Heavy Alcohol Users Research Articles

Impact Of Exercise Intensity On Cue Reactivity In Heavy Alcohol Users

Physical exercise has been shown to reduce craving for alcohol in alcoholics. There is a high prevalence of heavy alcohol use in college-aged adults (18-29 years of age). This can be predictive of an alcohol or other substance use disorder developing later in life. Acute exercise alters cue reactivity to addictive substances but it is unknown if the magnitude of change in cue reactivity is impacted by exercise intensity. PURPOSE: The purpose of this investigation is to examine the impact of acute aerobic exercise of varying intensities on cue reactivity to alcohol in heavy alcohol users. METHODS: Nine participants (8 females, 1 male) (Age = 21.5+0.5 years, BMI=23.9+01.1, VO2Max=32.25+1.06 ml.kg-1.min-1) completed 3 experimental sessions. Heavy alcohol use was identified using an adapted version of the CAGE questionnaire. During one session subjects rested (REST) for 30 minutes and during the other two sessions subjects exercised for 30 minutes at a moderate (MOD: 53+7% of Peak HR) or vigorous (VIG: 76+2% of Peak HR) exercise intensity. Sessions were randomized for each participant. Prior to and immediately following each session, EEG data were collected using a 64-channel system while subjects were exposed to 210 images (90 alcoholic drinks (ALC), 90 non-alcoholic drinks (NON), 30 control images). Images were presented in a random order and proceeded by a fixation stimulus using a variable time span (0.5 to 1.5 sec). Adaptive mean amplitude for P300 (210-240 ms post stimulus) and mean amplitude for the late positive potential (LPP) (400-600 ms post stimulus) were calculated in parietal-occipital electrodes. RESULTS: The P300 response to ALC increased from pre to post in both REST (pre=2.69±0.72 μV, post=3.41±0.52 μV; p=0.002) and VIG (pre=1.62±0.40 μV; post=2.95±0.51 μV, p<0.001) conditions. In comparison, the P300 response to ALC decreased in the MOD (pre=1.31±0.29 μV; post=0.66±0.32 μV, p<0.001) condition. The LPP to ALC was much greater after REST (2.55±0.69 μV) than after MOD (-0.10±0.32 μV; p<0.001) and VIG (0.73±0.78 μV; p=0.003). CONCLUSION: These findings suggest that the impact of exercise on cue reactivity to images of alcohol in heavy alcohol users is dependent on exercise intensity. Specifically, it appears that moderate intensity exercise has a greater benefit than vigorous exercise.

Characteristics of subjects with alcoholic cardiomyopathy and sudden cardiac death

ObjectiveTo study social and clinical characteristics of victims of sudden cardiac death (SCD) due to alcoholic cardiomyopathy (ACM).MethodsThe study population comprised a subset of Fingesture cohort. All subjects were verified...

Differential correlation of serum BDNF and microRNA content in rats with rapid or late onset of heavy alcohol use.

Heavy alcohol use reduces the levels of the brain-derived neurotrophic factor (BDNF) in the prefrontal cortex of rodents through the upregulation of microRNAs (miRs) targeting BDNF mRNA. In humans, an inverse correlation exists between circulating blood levels of BDNF and the severity of psychiatric disorders including alcohol abuse. Here, we set out to determine whether a history of heavy alcohol use produces comparable alterations in the blood of rats. We used an intermittent access to 20% alcohol using the two-bottle choice paradigm (IA20%2BC) and measured circulating levels of BDNF protein and miRs targeting BDNF in the serum of Long-Evans rats before and after 8 weeks of excessive alcohol intake. We observed that the drinking profile of heavy alcohol users is not unified, whereas 70% of the rats gradually escalate their alcohol intake (late onset), and 30% of alcohol users exhibit a very rapid onset of drinking (rapid onset). We found that serum BDNF levels are negatively correlated with alcohol intake in both rapid onset and late onset rats. In contrast, increased expression of the miRs targeting BDNF, miR30a-5p, miR-195-5p, miR191-5p and miR206-3p, was detected only in the rapid onset rats. Finally, we report that the alcohol-dependent molecular changes are not due to alterations in platelet number. Together, these data suggest that rats exhibit both late and rapid onset of alcohol intake. We further show that heavy alcohol use produces comparable changes in BDNF protein levels in both groups. However, circulating microRNAs are responsive to alcohol only in the rapid onset rats.

