Alcohol Screening Research Articles

S3106 N-Acetyl Cysteine Use in the Treatment of Ischemic Hepatitis in the Setting of COVID-19 Infection

Introduction: Acute liver injury occurs in 15-53% of COVID-19 patients. Most often, elevation in transaminases is mild, but severe liver injury has been described possibly secondary to hepatic ischemia. We present a case of ischemic hepatitis with concurrent COVID-19 infection, in which N-acetyl cysteine (NAC) administration led to clinical improvement and recovery. Case Description/Methods: A 58-year-old male with adult congenital heart disease (ACHD), on warfarin for atrial flutter and cardiac cirrhosis presented to the ER with generalized fatigue, chills, congestion, and cough. Patient tested positive for COVID-19. He was hemodynamically stable with an unremarkable exam. He was alert and oriented times three. He initially required 8 L of oxygen which continued to improve on a daily basis. His initial laboratory workup was notable for AST 1954 U/L, ALT 1905 U/L, INR 19.1, and total bilirubin 0.9 mg/dL. At baseline, patient’s liver enzymes were normal. He was admitted to the ICU due to the severity of his liver injury. Alcohol, acetaminophen, salicylate levels and urine drug screen were all within normal limits. Abdominal ultrasound revealed known liver cirrhosis and ascites. Acute hepatitis serologies including hepatitis E IgM, ANA, AMA, ASMA, anti-LKM, IGG subclasses, ceruloplasmin, alpha-1 antitrypsin, and celiac panel were done and unremarkable. In addition, HIV, VZV PCR, EBV PCR, HSV PCR and CMV PCR were also negative for acute infection. Patient was treated with a NAC protocol with decrease in elevated liver enzymes by half in the first 72 hours and >20-fold of the highest level upon discharge. Throughout his admission, his mental status remained normal. Discussion: Ischemic hepatitis (IH) results from insufficient blood flow volume and/or oxygen content to the hepatocytes. Acute hypoxic respiratory failure as a result of COVID-19 infection is one of the potential causes of this type of liver injury. Other possible causes of liver injury include direct viral cytopathic effect, cytokinesis and drug-induced liver injury. In the setting of COVID 19 infection, prompt diagnosis and recognition of IH is critical as studies describe mortality rates as high as 50%. We describe our clinical experience with NAC in the setting of COVID 19 with severe IH and propose that NAC is considered in the treatment of COVID-19 patients with ischemic hepatitis, however further research including prospective clinical trials is needed to better validate this.

Cross-sectional survey of the Mental health and Addictions effects, Service impacts and Care needs of children, youth and families during the COVID-19 pandemic: the COVID-19 MASC study protocol

IntroductionThe COVID-19 pandemic has had a tremendous negative effect on the mental health and well-being of Canadians. These mental health challenges are especially acute among vulnerable Canadian populations. People living...

GOING WITH THE FLOW: A UNIQUE PRESENTATION OF EISENMENGER SYNDROME

GOING WITH THE FLOW: A UNIQUE PRESENTATION OF EISENMENGER SYNDROME

The neuropeptide Y single-nucleotide polymorphism rs16147:T>C moderates the effect of alcohol dependence on depression in male Chinese Han population.

BackgroundPrevious studies suggest that alcohol dependence is associated with depression, however, the effect of alcohol dependence varies from individual to individual, which may be due to different genetic backgrounds. The interactions between alcohol dependence and different gene polymorphisms may finally shape the onset of depression. Neuropeptide Y (NPY), which can maintain homeostasis from high-stress stimulation, may protect individuals from the onset of depression. Here, we explored whether the NPY rs16147:T>C has an association with depression in individuals with alcohol dependence during the period of alcohol dependence withdrawal.MethodsA total of 455 males with alcohol dependence were recruited. The scale of Michigan Alcoholism Screening Test (MAST) and Self-Depression Scale (SDS) were respectively used to analyze the condition of alcohol dependence and depression. Genomic DNA was extracted from each blood sample and NPY polymorphisms were genotyped. The interaction between NPY rs16147:T>C and alcohol dependence on depression was first analyzed. Then, region of significance analysis was used to confirm which model provided the best fit for the interaction (diathesis-stress or differential susceptibility). Finally, by using internal replication analyses, the accuracy and robustness of the interaction results were improved.ResultsAlcohol dependence was positively correlated with depression. CC homozygotes of NPY rs16147:T>C exhibited less depression when exposed to low alcohol dependence, but more depression when exposed to high alcohol dependence. Individuals with the T allele showed the opposite result.ConclusionNPY rs16147:T>C might be correlated with susceptibility for depression in males during alcohol dependence withdrawal. The findings support the differential susceptibility model.

