treatment outcomes are well established in oncology research. Many cancer patients experience significant psychological distress, often manifesting as elevated levels of depression and anxiety. In the general population, alcohol consumption is commonly used as a coping mechanism for such distress. For cancer patients facing substantial psychological challenges, psycho-oncology care is available to help manage their symptoms and the overall impact of their condition. However, there is limited understanding of the alcohol consumption patterns in this particularly vulnerable group of patients, as well as the disease-related factors that may influence their drinking behavior. This study aims to examine the prevalence of potentially risky alcohol consumption in cancer patients receiving psycho-oncology care and to identify sociodemographic, health-related, and psychosocial factors associated with alcohol consumption after cancer diagnosis. By understanding drinking patterns and the factors associated with them, we aim to promote healthier behaviors and enhance treatment outcomes for cancer patients receiving psycho-oncology care. A consecutive sample of 1.225 patients from the psycho-oncology outpatient clinic of the University Medical Center Hamburg Eppendorf (UKE) was analyzed with regard to their alcohol consumption behavior using the Alcohol Use Disorders Identification Test-Consumption Items (AUDIT-C). Self-report questionnaires were employed to assess sociodemographic, health-related, and cancer-specific information. For statistical analysis, multiple linear regression was utilized. In the sample of cancer patients receiving psycho-oncology support one in six of both female and male patients showed risky alcohol drinking behavior (e.g. AUDIT-C above three for women and four for men). In the analysis (R-Square: 0.056) male gender (regression coefficient B 0.686, 95% CI: 0.453-0.919) and patientsreporting a higher physical health-related quality of life (SF8-PCS) (B 0.021, 95% CI: 0.011-0.032) were associated with higher levels of alcohol consumption, whereas having children (B -0.481, 95%CI: -0.700- -0.262) was associated with lower alcohol consumption. With regard to cancer type, a single-factor analysis of variance with gender as the centered covariate showed that patients with gastrointestinal cancer had had lower average consumption levels compared to the groups of patients with breast cancer, melanoma, genitourinary cancer, and lymphoma. Also, patients with sarcoma had lower average consumption levels than patients with lymphoma. The results allow to identify patient characteristics and cancer types associated with higher or lower alcohol consumption levels and higher likelihood of risky consumption behavior in this sample of cancer patients receiving psycho-oncological support. Cancer patients are particularly susceptible to the hazardous effects of alcohol consumption. The results of this study help to identify cancer patients at risk of worsening prognosis due to alcohol consumption and to develop intervention programs to minimize alcohol consumption in this group.

Insomnia and unhealthy alcohol use in a National Sample of Women Veterans 50 years and older enrolled in the Veterans Health Administration

In this study, we examined rates of insomnia and co-occurring unhealthy alcohol use in a national sample of women Veterans age 50 years and older. We further explored associations between sociodemographic measures, insomnia-related clinical characteristics, and unhealthy alcohol use, and analyzed whether women with insomnia were more likely to report unhealthy alcohol use. Study aims were evaluated using national Veterans Health Administration (VA) electronic health records data from VA’s Corporate Data Warehouse. Data were extracted for women Veterans ≥50 years old with ≥1 VA primary care visit in each study year (2018: 3/11/18–3/10/19; 2020: 3/11/20–3/10/21; 2022: 3/11/22–3/10/23). Cases of insomnia were identified via diagnostic codes and prescription medications for insomnia. Unhealthy alcohol use was identified via Alcohol Use Disorders Identification Test-Consumption screening scores indicating unhealthy alcohol use. Annual sample sizes ranged from 240,420–302,047. Over the study timeframe, insomnia rates (diagnosis or medication) among women ≥50 years old ranged from 18.11–19.29%; co-occurring insomnia and unhealthy alcohol use rates ranged from 2.02–2.52%. Insomnia and unhealthy alcohol use rates were highest among women aged 50–59 years old. Depression and physical health comorbidities were consistently associated with insomnia; associations by race and ethnicity were less consistent. Compared to women without insomnia, women Veterans with either concurrent or unremitting insomnia were more likely to endorse unhealthy alcohol use. Findings signal a potential need for assessment and preventative efforts aimed at addressing insomnia and unhealthy alcohol use among women Veterans.

