Severe Alcohol Use Disorder Research Articles

Influence of Personality Traits on the Severity of Alcohol Use Disorders.

Introduction: Alcohol Use Disorders (AUD) are the most prevalent psychiatric diagnosis in the general population. The study of personality characteristics, using Cloninger Personality Inventory (TCI-R), allows us to know the evolution of these patients at the beginning of treatment. Material and Method: We conducted a cross-sectional, observational and descriptive study for 3 years with a total of 304 patients. We studied the severity of their alcohol disorder by the Alcohol Dependency Intensity Scale (EIDA), Scale of Obsessive Consumption Compulsive (OCDS) and European version of the Addiction Severity Index (EUROPASI); we studied the relationship with the personality traits of TCI-R. Results and conclusions: The personality lines influence the evolution of alcohol use disorder (AUD). People with higher scores on Reward Dependency (RD), Persistence (P), Cooperation (CO) and Autotranscendence (ST) have a better prognosis while people with higher scores on Search for Novelty (SN) and Avoidance of Damage (AD) have a worst prognosis. Women present differences in consumption in relation to men, as a consequence of their personality. Women have lower scores in Persistence (P) y Self-Transcendence (ST) which are associated with the greater severity of their addiction.

Differences in the subjective and motivational properties of alcohol across alcohol use severity: application of a novel translational human laboratory paradigm.

The Allostatic Model proposes that Alcohol Use Disorder (AUD) is associated with a transition in the motivational structure of alcohol drinking: from positive reinforcement in early-stage drinking to negative reinforcement in late-stage dependence. However, direct empirical support for this preclinical model from human experiments is limited. This study tests predictions derived from the Allostatic Model in humans. Specifically, this study tested whether alcohol use severity (1) independently predicts subjective responses to alcohol (SR; comprised of stimulation/hedonia, negative affect, sedation and craving domains), and alcohol self-administration and 2) moderates associations between domains of SR and alcohol self-administration. Heavy drinking participants ranging in severity of alcohol use and problems (N = 67) completed an intravenous alcohol administration paradigm combining an alcohol challenge (target BrAC = 60 mg%), with progressive ratio self-administration. Alcohol use severity was associated with greater baseline negative affect, sedation, and craving but did not predict changes in any SR domain during the alcohol challenge. Alcohol use severity also predicted greater self-administration. Craving during the alcohol challenge strongly predicted self-administration and sedation predicted lower self-administration. Neither stimulation, nor negative affect predicted self-administration. This study represents a novel approach to translating preclinical neuroscientific theories to the human laboratory. As expected, craving predicted self-administration and sedation was protective. Contrary to the predictions of the Allostatic Model, however, these results were inconsistent with a transition from positively to negatively reinforced alcohol consumption in severe AUD. Future studies that assess negative reinforcement in the context of an acute stressor are warranted.

Concurrent use of alcohol with other drugs and DSM-5 alcohol use disorder comorbid with other drug use disorders: Sociodemographic characteristics, severity, and psychopathology

BackgroundLittle is known about the sociodemographic profiles, the intensity of drinking, the severity of alcohol use disorder (AUD), and psychopathology among individuals with specific patterns of concurrent alcohol and drug use and AUD and other drug use disorders (DUDs) comorbidity. MethodsData were from the National Epidemiologic Survey on Alcohol and Related Conditions-III. We examined sociodemographic correlates and psychopathology among individuals with specific patterns of concurrent use of alcohol and drug and AUD-DUD comorbidity relative to alcohol use or AUD only, respectively, using multinomial logistic regression. We also examined whether concurrent alcohol and drug use and AUD-DUD comorbidity increased the intensity of drinking and severity of AUD, respectively. ResultsThe majority (62.0%) of past-year drinkers used only alcohol. The 12-month prevalence of AUD only was 53.5%. Individuals with concurrent use of alcohol and drugs and AUD-DUD comorbidity were more likely to be men, younger, never/previously married, with lower education and income (odds ratios (ORs) ≥ 1.2). Concurrent use of alcohol and drugs and AUD- DUD comorbidity groups were more likely to experience psychopathology than the alcohol use only and AUD only groups, respectively (ORs ≥ 1.3). The intensity of drinking was greater among the concurrent use groups relative to the alcohol use only group, while the severity of AUD was greater among AUD-DUD comorbidity groups relative to the AUD only group. ConclusionsResearch on consequences and treatment outcome of concurrent use of alcohol and drugs and AUD-DUD comorbidity is warranted to inform the development of more effective prevention/intervention programs.

