Alcohol Use Disorder Outcomes Research Articles

Parenting and Home Environment in Childhood and Adolescence and Alcohol Use Disorder in Adulthood

PurposeParenting is a modifiable factor affecting the development of alcohol use disorder (AUD); however, the persistence of this effect into adulthood remains poorly understood. This study aimed to explore the longitudinal relationship between positive parenting and AUD in adulthood. MethodsData were gathered from the Christchurch Health and Development Study (CHDS), a birth cohort of 1,265 children born in Christchurch (New Zealand) in mid-1977. Positive parenting was quantified to age 16, and included the extent to which cohort members self-reported: high scores on measures of maternal and paternal care; low scores on a measure of maternal and paternal overprotection; high scores on a measure of parental attachment; low scores on a measure of parental intimate partner violence; and occasional or no use of physical punishment. Outcome measures were AUD incidence and symptoms at ages 15–35, with potential confounding factors and time-dynamic covariates included. ResultsThere was a significant association between positive parenting and AUD outcomes, with higher levels of positive parenting associated with a lower incidence of AUD and AUD symptoms. Controlling for confounding factors reduced the association between positive parenting and AUD outcomes, but they remained statistically significant. Adjustment for mental health, life stress, and employment reduced the magnitude of the association between positive parenting and alcohol outcomes to statistical nonsignificance. ConclusionsParenting factors in childhood and adolescence are linked to AUD outcomes in adulthood, as well as mental health, substance use, and life stress. Investment in positive parenting in adolescence may reduce AUD and associated harms in adulthood.

Childhood Trauma Predicts Less Remission from PTSD among Patients with Co-Occurring Alcohol Use Disorder and PTSD.

Post-traumatic stress disorder (PTSD) is highly prevalent among patients hospitalized for an alcohol use disorder (AUD). Hospitalization can improve PTSD and AUD outcomes in some but not all patients, but we lack data on the baseline predictors of PTSD non-remission. This study aimed to determine the baseline risk factors for non-remitted PTSD in patients hospitalized for an AUD. Of 298 AUD inpatients recruited in a rehabilitation center (Le Courbat, France), we included 91 AUD inpatients with a co-occurring PTSD and a longitudinal assessment at baseline (T1) and before discharge (T2: 8 weeks later). Patients were assessed for PTSD diagnosis/severity (PCL-5=PTSD Checklist for DSM-5), different types of trauma including childhood trauma (LEC-5=Life Events Checklist for DSM-5/CTQ-SF=Childhood Trauma Questionnaire, Short-Form), and AUD diagnosis/severity (clinical interview/AUDIT=Alcohol Use Disorders Identification Test). Rate of PTSD remission between T1 and T2 was 74.1%. Non-remitted PTSD at T2 was associated with a history of childhood trauma (physical, emotional or sexual abuse, physical negligence), but not with other types of trauma experienced, nor baseline PTSD or AUD severity. Among patients hospitalized for an AUD with co-occurring PTSD, PTSD remission was more strongly related to the existence of childhood trauma than to AUD or PTSD severity at admission. These patients should be systematically screened for childhood trauma in order to tailor evidence-based interventions.