Abstract P522: Alcohol Consumption and Cardiovascular Mortality After Myocardial Infarction

Background: Little is known about alcohol consumption in relation to long-term mortality risk after myocardial infarction (MI). We examined alcohol consumption in relation to total, coronary heart disease (CHD) and cardiovascular disease (CVD) mortality in the Alpha Omega Cohort of Dutch post-MI patients. Methods: We included 4,365 patients (60-80y, 79% male) with MI ≤10y before enrolment. Heavy alcohol users (≥6 glasses/d) were excluded from cohort participation. Dietary intake and alcohol consumption were assessed using a 203-item validated food-frequency questionnaire. Patients were classified as non-drinkers (0 g/d, n=956), very light (&gt;0-≤2 g/d, n=385), light (M: &gt;2-≤10, F: &gt;2-≤5 g/d, n=1,125), moderate (M: &gt;10-≤30, F: &gt;5-≤15 g/d, n=1,207) or heavy drinkers (M :&gt;30, F: &gt;15 g/d, n=692). Hazard ratios (HRs) for total, CHD and CVD mortality were obtained, adjusting for age, sex, education, smoking, BMI, physical activity, energy intake and other dietary factors. Results: Alcohol was consumed by 83% of men and 61% of women. During 11.1y follow up, 2,035 deaths occurred of which 575 from CHD and 801 from CVD. Compared to the reference group of very light drinkers, HRs (95%CI) for total mortality were 1.01 (0.85, 1.19) in non-drinkers, and 0.88 (0.74, 1.04), 0.85 (0.72, 1.01) and 0.91 (0.76, 1.10) in light, moderate and heavy drinkers respectively. Adding non-drinkers to the reference group did not affect HRs: 0.87 (0.78, 0.98), 0.85 (0.76, 0.96) and 0.91 (0.79, 1.05) for light, moderate and heavy drinkers. Associations were slightly stronger but non-significant for CVD and CHD mortality. Findings were roughly similar after exclusion of former drinkers (n=385), diabetics (n=883) and patients with poor health (n=1,010). Conclusion: Light to moderate alcohol consumption was weakly inversely associated with total, CVD and CHD mortality risk in post-MI patients. In this observational study, potential bias and confounding cannot be ruled out and findings should be interpreted cautiously in light of the totality of evidence.

Alcohol Use Is Associated With Hepatic Steatosis Among Persons With Presumed Nonalcoholic Fatty Liver Disease

Many individuals presumed to have nonalcoholic fatty liver disease (NAFLD) consume moderate amounts of alcohol. Little is known about patterns of alcohol use in patients with NAFLD or how drinking behaviors affect liver fat. We conducted a cross-sectional study of 2475 participants of the Framingham Heart Study with hepatic steatosis, as determined by computed tomography. We performed multivariable-adjusted logistic regression models to evaluate the association between alcohol drinking patterns and hepatic steatosis. Models were adjusted for sociodemographic factors, diet, and the components of the metabolic syndrome. We excluded heavy alcohol users, defined as women who consume more than 14 alcohol drinks per week and men who consume more than 21 alcohol drinks per week. In our sample (mean age, 49.8 ± 10.2 y; 50.3% women), the prevalence of hepatic steatosis was 17.5%. The total number of alcohol drinks per week and the maximum drinks consumed per drinking day each were associated with hepatic steatosis (adjusted odds ratio [aOR], 1.15; 95% CI, 1.02-1.29 and aOR 1.15; 95% CI, 1.02-1.30). Binge drinking occurred in 25.4% of individuals with presumed NAFLD and was associated with an increased odds of hepatic steatosis (aOR, 1.45; 95% CI, 1.06-1.98) among alcohol users. In a beverage-specific analysis, alcohol use patterns were associated with hepatic steatosis among beer drinkers, but not among wine drinkers. In a cross-sectional study of participants of the Framingham Heart Study with hepatic steatosis, we observed an association between alcohol use and liver fat, even after excluding heavy alcohol users from our analysis. Alcohol use therefore appears to be a risk factor for NAFLD. Prospective studies are needed to validate these findings and determine if alcohol use should be a focus for research, prevention, and treatment of presumed NAFLD.

