Prevalence Of Alcohol Use Disorders Research Articles

Alcohol use disorder and associated factors among human immunodeficiency virus infected patients attending antiretroviral therapy clinic at Bishoftu General Hospital, Oromiya region, Ethiopia.

BackgroundAlcohol consumption among patients with HIV/AIDS increases the burden of the disease. HIV/AIDS is an epidemic among Sub-Saharan African countries. Excessive use of alcohol causes a large degree of health problems, social and economic burden in societies. However, the prevalence and associated factors of alcohol use disorder among this group of people has not been studied very well. Therefore, this study sought to assess the magnitude and associated factors of alcohol use disorder among HIV patients attending the antiretroviral (ART) clinic.MethodsA hospital based cross sectional study design was conducted at Bishoftu General Hospital from May to June 2015. Systematic random sampling technique was used to select the study participants. Data was collected by face to face interview and chart review. Alcohol Use Disorder Identification Test (AUDIT) was used to assess alcohol use disorder. Bivariate and multivariate logistic regression analysis was carried out to identify associated factors and P-value < 0.05 was taken as statistically significant.ResultsA total of 527 participants were enrolled in the study with a response rate of 100%. The prevalence of alcohol use disorder (AUD) was 14.2%. Factors associated with alcohol use disorder were educational status AOR = 8.5 (95%CI: 1.70, 42.99), social support AOR = 0.5(95%CI: 0.26, 0.95), cigarette smoking AOR = 3.49(95%CI: 1.01, 12.13), khat chewing AOR = 5.11 (95% CI: 1.60, 16.33), family history of alcohol use AOR = 3.58 (95% CI: 1.52, 8.47), and missing ART drugs AOR 3.05 (95% CI: 1.302, 7.131).ConclusionThe prevalence of alcohol use disorder was high as compared to similar epidemiological studies. Educational status, social support, cigarette smoking, khat chewing, and family history of alcohol use were independent predictors. Providing health education about alcohol use and proper screening of alcohol use disorder among patients with HIV/AIDS is crucial. Strengthening the referral linkage with the psychiatric unit will decrease the burdens of the problem.

Sexual dimorphism in the neural impact of stress and alcohol.

Alcohol use disorder is a widespread mental illness characterized by periods of abstinence followed by recidivism, and stress is the primary trigger of relapse. Despite the higher prevalence of alcohol use disorder in males, the relationship between stress and behavioral features of relapse, such as craving, is stronger in females. Given the greater susceptibility of females to stress-related psychiatric disorders, understanding sexual dimorphism in the relationship between stress and alcohol use is essential to identifying better treatments for both male and female alcoholics. This review addresses sex differences in the impact of stressors on alcohol drinking and seeking in rodents and humans. As these behavioral differences in alcohol use and relapse originate from sexual dimorphism in neuronal function, the impact of stressors and alcohol, and their interaction, on molecular adaptations and neural activity in males and females will also be discussed. Together, the data reviewed herein, arising from a symposium titled "Sex matters in stress-alcohol interactions" presented at the Fourth Volterra Conference on Stress and Alcohol, will highlight the importance of identifying sex differences to improve treatments for comorbid stress and alcohol use disorder in both sexes.

