Unhealthy Alcohol Research Articles

Impact of Physicians’ Perception of Social Determinants of Health (SDoH) on the Practice of Lifestyle Medicine. Findings From a Family Physicians Survey

Lifestyle Medicine emphasizes evidence-based lifestyle changes to address chronic conditions Yet, concerns have emerged regarding its ability to address broader social determinants of health (SDoH). This study examines how family physicians’ perceptions of SDoH relate to their use of lifestyle medicine competencies. This cross-sectional survey was administered to 5770 family physicians. Participants rated the importance of LM core competencies and the impact of community conditions on patient health. Data analysis involved descriptive statistics, factor analysis, regression models, and t-tests. This study encompassed 447 responses. The findings revealed that while respondents recognized the effect of certain SDoH, such as access to unhealthy food (89%), alcohol (86%), and tobacco (83%), they showed less awareness of factors like racism and discrimination (53%), and access to parks (56%) or education (60%). Gender and the level of social deprivation in their area were significant factors influencing respondents’ perception of SDoH impact. Additionally, those who valued and used lifestyle medicine core competencies were more likely to acknowledge the influence of SDoH on patient health. Our findings suggest that comprehensive education on SDoH, especially with a focus on community aspects, is crucial across all levels of medical training to address this gap and ensure equitable care.

Phosphatidylethanol Can Improve Detection and Treatment of Unhealthy Alcohol Use.

Phosphatidylethanol Can Improve Detection and Treatment of Unhealthy Alcohol Use.

Unhealthy Alcohol Use: Screening and Behavioral Counseling Interventions.

Despite the increase in daily alcohol intake in recent decades and the implementation of national health screenings, effective management strategies for alcohol consumption remain outdated. This review evaluates intervention studies on screening and behavioral counseling for unhealthy alcohol use, with the aim of enhancing the effectiveness of interventions and improving health outcomes. On the basis of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation)- ADOLOPMENT framework, systematic reviews and randomized controlled trials were examined to investigate the effectiveness of screening and counseling interventions in reducing unhealthy alcohol use. Five key questions were generated, and an evaluation and quality assessment of existing systematic reviews and new evidence related to each key question were conducted. Updating the U.S. Preventive Services Task Force and Cochrane 2018 reviews, we identified five new randomized trials that evaluated screening and counseling interventions for unhealthy alcohol use. For Key Question 2, the sensitivity and specificity of the new screening studies were consistent with those of prior research. Brief interventions were confirmed to reduce alcohol use (Key Question 4a), although additional research is required for a wider array of health outcomes. One study highlighted the benefits of counseling interventions for newborn health indicators in pregnant women (Key Question 4b). No new evidence was found regarding the harms of screening (Key Question 3) or alcohol use reduction interventions (Key Question 5). This review supports the continued use of brief interventions to reduce alcohol consumption in highrisk groups and highlights the need for culturally tailored research in Korea.

Improving screening, brief intervention and referral to treatment for unhealthy alcohol use in diverse, low-resourced primary care clinics.

Implementation of screening brief intervention and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) remains low in primary care. ANTECEDENT (Partnerships to Enhance Alcohol Screening, Treatment, and Intervention) was a practice-facilitator led implementation study to increase SBIRT and MAUD use in diverse primary care clinics. From November 2019 - April 2023, we conducted a convergent parallel mixed methods evaluation. Participants were small and medium-sized primary care clinics in the Northwestern U.S. Clinics received foundational support (i.e., baseline/exit assessment, access to SBIRT Oregon website) and the option for supplemental implementation support (e.g., practice facilitation, expert consultation) over the 15-month intervention to improve SBIRT and MAUD. Qualitative and quantitative data regarding clinic characteristics, implementation strategies, and SBIRT/MAUD outcomes were collected through practice facilitator interviews, periodic reflections and clinic contact logs, interviews, pre-post surveys, and electronic health record (EHR) queries. Quantitative analyses included descriptive statistics, logistic regression, and the Wilcoxon sign-ranked test. Qualitative analysis took an immersion crystallization approach. Data were reviewed in a matrix to evaluate intervention adoption, implementation, and effectiveness. We recruited 75 unique clinics; 66 participated and 48 (73%) completed the study. Eight participating clinics chose to receive foundational support only (12%) while 58 chose to engage in supplemental support (88%) activities. Clinics that received supplemental support and completed the intervention (n = 42) engaged in practice facilitation (Mean: 293min, range: 75-550min); data review (38%), HIT support (31%), expert consultation (19%), and peer-to-peer learning (5%). Pre- and post-intervention assessments showed significant improvement in self-reported SBIRT process outcomes. Performance data improved among the subset of completing clinics able to produce data (n = 17). Clinics described positive experiences with ANTECEDENT support and highlighted remaining barriers to SBIRT and MAUD implementation. Participating clinics engaged in a diverse range of supportive activities. A flexible approach using practice facilitation and implementation support could be helpful for low-resourced primary care clinics in improving SBIRT and MAUD for unhealthy alcohol use.