2391 When Breast Cancer Comes Back With Vengeance: Death Within Three Weeks Secondary to Acute Liver Failure

INTRODUCTION: Breast cancer (BC) is the most common cancer in women in the developed and developing world. Here we report a patient with treated stage II HER2+ BC presenting with abnormal liver enzymes and jaundice, found to have innumerable hepatic lesions consistent with metastatic BC, with rapid progression to acute liver failure(ALF). CASE DESCRIPTION/METHODS: A 63-year-old female with history of stage II HER2+ BC who underwent six cycles of neoadjuvant chemotherapy, lumpectomy, radiation, letrozole for four years, presented with one week of abdominal distension, dark urine, pale stools, and jaundice. She denied a history of hepatitis, intravenous drug use, or herbal supplement use but used marijuana and was a former smoker and heavy alcohol user. Six years prior to admission, two tubulovillous adenomas, 1.0 × 1.0 × 0.8 cm and 1.5 × 1.5 × 1.2 cm were resected. Surveillance colonoscopy, six months later, revealed a tubular adenoma, 0.2 × 0.2 × 0.2 cm and a tubulovillous adenoma, 1.2 × 1.2 × 1.2 cm. She missed her repeat surveillance colonoscopy. Physical examination was notable for jaundice, scleral icterus, hepatomegaly, and abdominal distension. Workup included negative hepatitis panel, platelet count 121,000/uL, total bilirubin 14.2mg/dL, direct bilirubin 10.7mg/dL, alkaline phosphatase 1367 IU/L, aspartate aminotransferase 621 U/L, alanine aminotransferase 252 U/L, albumin 1.5 g/dL, prothrombin time 14.7 seconds, activated partial thromboplastin time 41.5 seconds, international normal ratio 1.2, CA 15-3 3900 U/mL, CA 19-9 7200 U/mL, and CEA 844 U/mL. CT Abdomen/Pelvis revealed innumerable hepatic metastases, hepatomegaly, and small volume ascites (image 1). She underwent IR-guided biopsy of a hepatic lesion, confirmed as metastatic HER2 equivocal BC. Within one week, she became encephalopathic and died whilst deciding between hospice and systemic chemotherapy. DISCUSSION: BC represents about 30% of all cancer diagnoses in women each year. Of those diagnosed at early stages, 20-30% will relapse with metastatic BC. HER2+ BC has a higher risk of relapse than other subtypes, and is more likely to spread to the brain, liver, bone, and lung. This patient’s hepatic involvement was concerning for metastatic BC or colon cancer, based on past tubulovillous adenomas and missed surveillance colonoscopy. Within three weeks of presentation, she died. This case highlights the fulminant progression of HER2+ BC causing ALF due to tumor infiltration of liver parenchyma with cessation of synthetic capacity.

Development and validation of an individualized risk prediction model for oropharynx cancer in the US population.

The incidence of oropharynx cancers has increased substantially in the United States. However, risk stratification tools for the identification of high-risk individuals do not exist. In this study, an individualized risk prediction model was developed and validated for oropharynx cancers in the US population. A synthetic, US population-based case-control study was conducted. Oropharynx cancer cases diagnosed at Ohio State University (n=241) were propensity-weighted to represent oropharynx cancers occurring annually in the United States during 2009-2014 (n=12,656). Controls (n=9327) included participants in the National Health and Nutrition Examination Survey (2009-2014) and represented the annual US population aged 30 to 69 years (n=154,532,508). The individualized 1-year absolute risk of oropharynx cancer was estimated with weighted logistic regression. The risk prediction model included age, sex, race, smoking, alcohol use, lifetime sexual partners, and oral oncogenic human papillomavirus (HPV) status. The model had good discrimination and calibration in split-sample validation (area under the curve [AUC], 0.94; 95% confidence interval [CI], 0.92-0.97; observed/expected [O/E], 1.01; 95% CI, 0.70-1.32) and external validation (AUC, 0.87; 95% CI, 0.84-0.90; O/E, 1.08; 95% CI, 0.77-1.39). In the US population, 1-year predicted risks of oropharynx cancer were highest for older individuals (21.1/100,000 for 65- to 69-year-olds), men (13.9/100,000), whites (10.4/100,000), smokers (18.0/100,000 for >20 pack-years), heavy alcohol users (18.4/100,000), and those with prevalent oral oncogenic HPV (140.4/100,000). The risk prediction model provided substantial risk stratification, with approximately 77% of all oropharynx cancers and approximately 99% of HPV-positive oropharynx cancers occurring in the 10% of the US population with the highest model-predicted risk. This risk prediction model will enable the efficient design of studies to address the outstanding questions pertaining to the natural history, screening, and secondary prevention of oropharynx cancers.

