Severe Alcohol Use Disorder Research Articles

Augmenting outpatient alcohol treatment as usual with online approach bias modification training: A double-blind randomized controlled trial

Previous research shows that automatic tendency to approach alcohol plays a causal role in problematic alcohol use and can be retrained by Approach Bias Modification (ApBM). ApBM has been shown to be effective for patients diagnosed with alcohol use disorder (AUD) in inpatient treatment. This study aimed to investigate the effectiveness of adding an online ApBM to treatment as usual (TAU) in an outpatient setting compared to receiving TAU with an online placebo training.139 AUD patients receiving face-to-face or online treatment as usual (TAU) participated in the study. The patients were randomized to an active or placebo version of 8 sessions of online ApBM over a 5-week period. The weekly consumed standard units of alcohol (primary outcome) was measured at pre-and post-training, 3 and 6 months follow-up. Approach tendency was measured pre-and-post ApBM training.No additional effect of ApBM was found on alcohol intake, nor other outcomes such as craving, depression, anxiety, or stress. A significant reduction of the alcohol approach bias was found. This research showed that approach bias retraining in AUD patients in an outpatient treatment setting reduces the tendency to approach alcohol, but this training effect does not translate into a significant difference in alcohol reduction between groups. Explanations for the lack of effects of ApBM on alcohol consumption are treatment goal and severity of AUD. Future ApBM research should target outpatients with an abstinence goal and offer alternative, more user-friendly modes of delivering ApBM training.

The impact of Covid-19 on the severity of alcohol use disorder: the significance of dual disorders

The impact of Covid-19 on the severity of alcohol use disorder: the significance of dual disorders

Harm Reduction Strategies for Severe Alcohol Use Disorder in the Context of Homelessness: A Rapid Review.

Severe alcohol use disorder (AUD) in the context of housing instability remains one of the most complex health and social issues. Homelessness is related to increased vulnerability to stigma, marginalization and harmful ways of alcohol consumption, including non-beverage alcohol use (NBA). As a result, severe intoxication, alcohol poisoning, injury and death are common occurrences. Although harm minimization strategies have been readily proposed and examined in the context of drug use, applying the same principles to severe AUD remains controversial within the research and treatment community. This article summarizes the emerging research on managed alcohol programs to increase awareness about alcohol-related strategies that address severe AUD and provide other wrap-around supports such as housing, health and social services to mitigate various harms, including COVID-19.

Assessment of suitability of Indian disability evaluation scale (IDEAS) to assess disability among persons with alcohol use disorders

Background: Alcohol use disorders (AUD) contribute substantially to the global disease and disability burden. The Indian Disability Evaluation and Assessment Scale (IDEAS) has seldom been used to measure disability in those with AUDs. Objectives: To assess the validity of IDEAS to quantify disability among persons with AUDs by measuring the level of agreement between IDEAS and World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.0). Materials and Methods: A cross-sectional measurement of disability and quality of life (QoL) measures was carried out among those seeking treatment for AUDs. Correlational analyses and Bland–Altman plot analysis were done to measure the level of agreement between IDEAS and WHODAS2.0. Results: The scores on the WHODAS and IDEAS show statistically significant positive correlation (Rho: 0.435, P = 0.0001) indicating convergent validity. There was a significant level of agreement of disability scores using both tools. The IDEAS score had significant negative correlation with the brief version (WHOQoL BREF-Hindi) measures (Rho: –0.301, P = 0.003) indicating divergent validity. Those with greater severity of AUD had higher IDEAS scores (b = 1.9, P = 0.046). Conclusions: IDEAS scores correlate with disability scores measured with WHODAS 2.0 and QoL assessment using WHOQOL-BREF Hindi in those with AUDs. This instrument can be used to quantify disability and provide socioeconomic compensations to these individuals.