Factors Associated With Motivation to Reduce Alcohol Use Among Patients With Chronic Liver Disease.

Alcohol use is prevalent among hepatology clinic patients with chronic liver disease (CLD). We explored factors associated with the importance and confidence dimensions of motivation to reduce drinking. Participants (N = 121) with unhealthy alcohol use (i.e., over NIH guidelines) receiving care in hepatology clinics from a safety-net hospital (SN, N = 54) and two Veterans Affairs Healthcare Systems (VA, N = 67) were enrolled in an alcohol intervention trial from March 2022 through October 2023. Baseline assessments included Generalised Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-8), Alcohol Use Disorders Identification Test (AUDIT), COVID-19 stress; and measures of importance and confidence to decrease alcohol use (readiness rulers, scales of 1-10). Liver disease aetiology and severity were extracted from electronic health records. We performed multivariable linear regression models with forward selection to assess pre-specified variables' associations with importance and confidence. The sample was 84% male, 40% Latino, 31% White, 18% Black and 11% other races; median age was 61 years. Median (Q1-Q3) AUDIT score was 16 (12-24), importance was 9 (6-10) and confidence was 8 (5-9). On multivariable analysis, VA site (vs. SN) participants had a 0.97-point lower importance score (p = 0.02); higher symptoms of depression (PHQ-8 score ≥ 10 vs. < 10) and AUDIT scores (for each point increase) were associated with higher importance score (estimates 1.2 and 0.08, p < 0.05, respectively). Liver disease aetiology and severity were not significantly associated with outcomes. Depression, alcohol problem severity and treatment site may influence motivation to reduce alcohol use and could inform future hepatology-based interventions.

Marketing Harm to Children: Children’s exposure to unhealthy commodity marketing using body cameras

Abstract Background Sophisticated, persuasive and extensive product marketing is a key driver of unhealthy commodity (UHC) consumption. This study aims to identify the nature and extent of children’s exposure to UHC marketing. Methods The study is a secondary analysis of Kids’Cam, a cross-sectional study in which 168 New Zealand 12-year-old children wore body cameras that automatically captured images of their environment every 7 seconds over four days. Images were analysed for exposure to UHC, Healthy and ‘Other’ marketing. Results Children were exposed to UHC marketing on average 76.2 times/day, nearly 2.5 times their daily exposure to ‘Healthy’ marketing. Exposure included: unhealthy food marketing (68.4/day), alcohol (5.7/day), gambling (2.1/day) and tobacco marketing (0.1/day). These exposure rates align with the level of statutory regulation each UHC faces in NZ. Food outlets were the most common setting for UHC marketing exposures, while product packaging was the most common medium. Coca-Cola (6.3/day) was the most common UHC exposure, followed by Cadbury, Tip Top, Bluebird and Powerade. Over half of children’s unhealthy food (54.9%) and alcohol (51.9%) marketing exposures were attributed to multinational corporations. In contrast, statutory bodies are responsible for almost all (97.4%) of children’s gambling marketing exposure. Conclusions Children currently grow up in an environment in which they are constantly persuaded to consume products that directly harm their health - an environment in which the profits of corporations are favoured over public health. Statutory regulation of UHC marketing is urgently needed to protect children from harm. Key messages • Children were exposed to unhealthy commodity marketing on average 76.2 times/day, nearly 2.5 times their daily exposure to ‘healthy’ marketing. • Statutory regulation of unhealthy commodity marketing is urgently needed to protect children from harm.