Negative Affect Intensity and Hostility in Individuals With Alcohol Use Disorder With or Without Posttraumatic Stress Disorder

ABSTRACTObjective: Negative affect intensity and hostility have both been implicated in alcohol use disorders (AUD) and posttraumatic stress disorder (PTSD) when they occur separately, but neither have been compared or explored among those with comorbid AUD and PTSD. This study is a secondary analysis designed to compare levels of negative affect intensity and hostility among those with AUD to those with comorbid AUD and PTSD. Methods: Participants (n = 113) were recruited from the placebo-controlled groups of two distinct 12-week clinical trials (NCT00342563 and NCT00744055). The Short Affect Intensity Scale and Buss-Durkee Hostility Inventory were administered at weeks 0, 4, 8, and 12 to all study participants to assess negative affect intensity and hostility levels, respectively. Results: Individuals with comorbid AUD and PTSD showed significantly higher levels of negative affect intensity and hostility than individuals with AUD only. These levels remained relatively stable over the course of the study in spite of all study participants showing clinically significant improvements in AUD severity and PTSD symptomatology (for those with dual diagnosis). Conclusions: Our results indicate that individuals with comorbid AUD and PTSD have higher levels of negative affect and higher levels of hostility compared to individuals with AUD alone. In addition, these heightened levels of negative affect intensity and hostility appear to function somewhat independently of diagnosis severity and symptomatology improvement. To our knowledge, this is the first study to compare negative affect intensity and hostility levels between individuals with AUD alone and those with comorbid AUD and PTSD.

Prevalence, patterns, and correlates of multiple substance use disorders among adult primary care patients

BackgroundAddressing multiple substance use disorders (SUDs) in primary care-based screening and intervention may improve SUD treatment access, engagement, and outcomes. To inform such efforts, research is needed on the prevalence and patterns of multiple SUDs among primary care patients. MethodsData were analyzed from a sample of 2000 adult (aged ≥ 18) primary care patients recruited for a multisite National Drug Abuse Treatment Clinical Trials Network (CTN) study (CTN-0059). Past-year DSM-5 SUDs (tobacco, alcohol, and drug) were assessed by the modified Composite International Diagnostic Interview. Prevalence and correlates of multiple versus single SUDs were examined. Latent class analysis (LCA) was used to explore patterns of multiple SUDs. ResultsMultiple SUDs were found among the majority of participants with SUD for alcohol, cannabis, prescription opioids, cocaine, and heroin. Participants who were male, ages 26–34, less educated, and unemployed had increased odds of multiple SUDs compared to one SUD. Having multiple SUDs was associated with greater severity of tobacco or alcohol use disorder. LCA of the sample identified three classes: class 1 (83.7%) exhibited low prevalence of all SUDs; class 2 (12.0%) had high-moderate prevalence of SUDs for tobacco, alcohol, and cannabis; class 3 (4.3%) showed high prevalence of SUD for tobacco, opioids, and cocaine. LCA-defined classes were distinguished by sex, age, race, education, and employment status. ConclusionsFindings suggest that primary care physicians should be aware of multiple SUDs when planning treatment, especially among adults who are male, younger, less educated, or unemployed. Interventions that target multiple SUDs warrant future investigation.

DRD2 promoter methylation and measures of alcohol reward: functional activation of reward circuits and clinical severity.

Studies have identified strong associations between D2 receptor binding potential and neural responses to rewarding stimuli and substance use. Thus, D2 receptor perturbations are central to theoretical models of the pathophysiology of substance dependence, and epigenetic changes may represent one of the fundamental molecular mechanisms impacting the effects of alcohol exposure on the brain. We hypothesized that epigenetic alterations in the promoter region of the dopamine D2 receptor (DRD2) gene would be associated with cue-elicited activation of neural reward regions, as well as severity of alcohol use behavior. The current study leveraged functional neuroimaging (fMRI) during an alcohol reward paradigm (n=383) to test associations among DRD2 promoter methylation in peripheral tissue, signal change in the striatum during the presentation of alcohol cues, and severity of alcohol use disorder (AUD). Controlling for age, DRD2 promoter methylation was positively associated with responses to alcohol cues in the right accumbens (partial r=0.144, P=0.005), left putamen (partial r=0.133, P=0.009), right putamen (partial r=0.106, P=0.039), left caudate (partial r=0.117, P=0.022), and right caudate (partial r=0.133, P=0.009), suggesting that DRD2 methylation was positively associated with robust activation in the striatum in response to reward cues. DRD2 methylation was also positively associated with clinical metrics of AUD severity. Specifically, controlling for age, DRD2 methylation was associated with Alcohol Use Disorders Identification Test total (partial r=0.140, P=0.002); Impaired Control Scale total (partial r=0.097, P=0.044) and Alcohol Dependence Scale total (partial r=0.152, P=0.001). Thus, DRD2 methylation may be a critical mechanism linking D2 receptors with functional striatal brain changes and clinical severity among alcohol users.