Altered neural dynamics in occipital cortices serving visual-spatial processing in heavy alcohol users.

Visual-spatial processing deficits have been previously linked to heavy alcohol use, but the underlying neurological mechanisms are poorly understood. Neuroimaging studies have shown alcohol-related aberrations in occipital cortices that appear to be associated with these neuropsychological deficits in visual-spatial processing, however the neural dynamics underlying this altered processing remains unknown. Twenty-three adults with high scores on the Alcohol Use Disorders Identification Test - Consumption (male: ⩾5, female: ⩾4) were compared to 30 demographically-matched controls with low Alcohol Use Disorders Identification Test - Consumption scores (⩽2). All participants completed a visual-spatial processing task while undergoing high-density magnetoencephalography. Time-frequency windows of interest were determined using a data-driven method, and spectrally-specific neural activity was imaged using a beamforming approach. Permutation testing of peak voxel time series was then used to statistically compare across groups. Participants with heavy alcohol use responded slower on the task and their performance was more variable. The magnetoencephalography data indicated strong theta (4-8 Hz), alpha (10-16 Hz), and gamma (62-72 Hz) responses in posterior brain regions across both groups. Following voxel time-series extraction, significant group differences were found in the left and right visual association cortices from about 375-550 ms post-stimulus, such that adults with heavy alcohol use had blunted alpha responses compared to controls. Individuals with heavy alcohol use exhibited aberrant occipital alpha activity during visual-spatial processing. These data are the first to show spectrally-specific differences during visual-spatial processing related to heavy alcohol use, and highlight alcohol's effect on systems-level neural activity.

Earlier age of onset in multiple system atrophy with smoking and heavy alcohol use

ObjectiveTo determine whether smoking or alcohol use impacts the age of onset and disease duration in multiple system atrophy (MSA). MethodsAll patients diagnosed with MSA at Mayo Clinic, Rochester between 1998 and 2012 completed standardized questionnaires surveying smoking and alcohol use at the time of presentation. ResultsOf 551 patients with smoking and alcohol use data, 281 were past or present smokers with age of onset of 60.76 years compared to 62.97 years in controls (p = 0.0144). Age of onset in the 87 heavy alcohol users was 56.87 years compared to 62.97 years in controls (p = 0.0133). There was no difference in disease duration for smokers (p = 0.2758) or heavy alcohol users (p = 0.4820) compared to controls. ConclusionOur findings show that smoking history and/or heavy alcohol use is associated with younger age of onset in MSA but do not influence survival.

Assessment of driving fitness among patients with alcohol-related visits to two hospitals in eastern Finland.

Objective:The aim of the present study was twofold. The first aim was to explore how frequently physicians evaluate driving fitness when a patient has a serious alcohol problem, which is accomplished by examining differences in physicians’ compliance with their intervention/notification obligation among different alcohol-related ICD-10 diagnoses. The second aim was to explore how many heavy alcohol users have a valid driving license.Methods:Data from all patients with an alcohol-related ICD-10 diagnosis code as a cause of a hospital visit were collected during a three-month period from Kuopio University Hospital and North Karelia Central Hospital.Results:Eighty-one percent (81%) of patients with alcohol-related ICD-10 diagnoses were heavy alcohol users and had alcohol withdrawal syndrome, alcohol-related organ disease or multidrug abuse combined with alcohol abuse. The driving fitness of these patients was significantly reduced, and the health requirements of the driving license were not met. Physicians evaluated driving fitness for only 20% of alcohol-related hospital visits/hospitalisations. Moreover, fitness to drive was evaluated in only 24% of cases of a patient with a major alcohol problem and a valid driving license. Driving fitness was most frequently evaluated in cases with alcohol-related convulsions (74%). In total, 80% of patients with a major alcohol problem had a valid driving license even though the requirements of driving fitness were not met.Conclusions:The obligation to evaluate the driving fitness of heavy alcohol users is often neglected, except in cases of alcohol-abuse-related convulsions. Physicians should play a greater role in monitoring road safety, or sanctions should be set for failures to obey the obligations. The driving fitness of a patient hospitalised due to alcohol use should be assessed more regularly. Cognition problems related to alcohol-related liver disease/alcohol-related dementia are probably often overlooked. Alcohol-abuse-related conditions are poorly recognised and remain unreported to the authorities.