An Optimized Approach Using Transfer Learning to Detect Drunk Driving

Although the statistics show a slow decline in traffic accidents in many countries over the last few years, drunk or drug-influenced driving still contributes to enough shares in those records to act. Nowadays, breath analysers are used to estimate breath alcohol content (BAC) by law enforcement as a preliminary alcohol screening in many countries. Therefore, since breath analysers or field sobriety testers do not accurately measure BAC, the analysis of blood samples of individuals is required for further action. Many researchers have presented various approaches to detect drunk driving, for example, using sensors, face recognition, and a driver’s behaviour to confound the shortcomings of the time-honoured approach using breath analysers. But each one has some limitations. This study proposed a plan to distinguish between drivers’ states, that is, sober or drunk, by the use of transfer learning from the convolutional neural network (CNN) features to the random forest (RF) features with an accuracy of up to 93%, which is higher than that of existing models. With the same dataset, to validate our research, a comparative analysis was performed with other existing model classifiers such as the simple vector machine (SVM) with an accuracy of 65% and the K-nearest neighbour (KNN) with an accuracy of 62%, and it was found that our approach is an optimized approach in terms of accuracy, precision, recall, F1-score, AUC-ROC curve, and Matthew’s correlation coefficient (MCC) with confusion matrix.

Readiness to change among justice-involved young adults in an alternative sentencing program who screened positive for alcohol or drug risk

IntroductionReadiness to change is a key component of substance use behavioral change; yet little is known about readiness to change among justice-involved young adults. This study 1) describes readiness to change alcohol and drug use and 2) examines predictors of readiness to change alcohol and drug use among justice-involved young adults. MethodJustice-involved young adults (18–24 years; n = 137) who were positive on a validated alcohol and/or drug screening tool completed an interview assessing substance use, readiness to change, and reasons to quit. A multivariable linear regression model examined whether reasons to change and substance use severity, and interactions between these, predicted readiness. ResultsMore than half of participants were contemplating or had decided to quit/cut down substance use. Personal reasons to quit were positively related to readiness to change; interpersonal reasons were negatively associated. ConclusionsThis study contributes information needed to design motivational interventions for substance use among justice-involved young adults. Personal reasons to quit using drugs are a potential intervention target.

Pediatric Subspecialist Alcohol Screening Rates and Concerns About Alcohol and Cannabis Use Among Their Adolescent Patients

PurposePediatric specialty care provides an opportunity to screen for and address patient substance use; however, little is known about providers’ screening rates, their opinions regarding substance use harms, or the potential marijuana to be used as a medication. MethodsWe surveyed national convenience samples of pediatric endocrinologists (N = 142) and rheumatologists (N = 83) and used descriptive statistics and multivariate logistic regression to examine alcohol screening rates, barriers, and for medical use of marijuana, differences between subspecialist concerns. ResultsIn all, 36.4% of providers reported screening adolescent patients annually or more, and a majority expressed concerns about impacts on disease management (80.0%/80.0%) and symptom management (69.3%/53.3%) from alcohol and marijuana, respectively. Nearly equal proportions disagreed (30.2%), were neutral (34.7%), or agreed (35.1%) that some patients would benefit from medical marijuana, although majorities were not comfortable recommending marijuana (62.7%) and did not believe marijuana is standardized enough to be used as medication (57.8%). DiscussionFewer than half of the subspecialists in our study routinely screen their adolescent patients for substance use, although many have concerns regarding the impacts of alcohol and marijuana use on their patients. Education and training on best practice could help to increase screening rates. There is agreement that marijuana is not standardized enough to be used as a medication. There is also a broad range of opinions regarding the pharmaceutical potential of marijuana and concerns about the impact of marijuana on underlying chronic medical conditions, which should be considered as marijuana policy continues to evolve.

