Levels Of Alcohol Risk Research Articles

Comorbid alcohol use disorder and posttraumatic stress disorder: A proof-of-concept randomized placebo-controlled trial of buprenorphine and naltrexone combination treatment.

Effective pharmacologic treatments for comorbid alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are lacking. Kappa (κ) opioid receptor antagonists may address this unmet need. Buprenorphine is a κ-opioid antagonist and a partial agonist of mu (μ) opioid receptors. Whereas naltrexone blocks all μ-mediated effects combining it with buprenorphine yields a pharmacologic net effect of opioid receptor antagonism. Because no κ-opioid receptor antagonist it available for clinical use, we tested this combination in a proof-of-concept study. Consenting participants were enrolled in a Phase II, multisite, double-blind, randomized, placebo-controlled trial evaluating the effectiveness of sublingual (SL) buprenorphine combined with extended-release (XR) injectable naltrexone for the treatment of comorbid AUD and PTSD. Eligible participants (n = 75) were randomized (1:1:1) to receive either buprenorphine 2 mg/day plus naltrexone-XR (n = 35), buprenorphine 8 mg/day plus naltrexone-XR (n = 6) or SL plus injectable placebo (n = 34) for 12 weeks. The buprenorphine 8 mg/day plus naltrexone-XR arm was dropped early in the trial due to the negative impact of COVID-19 on enrollment. A binary primary outcome of response at week 8 was defined as a decrease from baseline of ≥10 points on the past week Clinician-Administered PTSD Scale (CAPS-5) and a reduction of ≥1 of past month alcohol risk level, as defined by the World Health Organization (WHO) and measured by the Timeline Follow-Back. Based on the results of a futility analysis, enrollment was stopped prior to reaching the initial goal of 90 participants. At the week eight primary timepoint, there were no statistically significant differences between buprenorphine plus naltrexone-XR and placebo group for the primary composite outcome (OR = 0.63; p-value = 0.52), or the subcomponents of the PTSD outcome (OR = 0.76; p-value = 0.69) and AUD outcome (OR = 0.17; p-value = 0.08). The placebo arm had a significantly higher proportion of participants with ≥1 WHO risk level reduction than the buprenorphine plus naltrexone-XR arm (OR = 0.18, p value = 0.02). This is the first study to evaluate the potential of κ-opioid receptor antagonism for the treatment of comorbid AUD and PTSD. The combination of buprenorphine and naltrexone-XR showed no significant improvement over placebo for the composite, PTSD, or alcohol measures.

Effects of a multi-component alcohol prevention program in the workplace on hazardous alcohol use among employees

BackgroundThe workplace can be affected negatively by hazardous alcohol use, and intervening at an early stage remains a challenge. Recently, a multi-component alcohol prevention program, Alcohol Policy and Managers’ skills Training (hereafter, ‘APMaT’), was delivered at the organizational level. In a previous outcome evaluation, APMaT appeared to be effective at the managerial level. The current study takes a step further by aiming to evaluate the effectiveness of APMaT in decreasing the alcohol risk level among employees.MethodsData from 853 employees (control: n = 586; intervention: n = 267) were gathered through a cluster-randomized study. To analyze changes in the odds of hazardous alcohol use among employees, multilevel logistic regression was applied using group (control vs. intervention), time (baseline vs. 12-month follow-up), and the multiplicative interaction term (group × time) as the main predictors. The intervention effect was further adjusted for sociodemographic characteristics and policy awareness.ResultsNo statistically significant difference was observed in the odds of hazardous alcohol use, although employees in the intervention group showed a larger decrease compared to the control group. This remained even after adjusting for several factors, including the sociodemographic factors and policy awareness.ConclusionsThe findings are insufficient to determine the effectiveness of APMaT at the employee level at the current stage of the evaluation. Future studies should strive to identify issues with implementation processes in workplace-based alcohol interventions.Trial registrationThe trial was retrospectively registered on 11/10/2019; ISCRTN ID: ISRCTN17250048.