How Collegiate Fraternity and Sorority Involvement Relates to Substance Use During Young Adulthood and Substance Use Disorders in Early Midlife: A National Longitudinal Study

PurposeTo assess how social fraternity involvement (i.e., membership and residence) in college relates to substance use behaviors and substance use disorder symptoms during young adulthood and early midlife in a national sample. MethodsNational multi-cohort probability samples of US high school seniors from the Monitoring the Future study were assessed at baseline (age 18) and followed longitudinally via self-administered surveys across seven follow-up waves to age 35. The longitudinal sample consisted of 7,019 males and 8,661 females, of which 10% of males and 10% of females were active members of fraternities or sororities during college. ResultsMale fraternity members who lived in fraternity houses during college had the highest levels of binge drinking and marijuana use relative to non-members and non-students in young adulthood that continued through age 35, controlling for adolescent sociodemographic and other characteristics. At age 35, 45% of the residential fraternity members reported alcohol use disorder (AUD) symptoms reflecting mild to severe AUDs; their adjusted odds of experiencing AUD symptoms at age 35 were higher than all other college and noncollege groups except non-residential fraternity members. Residential sorority members had higher odds of AUD symptoms at age 35 when compared with their noncollege female peers. ConclusionsNational longitudinal data confirm binge drinking and marijuana use are most prevalent among male fraternity residents relative to non-members and non-students. The increased risk of substance-related consequences associated with fraternity involvement was not developmentally limited to college and is associated with higher levels of long-term AUD symptoms during early midlife.

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.

Exploration of treatment matching of problem drinker characteristics to motivational interviewing and non-directive client-centered psychotherapy

Motivational Interviewing (MI) is a known effective intervention for alcohol use disorder (AUD). MI's mechanisms of action remain inconsistently substantiated, and research in this area has been reliant on identifying relationships through strength of association rather than experimental manipulation of active ingredients. In two previous studies, a pilot and a larger replication study, we disaggregated MI into its hypothesized active ingredients by creating three conditions: MI, Spirit Only MI (SOMI, in which evocation of change talk was proscribed), and a non-therapy condition (NTC). Results from both studies yielded equivalent findings across all three conditions. In the current analyses, data from both studies were combined to test five participant characteristics as moderators of MI's component parts: 1) severity of baseline drinking, 2) severe AUD (met 6 or more criteria), 3) baseline self-efficacy to moderate drinking, 4) mean daily confidence to resist heavy drinking in the week prior to treatment initiation, and 5) depression. There were no significant findings related to baseline drinking, severe AUD, or baseline self-efficacy. Confidence yielded a significant interaction effect. When participants had high baseline confidence, drinking for those in MI increased compared to those in SOMI. Depression also yielded a significant moderating effect such that in the context of higher depressive symptoms, receipt of either therapy reduced drinking relative to NTC. Results are discussed in light of existing literature on MOBC with MI and the potential role exploring ambivalence may play for participants with particular characteristics.

The gender risk-severity paradox for alcohol use disorder from adolescence through young adulthood.

A large proportion of the public health costs of alcohol use disorder (AUD) can be accounted for by a small percentage of severe cases with a chronic course starting in adolescence and persisting into adulthood. However, chronicity may be a less effective marker of AUD severity in women than men due to a gender risk-severity paradox wherein comparable levels of risk exposure yield more co-occurring problems for women than men with AUD. To model this paradox, we compared trajectories of alcohol and drug use problems, depression symptoms, and antisocial behavior from ages 17 to 29 in men and women with a persistent, desistent, or no history of AUD. Problems followed a quadratic trajectory (i.e., increases followed by decreases), with gender and AUD chronicity moderating age-related change. Specifically, persistent and desistent courses differentiated the severity of problems more effectively in men while chronicity had less utility for differentiating AUD severity in women.