Adolescent Screening, Brief Intervention, Referral to Treatment: Defining a Research Agenda

In 2020, the United States Preventive Services Task Force (USPSTF) concluded for the second time in 13 years (or third if you include the alcohol Screening, Brief Intervention, Referral to Treatment [SBIRT] review) that there is insufficient evidence available to assess the effectiveness of SBIRT and more study is needed. This report, which focused on reducing substance use, misses some of SBIRT's potential benefits. For example, screening for substance use may lead to better clinical care, even if it does not reduce use.

Predictors of alcohol screening quality in a US general population sample and subgroups of heavy drinkers

Alcohol screening is one of the most cost-effective clinical preventive services and important for intervening in the development of alcohol problems. We examine predictors of the quality of alcohol screening, approximated by alcohol quantity screening, which is a prerequisite for appropriate counseling, and compare conventional regression approach with Classification and Regression Trees (CART). Data come from the 2020 National Alcohol Survey, a population survey of US adults aged 18 years and over. Analyses focus on those reporting any alcohol screening at all (N = 989). The primary outcome was whether a healthcare profession had ever asked how much they drink, which is necessary to identify heavy drinking. We examined 12 potential predictors of alcohol quantity: gender, age, race and ethnicity, education, marital status, having a usual source of primary care, insurance, and health conditions. Analyses were replicated in heavy episodic drinking (HED) and high intensity drinking (HID) subgroups, both warranting alcohol counseling. Logistic regression results show that having diabetes and not having a college degree predict missed alcohol quantity screening in the sample overall, and younger age predicts missed alcohol quantity screening in the HED/HID subgroups. CART identified Black and Hispanic respondents who had not attended college at high risk of missed screening for heavy drinking in the overall sample, and those with public insurance at high risk of missed screening for heavy drinking in the HED/HID subgroups. The quality of alcohol screening needs improvement in general, and to avoid unintended disparities in alcohol-related health services.

Pre-injury stimulant use in isolated severe traumatic brain injury: effect on outcomes

PurposeThe aim of this study was to assess the impact of pre-injury stimulant use (amphetamine, cocaine, methamphetamine and/or ecstasy) on outcomes after isolated severe traumatic brain injury (TBI).MethodsRetrospective 2017 TQIP study, including adult trauma patients (≥16 years old) who underwent drug and alcohol screening on admission and sustained an isolated severe TBI (head AIS ≥3). Patients with significant extracranial trauma (AIS ≥3) were excluded. Epidemiological and clinical characteristics, procedures and outcome variables were collected. Patients with isolated stimulant use were matched 1:1 for age, gender, mechanism of injury, head AIS and overall comorbidities, with patients with negative toxicology and alcohol screen. Outcomes in the two groups were compared with univariable and multivariable regression analysis.Results681 patients with isolated TBI and stimulant use were matched with 681 patients with negative toxicology and alcohol screen. The incidence of hypotension and CGS <9 was similar in the two groups.In multivariable regression analysis, stimulant use was not independently associated with mortality (OR 0.95, 95% CI 0.61–1.49). However, stimulant use was associated with longer hospital length of stay (HLOS) (RC 1.13, 95%CI 1.03–1.24).ConclusionPre-injury stimulant use is common in patients admitted for severe TBI, but was not independently associated with mortality when compared to patients with negative toxicology. However, stimulant use was associated with a significant longer HLOS.

Peer-led interventions to reduce alcohol consumption in college students: A scoping review.