The Feasibility and Acceptability of a Clinical Pharmacist-delivered Intervention to Reduce Bothersome Health Symptoms from Polypharmacy and Alcohol Use and Communicate Risk among People with HIV: Pilot Study Protocol.

Among persons with HIV (PWH), unhealthy alcohol use and polypharmacy contribute to bothersome symptoms (e.g., fatigue, dizziness, memory loss). However, effective risk communication targeting these associations is challenging. The HIV and Alcohol Research center focused on Polypharmacy (HARP) is conducting a pilot study that will generate feasibility and acceptability data on a clinical pharmacist-delivered counseling intervention targeting the modification of unhealthy alcohol use and polypharmacy in PWH. Counseling is guided by the Information-Motivation-Behavioral Skills-Motivational Interviewing (IMB-MI) model. Herein, we describe the study protocol. This pilot uses a one-group pre-test/post-test design. We will recruit 50 participants from those who participated in the consented cohort of the Veterans Aging Cohort Study. Participants must be prescribed ≥ 5 long-term medications, have a self-reported Alcohol Use Disorders Identification Test score > 0, and be living with HIV. We will exclude those with moderate-severe alcohol use disorder as identified by an Alcohol Symptom Checklist score ≥ 4. Data are collected using three self-administered surveys (baseline, immediately after booster intervention, and 30-days post-intervention), two PEth blood tests (baseline, 30 days post-intervention), and medication data from the electronic health record (baseline). The intervention includes a 60-minute IMB-MI-based counseling session followed by a booster session 2 weeks later. Some participants will also be asked to participate in a qualitative interview to provide feedback on the intervention. The pilot investigates the impact of an intervention on alcohol consumption and the use of multiple medications among PWH, exploring how best to reduce bothersome symptoms, communicate risk, and support behavior change in this population.

Innovative tools from WHO Europe to protect children from digital marketing of unhealthy products

Abstract Children in the WHO European Region are extensively exposed to marketing of unhealthy products, including tobacco, alcohol, HFSS foods, and gambling, which negatively influences their dietary choices, behaviors, and perceptions of a norm, threatening their health rights. Recognizing the urgency to protect children’s developmental potential and rights, WHO has actively addressed this issue both within Europe and globally. In 2010, WHO issued recommendations for Member States on marketing foods and beverages to children. Building on these efforts, the CLICK framework for monitoring digital marketing to children was introduced in 2018. In 2023, WHO released guidelines urging countries to adopt comprehensive, mandatory policies to protect children from HFSS food marketing. Despite political commitments and policies, children and adolescents continue to be exposed to unhealthy product marketing, increasing their risk of NCDs as online activity rises. At the same time, while efforts have focused on restricting specific products, rapid changes in digital marketing strategies necessitate broader measures. Emerging trends include promoting brand loyalty among young children through brand characters and logos. Tools and support are urgently needed to monitor and implement WHO recommendations in online settings, including brand marketing. Despite WHO recommendations, few countries have implemented mandatory policies. Reliable monitoring mechanisms are essential. To address this gap, the WHO Regional Office for Europe developed the KidAd platform to monitor children’s exposure to digital advertising.

Co-created improvement goals and strategies for implementing SBIRT and MAUDin primary care settings in a facilitator-supported, tailored implementation study.

Evidence-based approaches to screening and treatment for unhealthy alcohol use have the potential to reduce morbidity and mortality but are currently underutilized in primary care settings. To support implementation of screening, brief intervention, and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) by identifying goals co-developed by clinics and practice facilitators in a flexible implementation study. In a pragmatic implementation study, we used practice facilitation to support the implementation of SBIRT and MAUD in 48 clinical practices across Oregon, Washington, and Idaho. Our study used a tailored approach, in which facilitators and clinics co-identified implementation goals based on clinic needs. We used clinic contact logs, individual interviews, group periodic reflections with practice facilitators, and exit interviews with clinic staff to inform qualitative analysis. With support from practice facilitators, clinics identified goals spanning SBIRT, MAUD, reporting, targeted patient outreach, and quality improvement capacity. Goals addressed both the technical (e.g. data tracking) and social (e.g. staff training) aspects of SBIRT and MAUD. A decision tree summarizes emergent findings into a tool to support future implementation of SBIRT in primary care settings. A facilitator-supported, tailored approach to SBIRT implementation enabled clinics to identify a variety of goals to improve SBIRT and MAUD implementation. These identified priorities, along with a decision tree describing the hierarchical structure of these goals, could support future implementation efforts.