Characterizing a Hidden Group of At-Risk Drinkers: Epidemiological Profiles of Alcohol-Use Disorder Diagnostic Orphans

ABSTRACTBackground: Drinkers who report some symptoms of alcohol-use disorder (AUD) but fail to meet full criteria are “diagnostic orphans.” To improve risk-reduction efforts, we sought to develop better epidemiologic profiles of this underrecognized subgroup. Methods: This study estimated the population prevalence and described AUD symptoms of diagnostic orphans using the 2012–2013 National Epidemiological Survey of Alcohol and Related Conditions-III. Multivariate logistic regression was used to model odds of being a diagnostic orphan or meeting mild, moderate, and severe AUD criteria versus no AUD symptoms. Models were adjusted for the complex survey design using sampling weights and survey procedures (e.g., proc surveylogistic). Results: Among drinkers, 14% of men and 11% of women were classified as diagnostic orphans. The most common symptoms were drinking more or for longer periods than intended, wanting or trying unsuccessfully to quit or cut back, and drinking in ways that increased risk of injury. We noted broad similarities between diagnostic orphans and mild/moderate AUD groups. There were no differences in odds of diagnostic orphans status by race/ethnicity; however, female gender was associated with lower odds of diagnostic orphan status and all levels of AUD. Individual history of AUD, family history of problem drinking, concurrent smoking, and concurrent marijuana use were associated with greater odds of problem drinking, with stronger associations as AUD severity increased. Conclusions: Diagnostic orphans remain a sizeable and overlooked population of problem drinkers. Clarifying the array of symptoms and cooccurring disorders can improve screening and facilitate alcohol risk-reduction intervention efforts.

Low-threshold extended-release naltrexone for high utilizers of public services with severe alcohol use disorder: A pilot study

Extended-release naltrexone (XRNTX) is an effective treatment for alcohol use disorder (AUD). We sought to evaluate the feasibility, acceptability, and preliminary effectiveness and cost-effectiveness of XRNTX delivered as a stand-alone service to persons with severe AUD who are high utilizers of multiple urgent and emergency medical services (HUMS). Of 15 HUMS persons with severe AUD selected based on chart review, 11 agreed to participate. Participants received a mean of 4.5 injections (range 2–7). Modest benefits from XRNTX were observed in terms of patients' Urge-to-Drink Score and the costs of emergency medical services utilized. Though limited by a small sample size, costs including client utilization and study related expenses during the post-enrollment period were less than client utilization costs in the pre-enrollment period. We also observed non-significant improvements in the number of drinking days, but no change in quality of life as measured by the EQ-5D. Eighty-eight percent of participants perceived XRNTX as helping with their drinking. Findings need to be replicated in a larger study, however if replicated, the cost savings could be substantial.

Decreased plasma concentrations of BDNF and IGF-1 in abstinent patients with alcohol use disorders.

The identification of growth factors as potential biomarkers in alcohol addiction may help to understand underlying mechanisms associated with the pathogenesis of alcohol use disorders (AUDs). Previous studies have linked growth factors to neural plasticity in neurocognitive impairment and mental disorders. In order to further clarify the impact of chronic alcohol consumption on circulating growth factors, a cross-sectional study was performed in abstinent AUD patients (alcohol group, N = 91) and healthy control subjects (control group, N = 55) to examine plasma concentrations of brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1) and IGF-1 binding protein-3 (IGFBP-3). The association of these plasma peptides with relevant AUD-related variables and psychiatric comorbidity was explored. The alcohol group was diagnosed with severe AUD and showed an average of 13 years of problematic use and 10 months of abstinence at the moment of participating in the study. Regarding common medical conditions associated with AUD, we observed an elevated incidence of alcohol-induced liver and pancreas diseases (18.7%) and psychiatric comorbidity (76.9%). Thus, AUD patients displayed a high prevalence of dual diagnosis (39.3%) [mainly depression (19.9%)] and comorbid substance use disorders (40.7%). Plasma BDNF and IGF-1 concentrations were significantly lower in the alcohol group than in the control group (p<0.001). Remarkably, there was a negative association between IGF-1 concentrations and age in the control group (r = -0.52, p<0.001) that was not found in the alcohol group. Concerning AUD-related variables, AUD patients with liver and pancreas diseases showed even lower concentrations of BDNF (p<0.05). In contrast, the changes in plasma concentrations of these peptides were not associated with abstinence, problematic use, AUD severity or lifetime psychiatric comorbidity. These results suggest that further research is necessary to elucidate the role of BDNF in alcohol-induced toxicity and the biological significance of the lack of correlation between age and plasma IGF-1 levels in abstinent AUD patients.