Risky alcohol consumption among college students is a significant public health issue. In the college setting, students can collaborate in the implementation of peer-led interventions. To date, evidence of peer-led programmes in reducing harmful alcohol consumption in this population is inconclusive. The aim of the current scoping review is to provide a broad overview by systematically examining and mapping the literature on peer-led interventions for preventing risky alcohol consumption by college students. The specific aims were to (1) identify the underlying focus of the interventions and assess their (2) effectiveness and (3) feasibility. A comprehensive search was conducted in PubMed, PsycINFO, CINAHL, Cochrane Library, Web of Science, DART-Europe, RCAAP, Trove and ProQuest. The inclusion criteria were peer-led interventions that exclusively addressed alcohol consumption, college students as the target population and interventional studies (randomised controlled trials, quasi-experimental studies, systematic reviews and meta-analyses of interventions). The methodological quality of the articles was evaluated. From 6654potential studies, 13 were included. Nine interventions were described within these studies: Voice of Reason programme, Brief Advice sessions, Peer Theatre, Alcohol Education programme, Perceptions of Alcohol Norms intervention, Motivational Intervention, Alcohol Skills Training programme, Lifestyle Management Class and the Brief Alcohol Screening and Intervention for College Students. Only the last showed significant reductions in three of the four outcome measures: quantity and frequency of drinking, estimated peak blood alcohol concentration and alcohol-related consequences. It did not significantly decrease the number of heavy-drinking episodes. Peer interventions may be effective in preventing alcohol use among college students, although the evidence is weak and scarce. Further research is needed to strengthen the findings about peer-led interventions.

Thirty years of BASICS: Dissemination and implementation progress and challenges.

The first clinical trial of the Brief Alcohol Screening and Intervention for College Students (BASICS) was launched at the University of Washington in 1990. Since that time, multiple trials have demonstrated the efficacy of BASICS and related approaches in a variety of young adult populations and this information has been widely disseminated. However, in practice BASICS implementation varies considerably, including formats and mediums (e.g., group, telehealth, written/electronic feedback alone) not studied in the original research. Even if delivered in an individual in-person format, implementation can stray substantially from the original design. Adaptations may be necessary to address campus resource constraints or other barriers to implementation but can have unknown impacts on intervention effectiveness. Thus, despite wide-scale efforts to disseminate and implement BASICS, challenges remain, and there are several critical research gaps that need to be addressed to support campuses in implementing BASICS successfully. The current manuscript reviews several ways in which BASICS has been adapted to address these challenges, and provides recommendations for best implementation practices as well as future research needed to improve implementation and effectiveness of BASICS going forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prevalence and characteristics of hazardous and harmful drinkers receiving general practitioners’ brief advice on and support with alcohol consumption in Germany: results of a population survey

ObjectiveThe German treatment guideline on alcohol-related disorders recommends that general practitioners (GPs) offer brief advice on, and support with, reducing alcohol consumption to hazardous (at risk for health events) and...

From machine learning to deep learning: A comprehensive study of alcohol and drug use disorder

This study aims to train and validate machine learning and deep learning models to identify patients with risky alcohol and drug misuse in a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program. An observational cohort of 6978 adults was admitted in the western region of Alabama at three medical facilities between January and December of 2019. Data were cleaned and pre-processed using data imputation techniques and an augmented sampling data method. The primary analysis involved the multi-class classification of alcohol and drug misuse. Our study shows that accurate identification of alcohol and drug use screening instrument scores was best accomplished with mixed-effects models following the imputation of missing data using the Generative Adversarial Imputation Networks (GAIN) method and then followed by applying the Synthetic Minority Over-sampling TEchnique-Nominal Continuous (SMOTE-NC) data augmentation method. Although mixed models are commonly employed in studies of electronic health records (EHRs), using the GAIN method followed by SMOTE-NC for diagnosing alcohol and drug use disorder is novel and original.

An Observational Report of Screen Time Use Among Young Adults (Ages 18-28 Years) During the COVID-19 Pandemic and Correlations With Mental Health and Wellness: International, Online, Cross-sectional Study.