Engagement in substance use disorder treatment after an emergency department visit among persons at high risk of opioid overdose: A prediction analysis

BackgroundCertified peer recovery specialists (CPRS) and licensed clinical social workers (LCSWs) can facilitate substance use disorder (SUD) treatment engagement for emergency department (ED) patients at risk for overdose. Predictors of treatment engagement after such behavioral services are unknown. MethodsThis secondary analysis included Rhode Island ED patients at high risk for opioid overdose participating in a randomized controlled trial comparing the effectiveness of CPRS and LCSWs services (2018–2021). SUD treatment engagement within 90 days post-discharge was identified using statewide administrative data. Potential predictors were obtained from baseline questionnaires. Classification and regression trees (CART) were used to identify predictors of treatment engagement. ResultsIn the ED, 323 and 325 participants received CPRS and LCSWs services, respectively, among whom 141 (43.7 %) and 137 (42.2 %) engaged in SUD treatment within 90 days post-discharge. For the CPRS group, predictors of treatment engagement included unhealthy alcohol use, prescription opioid or benzodiazepine use in past 6 months, and lifetime history of: unstable housing, barriers to treatment, bipolar disorder diagnosis, addiction treatment, and recovery services. In the LCSW group, predictors included health insurance, current pain, opioid overdose in past year, and lifetime history of anxiety disorder diagnosis and mental illness treatment. However, CART had low predictive accuracy (CPRS: 60.9 %, LCSW: 54.8 %). ConclusionsAmong ED patients at high risk of opioid overdose receiving behavioral services, 90-day SUD treatment engagement was high. Sociobehavioral and clinical patient characteristics did not accurately predict treatment engagement. Behavioral services should be offered to all ED patients at high risk of opioid overdose.

Mlambe economic and relationship-strengthening intervention for alcohol use decreases violence and improves relationship quality in couples living with HIV in Malawi

IntroductionA syndemic of unhealthy alcohol use, intimate partner violence (IPV), and economic insecurity threatens to derail progress towards UNAIDS 95-95-95 targets in sub-Saharan Africa. We developed a combined economic and relationship-strengthening intervention called Mlambe to reduce unhealthy alcohol use and increase adherence to antiretroviral therapy for couples in Malawi. This study evaluates the additional impact of Mlambe on IPV and relationship dynamics. MethodsIn a pilot randomized controlled trial, 78 married couples (156 individuals) living with HIV and reporting unhealthy alcohol use based on the AUDIT-C (at least one partner) were recruited from HIV care clinics in Zomba, Malawi. The intervention arm (39 couples) received a 10-month program consisting of incentivized savings accounts with financial literacy education, relationship education, and couples counseling sessions to build relationship skills. The control arm (39 couples) received enhanced usual care (EUC) with brief alcohol counseling. We used linear mixed-effects models to assess the effects of Mlambe on relationship quality (e.g., constructive communication, unity, sexual satisfaction) and IPV (physical, sexual, and emotional) by including fixed effects for treatment arm and a random effect for dyad, and tested whether effects on IPV and relationship quality differed by gender. ResultsAt 10- and 15-month follow-up visits, couples in the Mlambe arm showed greater increases in couple communication, unity, sexual satisfaction, intimacy, and trust (Cohen's d ranged from 0.36 to 0.56; p < 0.05) as compared to EUC. Couples in the Mlambe arm also showed significant decreases in physical and emotional IPV (Cohen's d ranged from 0.33 to 0.49; p < 0.05) as compared to EUC. Subsequent moderation analyses indicated that women reported significantly greater improvements in relationship quality than men, except for sexual satisfaction (p < 0.05), and greater declines in physical IPV than men (p < 0.05). ConclusionsMlambe resulted in significant improvements in relationship quality and decreased IPV in couples, particularly for women who as a group reported lower relationship quality at baseline. Economic and relationship-strengthening interventions have potential to disrupt harmful syndemics of violence, substance use, and poverty among couples living with HIV. Clinical trial numberNCT#04906616.