0582 Examining OSA Screening and Treatment for Individuals on a PTSD and Alcohol Disorder Residential Treatment Unit

Abstract Introduction Obstructive sleep apnea (OSA) is highly co-occurring with both alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) and has been shown to interfere with both PTSD and AUD outcomes. However, OSA often goes undiagnosed and untreated in residential treatment facilities. Our study aimed to assess the feasibility of incorporating OSA screening and treatment onto a substance abuse residential rehabilitation treatment program (SARRTP). Further, we examine the relationship between adherence rates of CPAP on PTSD outcomes. Methods Participants were 35 consecutive veterans admitted to the SARRTP PTSD track who consented to screening. Veterans were on the unit for 4-6 weeks. OSA was diagnosed using Nox T3 recorders, a Type-3 portable OSA screener (using Apnea Hypopnea Index >= 5). Insomnia Severity Index and PTSD checklist were given at pre- and post-treatment. Results 64.7% of Veterans screened positive for OSA. 11.8% were previously diagnosed with OSA, but did not use a CPAP machine; 17.6% were previously diagnosed and were using a CPAP machine; and 35.3% were newly diagnosed with OSA. Individuals with untreated OSA had significantly more days drinking in the last 30 days (M = 21.17 days, SD = 11.41) compared to no OSA/Treated OSA group (M = 8.82 days, SD = 10.92). There was no difference in change in PCL scores from baseline to post-treatment by the no-OSA/high compliance group and the low compliance group. Conclusion Taken together, OSA screening on the unit was accepted by the participants, feasible, and effective in diagnosing OSA. OSA screening and treatment should be considered as necessary on SUD and PTSD units. We did not find that OSA adherence predicted change in PTSD score, this is most likely due to veterans receiving their CPAP late into their stay on the unit. Future studies will need to examine OSA treatment on long term treatment outcomes. Support: Support This work is supported by UCSD Academic Senate Grant and a Veterans Affairs RR&D CDA (1lK2Rx002120-01) to Peter Colvonen.

Prevalence of Adult ADHD Co-morbidity in Alcohol Use Disorders in a General Hospital Setup.

Background:Attention deficit hyperactive disorder (ADHD) symptoms persisting into adulthood can influence the course and outcome of alcohol use disorders (AUDs). A cross-sectional study was conducted to assess the prevalence of adult ADHD in patients admitted with AUDs in a general hospital setup.Methods:In this study, 100 consecutive inpatients with alcohol use disorder (AUD) were evaluated for the diagnosis of ADHD. Patients with AUD were assessed with Severity of Alcohol Dependence Questionnaire, Clinical Institute Withdrawal Assessment for Alcohol and Adult ADHD Self Report Scale. Among the subjects who screened positive for adult ADHD on ASRS, diagnosis of adult ADHD was confirmed using the DSM 5 diagnostic interview. Epi-Info Version 7.2 was used for data entry and analysis. Mann Whitney test and Chi-square test (or Fisher's Exact test) were used for statistical analysis.Results:Twenty-one subjects screened positive for adult ADHD. Among them, 19 subjects had a confirmative diagnosis of adult ADHD. Patients with adult ADHD comorbid with AUDs showed accelerated progression towards dependence, and early relapses.Conclusions:In all, 19% of treatment-seeking inpatients with AUDs have co-morbid adult ADHD. Regular screening of AUD patients for adult ADHD and addressing the psychopathology may improve the treatment outcome.

Prevalence and Correlates of Past-Year Recovery From DSM-5 Alcohol Use Disorder: Results From National Epidemiologic Survey on Alcohol and Related Conditions-III.

Little is known about remission, recovery, and other outcomes of alcohol use disorder (AUD) as defined by the DSM-5. Data from a large representative sample of the United States was used to examine correlates of past-year AUD status among individuals with prior-to-past-year AUD: persistent AUD, symptomatic high-risk drinking, asymptomatic high-risk drinking, symptomatic low-risk drinking, asymptomatic low-risk drinking (nonabstinent recovery, NAR), and abstainer (abstinent recovery, AR). Multiple logistic regression analyses were conducted to compare: (i) AR and NAR with persistent AUD, (ii) AR with NAR, and (iii) asymptomatic and symptomatic high-risk drinking with AR and NAR. Among individuals with AUD prior to past year (n=7,785), 34.2% were classified with persistent AUD, 8.8 and 1.6% were symptomatic high-risk and symptomatic low-risk drinkers, respectively, 21.5% were asymptomatic high-risk drinkers, 17.9% were asymptomatic low-risk drinkers, and 16.0% were abstainers. One-quarter of individuals with AUD prior to past year achieved AR or NAR without the benefit of treatment, while a much greater percentage of individuals achieving AR (43.2%) reported receiving treatment relative to those with NAR (12.3%). The number of lifetime AUD symptoms was greater among those achieving AR (among the treated) and lower among those achieving NAR relative to persistent AUD. The number of AUD symptoms was also greater among those achieving AR than NAR and lower among asymptomatic and symptomatic risk drinkers relative to those achieving AR and NAR. Consumption was greater among those achieving AR relative to those achieving NAR and greater among asymptomatic and symptomatic risk drinkers relative to AR and NAR. Odds of achieving AR or NAR relative to persistent AUD were generally lower among non-Hispanic Blacks and those with higher education, greater among women and married individuals, and lower among illicit drug users and individuals with histories of a personality disorder or mood/anxiety disorder. There appears to be a substantial level of recovery from AUD. Information on specific factors associated with AUD outcomes can be useful in targeting appropriate treatment efforts.