Rates and predictors of brief intervention for women veterans returning from recent wars: Examining gaps in service delivery for unhealthy alcohol use

BackgroundApproximately one in four women veterans accessing the Department of Veterans Affairs (VA) engage in unhealthy alcohol use. There is substantial evidence for gender-sensitive screening (AUDIT-C = 3) and brief intervention (BI) to reduce risks associated with unhealthy alcohol use in women veterans; however, VA policies and incentives remain gender-neutral (AUDIT-C = 5). Women veterans who screen positive at lower-risk-level alcohol use (AUDIT-C = 3 or 4) may screen out and therefore not receive BI. This study aimed to examine gaps in implementation of BI practice for women veterans through identifying rates of BI at different alcohol risk levels (AUDIT-C = 3–4; =5–7; =8–12), and the role of alcohol risk level and other factors in predicting receipt of BI. MethodsFrom administrative data (2010–2016), we drew a sample of women veterans returning from recent wars who accessed outpatient and/or inpatient care. Of 869 women veterans, 284 screened positive for unhealthy alcohol use at or above a gender-sensitive cut-point (AUDIT-C ≥ 3). We used chart review methods to abstract variables from the medical record and then employed logistic regression comparing women veterans who received BI at varying alcohol risk levels to those who did not. ResultsWhile almost 60% of the alcohol positive-risk sample received BI, among the subset of women veterans who screened positive for lower-risk alcohol use (57%; AUDIT-C = 3 or 4) only 34% received BI. Nurses in primary care programs were less likely to deliver BI than other types of clinicians (e.g., physicians, psychologists, social workers) in mental health programs; further, nurses in women's health programs were less likely to deliver BI than other types of clinicians in mixed-gender programs; Those women veterans with more medical problems were no more likely to receive BI than those with fewer medical problems. ConclusionsGiven that women veterans are a rapidly growing veteran population and a VA priority, underuse of BI for women veterans screening positive at a lower-risk level and those with more medical comorbidities requires attention, as do potential gaps in service delivery of BI in primary care and women's health programs. Women veterans health and well-being may be improved by tailoring screening for a younger cohort of women veterans at high-risk for, or with co-occurring disorders and then training providers in best practices for BI implementation.

Students' Drinking Status and Likelihood of Carrying a Weapon on Campus

The purpose of this study was to assess the association between different levels of alcohol risk, weapon carrying, and feeling of safety among 54,582 college students participating in the 2010 CORE Alcohol and Drug Survey. A higher number of binge drinking episodes was associated with higher likelihood of carrying a weapon. In addition, the interaction term in the model was significant which implies that the difference between those who feel safe and those who do not feel safe, in terms of carrying a weapon, is different for the levels of drinking risk.

Relationship Between Alcohol-related Family Adversity, Alcohol Use Across Adolescence, and Mental States Recognition in Young Adulthood.

Although a theoretical link between childhood adversity and mental states recognition has been established, empirical findings are mixed. Some prior work indicates that childhood adversity might enhance, preserve, or reduce mentalization skills in selected at-risk populations. In the current study, we examine whether the presence of risky alcohol use during adolescence moderates the association between childhood alcohol-related family adversity and mental states recognition in young adulthood. Secondary data analysis was conducted on 266 young adults who participated in the Michigan Longitudinal Study-a multiwave prospective study on at-risk youth. Children were assessed after initial recruitment (wave 1, target child age range 3-5 years), with assessments repeated every 3 years using parallel measures. The current study focuses on data spanning wave 2 (age range 7-9 years) through wave 6 (target child age range 18-21 years). A family adversity index was derived reflecting exposure to a maladaptive family environment during childhood as assessed at wave 1. An alcohol use risk factor was established reflecting early problem alcohol use during adolescence (target child age range 12-17 years). Mental states recognition was measured with a computerized version of the Reading the Mind in the Eyes Task (RMET) at wave 6. Information about demographics, psychopathological symptoms, and IQ was obtained. The alcohol use risk factor was tested as a potential moderator of the association between childhood family adversity on RMET performance during young adulthood. Alcohol use risk moderated the relationship between childhood alcohol-related family adversity, and negative and neutral mental states recognition. Specifically, childhood family adversity was positively associated with neutral mental states recognition among participants high in alcohol risk (P = 0.03) and positively associated with negative mental states recognition among participants at average (P = 0.02) and high (P = 0.002) levels of alcohol risk. Findings indicate that history of childhood adversity may actually improve young adult negative and neutral mental states recognition among those demonstrating high levels of risky alcohol use, as substance use may serve as an external self-regulatory tool. Clinical interventions that target enhancing metacognitive competence and emotion regulation could ultimately help to break the cycle of alcohol-related family adversity.