The relationship between the clinical characteristics of patients with alcohol use disorder and drinking motives

Changes in the motivational structure are considered one of the central characteristics of Alcohol Use Disorder (AUD). The latest motivational models of AUD were developed based on recent neurobiological research findings. According to these models, three main drinking motives can be identified — drinking as a reward, as a relief, and as a habit. The goal of the study was to explore the main differences in the psychological and clinical characteristics of patients with AUD depending on the predominant drinking motive. For this study, 76 individuals (50 men (65.79 %), average age 42.25 ± 9.36 y. o. (М ± SD)) undergoing in-patient treatment for the symptoms of AUD were recruited. The following methods were used: clinical interview, UCLA Reward, Relief, Habit Drinking Scale, Penn Alcohol Craving Scale, Obsessive Compulsive Drinking Scale, Hospital Anxiety and Depression Scale, Snaith-Hamilton Pleasure Scale, Behavioral Activation Scale/Behavioral Inhibition Scale, and Cognitive Emotion Regulation Questionnaire. The participants were divided into three groups depending on their predominant drinking motive. The participants with the predominant “drinking as a habit” motivation reported using strategies of “refocusing on planning” and “positive reappraisal” significantly less often. At the same time, the intensity of “drinking as a habit” motive positively correlated with the severity of anxiety and depressive symptoms, and negatively — with the strength of the behavioral inhibition system. The participants with the “drinking as a reward” motivation reported having greater reward responsiveness as compared to the combined group of participants with the relief and habit drinking motives. The intensity of “drinking as a relief” motivation positively correlated with the severity of depressive symptoms. It was also noted that the participants, who did not identify the predominant drinking motive, reported having decreased levels of emotional and physical functioning and less frequent use of the certain adaptive emotional regulation strategies. In contrast with the previous studies, the relationship between the prevailing drinking motives and characteristics of drinking or the severity of AUD was not identified.

An eye-tracking study of biased attentional processing of emotional faces in severe alcohol use disorder

BackgroundSocial cognition impairments in severe alcohol use disorder (SAUD) are increasingly established. However, fundamental aspects of social cognition, and notably the attentional processing of socio-affective information, remain unexplored, limiting our understanding of underlying mechanisms. Here, we determined whether patients with SAUD show attentional biases to specific socio-affective cues, namely emotional faces. MethodIn a modified dot-probe paradigm, 30 patients with SAUD and 30 demographically matched healthy controls (HC) were presented with pairs of neutral-emotional (angry, disgusted, happy, sad) faces while having their eye movements recorded. Indices of early/automatic (first fixations, latency to first fixations) and later/controlled (number of fixations, dwell-time) processes were computed. ResultsPatients with SAUD did not differ from HC in their attention to angry/disgusted/sad vs. neutral faces. However, patients with SAUD fixated/dwelled less on happy vs. neutral faces in the first block of stimuli than HC, who presented an attentional bias to happy faces. LimitationsSample-size was determined to detect medium-to-large effects and subtler ones may have been missed. Further, our cross-sectional design provides no explanation as to whether the evidenced biases precede or are a consequence of SAUD. ConclusionsThese results extend the social cognition literature in SAUD to the attentional domain, by evidencing the absence of a controlled attentional bias toward positive social cues in SAUD. This may reflect reduced sensitivity to social reward and could contribute to higher order social cognition difficulties and social dysfunction.

Association of supply sources of alcohol and alcohol-related harms in adolescent drinkers: the baseline characteristics of a high school cohort across Thailand

BackgroundThe main objective of this study was to investigate the association between parental supply of alcohol, alcohol–related harms, and the severity of alcohol use disorder in Thai 7th grade middle school students.MethodsA cross–sectional descriptive study obtained the baseline data from the project named the Thailand Parental Supply and Use of Alcohol, Cigarettes & Drugs Longitudinal Study Cohort in Secondary School Students in 2018. The sample size was 1187 students who have ever sipped or drank alcohol in the past 12 months. Pearson’s Chi square, binary logistic regression, and ordinal logistic regression are applied in the analysis.ResultsA single source of parental supply is not significantly associated with any alcohol-related harm and the severity of alcohol use disorder, while parental supply with peers and siblings supply of alcohol plays an important role in both outcomes. The increasing number of sources of alcohol supply increases the risk of alcohol–related harm and the severity of alcohol use disorder. Other risk factors found in both associations included binge drinking, alcohol flushing, low household economic status, distance from the student’s family, and poor academic performance. Gender, exposure to alcohol ads on social media and location of residency were not associated with alcohol–related harms or severity of alcohol use disorder.ConclusionsThe results did not support parental guidance in teaching or giving children a drink or sip of alcohol within family to prevent related harms when drinking outside with their peers.

Neural cue reactivity is not stronger in male than in female patients with alcohol use disorder.