Irresponsibility Stereotypes Exacerbate Effects of Sexual Violence on Cisgender Bisexual Women's Coping Drinking Motives.

Bisexual women experience disparities in alcohol use outcomes compared to both lesbian and heterosexual women. Bisexual women also experience higher rates of sexual violence (SV) and alcohol use following SV. We examined whether coping drinking motives mediate the link between adult SV severity and alcohol use and whether dimensions of binegativity (i.e., hostility, instability, irresponsibility) moderate the effects of SV. The sample consisted of 355 young (ages 18-35) cisgender bisexual women drinkers (Mage=25.8, 84.2% White) recruited via MTurk. Measures included: Sexual Experiences Survey-Short Form Victimization (Koss et al., 2007), Anti-Bisexual Experiences Scale (Brewster & Moradi, 2010), Modified Drinking Motives Questionnaire-Revised (Grant et al., 2007), and Alcohol Use Disorders Identification Test Consumption subscale (Babor et al., 2001). The PROCESS macro for SPSS was used. There was an interaction between SV severity and irresponsibility stereotypes in predicting coping motives. SV severity related to greater coping motives at mean and high, but not low, levels of irresponsibility stereotypes. Indirect effects of SV severity on alcohol use via coping motives were significant at mean and high, but not low, levels of irresponsibility stereotypes. Hostility and instability dimensions of binegativity did not interact with SV severity in predicting coping motives. Results identified SV severity and irresponsibility stereotypes as compounding experiences that may explain greater alcohol use. Bisexual women exposed to this dimension of binegativity may be particularly vulnerable to drink alcohol to cope with distress following SV. Interventions for alcohol use may be enhanced by helping bisexual women cope with SV-related distress and irresponsibility stereotypes.

Equivalence of Alcohol Use Disorder Symptom Assessments in Routine Clinical Care When Completed Remotely via Online Patient Portals Versus In Clinic via Paper Questionnaires: Psychometric Evaluation.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends the paper-based or computerized Alcohol Symptom Checklist to assess alcohol use disorder (AUD) symptoms in routine care when patients report high-risk drinking. However, it is unknown whether Alcohol Symptom Checklist response characteristics differ when it is administered online (eg, remotely via an online electronic health record [EHR] patient portal before an appointment) versus in clinic (eg, on paper after appointment check-in). This study evaluated the psychometric performance of the Alcohol Symptom Checklist when completed online versus in clinic during routine clinical care. This cross-sectional, psychometric study obtained EHR data from the Alcohol Symptom Checklist completed by adult patients from an integrated health system in Washington state. The sample included patients who had a primary care visit in 2021 at 1 of 32 primary care practices, were due for annual behavioral health screening, and reported high-risk drinking on the behavioral health screen (Alcohol Use Disorder Identification Test-Consumption score ≥7). After screening, patients with high-risk drinking were typically asked to complete the Alcohol Symptom Checklist-an 11-item questionnaire on which patients self-report whether they had experienced each of the 11 AUD criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) over a past-year timeframe. Patients could complete the Alcohol Symptom Checklist online (eg, on a computer, smartphone, or tablet from any location) or in clinic (eg, on paper as part of the rooming process at clinical appointments). We examined sample and measurement characteristics and conducted differential item functioning analyses using item response theory to examine measurement consistency across these 2 assessment modalities. Among 3243 patients meeting eligibility criteria for this secondary analysis (2313/3243, 71% male; 2271/3243, 70% White; and 2014/3243, 62% non-Hispanic), 1640 (51%) completed the Alcohol Symptom Checklist online while 1603 (49%) completed it in clinic. Approximately 46% (752/1640) and 48% (764/1603) reported ≥2 AUD criteria (the threshold for AUD diagnosis) online and in clinic (P=.37), respectively. A small degree of differential item functioning was observed for 4 of 11 items. This differential item functioning produced only minimal impact on total scores used clinically to assess AUD severity, affecting total criteria count by a maximum of 0.13 criteria (on a scale ranging from 0 to 11). Completing the Alcohol Symptom Checklist online, typically prior to patient check-in, performed similarly to an in-clinic modality typically administered on paper by a medical assistant at the time of the appointment. Findings have implications for using online AUD symptom assessments to streamline workflows, reduce staff burden, reduce stigma, and potentially assess patients who do not receive in-person care. Whether modality of DSM-5 assessment of AUD differentially impacts treatment is unknown.