APA Releases Practice Guideline for AUD Pharmacotherapy

Back to table of contents Previous article Next article PsychopharmacologyFull AccessAPA Releases Practice Guideline for AUD PharmacotherapyNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:19 Jan 2018https://doi.org/10.1176/appi.pn.2018.pp1b4AbstractAPA’s new guideline for alcohol use disorder provides information on the comparative benefits and risks of acamprosate, disulfiram, gabapentin, naltrexone, and topiramate. Despite the high prevalence of alcohol use disorder (AUD) in the United States, and the significant financial and public health burden of excess drinking, most people do not receive adequate treatment for this disorder. A recent analysis estimated that only 1 in 10 people diagnosed with AUD receive any treatment, and fewer still receive an evidence-based treatment. There are likely many reasons for the underuse of treatments for AUD, including a lack of awareness by both patients and providers about their options. To increase awareness about medications available to treat AUD, APA earlier this month released the Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder.“This new guideline is an important step in bringing effective, evidence-based treatments for alcohol use disorder to many more people and in helping address the public health burden of alcohol use,” APA President Anita Everett, M.D., said in a press release announcing the guideline’s release.This guideline offers recommendations or suggestions on various aspects of AUD pharmacotherapy. Recommendations reflect confidence that the benefits of the intervention clearly outweigh the harms. Suggestions reflect more uncertainty; the benefits of the intervention are still viewed as outweighing the harms, but the balance between the two may be harder to judge and patient preference is likely to play a greater role in deciding the treatment used.The specific guidance statements related to the prescribing of the five AUD medications are as follows: APA recommends that naltrexone or acamprosate be offered to patients with moderate to severe AUD who want to reduce drinking or achieve abstinence, prefer pharmacotherapy or have not responded to nonpharmacological treatments alone, and have no contraindications to the use of these medications.APA recommends that acamprosate not be used by patients who have severe renal impairment. For individuals with mild to moderate renal impairment, APA recommends that acamprosate not be used as a first-line treatment and, if used, the dose of acamprosate be reduced compared with recommended doses in individuals with normal renal function.APA recommends that naltrexone not be used by patients who have acute hepatitis or hepatic failure.APA recommends that naltrexone not be used as a treatment for AUD by individuals who use opioids or who have an anticipated need for opioids.APA suggests that disulfiram be offered to patients with moderate to severe AUD who want to achieve abstinence and prefer disulfiram or are intolerant to or have not responded to naltrexone and acamprosate. Patients should be informed of the risks of alcohol consumption while taking disulfiram (adverse reactions such as flushing and elevated heart rate occur if alcohol is consumed within 12 to 24 hours of taking disulfiram), and have no contraindications to the use of this medication.APA suggests that topiramate or gabapentin be offered to patients with moderate to severe AUD who want to reduce drinking or achieve abstinence and prefer topiramate or gabapentin or are intolerant to or have not responded to naltrexone and acamprosate, and have no contraindications to the use of these medications.In addition, the practice guideline includes recommendations and suggestions related to the psychiatric evaluation of patients with AUD and treatment planning, which are integral first steps toward using pharmacotherapy to treat AUD. While the guideline statements provide a good synopsis of the current understanding of these medications, Oscar Bukstein, M.D., M.P.H., a member of the Guideline Writing Group, said that it is important for physicians to read other portions of the practice guideline, which include explanations for each recommendation and suggestion.“The explanations provide important context about when and where certain pharmacotherapies might be appropriate,” said Bukstein, who is a psychiatrist at Boston Children’s Hospital. Bukstein added patient preference is always important to consider when choosing a pharmacotherapy. He explained that this is why the language reflected some interchangeability among the available options as opposed to ranking the medications in an algorithmic fashion. Still, as noted in the guideline, naltrexone and acamprosate are the treatments best supported by clinical and research evidence. “It’s important to keep in mind that these medications are to be used as adjuncts in a comprehensive AUD treatment program, which is why it was important to include statements related to treatment planning,” Bukstein told Psychiatric News. Recommending a particular nonpharmacological approach to be used alongside pharmacotherapy was outside the scope of this practice guideline. ■ ISSUES NewArchived

DSM-5 Alcohol Use Disorder Severity in Puerto Rico: Prevalence, Criteria Profile, and Correlates.

Our aim was to examine lifetime criteria profiles and correlates of severity (mild, moderate, severe) of DSM-5 alcohol use disorders (AUD) in Puerto Rico. Data are from a household random sample of individuals 18 to 64years of age in San Juan, Puerto Rico. The survey response rate was 83%. DSM-5 AUD was identified with the Spanish version of the World Health Organization's Composite International Diagnostic Interview. The analyses also identify correlates of each severity level using an ordered logistic regression model. The prevalence of lifetime DSM-5 AUD among men and women was 38 and 16%, respectively. Mild lifetime DSM-5 AUD was the most prevalent severity level among both men (18%) and women (9%). The most common criteria, independent of gender and severity level, were drinking larger quantities and for longer than planned (men range: 80 to 97%; women range: 78 to 91%) and hazardous use (men range: 56 to 91%; women range: 42 to 74%). Results from ordered logistic regression showed that the adjusted odds ratio for weekly drinking frequency, greater volume of alcohol consumed per drinking occasion, positive attitudes about drinking, drinking norms, and male gender invariantly increased risks across all DSM-5 AUD severity levels (mild, moderate, severe). Greater negative attitudes about drinking, low family cohesion, and Protestant religion were related to greater risks at higher AUD severity levels. AUD prevalence is high in San Juan, Puerto Rico. Prevalence rates for some criteria are equally high across severity levels and poorly differentiate between mild, moderate, or severe DSM-5 AUD. The sociodemographic and alcohol-related risks vary across DSM-5 severity levels.