Development of alcohol treatment for UK military personnel

The consumption of alcohol in the UK Armed Forces (AF) as ‘an agent to assist cohesion and informal operational debriefing’ is a social and psychological conceptualisation that has some empirical...

Proactive expert system intervention to prevent or quit at-risk alcohol use (PRINT): study protocol of a randomized controlled trial

BackgroundThe population impact of alcohol screening and brief intervention might be increased by approaching an entire population rather than individuals at high risk only. The aim is to present the protocol of the study “Testing a proactive expert system intervention to prevent and to quit at-risk alcohol use” (PRINT) which tests the efficacy of a computer-based brief intervention (i) to elicit drinking reductions among persons with at-risk alcohol use and (ii) to prevent at-risk alcohol use among current low-risk drinkers.Methods/designThe PRINT study is a two-arm randomized controlled trial with a 12-month follow-up. A total of 1648 participants will be proactively recruited in the waiting area of a municipal registry office. All 18- to 64-year-old persons with past year alcohol use will be randomized to either the intervention group or the control group. Participants in the intervention group will receive computer-generated individualized feedback letters at baseline, month 3, and month 6. Participants in the control group will receive assessment only. The primary outcome is the change in the number of drinks per day from baseline to month 12.DiscussionWe expect to provide a computer-based brief alcohol intervention that is appropriate for a wide range of people with alcohol use regardless of their initial alcohol-risk level. The intervention might have the potential to decrease alcohol use and alcohol-related problems on a population level at low costs.Trial registrationGerman Clinical Trials Register: DRKS00014274 (date of registration: 2018/03/12).

Erectile dysfunction and alcohol intake.

The objective of this work is to evaluate in a selection of patients with erectile dysfunction the influence of alcohol consumption and the response to alcohol abstinence with and without sildenafil association. Materials and Methods. In a population of 150 consecutive patients with erectile dysfunction we studied 50 patients aged between 22 and 77 years (mean 56±14 SD). These 50 patients were divided into three different treatment groups and were screened for three different levels of alcohol risk with two questionnaires. All patients were evaluated with an International Index Erectile Dysfunction (IIEF) questionnaire before and after one month of treatment. RESULTS. The 50 patients included 14 patients with high alcohol risk, 34 patients with low alcohol risk and only 2 patients with no alcohol risk. After one month, 29 patients responded to the therapy, and 21 did not respond. The IIEF questionnaire presented a statistically significant difference between the different risk groups before and after treatment (p≤0.05). All the patients were examined with a penile Doppler Ultrasound. Only 10 of them had an abnormal diastolic peak velocity (PDV) and only 1 presented both pathologic systolic peak velocity (PSV) and PDV. These 11 patients did not respond to therapies and 10 of them were at high alcohol risk. The alcohol consumption risk was directly correlated with PDV (p=0.00001; R2=0.4). CONCLUSIONS. The results of this study demonstrated a significant relationship between alcohol consumption and erectile dysfunction. This underlines the important therapeutic issue of alcohol abstinence in treating patients with erectile dysfunction.

The relevance of alcohol to dental practice

Alcohol is a very widely used drug which can cause dental disease and influence dental treatment. It is therefore important that dental professionals take an alcohol history from all patients and are aware of how to give alcohol reduction advice. This article discusses the impact of alcohol on oral health, including oral cancer, trauma, halitosis, tooth wear, periodontal disease and caries, with reference to the available literature. It also outlines current alcohol risk level advice and guidance regarding giving alcohol reduction advice in a dental setting.