Desistance and Severity of Alcohol Use Disorder: A Lifespan-Developmental Investigation.

Key to an understanding of alcohol use disorder (AUD) are the drinking-related reductions that begin in young adulthood and continue throughout the adult lifespan. Research is needed to precisely characterize the form of these reductions, including possible developmental differences across the lifespan. Using U.S.-representative data, we estimated multiple-group Markov models characterizing longitudinal transitions among five drinking statuses and differences in transition patterns across six adult age periods. While past research indicates relative developmental stability in overall AUD-desistance rates, we found far higher rates of Severe-AUD desistance in young adulthood relative to later ages. Especially considering the dramatic change reflected by Severe-AUD desistance (from 6+ symptoms to 0-1 symptoms), this result indicates a substantial developmental shift, with Severe-AUD-desistance rates peaking at 43-50% across ages 25-34 and then dropping to 22-24% across ages 35-55. We discuss implications regarding practical significance of young-adult "maturing out" and predictions regarding lifespan variability in desistance mechanisms.

An Examination of Behavioral and Neuronal Effects of Comorbid Traumatic Brain Injury and Alcohol Use

BackgroundChronic alcohol use disorders (AUDs) and traumatic brain injury (TBI) are highly comorbid and share commonly affected neuronal substrates (i.e., prefrontal cortex, limbic system, and cerebellum). However, no studies have examined how combined physical trauma and heavy drinking affect neurocircuitry relative to heavy drinking alone. MethodsThe current study investigated whether comorbid AUDs and mild or moderate TBI (AUDs+TBI) would negatively affect maladaptive drinking behaviors (n = 90 AUDs+TBI; n = 62 AUDs) as well as brain structure (i.e., increased atrophy; n = 62 AUDs+TBI; n = 44 AUDs) and function (i.e., activation during gustatory cue reactivity; n = 55 AUDs+TBI; n = 37 AUDs) relative to AUDs alone. ResultsParticipants reported a much higher incidence of trauma (59.2%) compared with the general population. There were no differences in demographic and clinical measures between groups, suggesting that they were well matched. Although maladaptive drinking behaviors tended to be worse for the AUDs+TBI group, effect sizes were small and not statistically significant. Increased alcohol-cue reactivity was observed in bilateral anterior insula and orbitofrontal cortex, anterior cingulate cortex, medial prefrontal cortex, posterior cingulate cortex, dorsal striatum, thalamus, brainstem, and cerebellum across both groups relative to a carefully matched appetitive control. However, there were no significant differences in structural integrity or functional activation between AUDs+TBI and AUDs participants, even when controlling for AUD severity. ConclusionsCurrent results indicate that a combined history of mild or moderate TBI was not sufficient to alter drinking behaviors and/or underlying neurocircuitry at detectable levels relative to heavy drinking alone. Future studies should examine the potential long-term effects of combined alcohol and trauma on brain functioning.

TLR4 Methylation Moderates the Relationship Between Alcohol Use Severity and Gray Matter Loss.

Alcohol use disorders (AUDs) are associated with decreased gray matter, and neuroinflammation is one mechanism through which alcohol may confer such damage, given that heavy alcohol use may promote neural damage via activation of toll-like receptor 4 (TLR4)-mediated inflammatory signaling cascades. We previously demonstrated that TLR4 is differentially methylated in AUD compared with control subjects, and the present study aims to extend this work by examining whether TLR4 methylation moderates the relationship between alcohol use and gray matter. We examined TLR4 methylation and gray matter thickness in a large sample (N = 707; 441 males) of adults (ages 18-56) reporting a range of AUD severity (mean Alcohol Use Disorders Identification Test score = 13.18; SD = 8.02). We used a series of ordinary least squares multiple regression equations to regress gray matter in four bilateral brain regions (precuneus, lateral orbitofrontal, inferior parietal, and superior temporal) on alcohol use, TLR4 methylation, and their interaction, controlling for demographic, psychological, and other substance use variables. After we corrected for multiple tests, a significant Alcohol × TLR4 Methylation interaction emerged in the equations modeling left precuneus and right inferior parietal gray matter. Follow-up analyses examining the nature of these interactions demonstrated a significant negative association between alcohol and precuneus and inferior parietal gray matter in individuals with low TLR4 methylation, but no relationship between alcohol and gray matter in the high methylation group. These findings suggest that TLR4 methylation may be protective against the damage conferred by alcohol on precuneus and inferior parietal gray matter, thereby implicating TLR4 for further investigation as a possible AUD treatment target.