Alcohol Use Disorder and its Correlates among Health Professionals

Background: Alcohol is commonly used psychoactive drug particularly among adults. Harmful use of alcohol leads to occupational, social and physical impairment. However, studies on Alcohol Use Disorder (AUD) among Health Professionals (HPs) remains limited in Ethiopia. Objective: This study aimed to determine prevalence of AUD and to identify its risk factors among HPs working in tertiary teaching hospital, Southwest Ethiopia. Methods: In this study, facility based cross-sectional study design was employed. Pretested, structured, self-administered questionnaire was utilized to collect data. The CAGE instrument was used to screen HPs for AUD. The data were coded, cleaned and analyzed by using SPSS version 16 software program. Variables with p-value <0.05 at multivariate logistic regression were identified to know the risk factors for AUD. Result: Off the total participants (n=334), 41.7% and 34.4% were ever and current users of alcohol respectively. Prevalence of AUD was 8.1%. Eighteen percent of current alcohol users felt the need to cut down. Few of them (5.1%) had the need of alcohol in the morning as an eye opener. The main reason given by participants for alcohol use was “to get relief from stress and exhaustion” (26.1%) followed by “peer pressure” (18.3%), and “for relaxation” (17.4%). Based on the results the results of this study, the odds of AUD were lower among those with higher education, no psychological distress, and no current khat use among HPs in Northwest Ethiopia. Conclusion: HPs identified to have prevalence of AUD the same to the general population. Prevention, treatment, and rehabilitation of AUD find to be crucial. Addressing enabling factors found to be important in this era of alcohol beverage promotions by companies.

Características de los Instrumentos de Tamizaje del Trastorno por Uso de Alcohol en Jóvenes Universitarios de Argentina

The prevalence of alcohol use disorders in university students is alarmingly high. Screening instruments are fundamental for both, epidemiological research and clinical practice. The aim of this article is to compare the performance of the most widely used screening instruments (AUDIT, AUDIT-C, TWEAK, RAPS-QF, and CAGE) in Argentinean university students. Screening tests, along with the Alcohol Section of the Composite International Diagnostic Interview that yields DSM 5 compatible diagnoses were administered to a probabilistic sample (N = 2,430) of university students from a national public university. The following characteristics were evaluated among others: optimal cut-off points, sensitivity, specificity, internal consistency, temporal stability, and item presence and discrimination capacity. The global appraisal of results suggests that the AUDIT and RAPS-QF would be preferable for evaluating AUD in this population.

Identification of heavy drinking in the 10-item AUDIT: Results from a prospective study among 18–21 years old non-dependent German males

BackgroundAlcohol consumption is pivotal for the subsequent development of alcohol use disorders (AUD). The Alcohol Use Disorders Identification Test (AUDIT) is a recommended AUD screening tool for prevention and primary care settings. The objectives of this study were to test how many participants with heavy drinking are unidentified by the AUDIT, if proportions of unidentified participants vary over time, and whether this unidentified risk group (URG) was clinically relevant in terms of drinking behavior reports and AUD risk factors, as well as future adverse outcomes, such as craving, dependence symptoms, or depression. MethodsOur prospective cohort study followed 164 German males aged 18–19years without an alcohol dependence diagnosis over 24months. Only men were included due to higher AUD prevalence and gender-specific differences in metabolism, drinking patterns, and progression to AUD. All participants were screened via telephone interview and answered questionnaires both in person and via internet. Heavy drinking was classified using the AUDIT consumption score (AUDIT-C≥4.50). Standardized AUD diagnoses and symptoms, as well as alcohol use-related outcome criteria were assessed via standardized Composite International Diagnostic Interview (CIDI), and self-report questionnaires. ResultsOne in four participants (22–28% across all four follow-ups) reported heavy drinking but was unidentified by AUDIT total score (i.e. score<8), thus qualifying for URG status. The URG status did not fluctuate considerably across follow-ups (repeated-measures ANOVA, p=0.293). URG participants identified at the six-month follow-up did not generally differ from participants without URG status in terms of AUD family history or temperament (multivariate ANOVA, p=0.114), except for anxiety sensitivity (pBonferroni<0.001). After two years, URG participants reported a similar level of adverse outcomes compared to low-risk participants (multivariate ANOVA, p=0.438), but less alcohol-related problems and less loss of control due to craving compared to high-risk participants (pBonferroni≤0.007). ConclusionsDespite the considerable number of heavy-drinking individuals unidentified by AUDIT total scores, an additional classification according to AUDIT-C values did not prove useful. Combining AUDIT and AUDIT-C scores might not be sufficient for identifying AUD risk groups among young adult German males. There is an urgent need for a replication of our findings among female participants.