Economic Impact of Lifestyle Behaviour and Quality of Sleep on Long-Term Sickness Absence

Background: Long-term sickness absence (LTSA; >10 days) creates huge economic burden for employers and societies. Lifestyle behaviours and quality of sleep may reduce the risk of LTSA, but the possible savings achieved through improving these risk factors have been poorly quantified. We aimed to provide monetary estimates for the association of risk factors with cost of LTSA. Methods: The Helsinki Health Study is a cohort of employees of the City of Helsinki, Finland (n=8960, response rate 67%). In 2007, the participants received a questionnaire that gathered information on their lifestyle and sleep. A sum of the risk factors was calculated: Participants received one point for being a smoker; heavy alcohol user (>7 portions/week for women and >14 portions/week for men); physically inactive (<14 MET hours/week); consuming fruits and vegetables <1 times/day; or suffering from insomnia symptoms 14+ days/month. Costs were estimated by using individual-level data on salaries and personnel cost, sickness allowances, and disability pensions obtained through registers between 2008 and 2013. Data were analysed using a two-part model. Findings: Employees with ≥3 risk factors had 6323∈ (95% CI 3822∈-8824∈) higher cost from LTSA over five years period than those with no risk factors. Physical inactivity (2464∈, 916∈-4012∈), smoking (2424∈, 880∈-3968∈), and poor sleep (5017∈, 3569∈-6466∈) contributed the most to the cost of LTSA. Interpretation: Having multiple unhealthy behaviors and insomnia symptoms may increase cost of LTSA over 50%. As the employers pay most of the cost, employers are urged to design interventions that encourage employees to improve their lifestyle. Funding: This study is supported by grants from the Finnish Work Environment Fund (#116178 to JL) and the Academy of Finland (#1294566 to JL). OR is supported by grants from the Academy of Finland (grant #1294514) and the Juho Vainio Foundation. Declaration of Interest: We declare no competing interest. Ethical Approval: The Helsinki Health Study protocol has been approved by the ethics committees of the Department of Public Health, University of Helsinki (30th of Nov 1998), and the City of Helsinki health authorities (3rd of Feb 2000), Finland.

Perceptions of Alcohol Advertising Vary Based on Psychological Characteristics

Background: The alcohol industry recognizes children and pregnant women as population sub-groups vulnerable to the effects of alcohol marketing. Research indicates that heavy alcohol users are also potentially vulnerable to alcohol marketing. The purpose of the current study is to determine if sub-groups defined by psychological characteristics should be classified as potentially vulnerable as well. Methods: College students (n = 326) from two northeast schools were recruited to complete a survey containing questions on demographics, alcohol use, and psychological characteristics (alcohol expectancies, alcohol dependence, sensation seeking traits, and past delinquent behaviors). Additionally, after viewing each of five alcohol ads (4 television and 1 magazine), participants answered questions about their perceptions of alcohol consumption, responsible drinking, excessive drinking, and appeal of the ads. Main effects were assessed using hierarchical linear modeling, with adjustment for age, sex, race, ethnicity, and AUDIT score. Results: Alcohol expectancies (p < .001), particularly the social and physical pleasure and social expressiveness sub-scales, and sensation seeking traits (p = .002) were positively associated with alcohol ad appeal. Alcohol dependence symptoms, specifically impaired control and tolerance, were positively associated with perceptions of responsible drinking (p = .035), even though mean perceived number of drinks consumed met the definition of binge drinking. Conclusions: Individuals with positive alcohol expectancies, sensation seeking traits, and alcohol dependence may be vulnerable to alcohol advertising and marketing. Because alcohol advertising often contains content that can serve as a cue or reinforce to drink, specific regulations may be needed to prevent alcohol-related harm from occurring in these sub-populations.

Resting state connectivity best predicts alcohol use severity in moderate to heavy alcohol users.