Risk of alcohol abuse in urban versus rural DUI offenders

Background: Research concerning driving under the influence (DUI) offenses in rural populations is scarce and has often been carried out in the context of substance abuse and illicit drug use. Although previous studies have suggested that rural individuals are more likely to abstain from alcohol use, recent trends suggest that alcohol and substance abuse problems in rural areas are occurring at rates similar to urban areas. It is possible that urban and rural DUI offenders may differ on psychological and behavioral characteristics associated with heavy alcohol consumption. Objective: The aim of this study was to examine alcohol use differences between urban and rural DUI offenders. Methods: Data from 11 066 DUI offenders in a Midwestern state were used for this study. The Alcohol subscale of the Driver Risk Inventory II was used to assess the risk of problem alcohol use. Results: Higher levels of alcohol risk were associated with rural DUI offenders after adjusting for several demographic variables and blood-alcohol content level at time of arrest [Medium Risk OR = 1.43, 95% CI: (1.20, 1.71); Problem Risk OR = 1.43, 95% CI: (1.19, 1.72); Severe Risk OR = 1.38, 95% CI: (1.14, 1.67)]. Conclusions: The results of this study indicate that rural DUI offenders have a significantly greater risk of heavy alcohol use when compared to urban DUI offenders. Practical implications of these results suggest that evaluators and assessors should be aware of an increased likelihood of alcohol problems in rural DUI individuals relative to those in urban areas.

Quality of life among hazardous and harmful drinkers: EQ-5D over a 1-year follow-up period

To investigate the ability of the EQ-5D to discriminate between levels of alcohol risk in a large sample of hazardous and harmful drinkers, and to explore the relationship between transitions between alcohol risk levels and changes in EQ-5D up to 12 months. This is a web-based randomised controlled trial evaluating a novel intervention for hazardous and harmful alcohol consumption. EQ-5D scores were compared among groups of drinkers at baseline (low/medium/high risk according to self-reported past week alcohol consumption), and changes in EQ-5D scores were estimated as a function of changes in alcohol consumption level. Baseline EQ-5D scores were dominated by problems with anxiety/depression, which increased with alcohol risk level, whilst high-risk drinkers also experienced more problems with physical HRQoL dimensions. However, the tool demonstrated a considerable ceiling effect. At follow-up, despite considerable reductions in alcohol consumption across the sample, significant changes in aggregated EQ-5D index scores were only observed for high-risk drinkers at baseline who reduced their drinking, with small improvements (0.04-0.06) compared to those who did not reduce. Our results suggest that the three-option EQ-5D may not be an optimal primary end point for measuring clinical and cost-effectiveness in randomised controlled trials of interventions among hazardous and harmful alcohol users, although further testing of the sensitivity of the tool in these populations is needed.

Naltrexone and Nalmefene: Any Meaningful Difference?

In this issue of Biological Psychiatry, Mann and colleagues (1) report the results of a double-blind placebo-controlled clinical trial of the opioid antagonist nalmefene in the treatment of 598 alcohol-dependent participants drinking at a moderate or greater alcohol risk level according to the World Health Organization criteria for alcohol risk. The study used a somewhat different design in that the medication (20mg nalmefene or placebo) was taken in a targeted or “as-needed fashion,” that is, on days when participants perceived that they were at high risk for drinking.

Feasibility of a computer-assisted alcohol SBIRT program in an urban emergency department: patient and research staff perspectives