Reasons for not seeking alcohol treatment among a sample of Florida adults with HIV who perceived the need for treatment

BackgroundA minority of people who need alcohol treatment receive it. Unhealthy alcohol use is common among people with HIV (PWH) and can lead to negative health outcomes. The aims of this multi-methods study are to (1) quantitatively describe the prevalence, psychosocial characteristics, and demographic traits of a sample of PWH currently receiving HIV care in Florida who had a self-reported need for alcohol treatment but did not seek care and (2) qualitatively explore reasons why PWH did not seek treatment.MethodsPWH enrolled in the Florida Cohort Study between October 2020 and February 2023 who had drinking history (N = 487) completed a cross-sectional survey that asked if there was a time when they recognized they needed help for their drinking but did not seek it. If yes, they were asked an open-ended follow-up question about reasons why they did not seek care. Demographic and behavioral differences between those who did and did not endorse a time when they needed alcohol treatment were determined using multivariable logistic regression, while qualitative data were analyzed with thematic analysis based in the Social-Ecological Model to assess reasons for not seeking care at the individual, social, and systems levels.ResultsA quarter of PWH (n = 129) with lifetime drinking indicated a time they needed care but did not seek it. Patients who endorsed a time where they perceived the need for treatment but did not seek it were more likely to endorse current at-risk drinking and a history of ever trying to reduce their drinking or formally seek professional alcohol treatment. The most common reasons participants did not seek care were individual level factors and included shame, denial, fear, wanting to do it on their own, not feeling ready, and not wanting to seek care.ConclusionsPWH experienced barriers largely at the individual level that prevented them from seeking alcohol treatment despite a recognized need, though many eventually sought care. Providers and public health professionals should consider helping to address various barriers, particularly internal barriers, when designing interventions to help PWH seek care.

Prevalence and co-occurrence of symptoms of mental and substance use disorders among people with HIV age 40 and older in low- and middle-income countries: a cross-sectional study.

Due to the increased effectiveness of and access to antiretroviral therapy (ART), people with HIV (PWH) are living longer. As a result, the population of older PWH has increased. Mental and substance use disorders (MSDs) are common and frequently co-occurring among PWH and are associated with poor HIV care outcomes. Research into the prevalence and co-occurrence of MSDs among ageing PWH remains limited, particularly in low- and middle-income countries (LMICs). We analysed data collected between 2020 and 2022 from the International epidemiology Databases to Evaluate AIDS (IeDEA) Sentinel Research Network cohort of PWH aged 40 years or older on ART at 11 HIV clinics in Brazil, Côte d'Ivoire, India, Kenya, Mexico, Uganda, Rwanda, Togo, Vietnam, Zambia and Zimbabwe. We estimated the prevalence and co-occurrence of unhealthy alcohol use (AUDIT-C ≥3 for women, ≥4 for men), unhealthy drug use (ASSIST >3 for cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens and/or opioids), and moderate to severe symptoms of depression (PHQ-9 ≥10), anxiety (GAD-7 ≥10) and post-traumatic stress disorder (PTSD) (PCL-5 ≥33). Psychiatric multimorbidity was defined as having symptoms of two or more disorders assessed. Log binomial models assessed the association between socio-demographic and HIV care characteristics and symptoms of anxiety, depression, PTSD or unhealthy substance use. Of 2821 participants, the prevalence of unhealthy alcohol and drug use was 21% and 5%, respectively. The prevalence of moderate to severe symptoms of depression, anxiety and PTSD was 14%, 9% and 6%, respectively. Overall, the prevalence of psychiatric multimorbidity was 11%. Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. In binomial models, the prevalence of symptoms of depression and anxiety was higher, while the prevalence of unhealthy alcohol and drug use was lower among women than men. Unhealthy alcohol use and symptoms of depression were most commonly reported, among this cohort of PWH aged 40 or older across 11 LMICs. Integration of MSD screening and treatment into HIV care should be prioritized. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.

Consumer support for restrictive policies on unhealthy food and beverage delivery via drones.