Studying Sex Differences in Animal Models of Addiction: An Emphasis on Alcohol-Related Behaviors.

Animal models are essential for understanding the biological factors that contribute to drug and alcohol addiction and discovering new pharmacotherapies to treat these disorders. Alcohol (ethanol) is the most commonly abused drug in the world, and as the prevalence of alcohol use disorder (AUD) increases, so does the need for effective pharmacotherapies. In particular, treatments with high efficacy in the growing number of female AUD sufferers are needed. Female animals remain underrepresented in biomedical research and sex differences in the brain's response to alcohol are poorly understood. To help bridge the gender gap in addiction research, this Review discusses strategies that researchers can use to examine sex differences in the context of several common animal models of AUD. Self-administration, two-bottle choice, drinking in the dark, and conditioned place preference are discussed, with a focus on the role of estrogen as a mediator of sex differences in alcohol-related behaviors.

Novel Small-Molecule Inhibitors of Protein Kinase C Epsilon Reduce Ethanol Consumption in Mice

BackgroundDespite the high cost and widespread prevalence of alcohol use disorders, treatment options are limited, underscoring the need for new, effective medications. Previous results using protein kinase C epsilon (PKCε) knockout mice, RNA interference against PKCε, and peptide inhibitors of PKCε predict that small-molecule inhibitors of PKCε should reduce alcohol consumption in humans. MethodsWe designed a new class of PKCε inhibitors based on the Rho-associated protein kinase (ROCK) inhibitor Y-27632. In vitro kinase and binding assays were used to identify the most potent compounds. Their effects on ethanol-stimulated synaptic transmission; ethanol, sucrose, and quinine consumption; ethanol-induced loss of righting; and ethanol clearance were studied in mice. ResultsWe identified two compounds that inhibited PKCε with Ki <20 nM, showed selectivity for PKCε over other kinases, crossed the blood-brain barrier, achieved effective concentrations in mouse brain, prevented ethanol-stimulated gamma-aminobutyric acid release in the central amygdala, and reduced ethanol consumption when administered intraperitoneally at 40 mg/kg in wild-type but not in Prkce−/− mice. One compound also reduced sucrose and saccharin consumption, while the other was selective for ethanol. Both transiently impaired locomotion through an off-target effect that did not interfere with their ability to reduce ethanol intake. One compound prolonged recovery from ethanol-induced loss of righting but this was also due to an off-target effect since it was present in Prkce−/− mice. Neither altered ethanol clearance. ConclusionsThese results identify lead compounds for development of PKCε inhibitors that reduce alcohol consumption.

Craving as a DSM-5 Symptom of Alcohol Use Disorder in Non-Treatment Seekers.

DSM-5 has added craving as a new criterion and changed the diagnostic structure of alcohol use disorder (AUD). Though craving has long been a target of intervention, less is known about the impact this addition will have on prevalence and factor structure of AUD, particularly in non-treatment seeker with alcohol problems. Non-treatment seeking individuals reporting alcohol-related problems (N = 296) completed a structured clinical interview and the Penn Alcohol Craving Scale (PACS). PACS scores greater than 20 were considered to meet diagnostic criteria for the alcohol craving symptom. This study examined DSM-IV to DSM-5 diagnostic conversion and conducted an exploratory factor analysis to test the factor structure of the DSM-5 symptoms, including craving. The mean PACS score was 13.1 and alcohol craving was strongly correlated with other measures of alcohol use. Using the proposed cut-off score of PACS > 20, 46 participants (16.2%) met criteria for alcohol craving. Craving loaded moderately (0.47) onto the retained DSM symptoms and produced a unidimensional factor structure. The majority of participants who met for a DSM-IV AUD also met for a DSM-5 AUD (98.8%). Craving prevalence using the PACS was relatively low compared to the remaining 10 DSM-5 symptoms, possibly due to the non-treatment seeking nature of the sample. Conversion of DSM-IV to DSM-5 in this sample led to a small increase in overall AUD prevalence. Craving loaded well onto a single factor structure for AUD.