Prevalence of work hour alcohol use and associated factors among psychiatrists in China.

Since 2012, work-hour alcohol use (WHAU) has been prohibited in China. However, there is a lack of national data on WHAU among healthcare workers, including psychiatrists. We collected data from psychiatrists in 41 tertiary psychiatric hospitals using an online questionnaire, which included demographics, work-related factors, WHAU, and the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). Out of 2911 psychiatrists who completed the survey, 4.29% reported having heard (3.13%) or witnessed (1.17%) WHAU among colleagues, and .51% (95% CI: .26%-.78%) admitted to their own WHAU. Most participants (95.57%) reported awareness of the policy against WHAU. Poisson regression demonstrated the unawareness of WHAU policy (incidence-rate ratios [IRR] 11.08; 95% CI: 3.56-34.52; P < .001), lower income (IRR .87; 95% CI: .79-0.96; P = .008), and higher AUDIT-C scores (IRR 1.48; 95% CI: 1.22-1.80; P < .001) were significantly associated with WHAU occurrences. The survey indicates that WHAU among psychiatrists is more prevalent than expected, correlating with insufficient awareness of hospital policies. This suggests a need for targeted educational interventions.

The effectiveness of an ultra-brief intervention in 1 min for hazardous drinking in a general hospital setting: A quasi-randomized pilot trial.

We investigated the effectiveness of an ultra-brief intervention (Ultra-BI) for patients with hazardous drinking behaviors admitted to a general hospital. In a quasi-randomized controlled trial at a general hospital in Japan, we assigned participants to intervention or control groups based on the last digit of their patient ID (odd for intervention, even for control). The study included inpatients with Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) scores of ≥5 for men and ≥4 for women. The intervention involved providing advice and feedback within 1 min, accompanied by a leaflet on alcohol-related issues (Ultra-BI). The control group did not receive any intervention. The primary outcome was average weekly alcohol consumption at 3 months postintervention. The study included 68 participants. The intervention group showed a reduction in average weekly alcohol consumption by -69.7 g/week compared to the control group (95% confidence interval [CI] -145.7 to 6.3 g/week, p = 0.07). Post-hoc analysis, adjusting for baseline values, indicated a between-group difference of -78.7 g/week (95% CI -135.2 to -22.2 g/week, p = 0.007). This pilot trial suggests the potential effectiveness of the Ultra-BI in general hospital wards. Further large-scale studies are required to confirm these findings.

Associations Between Alcohol Use, Antiretroviral Therapy Use, and Viral Load Suppression Among People Living with HIV in Rural Central Uganda

Alcohol use among people living with HIV (PWH) is common and may negatively affect engagement in HIV care. We evaluated the relationships between alcohol use, ART use, and viral suppression among PWH in Uganda. PATH/Ekkubo was a trial evaluating a linkage to HIV care intervention in four Ugandan districts, Nov 2015-Sept 2021. Our analytical sample included: (1) baseline data from individuals not enrolled in the intervention trial (previously diagnosed HIV+); and 12-month follow-up data from the control group (newly diagnosed or previously diagnosed, but not in care). Level of alcohol use was categorized using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C): none (AUDIT-C = 0), low (women = 1–2, men = 1–3), medium (women = 3–5, men = 4–5), high/very high (6–12). Multivariable logistic regression models evaluated associations between alcohol use, ART use and viral suppression (a viral load of < 20); we also stratified by gender. Among 931 PWH, medium (OR: 0.43 [95% CI 0.25–0.72]) and high/very high (OR: 0.22 [95% CI 0.11–0.42]) levels of alcohol use were associated with lower odds of being on ART. In a sub-sample of 664, medium use (OR: 0.63 [95% CI 0.41–0.97]) was associated with lower odds of viral suppression. However, this association was not statistically significant when restricting to those on ART, suggesting the relationship between alcohol use and viral suppression is explained by ART use. Among men, high/very high, and among women, medium alcohol use levels were associated with lower odds of being on ART and being virally suppressed. Interventions for PWH who use higher levels of alcohol may be needed to optimize the benefits of Uganda’s Universal Test and Treat strategy.