BackgroundScreen time (ST) drastically increased during the COVID-19 pandemic, but there is little research on the specific type of ST use, degree of change from before COVID-19, and possible associations with other factors. Young adults are a particular interest since previous studies have shown the detriment ST has on a young person’s health. With the combination of a life-changing pandemic, there are unreached depths regarding ST and young adults. This study aims to provide insight into these unknowns.ObjectiveThis study aims to assess ST in 3 domains (entertainment, social media [SM], and educational/professional) in young adults early in the COVID-19 pandemic; identify trends; and identify any correlations with demographics, mental health, substance abuse, and overall wellness.MethodsAn online, cross-sectional observational study was performed from September 2020 to January 2021 with 183 eligible respondents. Data were collected on ST, trauma from COVID-19, anxiety, depression, substance use, BMI, and sleep.ResultsThe average total ST during COVID-19 was 23.26 hours/week, entertainment ST was 7.98 hours/week, SM ST was 6.79 hours/week, and ST for educational or professional purposes was 8.49 hours/week. For all categories, the average ST during COVID-19 was higher than before COVID-19 (P<.001). We found ST differences between genders, student status, and continent of location. Increased well-being scores during COVID-19 were correlated with greater change in total ST (P=.01). Poorer sleep quality (P=.01) and longer sleep duration (P=.03) were associated with a greater change in entertainment ST (P=.01). More severe depression and more severe anxiety was associated with the amount of entertainment ST (P=.047, P=.03, respectively) and greater percent change in SM (P=.007, P=.002, respectively). Greater stress from COVID-19 was associated with the amount of ST for educational/professional purposes (P=.05), change in total ST (P=.006), change in entertainment ST (P=.01), and change in ST for educational/professional purposes (P=.02). Higher Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) tobacco scores were associated with greater change in total ST (P=.004), and higher pack-years were associated with greater change in SM ST (P=.003). Higher alcohol scores (P=.004) and servings of alcohol per week (P=.003) were associated with greater change in entertainment ST. Quarantining did not negatively impact these variables.ConclusionsThere is no doubt ST and worsening mental health increased during COVID-19 in young adults. However, these findings indicate there are many significant associations between ST use and mental health. These associations are more complex than originally thought, especially since we found quarantining is not associated with mental health. Although other factors need to be further investigated, this study emphasizes different types of ST and degree of change in ST affect various groups of people in discrete ways. Acknowledging these findings can help young adults optimize their mental health during pandemics.

Alcohol and Psoriasis for the Dermatologist: Know, Screen, Intervene.

Psoriasis patients are at increased risk of harmful alcohol use and alcohol dependency with many deleterious effects. Increasing alcohol use is associated with worsening psoriasis severity, is a risk factor for poor response to systemic treatments and may impact on comorbidities such as psoriatic arthritis, cardiovascular disease, cancer and liver disease. Harmful alcohol use and alcohol dependency can be defined by the updated ICD-11 coding system and screening can be completed using many tools including the Cut down, Annoyed, Guilty, Eye-Opener (CAGE), Alcohol Use Disorders Identification Test (AUDIT) and Michigan Alcohol Screening Test (MAST) questionnaires. Dermatologists may be able to complete brief interventions encouraging alcohol reduction in psoriasis patients. Psoriasis patients may respond to messages of gain with reduced psoriasis severity and loss with reduced cardiovascular risk. It is important for dermatologists to discuss alcohol with all psoriasis patients, to be aware of the impact of alcohol in psoriasis and to familiarise themselves with screening tools, brief intervention and local services available to patients who require specialist input for harmful alcohol use or alcohol dependency.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40257-022-00713-z.

Alcohol use and family-related factors among Spanish university students: the unHicos project

BackgroundDuring adolescence and youth there are relevant changes in the consolidation, gain or loss of consumption habits and lifestyles and the family factors has a fundamental role to development these habits. The study of the consumption of toxins, such as alcohol intake, is crucial at this stage due to the repercussions that said consumption presents in adulthood. Therefore, the objective of our study was to evaluate the associations between alcohol consumption patterns and related family factors (family functioning, family history of alcohol consumption) in Spanish university students.MethodsObservational, descriptive, cross-sectional, multicenter study, carried out in first-year university students from 11 Spanish universities. Through an online questionnaire, alcohol consumption (risky consumption and intensive consumption or binge drinking), family functioning and history of alcohol in the family were evaluated.Risky alcohol consumption and binge drinking were assessed using the AUDIT test, and family functioning was assessed using the family APGAR questionnaire. A descriptive analysis of the data was performed, as well as the Chi-Square test and Student's T-Test, and non-conditional logistic regression models were carried out to examine this association.ResultsThe prevalence of risky alcohol consumption identified in the 10,167 respondents was 16.9% (95% CI = 16.2–17.6), and that of BD was 48.8% (95% CI = 47.9–48.8). There is a significant association between risky alcohol consumption and family functioning in students of both sexes, with greater consumption in the face of severe dysfunctional support (men OR = 1.72; p < 0.001 and women OR = 1.74; p < 0.001) and family history of consumption (p = 0.005). Regarding the binge drinking pattern, no statistically significant differences were observed.ConclusionsRisky alcohol consumption in university students is associated with dysfunctional family support, unlike the binge drinking pattern, where there is no such association.The findings of this study show the importance of creating prevention programs focused on the family approach in university students, which include alcohol screening in the population with a family history of this substance, and greater social support from health services.