BackgroundIn the United States, 13% of adults are estimated to have alcohol use disorder (AUD). Most studies examining the neurobiology of AUD treat individuals with this disorder as a homogeneous group; however, the theories of the neurocircuitry of AUD call for a quantitative and dimensional approach. Previous imaging studies find differences in brain structure, function, and resting-state connectivity in AUD, but few use a multimodal approach to understand the association between severity of alcohol use and the brain differences.MethodsAdults (ages 22–60) with problem drinking patterns (n = 59) completed a behavioral and neuroimaging protocol at the National Institutes of Health. Alcohol severity was quantified with the Alcohol Use Disorders Identification Test (AUDIT). In a 3 T MRI scanner, participants underwent a structural MRI as well as resting-state, monetary incentive delay, and face matching fMRI scans. Machine learning was applied and trained using the neural data from MRI scanning. The model was tested for generalizability in a validation sample (n = 24).ResultsThe resting state-connectivity features model best predicted AUD severity in the naïve sample, compared to task fMRI, structural MRI, combined MRI features, or demographic features. Network connectivity features between salience network, default mode network, executive control network, and sensory networks explained 33% of the variance associated with AUDIT in this model.ConclusionsThese findings indicate that the neural effects of AUD vary according to severity. Our results emphasize the utility of resting state fMRI as a neuroimaging biomarker for quantitative clinical evaluation of AUD.

Liver Fat Is Associated With Markers of Inflammation and Oxidative Stress in Analysis of Data From the Framingham Heart Study

Nonalcoholic fatty liver disease is an inflammatory condition that results in progressive liver disease. It is unknown if individuals with hepatic steatosis, but not known to have liver disease, have higher serum concentrations of markers of systemic inflammation and oxidative stress. We collected data from 2482 participants from the Framingham Heart Study (mean age, 51 ± 11 y; 51% women) who underwent computed tomography and measurement of 14 serum markers of systemic inflammation. Heavy alcohol users were excluded. The liver:phantom ratio (a continuous parameter of liver attenuation relative to a calibration phantom) was used to identify individuals with radiographic evidence of liver fat. Primary covariates included age, sex, smoking, alcohol, aspirin use, hypertension, dyslipidemia, diabetes, and cardiovascular disease. Body mass index and visceral fat were secondary covariates. We used multivariable linear regression models to assess the association between liver fat and systemic inflammatory markers. In multivariable-adjusted models, liver fat was associated with the following inflammatory markers: high-sensitivity C-reactive protein (P < .001), urinary isoprostanes (P < .001), interleukin 6 (P < .001), intercellular adhesion molecule 1 (P < .001), and P-selectin (P= .002). Additional adjustment for body mass index or visceral fat attenuated the results slightly, although all associations remained statistically significant (P for all ≤ .01). In a community-based cohort, individuals with hepatic steatosis without known liver disease had higher mean serum concentrations of systemic markers of inflammation. Studies are needed to determine whether treatment of hepatic steatosis reduces systemic inflammation.

Concurrent binge drinking and current tobacco use and its social and health correlates among adults in Laos

ABSTRACTThe aim of this study was to examine sociodemographic and health correlates of concurrent binge drinking and tobacco use in a national adult population in Laos. A cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The total sample included 2,543 individuals 18–64 years. Questionnaire interview, blood pressure, and anthropometric measurements, and biochemistry tests were conducted. Results indicate that 18.6% (38.3% in men and 5.2% in women) of the participants had engaged in concurrent current tobacco use and past month binge drinking, 15.2% in current tobacco use only and 28.4% in past month binge drinking only. Among current tobacco users, 42.2% engaged in frequent heavy drinking (3 or more times/month), and among past month heavy alcohol users, 55.8% were daily current tobacco users. In adjusted analysis, being 35 to 49 years old, lower education, having normal weight, and moderate or high physical activity were associated with concurrent current tobacco use and past month heavy drinking. Current tobacco use alone increased with age and decreased with education and heavy drinking alone decreased with age and increased with education. Findings suggest sociodemographic and health factors are important for public health interventions in addressing concurrent tobacco and alcohol use.

Identifying Barriers to Mental Health Service Utilization Among Heavy Drinking Community College Students

ABSTRACTThere are limited findings on mental health prevalence and service utilization rates among community college (CC) students. Utilizing a heavy drinking CC sample, the current study examined: 1) prevalence of mental health symptoms, 2) mental health service utilization and perceived unmet service need, and 3) barriers to service utilization. Participants were 142 CC students who were heavy alcohol users (70% female; 59% White) from three public CCs in the Pacific Northwest who were participating in a larger study designed to adapt a brief intervention for high-risk alcohol use. Findings of the current study revealed that 32% of CC students had a positive screen for depression; 25% had a positive screen for anxiety; a total of 28% received mental health services in the past 12 months; a total of 41% reported a perceived unmet need for mental health srvices at some point in the past 12 months (i.e., needing mental health services but not receiving it). Students with mental health symptoms reported more barriers to receiving services, and were more likely to not receive services due to cost, compared to students without mental health symptoms. There were differences in type of barrier as a function of alcohol use severity, although there was no difference in number of barriers. Campuses may benefit from understanding mental health service utilization barriers their students report and to effectively advertise the services offered. Training of student services personnel staff and faculty in screening for mental health or substance use may be a worthwhile and cost-effective endeavor.