Sex differences in the association between social jetlag and hazardous alcohol consumption in Korean workers: A nationwide cross-sectional study

BackgroundSocial jetlag, the misalignment between biological and social rhythms, can lead to adverse health outcomes. This study explored the association between social jetlag and hazardous alcohol consumption, as well as the sex differences in this association. MethodsThis study included a nationally representative sample of Korean workers consisting of 11,462 individuals (5479 women). Social jetlag was calculated as the difference in the mid-point between sleep onset and offset on free days and workdays. Hazardous alcohol consumption was determined using the Alcohol Use Disorder Identification Test–Consumption (range 0–12), with a cutoff of ≥6 for men, ≥5 for women, and ≥3 for those aged ≥65. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95 % confidence intervals (CIs). ResultsAmong men, 599 out of 5983 individuals (10.0 %) had ≥120 min of social jetlag. Among women, 550 out of 5479 individuals (10.0 %) had ≥120 min of social jetlag. The prevalence of hazardous alcohol use was 56.2 % for men and 27.3 % for women. In the regression analysis, there was a significant sex interaction, where social jetlag ≥120 min was associated with hazardous alcohol consumption in female workers (OR: 1.52, 95 % CI: 1.18–1.96), but not in male workers (OR: 1.04, 95 % CI: 0.84–1.29). ConclusionHigh social jetlag was associated with an increased likelihood of hazardous alcohol consumption among women. Our findings underscore the importance of considering sex differences in future research and policy interventions regarding social jetlag and its associated behavior outcomes.

Associations Between a Primary Care-Delivered Alcohol-Related Brief Intervention and Subsequent Opioid-Related Outcomes.

The co-occurrence of unhealthy alcohol use and opioid misuse is high and associated with increased rates of overdose, emergency health care utilization, and death. The current study examined whether receipt of an alcohol-related brief intervention is associated with reduced risk of negative downstream opioid-related outcomes. This retrospective cohort study included all VISN-6 Veterans Affairs (VA) patients with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening results (N=492,748) from 2014 to 2019. Logistic regression was used to examine the association between documentation of an alcohol-related brief intervention and probability of a new 1) opioid prescription, 2) opioid use disorder (OUD) diagnosis, or 3) opioid-related hospitalization in the following year, controlling for demographic and clinical covariates. Of the veterans, 13% (N=63,804) had "positive" AUDIT-C screen results. Of those, 72% (N=46,216) had a documented alcohol-related brief intervention. Within 1 year, 8.5% (N=5,430) had a new opioid prescription, 1.1% (N=698) had a new OUD diagnosis, and 0.8% (N=499) had a new opioid-related hospitalization. In adjusted models, veterans with positive AUDIT-C screen results who did not receive an alcohol-related brief intervention had higher odds of new opioid prescriptions (adjusted odds ratio [OR]=1.10, 95% CI=1.03-1.17) and new OUD diagnoses (adjusted OR=1.19, 95% CI=1.02-1.40), while new opioid-related hospitalizations (adjusted OR=1.19, 95% CI=0.99-1.44) were higher although not statistically significant. Removal of medications for OUD (MOUD) did not impact associations. All outcomes were significantly associated with an alcohol-related brief intervention in unadjusted models. The VA's standard alcohol-related brief intervention is associated with subsequent lower odds of a new opioid prescription or a new OUD diagnosis. Results suggest a reduction in a cascade of new opioid-related outcomes from prescriptions through hospitalizations.