A qualitative exploration of social support during treatment for severe alcohol use disorder and recovery

IntroductionSevere alcohol use disorder (AUD) affects multiple aspects of an individual's life as well as their loved ones' lives. Perceived social support has the potential to help or hinder recovery efforts. MethodsIn this analysis we seek to understand the changes of social networks among individuals with severe AUD (n=33) throughout their recovery process and the potential relationship between the quality and nature of those networks and sustained sobriety as they transition from an inpatient research facility providing rehabilitation treatment back to the community. Interviews were conducted in 2014 and 2015. We conducted in-depth thematic analysis of themes related to social support using an exploratory approach. ResultsThe most common types of social support mentioned in both inpatient and outpatient settings were instrumental and emotional. Participants most frequently mentioned Alcoholics Anonymous (AA), an abstinence-based support system, as a source of support and often used the inpatient program as an exemplar when describing their ideal social networks. ConclusionThese data provide insight into the complexity of the issues and barriers that individuals in recovery may be facing across “transition periods.” From an intervention standpoint, it may be beneficial to focus on helping people choose environments and their accompanying social contexts and networks that are most conducive to recovery. Further elucidating the concept of social support and its role in recovery could provide information on unique needs of individuals and guide clinicians in engaging patients to develop new or sustain healthy existing social networks that result in continued sobriety.

Association of Attention-deficit Hyperkinetic Disorder with Alcohol Use Disorders in Fishermen.

Introduction:Alcohol use is a widely prevalent problem and poses hazard during work for certain groups such as fishermen. Disorders such as Attention-Deficit/Hyperkinetic Disorder (ADHD) correlate with early onset and greater severity of alcohol use disorders.Aims:We planned to study the frequency of ADHD among fishermen in a fishing hamlet of southern India using adult ADHD self-reported scale (ASRS) and correlated with the severity of alcohol use disorder as evidenced by age at initiation of alcohol use, presence of harmful use, or dependence use as defined by Alcohol Use Disorders Identification Test (AUDIT).Subjects and Methods:This was a community-based interview using AUDIT questionnaire for severity of alcohol use and the ASRS to detect ADHD.Results:The prevalence of adult ADHD among fishermen in this study was 25.7% using the critical items of the ASRS. ADHD was about twice as likely in participants with dependence as those without dependence (odds ratio = 2.10). ADHD was also more likely in participants with onset of use before 30 years of age than others (25.1% vs. 15.4%) (P = 0.27).Discussion:We found a high frequency of alcohol use among fishermen (79.8%). However, only 9.9% had alcohol dependence which is higher than the general population (2.3%) in the region. Fishermen with alcohol dependence were twice as likely to have ADHD as those without alcohol dependence.Conclusion:In a community-based survey of fishermen, the prevalence of alcohol dependence was about 10%. The presence of alcohol dependence predicted a two times higher likelihood of ADHD among fishermen than those without alcohol dependence.

Alcohol use disorder increases the risk of necrotizing fasciitis: A nationwide retrospective cohort study.

This nationwide retrospective cohort study determined the association between alcohol use disorder (AUD) and the risk of necrotizing fasciitis (NF).This study used health insurance claims data of 52,212 in-patients with AUD and 208,848 controls randomly frequency-matched by age and sex at a 1:4 ratio. The AUD cohort included patients newly diagnosed with AUD between January 1, 2000 and December 31, 2008. The NF event occurrence was observed until December 31, 2011. We used the Kaplan–Meier method to present the cumulative incidence curve and Cox proportional hazard models to depict the risk of NF in patients with AUD.The incidence of NF was 19.4 per 10,000 person-years in the AUD cohort, which was nearly 7.73-fold higher than that in the comparison cohort (2.54 per 10,000 person-years). After adjustment for age, sex, and comorbidities, the patients with AUD exhibited a 3.55-fold higher risk of NF than did the controls (hazard ratio [HR] = 3.55, 95% confidence interval [CI] = 3.00–4.20). Nevertheless, in the AUD groups without any comorbidity, patients with AUD exhibited a significant 15.2-fold higher risk of NF than did the comparison cohort (HR = 15.2, 95% CI = 10.9–21.3). Moreover, the adjusted HRs of NF risk with respect to the severity of AUD were 2.15 (95% CI = 1.76–2.62), 4.54 (95% CI = 3.67–5.62), and 10.7 (95% CI = 8.66–13.2) for mild, moderate, and severe AUD, respectively.This study indicated that AUD should be considered an independent and significant risk factor for NF.