Males consume more alcohol than females, and alcohol use disorder (AUD) is more prevalent in males than females. However, females progress faster to AUD. Sex differences in neural alcohol cue reactivity were previously observed in young social drinkers, indicating a role of hypersensitivity to alcohol-related cues in very early stages of addiction. To our knowledge, this is the first study on patients diagnosed with AUD to test sex differences in neural reactivity to alcohol cues in order to widen previous findings. We analyzed data from previous studies, using a well-established functional magnetic resonance imaging (fMRI) paradigm to compare neural reactivity to alcohol cues between 42 female and 124 male patients with AUD (mean age 45 and 46 years) in predefined regions of interest that were implicated by previous studies (ventral and dorsal striatum as well as caudate, putamen, amygdala, hippocampus, insula, anterior cingulate cortex, and medial prefrontal cortex) using independent samples t-tests. Post-hoc, effect size calculations were performed. Throughout all nine regions of interest, we found no statistically significant sex differences in neural reactivity toward alcoholic pictures alone or in comparison to neutral pictures (p > 0.05, FDR-corrected). Post-hoc effect size estimates indicated a magnitude between 0.137 and 0.418 (Hedge's g) on alcohol reactivity to alcohol cues compared to neutral cues and indicate very small to less than medium effect sizes in the direction of higher cue reactivity in female patients. Previous studies showed sex differences in neural alcohol cue reactivity in younger social and problematic alcohol drinkers, i.e., stronger striatal cue-reactivity in males. After correction for multiple comparisons, we did not observe significant sex differences in a cohort of middle-aged females and males with AUD. Sex differences that are present during early phases of addiction development might disappear at later stages of AUD and might thus be considered as clinically less relevant in patients with more severe AUD.

Assessing Clinically Significant Cognitive Impairment Using the NIH Toolbox in Individuals with Co-occurring Serious Mental Illness and Alcohol Use Disorder.

Serious mental illnesses (SMI) and alcohol use disorder (AUD) co-occurrence (SMI-AUD) is common, yet little is known about the prevalence and risk factors of cognitive impairment for this population. We used the National Institutes of Health (NIH) Toolbox to identify clinically significant cognitive impairment (CSCI), describe the cognitive profile, and investigate whether psychiatric and AUD severity measures are associated with CSCI in individuals with SMI-AUD. CSCI was defined as 2 or more fully corrected fluid subtest T scores below a set threshold based on an individual's crystalized composite score. Psychiatric severity measures included the Structured Clinical Interview for DSM-V (SCID-5) for SMI diagnosis and the Positive and Negative Syndrome Scale. AUD severity measures included the SCID-5 for AUD symptom severity score, years of alcohol use, and urine ethyl glucuronide levels. A multivariable logistic regression was used to investigate the adjusted effects of each variable on the probability of CSCI. Forty-one percent (N = 55/135) of our sample had CSCI compared with the base rate of 15% from the NIH Toolbox normative sample. Subtests measuring executive function most frequently contributed to meeting criteria for CSCI (Flanker and Dimensional Change Card Sort). A history of head injury ( P = 0.033), increased AUD symptom severity score ( P = 0.007) and increased negative symptom severity score ( P = 0.027) were associated with CSCI. Cognition should be considered in the treatment of people with SMI-AUD, particularly in those with history of brain injury, higher AUD symptom severity, and/or negative symptom severity.

Childhood Trauma and Dissociation Correlates in Alcohol Use Disorder: A Cross-Sectional Study in a Sample of 587 French Subjects Hospitalized in a Rehabilitation Center.

This study aimed to determine whether dissociative symptoms and childhood trauma (CT) may help identify a specific subgroup of patients among those hospitalized for alcohol use disorder (AUD). We assessed 587 patients hospitalized for an AUD in a French addiction rehabilitation center (cross-sectional study) regarding dissociative symptoms (DES-taxon), childhood trauma (CTQ), depression (BDI), anxiety (STAI-state and STAI-trait), posttraumatic stress disorder (PTSD; PCL-5), and AUD symptoms (AUDIT). We ran a hierarchical cluster analysis and compared the clusters in terms of dissociation and CT, as well as AUD, depressive, anxiety, and PTSD symptoms. We identified three clusters of patients: (1) patients with low AUD severity and low dissociation (LALD); (2) patients with high AUD severity and low dissociation (HALD); (3) patients with high AUD severity and high dissociation (HAHD). Patients from the HAHD group had significantly higher dissociation and more severe depression, anxiety, and PTSD symptoms than those with LALD and HALD. They also reported more emotional and sexual abuse than those with LALD. Among patients with an AUD, those with high dissociation may constitute an independent subgroup that exhibits a higher prevalence for CT and higher AUD severity, as well as higher depression, anxiety, and PTSD symptoms. Patients with more severe AUD and associated psychiatric symptoms should be systematically screened for dissociation and provided with tailor-based treatments.