Use of psychoactive substances among nursing and medical students

Introduction: The use of psychoactive substances has been a worldwide problem that also affects university students. This study aimed to raise patterns of psychoactive substances used among Nursing and Medical students of a public institution of higher education. Materials and methods: Cross-sectional study of quantitative approach, conducted between September and November 2020 in the context of a public higher education institution in southern Bahia, Brazil. The sample consisted of 202 university students. Data were collected using an online questionnaire and the scale of screening for the use of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The descriptive statistical analysis was performed. Results: Most university students from nursing and medical courses (77.7%, n=156) have already used any of the PAS in lifetime. Among those who have used some substances, the highest frequency of use was alcoholic beverages (nursing 56%; medicine 43.4%), followed by marijuana (nursing 17.6%; medicine 23.6%) and tobacco (nursing 13.7%; medicine 10.4%). There was no use of hallucinogens and cocaine/crack by nursing students. Conclusion: The high incidence of PAS use (alcohol, tobacco, marijuana and hypnotics/sedatives) among students, in isolation or poly-use, represents risks that should be considered as a warning to the necessity of developing mental and academic health strategies regarding the use of PSA.

Blended-eLearning Improves Alcohol Use Care in Kenya: Pragmatic Randomized Control Trial Results and Parallel Qualitative Study Implications

Alcohol use is the 5th most important risk factor contributing to the global burden of diseases, with stigma and a lack of trained health workers as the main barriers to adequate care. This study assesses the impact of providing blended-eLearning courses teaching the alcohol, smoking, and substance involvement screening test (ASSIST) screening and its linked brief intervention (BI). In public and private facilities, two randomized control trials (RCTs) showed large and similar decreases in alcohol use in those receiving the BI compared to those receiving only the ASSIST feedback. Qualitative findings confirm a meaningful reduction in alcohol consumption; decrease in stigma and significant practice change, suggesting lay health workers and clinicians can learn effective interventions through blended-eLearning; and significantly improve alcohol use care in a low- and middle-income country (LMIC) context. In addition, our study provides insight into why lay health workers feedback led to a similar decrease in alcohol consumption compared to those who also received a BI by clinicians.

5-Year Retrospective Evaluation of Drug Addicts with Psychiatric Problems in the Emergency Department

Introduction: Illicit drug addiction and comorbid psychiatric disorders are among the most complex patient groups in the emergency department. In this study, to share the results of patients who admitted to our emergency department after illicit drug abuse and accepted hospitalization and treatment in the rehabilitation clinic. Methods: The study was planned retrospectively and in two centers. The medical records of patients who were admitted to the emergency department between 1th of January 2015 and 31th of December 2019 and subsequently received addiction treatment in our rehabilitation clinic were examined. Among the patients included in the study, the data of the patients with positive results in the urine drug and alcohol screening were analyzed and the study was completed. Results: In our study, the mean age was 32.09 y. It was observed that 12.5% of the cases had a psychiatric disorder. The most frequently detected illicit drugs are amphetamine and cannabis. The average length of stay was 11.57 days. The average number of admissions to the emergency department was 5.81 ± 3.03. The most common symptoms at admission were injury 114 and muscle pain 94. Conclusion: Especially low socioeconomic level increases susceptibility to illicit drug abuse. In addition, individuals with psychiatric problems also tend to use illicit drugs. With illicit drug abuse, the possibility of being involved in judicial cases also increases. It is appropriate to follow up patients who apply to the emergency department by rehabilitation units for their long-term treatment.