High Alcohol Severity Research Articles

Characterizing Clinical Heterogeneity in a Large Inpatient Addiction Treatment Sample: Confirmatory Latent Profile Analysis and Differential Levels of Craving and Impulsivity.

Individuals with substance use disorders (SUDs) have highly heterogeneous presentations and identifying more homogeneous subgroups may foster more personalized treatment. This study used SUD and other psychiatric indicators to characterize latent subgroups of patients in a large inpatient addiction treatment program. The resulting subgroups were then analyzed with respect to differences on clinically informative motivational mechanisms. Patients (n = 803) were assessed for severity of SUD (ie, alcohol use disorder, drug use disorder), post-traumatic stress disorder, anxiety disorders, and major depressive disorder. Confirmatory latent profile analysis (CLPA) was used to identify latent subgroups, hypothesizing 4 subgroups. Subgroups were then characterized with respect to multiple indicators of impulsivity (ie, delay discounting and impulsive personality traits via the UPPS-P) and craving. The CLPA confirmed the hypothesized 4-profile solution according to all indicators (eg, entropy = 0.90, all posterior probabilities ⩾.92). Profile 1 (n = 229 [32.2%], 24.9% female, median age in range of 45-49) reflected individuals with high alcohol severity and low psychiatric severity (HAlc/LPsy). Profile 2 (n = 193 [27.1%], 29.3% female, median age in range of 35-39) reflected individuals with high drug and psychiatric severity (HDrug/HPsy). Profile 3 (n = 160 [22.5%], 37.6% female, median age in range of 45-49) reflected individuals with high alcohol severity and psychiatric severity (HAlc/HPsy). Profile 4 (n = 130 [18.3%], 19.4% female, median age in range of 35-39) reflected individuals with high drug severity and low psychiatric severity (HDrug/LPsy). Both high comorbid psychiatric severity subgroups exhibited significantly higher craving and facets of impulsivity. The results provide further evidence of 4 latent subgroups among inpatients receiving addiction treatment, varying by alcohol versus other drugs and low versus high psychiatric comorbidity. Furthermore, they reveal the highest craving and impulsivity in the high psychiatric comorbidity groups, suggesting targets for more intensive clinical intervention in these patients.

Preliminary study of alcohol problem severity and response to brief intervention

BackgroundFindings have been mixed as to whether brief intervention (BI) is appropriate and effective for individuals with more severe alcohol use problems. Motivation to change drinking has been supported as a mechanism of behavior change for BI. This exploratory study examined aspects of motivation as mechanisms of clinical response to BI and alcohol problem severity as a moderator of treatment effects.MethodsNon-treatment-seeking heavy drinkers (average age = 35 years; 57% male) were randomized to receive BI (n = 27) or attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and post-intervention: importance, confidence, and readiness. Moderated mediation analyses were implemented with treatment condition as the focal predictor, changes in motivation as mediator, 1-month follow-up drinks per day as the outcome, and an alcohol severity factor as second-stage moderator.ResultsAnalysis of importance displayed a significant effect of intervention condition on importance (p < 0.003) and yielded a significant index of moderated mediation (CI − 0.79, − 0.02), indicating that the conditional indirect effect of treatment condition on drinking through importance was stronger for those with higher alcohol severity. For all motivation indices, alcohol severity moderated the effect of post-intervention motivation levels on drinking (p’s < 0.05). The direct effect of treatment condition on drinking was not significant in any model.ConclusionsFindings highlight the relevance of considering one’s degree of alcohol problem severity in BI and alcohol screening efforts among non-treatment seeking heavy drinkers. These nuanced effects elucidate both potential mechanisms and moderators of BI response.Trial registration Clinicaltrials.gov: NCT04710095. Registered January 14, 2021—retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT04710095.

Identifying Patterns of Alcohol Use and Obesity-Related Factors Among Emerging Adults: A Behavioral Economic Analysis.