Randomized controlled trial of harm reduction treatment for alcohol (HaRT-A) for people experiencing homelessness and alcohol use disorder

BackgroundPeople experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, harm reduction treatment for alcohol (HaRT-A) was developed together with people with lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. A three-month, two-arm randomized controlled trial was conducted to test the initial efficacy of HaRT-A compared to a services-as-usual control condition. MethodsPeople experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Self-reported alcohol use, alcohol-related harm, motivation, and QoL as well as urinary ethyl glucuronide were assessed over a 3-month follow-up. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: a) collaborative tracking of participant-preferred alcohol metrics, b) elicitation of harm-reduction and QoL goals, and c) discussion of safer-drinking strategies. ResultsCompared to control participants, HaRT-A participants reported significantly greater increases in confidence to engage in harm reduction and decreases in peak alcohol use, alcohol-related harm, AUD symptoms, and positive urinary ethyl glucuronide tests (ps < .05). Findings were inconclusive regarding group differences on QoL (ps > .12). ConclusionA low-barrier, low-intensity, patient-driven, harm-reduction approach has at least short-term efficacy in improving AUD outcomes in this population. Future studies are needed to establish its longer-term efficacy.

Personality disorder and treatment outcome in alcohol use disorder.

As personality disorder impacts the outcome of most major mental disorders, it would be consistent for it to impact negatively on the outcome of alcohol use disorders (AUDs). This update is to provide an up-to-date overview of the recent literature examining the impact of personality disorder and personality traits on the treatment outcome of AUDs. Comorbidity between personality disorder and AUD is significant and approaches 50%. Patients with AUD and comorbid personality disorder are substantially less likely to remain in treatment, drink more per drinking day and drink more frequently. If retained in treatment, comorbidity does not, however, lead to poorer outcomes. Relapse to drinking is more common in patient with high novelty seeking and lower reward dependence and persistence. Reporting from most studies is of moderate-to-poor quality and a single high-quality study may alter these findings. Landmark alcohol studies are notably quiet on the impact of personality on AUD treatment outcome. Both personality disorder and higher novelty seeking impact negatively on the treatment outcome of AUD. As personality disorder is common in this group, clinicians engaged in AUD treatment should screen for personality disturbance, either disorder or high novelty seeking.

The six-year outcome of alcohol use disorders in men: A population based study from India