The effectiveness of a brief intervention for intensive care unit patients with hazardous alcohol use: a randomized controlled trial.

Screening for hazardous alcohol use and performing brief interventions (BIs) are recommended to reduce alcohol-related negative health consequences. We aimed to compare the effectiveness (defined as an at least 10% absolute difference) of BI with usual care in reducing alcohol intake in intensive care unit survivors with history of hazardous alcohol use. We used Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) score to assess history of alcohol use. Emergency admitted adult ICU patients in three Finnish university hospitals, with an AUDIT-C score > 5 (women), or > 6 (men). We randomized consenting eligible patients to receive a BI or treatment as usual (TAU). BI was delivered by the time of ICU discharge or shortly thereafter in the hospital ward. Control patients received TAU. The primary outcome was self-reported alcohol consumption during the preceding week 6 and 12months after randomization. Secondary outcomes were the change in AUDIT-C scores from baseline to 6 and 12months, health-related quality of life, and mortality. The trial was terminated early due to slow recruitment during the pandemic. We randomized 234 patients to receive BI (N = 117) or TAU (N = 117). At 6months, the median alcohol intake in the BI and TAU groups were 6.5g (interquartile range [IQR] 0-141) and 0g (0-72), respectively (p = 0.544). At 12months, it was 24g (0-146) and 0g (0-96) in the BI and TAU groups, respectively (p = 0.157). Median change in AUDIT-C from baseline to 6months was - 1 (- 4 to 0) and 2 (- 6 to 0), (p = 0.144) in the BI and TAU groups, and to 12months - 3 (- 5 to - 1) and - 4 (- 7 to - 1), respectively (p = 0.187). In total, 4% (n = 5) of patients in the BI group and 11% (n = 13) of patients in the TAU group were abstinent at 6months, and 10% (n = 12) and 15% (n = 17), respectively, at 12months. No between-groups difference in mortality emerged. As underpowered, our study cannot reject or confirm the hypothesis that a single BI early after critical illness is effective in reducing the amount of alcohol consumed compared to TAU. However, a considerable number in both groups reduced their alcohol consumption. ClinicalTrials.gov (NCT03047577).

Mining clinical data for novel medications to treat alcohol use disorder

BackgroundAlcohol use disorder (AUD) is a highly prevalent and often debilitating condition associated with high morbidity and mortality. Current AUD medications have limited efficacy and uptake. Alternative pharmacological options are needed. MethodsWe constructed a mechanistic tree of all US Food and Drug Administration approved medications and used a tree-based scan statistic, TreeScan, to identify medications associated with greater than expected improvements in alcohol consumption. Our cohort included all United States (US) Department of Veterans Affairs (VA) patients with a diagnosis of AUD between 10/1/1999 and 9/30/2019 with multiple Alcohol Use Disorders Identification Test-Consumption Module scores within the VA electronic health record data. ResultsMedications statistically associated with decreased alcohol consumption had, at large, minor effect sizes. Medications used in the treatment of chronic or life-threatening conditions like diabetes, chronic kidney disease, hepatitis C virus, or cancer produced larger effect sizes. Asenapine, an atypical antipsychotic, had a large effect with an observed to expected ratio of 1.78 (p = 0.003). Our findings were replicated in a propensity score matched population. ConclusionMost medications significantly associated with decreased alcohol consumption in our analysis were either contraindicated with alcohol or likely attributable to patients abstaining from alcohol due to severe illness. However, the large effect of asenapine is notable, and a worthwhile candidate for more careful analysis.

Alcohol screening in 22 Australian Aboriginal Community Controlled Health Organisations: Clinical context and who is screened.