Alcohol and drug use among deaf and hard-of-hearing individuals: A secondary analysis of NHANES 2013–2014

ABSTRACTBackground: Within the field of behavioral health research, one of the most understudied populations is the US deaf and hard-of-hearing (D/HH) population—a diverse group of individuals with hearing loss that have varied language and communication preferences, community affiliations, and sociocultural norms. Recent research identified concerning behavioral health disparities experienced by the D/HH population; yet, little research has been conducted to extend these findings to the topic of substance use disorder. Methods: To begin to fill this gap, the authors conducted a secondary analysis of data from the 2013–2014 administration of the National Health and Nutrition Examination Survey, comparing alcohol and drug use between participants based on their reported hearing status, i.e., D/HH or hearing. Results: Findings suggest that the overall lifetime prevalence of alcohol and drug use does not differ based on hearing status, and that D/HH and hearing adolescents begin using cannabis on a similar timeline. However, findings also revealed that D/HH respondents were more likely to have been regular cannabis users and heavy alcohol users than hearing respondents. In other words, when D/HH individuals use substances, they tend to be heavy users. Conclusions: These findings stress the importance of directing resources to the prevention and treatment of heavy alcohol use in the D/HH population, given that binge drinking is associated with a number of health problems and social consequences. Additionally, the continuation of this empirical work is rather urgent given recent legislative changes regarding cannabis use. D/HH individuals possess a number of risk factors for substance use disorder and, as such, may be more greatly impacted by these legislative changes than individuals from the general US population. It is imperative that this impact be captured by future research efforts in order to inform the development of prevention and intervention efforts for the traditionally underserved D/HH population.

Transdiagnostic Effects of Ventromedial Prefrontal Cortex Transcranial Magnetic Stimulation on Cue Reactivity

BackgroundElevated frontal and striatal reactivity to drug cues is a transdiagnostic hallmark of substance use disorders. The goal of these experiments was to determine if it is possible to decrease frontal and striatal reactivity to drug cues in both cocaine users and heavy alcohol users through continuous theta burst stimulation (cTBS) to the left ventromedial prefrontal cortex (VMPFC). MethodsTwo single-blinded, within-subject, active sham–controlled experiments were performed wherein neural reactivity to drug/alcohol cues versus neutral cues was evaluated immediately before and after receiving real or sham cTBS (110% resting motor threshold, 3600 pulses, Fp1 location; N = 49: 25 cocaine users [experiment 1], 24 alcohol users [experiment 2]; 196 total functional magnetic resonance imaging scans). Generalized psychophysiological interaction and three-way repeated-measures analysis of variance were used to evaluate cTBS-induced changes in drug cue-associated functional connectivity between the left VMPFC and eight regions of interest: ventral striatum, left and right caudate, left and right putamen, left and right insula, and anterior cingulate cortex. ResultsIn both experiments, there was a significant interaction between treatment (real/sham) and time (pre/post). In both experiments, cue-related functional connectivity was significantly attenuated following real cTBS versus sham cTBS. There was no significant interaction with region of interest for either experiment. ConclusionsThis is the first sham-controlled investigation to demonstrate, in two populations, that VMPFC cTBS can attenuate neural reactivity to drug and alcohol cues in frontostriatal circuits. These results provide an empirical foundation for future clinical trials that may evaluate the efficacy, durability, and clinical implications of VMPFC cTBS to treat addictions.