Psychoactive substance use in specialized psychiatric care patients.

Objective Life expectancy of psychiatric patients is markedly shorter compared to the general population, likely partly due to smoking or misuse of other substances. We investigated prevalence and correlates of substance use among psychiatric patients. Methods Within the Helsinki University Psychiatric Consortium Study, data were collected on substance use (alcohol, smoking, and illicit drugs) among patients with schizophrenia or schizoaffective disorder (n = 113), bipolar (n = 99), or depressive disorder (n = 188). Clinical diagnoses of substance use were recorded, and information on smoking, hazardous alcohol use, or misuse of other substances was obtained using questionnaires. Results One-fourth (27.7%) of the patients had clinical diagnoses of substance use disorders. In addition, in the Alcohol Use Disorders Identification Test, 43.1% had hazardous alcohol use and 38.4% were daily smokers. All substance use was more common in men than in women. Bipolar patients had the highest prevalence of alcohol use disorders and hazardous use, whereas those with schizophrenia or schizoaffective disorder were more often daily smokers. In regression analyses, self-reported alcohol consumption was associated with symptoms of anxiety and borderline personality disorder and low conscientiousness. No associations emerged for smoking. Conclusions The vast majority of psychiatric care patients have a diagnosed substance use disorder, hazardous alcohol use, or smoke daily, males more often than females. Bipolar patients have the highest rates of alcohol misuse, schizophrenia or schizoaffective disorder patients of smoking. Alcohol use may associate with symptoms of anxiety, borderline personality disorder, and low conscientiousness. Preventive and treatment efforts specifically targeted at harmful substance use among psychiatric patients are necessary.

The Neurobiological Mechanism of Chemical Aversion (Emetic) Therapy for Alcohol Use Disorder: An fMRI Study.

A recent NIH epidemiology study found the lifetime prevalence of alcohol use disorder in the United States to be 29%. Alcohol drinking behavior is strongly “learned” via pleasure center activation/reinforcement. Alcohol craving is a powerful desire to drink alcoholic beverages. Craving was added as one of the defining criteria for alcohol use disorder in DSM5, and craving reduction is becoming an increasingly important treatment goal. In the current study, patients with alcohol use disorder received 10 days of inpatient multi-modal treatments at Schick Shadel Hospital (SSH) of Seattle. The treatments included five chemical aversion conditioning sessions that associated alcohol cues (and alcohol) with nausea and emesis. All patients met DSM4 criteria for alcohol use disorder, were heavy drinkers, and reported craving alcohol pre-treatment. Craving reduction was one of the primary treatment goals. This is the first fMRI study to measure the effects of chemical aversion therapy on alcohol craving-related brain activity. Patients were recruited as subjects for the University of Washington (UW) brain scan study following SSH admission but before treatment onset. Prior to treatment, patients reported craving/desire for alcohol. After treatment (after four SSH chemical aversion treatments, again after five SSH chemical treatments, 30 and 90-days post-discharge), these same patients reported avoidance/aversion to alcohol. Most of the participants (69%) reported being still sober 12 months post-treatment. Consistent with a craving reduction mechanism of how chemical aversion therapy facilitates sobriety, results of the UW fMRI brain scans showed significant pre- to post-treatment reductions in craving-related brain activity in the occipital cortex. Additional fMRI brain scan studies are needed to further explore the neurobiological mechanism of chemical aversion therapy treatment for alcohol use disorder, and other substance use disorders for which chemical aversion therapy is used (e.g., opioid dependence and cocaine dependence). Substance use disorders are estimated to affect well over one billion people worldwide.