Alcohol screening among Indigenous Australians is important to identify individuals needing support to reduce their drinking. Understanding clinical contexts in which clients are screened, and which clients are more or less likely to be screened, could help identify areas of services and communities that might benefit from increased screening. We analysed routinely collected data from 22 Aboriginal Community Controlled Health Organisations Australia-wide. Data collected between February 2016 and February 2021 were analysed using R, and aggregated to describe screening activity per client, within 2-monthly extraction periods. Descriptive analyses were performed to identify contexts in which clients received an Alcohol Use Disorders Identification Test consumption (AUDIT-C) screen. Multi-level logistic regression determined demographic factors associated with receiving an AUDIT-C screen. Three models are presented to examine if screening was predicted by: (i) age; (ii) age and gender; (iii) age, gender and service remoteness. We observed 83,931 occasions where AUDIT-C was performed at least once during a 2-monthly extraction period. Most common contexts were adult health check (55.0%), followed by pre-consult examination (18.4%) and standalone item (9.9%). For every 10 years' increase in client age, odds of being screened with AUDIT-C slightly decreased (odds ratio 0.98; 95% confidence interval [CI] 0.98, 0.99). Women were less likely to be screened with AUDIT-C (odds ratio 0.95; 95% CI 0.93, 0.96) than men. This study identified areas where alcohol screening can be increased (e.g., among women). Increasing AUDIT-C screening across entire communities could help reduce or prevent alcohol-related harms. Future Indigenous-led research could help identify strategies to increase screening rates.

Spironolactone in Alcohol Use Disorder (SAUD): Introduction to an ongoing double-blind, placebo-controlled, ascending dose, Phase 1b study

Introduction Efforts are critically needed to increase the armamentarium of options that clinicians can use to treat patients with alcohol use disorder (AUD). Numerous preclinical studies support the hypothesis that mineralocorticoid receptor (MR) pharmacological antagonism may represent a novel and promising treatment for AUD. Namely, the non-selective MR antagonist spironolactone dose-dependently decreased 1) the intake of alcohol in mice in a model of alcohol binge drinking procedure and 2) alcohol self-administration in dependent and non-dependent rats (Farokhnia, Rentsch, Choung et al., Mol Psychiatry 2022; 27(11):4642-4652). Furthermore, two U.S.-based independent human pharmacoepidemiologic studies utilizing electronic health records data showed that patients treated with spironolactone for any indication reduced their weekly alcohol use in a primary care-type medical setting (Palzes et al., Neuropsychopharmacology 2021; 46(12):2140-2147) and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) score in a Veterans Affairs medical setting (Farokhnia, Rentsch, Choung et al., 2022; 27(11):4642-4652). In both studies, spironolactone-treated patients were compared to matched ones without spironolactone prescription using propensity score matching.Objectives We are conducting a Phase 1b human study to assess the pharmacokinetics and pharmacodynamics of spironolactone-alcohol co-administration and testing the safety and tolerability of spironolactone, alone and combined with alcohol in individuals with AUD.MethodsSpironolactone in Alcohol Use Disorder (SAUD) is a double-blind, placebo-controlled, randomized, within-subject, ascending dose study with spironolactone (0, 100, 200, 400 mg/day) PO for 5 days to reach steady-state, followed by oral fixed-dose alcohol administration aimed at reaching a blood alcohol level of approximately 0.08 %. Our sample consists of 12 adults diagnosed with AUD.ResultsThe primary endpoint is to measure spironolactone and alcohol PK during concomitant administration. Our secondary endpoints are 1) assessment of subjective and cognitive effects of acute alcohol administration during concomitant spironolactone treatment; 2) number and severity of adverse events (AEs) experienced, compared between placebo (0 mg/day) and all three spironolactone doses; 3) PK characteristic of spironolactone active metabolites, canrenone, 7-α-thiomethylspirolactone (TMS) and 6β-hydroxy-7α-thiomethylspirolactone (HTMS), before and after administration of alcohol. Recruitment is underway.ConclusionsThe above-mentioned preclinical and clinical evidence suggest that spironolactone may be repurposed for the treatment of AUD. Our Phase 1b study is a key step before moving to larger efficacy trials.Disclosure of InterestNone Declared

Association between smoking and lack of HIV virological suppression in a cross-sectional study of persons with HIV on antiretroviral therapy in Uganda.