Although heavy alcohol consumption and maladaptive eating behaviors have been shown to co-occur among college students, less is known about the co-occurrence of these behaviors in a more diverse community-dwelling, emerging adult sample. The purpose of this study was to: (i) identify classes of emerging adults by their reported alcohol consumption patterns, food addiction symptoms, and body mass index; and (ii) determine whether these classes differed on indices of behavioral economic reinforcer pathology (e.g., environmental reward deprivation, impulsivity, alcohol demand). Emerging adult participants were recruited as part of a study on risky alcohol use (n=602; 47% white, 41.5% Black; mean age=22.63, SD=1.03). Participants completed questionnaires on alcohol and food-related risk factors and underwent anthropometric assessment. Latent profile analysis suggested a four-profile solution: a moderate alcohol severity, overweight profile (Profile 1; n=424, 70.4%), a moderate alcohol severity, moderate food addiction+obese profile (Profile 2; n=93, 15.4%), a high alcohol severity, high food addiction+obese profile (Profile 3; n=44, 7.3%), and a high alcohol severity, overweight profile (Profile 4; n=41, 6.8%). Individuals in Profile 1 reported significantly lower levels of environmental reward deprivation than either Profile 2 or 3, and participants in Profile 3 reported significantly higher environmental reward deprivation than those in Profile 4 (p<0.001). Profile 4 demonstrated significantly higher alcohol demand intensity and Omax and lower demand elasticity than Profile 1, Profile 2, or Profile 3. Profile 4 also demonstrated significantly greater proportionate substance-related reinforcement than Profile 1 (p<0.001) and Profile 2 (p=0.004). Maladaptive eating patterns and alcohol consumption may share common risk factors for reinforcer pathology including environmental reward deprivation, impulsivity, and elevated alcohol demand.

Predictors of premature treatment termination in a large residential addiction medicine program

BackgroundWhile inpatient programs are a common setting for addiction treatment, patients' premature termination is a major concern. Predicting premature treatment termination has the potential to substantially improve patient outcomes by identifying high-risk profiles and suggesting care paths that might reduce dropout. The current study examined the predictors of premature termination from an inpatient addiction medicine service. MethodsIn 1082 patients admitted to a large inpatient addiction medicine service, we used intake assessments of severity of alcohol use disorder, illicit drug use disorder, post-traumatic stress disorder (PTSD), anxiety disorders, and major depressive disorder to predict planned termination (n = 922) or premature termination (n = 160). We used two complementary analytic approaches—traditional binary logistic regression and a data-driven latent profile analysis (LPA). ResultsBinary logistic regression revealed that alcohol use severity, illicit drug use severity, and PTSD severity significantly predicted termination status, although alcohol use severity notably exhibited an inverse relationship. The LPA revealed four distinct profiles, with one profile exhibiting a significantly higher rate of premature termination and another exhibiting a significantly lower rate of premature termination. The high-risk profile was characterized by high drug severity, high comorbid psychopathology (PTSD, depression, and anxiety symptoms), but low alcohol severity. The low-risk profile was characterized by high alcohol severity, but low drug use and low comorbid psychopathology. ConclusionsThese results provide converging evidence that illicit drug severity and psychiatric severity, and particularly PTSD, were associated with premature termination. Moreover, the LPA revealed distinct latent subgroups of patients with meaningfully higher and lower risk of premature termination, suggesting that addiction services should develop strategies for identifying high-risk individuals or develop care paths for high-risk symptom clusters. Approaches that are trauma-informed or otherwise focus on the management of comorbid psychiatric conditions may be particularly appropriate for reducing premature termination.