Mediation of effects of the level of response to alcohol and impulsivity 15 years later in 36-year-old men: Implications for prevention efforts

BackgroundAlthough the prevalence of alcohol use disorders (AUDs) has increased in older individuals in the recent decade, there are few programs to mitigate that increase. The current analyses evaluate the feasibility of applying to older drinkers elements of an approach to prevent heavier drinking in young adults by focusing on mediators of effects of two risk factors for alcohol problems, low levels of response to alcohol (low LRs) and higher impulsivity. MethodsData were extracted from the San Diego Prospective Study (SDPS). Structural Equation Models evaluated relationships among age 36 low LRs and higher impulsivity; age 46 perceived peer drinking, alcohol expectancies, and drinking to cope; and age 51 alcohol problems, even after controlling for age 36 alcohol problems. ResultsRelationships of age 36 low LRs to later alcohol problems was both direct and linked to age 46 heavy drinking peers. LR also operated indirectly through peer drinking to alcohol expectancies and drinking to cope. Age 36 impulsivity had no direct path to later alcohol problems and operated primarily through mediation by alcohol expectancies and via expectancies to drinking to cope. After controlling for age 36 alcohol problems, the low LR and impulsivity results remained robust. ConclusionsPrograms for mitigating increases in alcohol problems in middle-age drinkers should consider identifying individuals with low LRs and/or higher impulsivity and implementing prevention approaches similar to a program used in young adults. The approach should emphasize some different mediators for older drinkers with low LRs and those with higher impulsivity.

Ethanol-induced autonomic responses and risk taking increase in young adults with a positive family history of alcohol problems

The mechanisms that underlie the greater prevalence of alcohol use disorders in individuals with a positive family history (FH+) of alcohol abuse are still under investigation. These subjects may exhibit differential sensitivity to alcohol's effects on psychomotor stimulation and impulsivity. Alcohol-induced psychomotor stimulation, measured as the heart rate (HR) response, is a proxy for the positive rewarding effects of the drug. We analyzed alcohol-induced effects on time perception (Time Production Task), risk taking (Balloon Analogue Risk Task [BART]), and HR in FH+ and FH− participants. In the FH+ and FH− groups, women and men received 0.6 and 0.7g/kg alcohol, respectively. The alcohol dose yielded a breath alcohol concentration of 0.08% throughout the experiment. The control groups received placebo, and the subjective perception of alcohol intoxication was assessed. Alcohol intoxication significantly increased HR and the adjusted average number of pumps on the BART (a measure of risk taking) in FH+ men and women but not in FH− participants. Behavioral impulsivity was unaffected by alcohol or a FH of alcohol abuse. FH− but not FH+ participants who received alcohol reported significantly greater subjective perception of alcohol's effects than their placebo counterparts. These results indicate that FH+ individuals presented heightened sensitivity to alcohol-induced HR stimulation and alcohol-induced risk taking compared with their FH− counterparts. FH+ subjects, however, were insensitive to the subjective effects of alcohol. This idiosyncratic response pattern may be a likely pathway by which a FH of alcohol problems promotes alcohol drinking.

The cultural aspect: How to measure and interpret epidemiological data on alcohol-use disorders across cultures.

Aims:To examine the cultural impact on the diagnosis of alcohol-use disorders using European countries as examples.Design:Narrative review.Results:There are strong cultural norms guiding heavy drinking occasions and loss of control. These norms not only indicate what drinking behaviour is acceptable, but also whether certain behaviours can be reported or not. As modern diagnostic systems are based on lists of mostly behavioural criteria, where alcohol-use disorders are defined by a positive answer on at least one, two or three of these criteria, culture will inevitably co-determine how many people will get a diagnosis. This explains the multifold differences in incidence and prevalence of alcohol-use disorders, even between countries where the average drinking levels are similar. Thus, the incidence and prevalence of alcohol-use disorders as assessed by surveys or rigorous application of standardised instruments must be judged as measuring social norms as well as the intended mental disorder.Conclusions:Current practice to measure alcohol-use disorders based on a list of culture-specific diagnostic criteria results in incomparability in the incidence, prevalence or disease burden between countries. For epidemiological purposes, a more grounded definition of diagnostic criteria seems necessary, which could probably be given by using heavy drinking over time.