ObjectivesThe study objective was to assess the feasibility of a computerized alcohol-screening interview (CASI) program to identify at-risk alcohol users among adult emergency department (ED) patients. The study aimed to evaluate the feasibility of implementing a computerized screening, brief intervention, and referral to treatment (SBIRT) program within a busy urban ED setting, to report on accurate deployment of alcohol screening results, and to assess comprehension and satisfaction with CASI from both patient and research staff perspectives.MethodsResearch assistants (RAs) screened a convenience sample of medically stable ED patients. The RAs brought CASI to patients’ bedsides, and patients entered their own alcohol consumption data. The CASI intervention consisted of an alcohol use screening identification test, a personalized normative feedback profile, NIAAA low-risk drinking educational materials, and treatment referrals (when indicated).ResultsFive hundred seventeen patients were enrolled. The median age of participants was 37 years (range, 21-85 years); 37% were men, 62% were Hispanic, 7% were Caucasian, 30% were African American, and 2% were multiracial. Eighty percent reported regular use of computers at home. Eighty percent of patients approached consented to participate, and 99% of those who started CASI were able to complete it. Two percent of interviews were interrupted for medical tests and procedures, however, no patients required breaks from using CASI for not feeling well. The CASI program accurately provided alcohol risk education to patients 100% of the time. Thirty-two percent of patients in the sample screened positive for at-risk drinking. Sixty percent of patients reported that CASI increased their knowledge of safe drinking limits, 39% reported some likeliness to change their alcohol use, and 28% reported some intention to consult a health care professional about their alcohol use as a result of their screening results. Ninety-three percent reported CASI was easy to use, 93% felt comfortable receiving alcohol education via computer, and 89% liked using CASI. Ninety percent of patients correctly identified their alcohol risk level after participating in CASI. With regard to research staff experience, RAs needed to provide standby assistance to patients during <1% of CASI administrations and needed to troubleshoot computer issues in 4% of interviews. The RAs distributed the correct alcohol risk normative profiles to patients 97% of the time and provided patients with treatment referrals when indicated 81% of the time. The RAs rated patients as “not bothered at all” by using CASI 94% of the time.ConclusionsThis study demonstrates that an ED-based computerized alcohol screening program is both acceptable to patients and effective in educating patients about their alcohol risk level. Additionally, this study demonstrates that few logistical problems related to using computers for these interventions were experienced by research staff: in most cases, staff accurately deployed alcohol risk education to patients, and in all cases, the computer provided accurate education to patients. Computer-assisted SBIRT may represent a significant time-saving measure, allowing EDs to reach larger numbers of patients for alcohol intervention without causing undue clinical burden or interruptions to clinical care. Future studies with follow-up are needed to replicate these results and assess drinking reductions post-intervention.

Erectile dysfunction and alcohol intake

The objective of this work is to evaluate in a selection of patients with erectile dysfunction the influence of alcohol consumption and the response to alcohol abstinence with and without sildenafil association. Materials and Methods. In a population of 150 consecutive patients with erectile dysfunction we studied 50 patients aged between 22 and 77 years (mean 56±14 SD). These 50 patients were divided into three different treatment groups and were screened for three different levels of alcohol risk with two questionnaires. All patients were evaluated with an International Index Erectile Dysfunction (IIEF) questionnaire before and after one month of treatment. Results. The 50 patients included 14 patients with high alcohol risk, 34 patients with low alcohol risk and only 2 patients with no alcohol risk. After one month, 29 patients responded to the therapy, and 21 did not respond. The IIEF questionnaire presented a statistically significant difference between the different risk groups before and after treatment (p≤0.05). All the patients were examined with a penile Doppler Ultrasound. Only 10 of them had an abnormal diastolic peak velocity (PDV) and only 1 presented both pathologic systolic peak velocity (PSV) and PDV. These 11 patients did not respond to therapies and 10 of them were at high alcohol risk. The alcohol consumption risk was directly correlated with PDV (p=0.00001; R=0.4). Conclusions. The results of this study demonstrated a significant relationship between alcohol consumption and erectile dysfunction. This underlines the important therapeutic issue of alcohol abstinence in treating patients with erectile dysfunction.

Drinking Behavior from High School to Young Adulthood: Differences by College Education

Recent serious alcohol-related events have raised public awareness of the prevalence of at-risk alcohol use among college undergraduates, but heavy alcohol consumption during late adolescence and young adulthood is not limited to college students. Alcohol consumption typically peaks in young adulthood regardless of education level, and risks related to alcohol misuse are shared by young adults, regardless of their educational choices. Differences in alcohol risk between college-attending and non-college-attending young adults are generally small, and emphasize the need for research examining the drinking patterns of both of these groups. To better understand patterns of at-risk alcohol use and its association with education, this study compared at-risk alcohol use from 12 grade to young adulthood (age 24) in a sample of never-married young adults. Three groups were formed based on completed education when the survey was administered in young adulthood: high school or less, postsecondary education without a four-year college degree, and completed college. Men who completed college experienced the greatest increase in at-risk drinking from grade 12 to young adulthood; however, their at-risk alcohol use did not differ markedly from men in the other education groups in young adulthood. Men who did not complete college had high levels of alcohol risk in 12 grade and maintained or increased those levels in young adulthood, demonstrating a pattern of prolonged risk. Women whose completed education was high school or less experienced the fewest increases in at-risk alcohol use. Education group differences were not explained by place of residence or employment status. These results emphasize the need to intervene early to prevent at-risk alcohol use, and emphasize that at-risk alcohol use is neither unique, nor necessarily the highest among individuals who complete college.