Determinants of health-related quality of life in recently detoxified patients with severe alcohol use disorder

BackgroundHealth-related quality of life (HRQoL) is an important clinical outcome in Alcohol Use Disorder (AUD) and is considered as a relevant indicator of treatment success. While a better understanding of the factors affecting HRQoL would enable to adjust patients’ care to favour treatment outcome, the determinants of HRQoL in AUD remain unclear. This study aims at describing HRQoL in AUD patients and at identifying its best predictors.Methods53 recently detoxified patients with severe AUD (sAUD) underwent a cognitive assessment and filled in a HRQoL questionnaire dedicated to AUD patients (Alcohol Quality of Life Scale; AQoLS), as well as questionnaires concerning socio-demographics, alcohol history, sleep quality, depression, anxiety and impulsivity. 38 healthy controls (HC) underwent the same assessment (except AQoLS) in order to identify the altered cognitive and clinical variables that could potentially be determinants of HRQoL in sAUD.ResultssAUD patients reported that alcohol affects their HRQoL mainly in the “negative emotions”, “control”, “relationships”, and “sleep” domains. Compared to HC, they were impaired on episodic memory, working memory, executive functions, and processing speed tasks. They also reported lower sleep quality, higher depression, anxiety and impulsivity. No association was found between AQoLS total score and socio-demographics, cognitive performance, or sleep quality in patients. We found a significant correlation between HRQoL and depression/anxiety as well as impulsivity. Anxiety and impulsivity were indeed the only significant predictors of HRQoL, explaining 47.7% of the variance.ConclusionAnxiety and impulsivity are crucial determinants of HRQoL in recently detoxified sAUD patients. Since anxiety and impulsivity are frequent issues in addiction and especially in AUD, they should be particularly considered by clinicians to favour treatment outcomes.

Early Improvement of Neuropsychological Impairments During Detoxification in Patients with Alcohol Use Disorder.

To assess recovery of alcohol-related neuropsychological deficits in a group of patients with pure severe alcohol use disorder (AUD) during a detoxification program using the Brief Evaluation of Alcohol-Related Neuropsychological Impairment (BEARNI) test. Thirty-two patients with severe AUD using DSM-IV criteria (24 men, mean age = 45.5 ± 6.8years old) were assessed using the BEARNI 8 ± 2days after alcohol cessation (T1) and then were reassessed within 18 ± 2days after alcohol cessation (T2). The primary study endpoint was the number of patients initially impaired at T1 who recovered cognitive functions at T2 assessment. At T1, 59% (n = 19) patients with pure severe AUD had at least one impaired cognitive function assessed by the BEARNI. At T2, 63% of the patients with AUD with deficits at T1 had normal BEARNI cognitive scores (χ2 = 7.7, P = 0.005); specifically, the percentages of participants with normal subtest scores were 63% on memory (χ2 = 12.4, P = 0.0004), 100% on verbal fluency (χ2 = 16; P = <0.0001), 60% on alphabetical span (χ2 = 12.8; P = 0.0003) and 67% on visuospatial (χ2 = 15, P = 0.0001). The cognitive impairments of two-thirds of patients with pure AUD included in the present study recovered within 18days of abstinence, earlier than reported in previous studies.