Grey matter dysmyelination during abstinence in ethanol dependence

White matter atrophy/demyelination observed in heavy alcohol users is often reported as reduced fractional anisotropy (FA) and increased mean and radial diffusivity (MD and RD, respectively) quantified using diffusion tensor imaging (DTI). Several lines of research suggest that neurobehavioral impairments in grey matter areas like the medial prefrontal cortex (mPFC) are critical components of alcohol dependence and relapse vulnerability. Previous research revealed that homeostatic imbalance in myelinating cells in mPFC of a rat model of alcoholism was associated with increased risk of relapse-like behavior during protracted abstinence. Therefore, we investigated the demyelination in the mPFC at several time points during protracted abstinence from heavy alcohol exposure. Adult male rats underwent chronic intermittent ethanol exposure (CIE), where rats breathed air containing ethanol vapor for 14 hours/day to elicit blood alcohol levels (125–250 mg/dl), and neurobehavioral deficits mirroring moderate-severe alcohol use disorder. Myelination was investigated first using DTI in vivo, followed by post-mortem immunoblotting analyses of myelin-associated proteins in mPFC after various durations of ethanol abstinence (1 day; 1d, 7d, 21d, and 42d) in CIE rats and in age-matched ethanol-naive controls (n = 6–10/group). In the corpus callosum (white matter), we observed a transient decrease in FA (to ~ 90% of controls) and increase in RD (~ 180%) at 7d that normalized later (21–42d; ps < 0.05). These white-matter microstructural data indicate demyelination followed by recovery in the CIE model, which mirrors the results obtained from neuroimaging in human alcoholics. In the mPFC (grey matter), increased MD and RD (both ~160%), and surprisingly, increased FA (~105%) was observed at 7d (ps < 0.05). Concurrently, increased expression of myelin basic protein and myelin oligodendrocyte glycoprotein in the mPFC were observed at 7d (ps < 0.05). All changes in DTI measures and protein expression were normalized by 21–42d (ps < 0.05). These results suggest microstructural damage that is inconsistent qualitatively, with both demyelination and hypermyelination. Electron microscopic analysis was conducted in 7d abstinent and control rats (n = 4–5/group) to determine ultrastructural characteristics of mPFC neurons at this critical interval. Results revealed damaged myelinated axons in the mPFC, such that more fibers were flayed (~160%), and these flays occupied a greater portion of the axonal perimeter (~160%) in rats with a history of CIE compared to naïve controls (ps < 0.05). The flayed damage is consistent with demyelination suggested by the increased MD and RD. The increased FA may reflect the accumulation of myelin-associated proteins due to reduced turnover and compensatory de novo protein synthesis. Taken together, these results suggest transient dysmyelination in the mPFC of rats with a history of CIE; future studies should investigate its functional implications. DTI measures observed in white matter area (corpus callosum) of the rat model was translationally valid, therefore providing credence to the translational relevance of the observed grey matter (mPFC) DTI changes. Thus, the current model may provide valuable insights into the causal link between heavy alcohol intake, mPFC myelin neuropathology, and relapse and thereby may be developed into a diagnostic indicator for future risk for relapse during abstinence. Support or Funding Information Funding: AA020098, AA06420 and DA034140All research reported has been conducted in conformance with the FASEB Statement of Principles for the use of Animals in Research and Education. Damaged (flayed) myelin in mPFC of alcohol abstinent subject This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Perceptions of Alcohol Advertising among High Risk Drinkers

ABSTRACTBackground: Individuals who are particularly vulnerable to the influence of alcohol advertising, such as youth, need special protections, yet little research has been done to determine if other vulnerable groups exist. Secondary data analysis was conducted to determine if perceptions of alcohol advertising differ between groups based on their alcohol use and whether the definition of “vulnerable” should be expanded beyond demographic categories. Methods: Students (n = 326) from 2 U.S. colleges viewed 5 alcohol ads and rated them using a scale designed to detect violations of the alcohol industry's self-regulated marketing codes. Individuals with a history of excessive alcohol use, as measured by the Alcohol Use Disorders Identification Test (AUDIT), were considered potentially vulnerable to alcohol advertising and were compared against individuals without a history of excessive alcohol use. Hierarchical linear modeling was used to determine between-group differences in 4 dependent variables (ad appeal, perceived alcohol consumption, perceived excessive drinking, and perceived responsible drinking). All models were adjusted for age, race, ethnicity, sex, and parental alcohol use. Results: AUDIT risk categories were positively associated with ad appeal (p < 0.001), the amount of alcohol perceived to be consumed (p < 0.01), and perceptions of responsible drinking (p < 0.05). There was no significant associated with perceptions of excessive drinking. Conclusions: Individuals with a history of heavy alcohol use perceived greater alcohol consumption in alcohol ads but perceived this consumption, which often met the definition for binge drinking, to be responsible. Stricter regulations may be needed to protect heavy alcohol users from the effects of alcohol advertising.