Drone delivery services are set to increase unhealthy food and alcohol accessibility. The aim of this study was to evaluate public receptiveness to various options for regulating drone food and beverage deliveries and to identify sociodemographic differences in receptiveness. In total, 1079 adults were surveyed to assess total support and differences in support between population subgroups (e.g.age, sex, location, existing habits) for nine potential drone policies covering curfews, quotas, and product bans. Support was measured on five-point agreement scales, with mean individual policy support (M) and grand mean support calculated for all assessed policies (grand M). There was moderate support for all assessed policies (grand M=3.5), ranging from M=3.2 (drone delivery quotas for shopping centres and dwellings) to M=3.7 (night curfews, airspace quotas). Factors associated with policy support were older age, metropolitan residenceand using grocery delivery services. Public support exists for policies designed to restrict drone food and beverage deliveries. Drone food and beverage delivery policies will likely be supported by the public and could assist in controlling the accessibility of such products for the benefit of population dietary health.

Alcohol Associated Hepatitis Trends Before and Following the Onset of the COVID-19 Pandemic Across Two Distinct Cohorts in the United States and Hong Kong

Background and AimsAlcohol-associated liver disease (ALD) burden has been rising globally, fueled by increases in high-risk alcohol use following the COVID-19 pandemic. We aim to evaluate trends in annual incidence of alcohol-associated hepatitis (AH) before and following onset of the COVID-19 pandemic across two geographically distinct populations in the U.S. and Hong Kong. MethodsUsing U.S. national Veterans Affairs (VA) data and Hong Kong territory-wide data, trends in annual incidence of AH were evaluated from 2000 to 2023. AH was identified using a combination of ICD-9/10 diagnostic codes, laboratory data, and available alcohol use data. ResultsAmong the VA, annual incidence of AH rose steadily from 39.4 to 53.7 per 100,000-persons (2010 to 2020), then declined to 36.2 per 100,000-persons in 2023. Annual AH incidence was substantially lower in Hong Kong, but demonstrated similar trends, peaking at 0.28 per 100,000-persons during the first year of the pandemic. Among both cohorts, incidence of AH was significantly higher in men vs. women, but particularly for the VA cohort, the rise in AH incidence was more rapid in women. Among both cohorts, the highest incidence of AH in 2023 was among the age 40-49 years group (VA: 72.7 per 100,000-persons; Hong Kong: 1.89 per 100,000-persons). ConclusionsWe provide a comprehensive analysis of epidemiological trends in AH incidence across two distinct populations, highlighting the need for continued awareness of targeted interventions to curb unhealthy alcohol use and its complications. Impact and ImplicationsAlcohol-associated hepatitis (AH) is a severe complication of high-risk alcohol use associated with significant morbidity and mortality. Increasing alcohol use fueled by the COVID-19 pandemic has led to parallel increases in alcohol-related co-morbidities. The current study provides a comprehensive analysis of trends in the incidence of AH across two distinct world regions before and following the onset of the COVID-19 pandemic. Better identifying epidemiological trends in AH incidence as well as highlighting populations most effected can help target public health resources and health system interventions to address the dangers of high-risk alcohol use more effectively.

Was receipt of any specialty alcohol treatment during the pandemic effective at reducing drinking for patients with or at risk of AUD?