Post-Combat-Injury Opioid Prescription and Alcohol Use Disorder in the Military

Previous studies have identified combat exposure and combat traumatic experience as problematic drinking risk factors. Increasing evidence suggests that opioid use increases the risk of alcohol use disorder. This study investigated the association between opioid prescription use after injury and (1) alcohol use disorder and (2) severity of alcohol use disorder among deployed military servicemembers. Deidentified health records data of 9,029 deployed servicemembers from a retrospective cohort study were analyzed. Data were randomly selected from the Department of Defense Trauma Registry and included servicemembers with combat injuries during deployment in Iraq or Afghanistan (2002-2016). Pharmacy records and International Classification of Diseases, Ninth and Tenth Revision diagnosis codes were used. Three groups were identified (no opioid prescription use, nonpersistent opioid prescription use, and persistent opioid prescription use) and were compared on the basis of alcohol use disorder risk using Cox proportional hazard models. Data analyses were performed in 2021. Of the 9,029 servicemembers with combat injury, 2,262 developed alcohol use disorder (1,322 developed severe alcohol use disorder). Compared with no opioid prescription use, increased alcohol use disorder risk was associated with persistent opioid prescription use, with a hazard ratio of 1.13 (95% CI=1.02, 1.26). After covariate adjustment, increased risk remained statistically significant (hazards ratio=1.24; 95% CI=1.10, 1.39). There was no significant difference in alcohol use disorder risk between no opioid prescription use and nonpersistent opioid prescription use. The risk of severe alcohol use disorder did not vary by opioid use among servicemembers with alcohol use disorder diagnosis. The findings of the study suggest that the incidence of alcohol use disorder was higher among injured servicemembers with persistent opioid prescription use than among those without opioid use. If replicated in prospective studies, the findings highlight the need for clinicians to consider the current and history of alcohol use of patients in initiating treatment involving opioids.

Plasma tau, NfL, GFAP and UCHL1 as candidate biomarkers of alcohol withdrawal-associated brain damage: A pilot study.

In this translational study, we investigated the plasma tau protein, neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCHL1), which are established biomarkers of neurological injury, as predictive biomarkers of alcohol withdrawal-associated brain toxicity. In the clinical study, patients with severe alcohol use disorder (AUD) on D1 of hospitalization for alcohol cessation (AC) (N = 36) were compared to severe AUD patients with at least 3 months of abstinence (N = 16). Overall, patients were 40 men (76.9%), aged 49.8 years [SD ±9.9]. Tau, NfL, GFAP and UCHL1 levels were measured using SIMOA and analysed with a quasipoisson regression model adjusted for age and sex. The NfL level was higher in the AC group (p = 0.013). In the AC group, the tau (p = 0.021) and UCHL1 (p = 0.021) levels were positively associated with the dose of diazepam per weight, and the tau (p = 0.045), NfL (p = 4.9 × 10-3 ) and UCHL1 (p = 0.036) levels were higher in the presence of signs of Wernicke's encephalopathy (n = 9). In the preclinical study, NfL and GFAP levels were assessed in the alcohol deprivation effect (ADE) procedure (N = 17) and control Wistar rats (N = 15). Furthermore, ADE rats were prospectively assessed: after 24 h (T1) and 3 weeks of AC (T2) (paired-samples Wilcoxon and Mann-Whitney tests). The NfL level was higher in the ADE model than in the control rats at both T1 and T2 (p = 0.033 and p = 1.3 × 10-3 ) and higher at T2 than at T1 (p = 0.040). Plasma tau, NfL and UCHL1 are potential biomarkers of brain suffering during alcohol withdrawal.

Conceptualization of Alcohol Use Disorder (AUD): Can Theoretical or Data Driven Approaches Improve the Construct Validity of AUD?

The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) definition of alcohol use disorder (AUD) has been criticized on the ground that it leads to high prevalence rates and a highly heterogeneous group. Failure of the DSM to consider development may exacerbate these issues (e.g., conflating experimentation with problematic drinking). Wakefield and Schmitz (2015) proposed a definition of AUD that comports to the harmful dysfunction (HD) theory of mental disorders while data-driven approaches have suggested that key symptoms like craving, failure to fulfill obligations, hazardous use, and alcohol use despite interpersonal consequences are optimal (OPT) criteria for AUD (Stevens et al., 2019). Prior work suggests both may reduce the likelihood of conflating experimentation with problematic drinking during key developmental periods. Continuous and categorical structural equation models of DSM, HD, and OPT criteria were compared on A) prevalence, B) patterns of alcohol use in adolescence (age 10-18 years) C) early AUD symptoms in adolescence (age 13-15) and D) concurrent alcohol use and alcohol consequences to assess prospective and concurrent convergent validity using a longitudinal design (N = 765; ages 10-21 years). Results supported prior literature that the HD and OPT criteria produced a smaller diagnostic class than the DSM. Furthermore, the HD and OPT criteria had larger and more consistent effects with validators than the DSM with the OPT criteria having the largest effects and the least criteria. Future work should consider whether the OPT or HD criteria better reflect AUD severity than the DSM across development.