Comparison of DSM-IV and DSM-5 criteria for alcohol use disorders in VA primary care patients with frequent heavy drinking enrolled in a trial

BackgroundCriteria for alcohol use disorders (AUD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) were intended to result in a similar prevalence of AUD as DSM-IV. We evaluated the prevalence of AUD using DSM-5 and DSM-IV criteria, and compared characteristics of patients who met criteria for: neither DSM-5 nor DSM-IV AUD, DSM-5 alone, DSM-IV alone, or both, among Veterans Administration (VA) outpatients in the Considering Healthier drinking Options In primary CarE (CHOICE) trial.MethodsVA primary care patients who reported frequent heavy drinking and enrolled in the CHOICE trial were interviewed at baseline using the DSM-IV Mini International Neuropsychiatric Interview for AUD, as well as questions about socio-demographics, mental health, alcohol craving, and substance use. We compared characteristics across 4 mutually exclusive groups based on DSM-5 and DSM-IV criteria.ResultsOf 304 participants, 13.8% met criteria for neither DSM-5 nor DSM-IV AUD; 12.8% met criteria for DSM-5 alone, and 73.0% met criteria for both DSM-IV and DSM-5. Only 1 patient (0.3%) met criteria for DSM-IV AUD alone. Patients meeting both DSM-5 and DSM-IV criteria had more negative drinking consequences, mental health symptoms and self-reported readiness to change compared with those meeting DSM-5 criteria alone or neither DSM-5 nor DSM-IV criteria.ConclusionsIn this sample of primary care patients with frequent heavy drinking, DSM-5 identified 13% more patients with AUD than DSM-IV. This group had a lower mental health symptom burden and less self-reported readiness to change compared to those meeting criteria for both DSM-IV and DSM-5 AUD.Trial Registration ClinicalTrials.gov NCT01400581. 2011 February 17

High prevalence of alcohol use disorders in patients with inflammatory skin diseases.

There is a known association between psoriasis and heavy alcohol consumption. The association between heavy alcohol consumption and other inflammatory skin diseases remains to be defined. To examine the prevalence of heavy drinking using the Alcohol Use Disorders Identification Test (AUDIT) in patients with inflammatory skin disease. We conducted an observational cross-sectional study in a single hospital outpatient department. We recruited 609 patients with either psoriasis, eczema, cutaneous lupus or other inflammatory disorders, and a reference population with skin lesions. Primary outcome was the proportion of patients in each group with an alcohol use disorder (AUD). The observed prevalence of AUD was 30·6% in patients with psoriasis, 33·3% in those with eczema, 12·3% in those with cutaneous lupus, 21·8% in those with other inflammatory disease and 14·3% in those with non-inflammatory disease. Odds ratios (OR) for AUD in patients in the inflammatory groups compared with those in the noninflammatory groups, adjusted for age and sex, were as follows: psoriasis 1·65 [95% confidence interval (CI) 0·86-3·17], eczema 2·00 (95% CI 1·03-3·85), lupus 1·03 (95% CI 0·39-2·71), other inflammatory disease 1·32 (95% CI 0·68-2·56). ORs were reduced if also adjusted for Dermatology Life Quality Index (DLQI). The prevalence of DLQI ≥ 11 was 31·1% for psoriasis, 43·7% for eczema, 17·5% for cutaneous lupus, 17·2% for other inflammatory disease and 2·8% for noninflammatory disease. Patients with eczema attending a hospital clinic have been shown to have high levels of AUD of a similar level to patients with psoriasis and higher than patients with noninflammatory skin diseases.

Alcohol use disorder and tuberculosis treatment: A longitudinal mixed method study in Thailand.

ObjectiveThe relationship between tuberculosis (TB) treatment and alcohol use disorders over time is under-researched. The aim of this investigation was to study alcohol use and TB medication adherence and its predictors among TB patients over a period of 6 months.MethodsA longitudinal investigation was carried out with new TB and TB retreatment patients systematically selected from two hospitals and had screened positive for hazardous or harmful alcohol use in Sisaket Province in Thailand. Alcohol use disorders were measured with Alcohol Use Disorder Identification Test (AUDIT)-C at baseline, 3 months and 6 months.ResultsOf the 295 TB patients who were screened with AUDIT-C, 72 (24.4%) tested positive for hazardous or harmful alcohol use. At 6 months, 72 TB patients had completed the follow-up. At the 6-month follow-up, hazardous or harmful drinking was reduced by 84.7%. Multivariate logistic regression analysis using generalised estimation equation modelling found that alcohol use significantly reduced over time, whereas there was no change in current tobacco use.ConclusionThe prevalence of alcohol use disorders significantly reduced over a period of 6 months.