Smoking and alcohol use frequently co-occur and are the leading causes of preventable death in sub-Saharan Africa (SSA) and are common among people living with HIV (PLWH). While alcohol use has been shown to be associated with reduced adherence to antiretroviral treatment (ART), which may affect HIV viral suppression, the independent effect of smoking on HIV outcomes in SSA is unknown. We aimed to 1) describe the prevalence of current smoking and correlates of smoking; 2) assess the association of smoking with viral suppression, adjusting for level of alcohol use; 3) explore the relationship between smoking and CD4 cell count <350 cells/mm3, among participants who are virally suppressed. We analyzed data from the Drinkers Intervention to Prevent Tuberculosis (DIPT) and the Alcohol Drinkers' Exposure to Preventive Therapy for TB (ADEPTT) studies conducted in Southwest Uganda. The studies enrolled PLWH who were on ART for at least 6 months and co-infected with latent tuberculosis and dominated with participants who had unhealthy alcohol use. Current smoking (prior 3 months) was assessed by self-report. Alcohol use was assessed using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C, modified for prior 3 months) and phosphatidylethanol (PEth), an alcohol biomarker. We used logistic regression to estimate the cross-sectional association between smoking and lack of virological suppression (≥40 copies/ml), adjusting for level of alcohol use and other covariates, and to examine the association between smoking and CD4 cell counts among PLWH with viral suppression. Of the 955 participants enrolled from 2017 to 2021 who had viral load (VL) results, 63% were men, median age was 40 years (interquartile range [IQR] 32-47), 63% engaged in high/very high-risk alcohol use (AUDIT-C≥6 or PEth≥200 ng/mL), and 22% reported smoking in the prior 3 months. Among 865 participants (91%) with viral suppression and available CD4 count, 11% had a CD4 cell count <350 cells/mm3. In unadjusted and adjusted analyses, there was no evidence of an association between smoking and lack of virological suppression nor between smoking and CD4 count among those with viral suppression. The prevalence of smoking was high among a study sample of PLWH in HIV care with latent TB in Southwest Uganda in which the majority of persons engaged in alcohol use. Although there was no evidence of an association between smoking and lack of virological suppression, the co-occurrence of smoking among PLWH who use alcohol underscores the need for targeted and integrated approaches to reduce their co-existence and improve health.

Gender differences in alcohol drinking among adolescents: a school-based survey in China

BackgroundAlcohol drinking among adolescents is associated with their health development. However, the prevalence of alcohol drinking among adolescents in Southwestern China remains largely unexplored. This study aimed to investigate the...

Emotion Regulation, Coping Strategies, and Hazardous Drinking Among Family Caregivers of People With Alzheimer's Disease and Related Dementias.

The current study investigated hazardous drinking and alcohol use disorders among 453 family caregivers of individuals living with Alzheimer's disease and related dementias (ADRD). We examined the prevalence of hazardous drinking and its relationship with emotion regulation and coping strategies (problem-solving, social support, and avoidance) using data from the first wave of a longitudinal study on daily ADRD caregiving experiences. A binary logistic regression model was performed to predict the relationship between potential risk factors and hazardous drinking. Findings revealed that 18.1% of ADRD caregivers screened positive for hazardous drinking based on the Alcohol Use Disorders Identification Test-Consumption. Caregivers experiencing greater difficulties in emotion regulation and greater reliance on avoidance as a coping strategy were at higher risk of screening positive for hazardous drinking. These findings stress the importance of targeted interventions to improve emotion regulation and reduce avoidance coping in ADRD caregivers, ultimately enhancing their well-being. [Research in Gerontological Nursing, 17(2), 81-90.].

Association of Alcohol Use with COVID-19 Infection and Hospitalization Among People Living with HIV in the United States, 2020.