History of Delirium Tremens in AUD Patients in Treatment: Relationship to AUD Severity and Other Factors.

IntroductionDelirium tremens (DT) occurs after stopping prolonged, high alcohol intake and may be life-threatening if untreated. We need to know about clinical correlates of DT in order to provide the best clinical care.MethodsAt admission to inpatient treatment a cohort of 114 alcohol use disorder (AUD) patients were interviewed and examined concerning psychiatric diagnosis and symptoms, trauma experiences and alcohol related measures and if they had experienced DT.ResultsTwenty-four percent of the patients reported a life-time experience of DT. These patients were predominantly males and had lower educational level. More of the patients in the DT than the non-DT group reported at least one suicide attempt, were diagnosed with PTSD, and dropped out of treatment. Also, having parents with alcohol problems was more common among these patients, and they reported a longer duration of problematic drinking and a higher number of drinks needed to feel an effect of drinking. In the multivariable adjusted analysis only a diagnosis of PTSD (OR=5.71; 95% confidence interval (CI): 1.34–24.31) and duration of problematic drinking with a 6% increase in risk for every year (OR=1.06; 95% CI: 1.01–1.11) remained significant risk factors for having DT experience.Discussion and conclusionHaving experienced DT was more prevalent in the current investigation than in earlier studies. Patients that had experienced DT seemed to have more serious AUD, especially signified by a longer duration of drinking. These patients seemed to have many clinical disadvantages including more drop-out and higher suicide rate. PTSD could be a risk factor for DT but may also follow the DT experience.

In Case You Haven't Heard…

Are you a perfectionist? If so, you have a lot in common with many professionals, including doctors, and you have a propensity for alcohol use disorder (AUD) because that's engraved in your personality, a new study has found. According to the study, some kinds of perfectionism play a role in the development of severe AUD. The study, conducted by researchers in Belgium, linked self‐oriented perfectionism (exaggerated performance standards placed on oneself), socially‐prescribed perfectionism (a perception of high expectations coming from other people), and other‐orientated perfectionism (setting unrealistically high standards for others), to vulnerability for severe AUD. The study was published in Alcoholism: Clinical &amp; Experimental Research. For more, see https://www.newswise.com/articles/perfectionism‐may‐be‐a‐risk‐factor‐for‐severe‐alcohol‐use‐disorder‐novel‐study‐shows

Patterns of Alcohol Consumption Among Individuals With Alcohol Use Disorder During the COVID-19 Pandemic and Lockdowns in Germany

Alcohol consumption (AC) leads to death and disability worldwide. Ongoing discussions on potential negative effects of the COVID-19 pandemic on AC need to be informed by real-world evidence. To examine whether lockdown measures are associated with AC and consumption-related temporal and psychological within-person mechanisms. This quantitative, intensive, longitudinal cohort study recruited 1743 participants from 3 sites from February 20, 2020, to February 28, 2021. Data were provided before and within the second lockdown of the COVID-19 pandemic in Germany: before lockdown (October 2 to November 1, 2020); light lockdown (November 2 to December 15, 2020); and hard lockdown (December 16, 2020, to February 28, 2021). Daily ratings of AC (main outcome) captured during 3 lockdown phases (main variable) and temporal (weekends and holidays) and psychological (social isolation and drinking intention) correlates. Of the 1743 screened participants, 189 (119 [63.0%] male; median [IQR] age, 37 [27.5-52.0] years) with at least 2 alcohol use disorder (AUD) criteria according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) yet without the need for medically supervised alcohol withdrawal were included. These individuals provided 14 694 smartphone ratings from October 2020 through February 2021. Multilevel modeling revealed significantly higher AC (grams of alcohol per day) on weekend days vs weekdays (β = 11.39; 95% CI, 10.00-12.77; P < .001). Alcohol consumption was above the overall average on Christmas (β = 26.82; 95% CI, 21.87-31.77; P < .001) and New Year's Eve (β = 66.88; 95% CI, 59.22-74.54; P < .001). During the hard lockdown, perceived social isolation was significantly higher (β = 0.12; 95% CI, 0.06-0.15; P < .001), but AC was significantly lower (β = -5.45; 95% CI, -8.00 to -2.90; P = .001). Independent of lockdown, intention to drink less alcohol was associated with lower AC (β = -11.10; 95% CI, -13.63 to -8.58; P < .001). Notably, differences in AC between weekend and weekdays decreased both during the hard lockdown (β = -6.14; 95% CI, -9.96 to -2.31; P = .002) and in participants with severe AUD (β = -6.26; 95% CI, -10.18 to -2.34; P = .002). This 5-month cohort study found no immediate negative associations of lockdown measures with overall AC. Rather, weekend-weekday and holiday AC patterns exceeded lockdown effects. Differences in AC between weekend days and weekdays evinced that weekend drinking cycles decreased as a function of AUD severity and lockdown measures, indicating a potential mechanism of losing and regaining control. This finding suggests that temporal patterns and drinking intention constitute promising targets for prevention and intervention, even in high-risk individuals.