BackgroundDespite the large and growing public health problem of alcohol use disorders (AUD) in India there is a dearth of evidence about the longitudinal outcomes in AUD. The aim of this study is to describe the course and outcomes of AUD in a population based sample of men in India. MethodsA community cohort of 1899 adult (18–49 years at baseline) men who participated in a cross-sectional survey in Goa, India between 2006 and 08, were re-interviewed face to face 6 years later (2012–14). A range of outcomes including social problems (e.g., workplace problems, domestic violence), morbidity (e.g., range of physical and mental health problems), biological parameters (e.g., mean corpuscular volume [MCV], gamma-glutamyl transpeptidase [GGT]) and mortality were measured at follow up. For the association of AUD at baseline with outcomes at follow-up, multivariable logistic regression was used to estimate odds ratios (OR). Analyses were weighted to account for baseline sampling design, age distribution, rural and urban sample sizes, number of adults aged 18–49 years in the household (at baseline), and non-response (at baseline). Results1514 (79.7%) were seen at follow-up; a loss to follow up of 20.3%. At follow up, 3.7% of baseline non-drinkers and 15.0% of baseline casual drinkers had AUD. 46.9% of baseline hazardous drinkers and 55.4% baseline harmful drinkers continued to have AUD at follow up. Of those with AUD at baseline, 21.8% had stopped drinking at follow-up. Compared to being abstinent, harmful drinking at baseline was associated with several outcomes at follow-up: workplace/social problems, hypertension, death, tobacco use, suicidality, anxiety disorders, and raised GGT (p<0.002). Hazardous drinking at baseline was associated with tobacco use and raised GGT and MCV (p<0.002) at follow-up. ConclusionOur findings of high persistent and new AUD in the community and the association with a range of long term adverse events are an important addition to the limited evidence about the course and outcomes of AUD in India, which have the potential for informing health policy.

The course and outcome of alcohol use disorders in men in Goa: A population- based follow-up study

Background:Research on the natural history and long-term outcomes of alcohol use disorders (AUD) is important to guide health policy. However, attrition is a major challenge in longitudinal studies and can affect validity of findings.Materials and Methods:A 4-year follow-up study was conducted on a randomly selected subgroup of a sample of men in rural and urban communities in Goa to assess attrition, preliminary estimates of AUD outcomes, and chronic disease risk factors.Results:Overall attrition rate was 16.7% with a higher attrition in AUD compared to abstainers or casual drinkers. Incidence of AUD at 4 years was 12.8% while the persistence rate of AUD was 53.9%. A trend for poorer health and health behaviors and higher blood pressure was observed in AUD.Conclusion:The results of this study suggest a relatively low attrition rate despite the long follow-up period and support the feasibility of conducting a definitive cohort study with the entire sample.

GOODWIN ET AL. RESPOND

We appreciate the letter from Glasser and think she makes an excellent point about the potential usefulness of Nicotine Anonymous (NicA), a program built on the model of Alcoholics Anonymous (AA) and Narcotics Anonymous. Because use of nicotine-containing products is both prevalent and highly addictive, greater dissemination of knowledge on the availability of NicA should serve a useful public health purpose. This is especially true considering a majority of persons who smoke say they would like to quit, and yet only a small percentage are successful each year. The small size of NicA relative to AA is indicated by the number of meetings worldwide shown on the Web sites of each organization. We have also wondered over the years about the reasons for this discrepancy in size, given the serious health consequences of smoking and the widespread prevalence of smoking in the general population. The lack of research attention to NicA is consistent with the lack of direct evidence on the efficacy of AA for alcohol dependence because AA does not make itself available for randomized clinical efficacy trials. However, several studies of professional intervention to encourage AA involvement have found that Twelve-Step Facilitation1 is as effective as other evidence-based behavioral interventions for improving the outcome of alcohol use disorders. Parallel research on facilitation of involvement in NicA might serve a useful purpose in learning more about the effectiveness of this program in reducing smoking among its participants. Given that participation in NicA is free, perhaps this letter can alert professionals to refer patients to NicA if it is available in their area, especially for individuals without the means to afford other treatments, which can be quite expensive (e.g., a trial of the nicotine patch is approximately $320). The NicA Web site (http://www.nicotine-anonymous.org) also provides information that can be used to start new meetings, for which a professional degree is not required. As individuals in lower socioeconomic strata are the fastest growing population of smokers, low-cost or free alternatives to reduce smoking are urgently needed.