Alcohol use was associated with elevated COVID-19 risk in the general population. People with HIV (PWH) have high prevalences of alcohol use. To evaluate the effect of alcohol use on COVID-19 risks among PWH, we estimated the risk of COVID-19 diagnosis and COVID-19-related hospitalization among PWH in routine care at 8 HIV primary care centers that contributed data to the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort according to their alcohol use just prior to the COVID-19 pandemic. The CNICS data repository includes demographic characteristics, clinical diagnoses, and laboratory test results from electronic medical records and other sources. Alcohol use, substance use, and mental health symptoms were self-reported on tablet-based standardized surveys. Alcohol use was categorized according to standard, sex-specific Alcohol Use Disorder Identification Test-Consumption instrument cut-offs. We followed 5,496 PWH (79% male, 48% Black race, median age = 53 years) from March 1, 2020 to December 31, 2020. Relative to PWH with no baseline alcohol use, the adjusted hazard ratio (aHR) of COVID-19 diagnosis was 1.09 (95% confidence interval [CI]: 0.78, 1.51) for lower-risk drinking and 1.19 (95%CI: 0.81, 1.73) for unhealthy drinking. The aHR of COVID-19-related hospitalization was 0.82 (95%CI: 0.33, 1.99) for lower-risk drinking and 1.25 (95%CI: 0.50, 3.09) for unhealthy drinking. Results were not modified by recent cocaine or non-prescribed opioid use, depressive symptoms, or diagnoses of alcohol use disorder. The study suggested a slightly increased, but not statistically significant risk of COVID-19 diagnosis and hospitalization associated with unhealthy alcohol use.

Burnout Mediates the Association Between Workaholism and Substance Use: Findings from a French National Company.

To examine the mediation effect of burnout on the association between workaholism and tobacco and alcohol use. A total of 2199 workers from the French national electricity company fulfilled an online questionnaire. Smoking status, alcohol use disorder based on the Alcohol Use Disorders Identification Test-Consumption and workaholism based on the Work Addiction Risk Test were used as binary variables. Burnout was assessed as a continuous variable with the Copenhagen Burn-Out Inventory. Mediation analyses tested the direct effect of the associations between workaholism and each substance use, as well as the indirect effect passing through burnout, while adjusting for sociodemographic factors (gender, age, occupational grade and marital life), work stress using the effort-reward imbalance and overcommitment. When testing the mediation effect of burnout on the relation between workaholism and smoking, there was a significant direct effect of workaholism on smoking (Estimated effect of 0.27 [95% CI 0.01; 0.54]) and a significant indirect effect passing through burnout (Estimated effect of 0.09 [95% CI 0.02; 0.15]). When testing the mediation effect of burnout on the relation between workaholism and alcohol use, the direct effect of workaholism on alcohol use was not significant (Estimated effect of 0.21 [95% CI - 0.01; 0.44]) while the indirect effect passing through burnout was significant (Estimated effect of 0.10 [95% CI 0.04; 0.17]). Information and prevention regarding substance use should be reinforced among workers exposed to workaholism, especially if their workaholism led to a high level of burnout. Preventing the emergence of burnout among workaholics might have some benefits on their tobacco and alcohol use.

Is the Association Between Alcohol Consumption and Mental Well-Being in University Students Linear, Curvilinear or Absent?

Background: Both alcohol consumption and mental well-being problems have been found to be prevalent in higher educated students and often have severe consequences. However, previous findings of the association between these constructs are mixed, possibly because often linear models are fitted, while some theories suggest a curvilinear association between the two concepts. Objectives: To clarify previously mixed findings, the current study compared curvilinear and linear models for the relationship between alcohol consumption and mental well-being in university students. Because of potential gender differences in this relationship, these models were explored for females and males separately. Data from the first cross-sectional online survey wave of the Healthy Student Life project including 2,631 female and 998 male students was used. The Alcohol Use Disorders Identification Test-consumption was used to measure alcohol consumption. Mental well-being was assessed by six sub-concepts (i.e., depressive symptoms, anxiety, stress, life satisfaction, happiness, and self-rated mental health). Results: For females both linear (for anxiety, life satisfaction, and self-rated mental health) and curvilinear (for depression, stress, and happiness) associations were found, while for males no support for either curvilinear or linear models was found. Conclusions: Results should be interpreted with caution due to the small effect sizes in the relationships for females but may suggest that testing the curvilinear association between alcohol consumption and mental well-being is an important future endeavor.