Predicting severe alcohol use disorders in primary care using number of heavy drinking days.

Although screening for unhealthy alcohol use is becoming more common, severe alcohol use disorders (AUDs) associated with the most severe medical and socio-economic sequelae still often go unidentified in primary care. To improve identification of severe AUDs and aid clinical decision-making, we aimed to identify a threshold of heavy drinking days (HDDs) associated with severe AUDs. This cohort study analyzed electronic health record data of 138 765 adults who reported ≥ 1 HDD (4+ drinks/occasion for women and men aged ≥ 65 years, 5+ for men aged 18-64 years) during a 3-month period at a routine alcohol screening in primary care in a large Northern California, USA health-care system from 2014 to 2017. Our sample was 66.5% male, 59.7% white, 11.0% Asian/Pacific Islander, 5.0% black, 17.4% Latino/Hispanic and 7.0% other/unknown race/ethnicity; the mean age was 40.6years (standard deviation = 15.2). We compared sensitivity and specificity of different thresholds of the reported number of HDDs during a 3-month period for predicting severe AUD diagnoses in the following year, in the full sample and by sex and age. The prevalence of severe AUD diagnoses in the year after the screening was 0.6%. The optimal threshold predicting future severe AUD diagnoses in the full sample was ≥ 5 HDDs during a 3-month period [sensitivity = 68.9%, 95% confidence interval (CI) = 65.9, 72.0; specificity = 63.2%, 95% CI = 62.9, 63.4], but varied by sex and age. Women had a lower threshold than men (4 versus 6 HDDs), which decreased as women aged (from 5 HDDs among 18-24 years to 4 HDDs ≥ 25 years), but increased as men aged (from 5 HDDs among 18-24 years to 6 HDDs among 25-64 years, to 7 HDDs ≥ 65 years). Five or more heavy drinking days in a 3-month period may indicate heightened risk of future severe alcohol use disorder in an adult primary care population. The optimal thresholds are lower for women than for men, and thresholds decrease as women age but increase as men age.

Heterogeneity in Alcohol-Related Severity and Interests in Going to Treatment in Community Adults with Alcohol Use Disorder (AUD)

Rationale Alcohol use disorder (AUD) is highly prevalent among adults in the US and is associated with substantial personal and societal costs. Yet only a small percentage of adults with AUD initiate treatment, including those with severe AUD symptoms who are most in need of treatment. In this paper we use latent profile analysis (LPA) to describe differences in symptoms of AUD severity and alcohol-related consequences among untreated adults with severe AUD symptoms who were recruited from the community. Identification of such differences will result in better understanding of this population and will improve methods of treatment outreach. Method The LPAs were conducted on the baseline data of 403 (50% male, 77% White, M age = 40.74 with severe AUD recruited from the community and enrolled in a trial of an intervention designed to encourage treatment initiation. Participants reported no prior AUD treatment history. The LPAs were based on indicators of AUD severity, alcohol-related negative consequences, and self-reported intention to initiate AUD treatment. Results The LPAs revealed 4 profiles. Profile membership was predicted by baseline participant sex and whether they were living with a partner and was associated with baseline past 30-days alcohol consumption. Conclusions The findings characterize and describe the variability among adults in the community with untreated severe AUD on variables that tend to motivate such individuals to seek treatment, which could significantly advance treatment outreach efforts.