Quantifying the global contribution of alcohol consumption to cardiomyopathy

BackgroundThe global impact of alcohol consumption on deaths due to cardiomyopathy (CM) has not been quantified to date, even though CM contains a subcategory for alcoholic CM with an effect of heavy drinking over time as the postulated underlying causal mechanism. In this feasibility study, a model to estimate the alcohol-attributable fraction (AAF) of CM deaths based on alcohol exposure measures is proposed.MethodsA two-step model was developed based on aggregate-level data from 95 countries, including the most populous (data from 2013 or last available year). First, the crude mortality rate of alcoholic CM per 1,000,000 adults was predicted using a negative binomial regression based on prevalence of alcohol use disorders (AUD) and adult alcohol per capita consumption (APC) (n = 52 countries). Second, the proportion of alcoholic CM among all CM deaths (i.e., AAF) was predicted using a fractional response probit regression with alcoholic CM crude mortality rate (from Step 1), AUD prevalence, APC per drinker, and Global Burden of Disease region as predictions. Additional models repeated these steps by sex and for the wider Global Burden of Disease study definition of CM.ResultsThere were strong correlations (>0.9) between the crude mortality rate of alcoholic CM and the AAFs, supporting the modeling strategy. In the first step, the population-weighted mean crude mortality rate was estimated at 8.4 alcoholic CM deaths per 1,000,000 (95% CI: 7.4–9.3). In the second step, the global AAFs were estimated at 6.9% (95% CI: 5.4–8.4%). Sex-specific figures suggested a lower AAF among females (2.9%, 95% CI: 2.3–3.4%) as compared to males (8.9%, 95% CI: 7.0–10.7%). Larger deviations between observed and predicted AAFs were found in Eastern Europe and Central Asia.ConclusionsThe model proposed promises to fill the gap to include AAFs for CM into comparative risk assessments in the future. These predictions likely will be underestimates because of the stigma involved in all fully alcohol-attributable conditions and subsequent problems in coding of alcoholic CM deaths.

Alcohol Use Disorders and Immigration up to the Third Generation in France: Findings from a 39,617-Subject Survey in the General Population.

In the United States, first-generation immigrants (FGIs) show lower prevalence rates of alcohol use disorders (AUDs) than the native population, although they experience more psychosocial risk factors. This epidemiological phenomenon is called an "immigrant paradox." No previous study has investigated whether immigrants also exhibit a reduced risk of AUDs in Europe. In a study of the general population in France, we have assessed the adjusted risk of AUDs between nonimmigrants and FGIs, second-generation immigrants (SGIs), and third-generation immigrants (TGIs). A cross-sectional survey based on face-to-face interviews was conducted among 39,617 French subjects recruited using a quota-sampling strategy. The sociodemographic data collected helped determine the subjects' immigration status. The AUD assessment was performed using the Mini International Neuropsychiatric Interview (version 5.0.0). A multivariable logistic regression model was used to define the independent risk factors for AUDs with backward selection. The overall prevalence of AUDs in the sample was 4.34%. AUDs were diagnosed in 3.82% of the native population versus 5.84% of the immigrant population: 4.67% of FGIs, 5.71% of SGIs, and 6.63% of TGIs (p<0.0001). The multivariable model showed that FGIs did not have a significantly different risk of AUDs compared to the native population (p=0.5936), whereas SGIs (odds ratio [OR]=1.18; 95% confidence interval [CI] [1.01 to 1.39]; p=0.0496) and, to a greater extent, TGIs (OR=1.38; 95% CI [1.17 to 1.63]; p=0.0002) had a significantly greater risk of AUDs. The area under the curve of the model was 0.753. Relative to French natives, a generational risk gradient for AUDs was found in the immigrant subjects, with a similar risk of FGIs, and an increased risk of SGIs and TGIs. In terms of the risk of AUDs, no "immigrant paradox" existed in French population. These results are in line with other recent findings, suggesting that the "immigrant paradox" is rarely found in Europe regarding many health-related issues.