Alcohol and energy drink use among adolescents seeking emergency department care

Emergency department (ED) visits due to energy drinks rose drastically from 2007 to 2011. Consuming alcohol mixed with energy drinks by young people is particularly concerning. Among youth (aged 14–20years) in the ED reporting past-year alcohol use, we assessed frequency, reasons, and medical consequences of consuming alcohol and energy drinks in the same beverage or on the same occasion, and relationships with other risk behaviors. The sample included 439 youth (Mage=18.6years, SD=1.4; 41% male; 73% Caucasian): those who drank alcohol, but not energy drinks (Non-Users; 41%, n=178), those who drank alcohol and energy drinks on separate occasions (Separate; 23%, n=103), and those who combined alcohol and energy drinks in the same beverage or on the same occasion (Combined; 36%, n=158). Common reasons for combining energy drinks and alcohol were hiding the flavor of alcohol (39%) and liking the taste (36%). Common consequences were feeling jittery (71%) and trouble sleeping (46%). Combined users had the highest rates of risk behaviors (e.g., drug use, sexual risk behaviors, driving after drinking) and alcohol use severity. Multinomial logistic regression indicated that men, those who had sex after substance use, those who had used drugs, and those with higher alcohol severity were more likely to be Combined users than Non-Users. Those with higher alcohol severity were also more likely to be Combined users than Separate users. Combining energy drinks and alcohol is associated with higher rates of other risk behaviors among young drinkers. Future studies are needed to determine longitudinal relationships of energy drink use on substance use problem trajectories.

Applicability of Type A/B alcohol dependence in the general population

BackgroundThis study examined the concurrent and predictive validity of Type A/B alcohol dependence in the general population—a typology developed in clinical populations to gauge severity of dependence. MethodsData were drawn from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The sample included 1,172 alcohol-dependent drinkers at baseline who were reinterviewed three years later. Latent class analysis was used to derive Type A/B classification using variables replicating the original Type A/B typology. Predictive validity of the Type A/B classification was assessed by multivariable linear and logistic regressions. ResultsA two-class solution consistent with Babor's original Type A/B typology adequately fit the data. Type B alcoholics in the general population, compared to Type As, had higher alcohol severity and more co-occurring drug, mental, and physical health problems. In the absence of treatment services utilization, Type B drinkers had two times the odds of being alcohol dependent three years later. Among those who utilized alcohol treatment services, Type B membership was predictive of heavy drinking and drug dependence, but not alcohol dependence, three years later. ConclusionsFindings suggest that Type A/B classification is both generalizable to, and valid within, the US general population of alcohol dependent drinkers. Results highlight the value of treatment for mitigating the persistence of dependence among Type B alcoholics in the general population. Screening for markers of vulnerability to Type B dependence could be of clinical value for health care providers to determine appropriate intervention.

Do 12-step meeting attendance trajectories over 9 years predict abstinence?

This study grouped treatment-seeking individuals (n = 1825) by common patterns of 12-step attendance using 5 waves of data (75% interviewed Year 9) to isolate unique characteristics and use-related outcomes distinguishing each class profile. The “high” class reported the highest attendance and abstention. The “descending” class reported high baseline alcohol severity, long treatment episodes, and high initial attendance and abstinence, but by Year 5, their attendance and abstinence dropped. The “early-drop” class, which started with high attendance and abstinence but with low problem severity, reported no attendance after Year 1. The “rising” class, with fairly high alcohol and psychiatric severity throughout, reported initially low attendance, followed by increasing attendance paralleling their abstention. Last, the “low” and “no” classes, which reported low problem severity and very low/no attendance, had the lowest abstention. Female gender and high alcohol severity predicted attendance all years. Consistent with a sustained benefit for 12-step exposure, abstinence patterns aligned much like attendance profiles.

Interactions Among DUI Offender Characteristics and Traditional Intervention Modalities: a long‐term recidivism follow‐up

Using long-term DUI (Driving Under the Influence of Alcohol) arrest recidivism data from a controlled study of DUI intervention effectiveness, interactions among DUI interventions, age, race, education, and alcohol severity were estimated using logit analysis. Data were collected in a 9-year follow-up study of the Mississippi DUI Probation Project. The effects of short-term interventions (alcohol education schools for low alcohol severity offenders and structured group interventions for high alcohol severity offenders) were specified by educational level. Short-term rehabilitation was modestly effective for those with less than 12 years of education, but less effective or detrimental for the more highly educated. The effects of probation were specified by age and education, being more effective for those under 30 years and 55 years or older than for the middle age group. Probation was most effective for well-educated older (55+) offenders. An analysis of the under 30 years group also suggested that probation was especially effective for young well-educated Minority offenders.