IntroductionThe COVID-19 pandemic changed the way healthcare providers delivered most health services, including treatment for alcohol use disorder (AUD). Specialty alcohol treatment remained available through the pandemic, and within some systems treatment use increased likely due to telehealth availability. However, the field knows little about the relationship between the pandemic's expanded access to specialty alcohol treatment and alcohol use outcomes. MethodsThe sample included 14,712 patients from Kaiser Permanente Northern California who screened positive for unhealthy alcohol use in primary care and had an AUD diagnosis or risked developing an AUD by reporting 5 or more heavy drinking days in a 3-month period between 1/1/2019 and 2/29/2020 (pre-pandemic). The study examined the receipt of any specialty alcohol treatment (including at least one outpatient, inpatient, or telehealth specialty treatment encounter, or pharmacotherapy prescription) from 3/1/2020 (pandemic start) to either the first completed follow-up alcohol screening or 6/20/2022 (study period end). The outcomes of alcohol use included changes in heavy drinking days, drinks per week, drinking days per week, and drinks per drinking day between the pre- and post-pandemic periods. ResultsOn average patients significantly decreased alcohol use across all four alcohol use measures examined, regardless of whether they received treatment. However, those who received any treatment compared to those who did not have greater reductions in alcohol use, with an additional decrease of −3.55 heavy drinking days (95 % CI = −5.93, −1.17), −3.80 drinks per week (95 % CI = −5.18, −2.42), −0.72 drinks per drinking day (95 % CI = −1.14, −0.30), and − 1.01 drinking days per week (95 % CI = −1.30, −0.72). Treatment effects were greatest among patients who exceeded both daily and weekly limits pre-pandemic, with an additional decrease of −10.75 heavy drinking days (95 % CI = −15.28, −6.21), −12.83 drinks per week (95 % CI = −16.31, −9.35), −1.67 drinks per drinking day (95 % CI = −2.19, −1.14), and −2.02 drinking days per week (95 % CI = −2.41, −1.63). ConclusionsOn average, patients decreased alcohol use during the onset of the pandemic, however, those who had any specialty alcohol treatment had significantly greater decreases, suggesting that the hybrid in-person and telehealth treatment approach was effective during the pandemic.

Epidemiology of metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD)

Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD) together represent the majority of individuals with steatotic liver disease (SLD). MASLD and ALD prevalence continues to rise globally, which is driven by several factors including an aging population, increasing prevalence of cardiometabolic risk factors such as obesity and diabetes mellitus, and the increasing trends in high-risk unhealthy alcohol use which surged during the COVID-19 pandemic. As a result, MASLD, as well as ALD-related cirrhosis and hepatocellular carcinoma, is also on the rise, becoming major etiologies contributing to end-stage liver disease among adults awaiting liver transplantation. Accurately understanding MASLD and ALD epidemiology is critical to guide healthcare resource planning and health policy. Accurate estimates of MASLD and ALD epidemiology are particularly important to understand in the context of recent updates in nomenclature terminology. This review provides an updated assessment of existing literature describing the epidemiology of MASLD and ALD.

Supporting alcohol brief interventions and pharmacotherapy provision in Australian First Nations primary care: exploratory analysis of a cluster randomised trial

IntroductionPrimary care provides an important opportunity to detect unhealthy alcohol use and offer assistance but many barriers to this exist. In an Australian context, Aboriginal Community Controlled Health Services (ACCHS) are community-led and run health services, which provide holistic primary care to Aboriginal and Torres Strait Islander peoples. A recent cluster randomised trial conducted with ACCHS provided a service support model which showed a small but significant difference in provision of ‘any treatment’ for unhealthy alcohol use. However, it was not clear which treatment modalities were increased.AimsTo test the effect of an ACCHS support model for alcohol on: (i) delivery of verbal alcohol intervention (alcohol advice or counselling); (ii) prescription of relapse prevention pharmacotherapies.MethodsIntervention: 24-month, multi-faceted service support model. Design: cluster randomised trial; equal allocation to early-support (‘treatment’) and waitlist control arms. Participants: 22 ACCHS. Analysis: Multilevel logistic regression to compare odds of a client receiving treatment in any two-month period as routinely recorded on practice software.ResultsSupport was associated with a significant increase in the odds of verbal alcohol intervention being recorded (OR = 7.60, [95% CI = 5.54, 10.42], p < 0.001) from a low baseline. The odds of pharmacotherapies being prescribed (OR = 1.61, [95% CI = 0.92, 2.80], p = 0.1) did not increase significantly. There was high heterogeneity in service outcomes.ConclusionsWhile a statistically significant increase in verbal alcohol intervention rates was achieved, this was not clinically significant because of the low baseline. Our data likely underestimates rates of treatment provision due to barriers documenting verbal interventions in practice software, and because different software may be used by drug and alcohol teams. The support made little impact on pharmacotherapy prescription. Changes at multiple organisational levels, including within clinical guidelines for primary care, may be needed to meaningfully improve provision of alcohol treatment in ACCHS.Trial registrationACTRN12618001892202 (retrospectively registered on 21/11/2018).

Integrated stepped alcohol treatment with contingency management for unhealthy alcohol use among people with HIV: A randomized controlled trial.

We examined the impact of integrated stepped alcohol treatment with contingency management (ISAT+CM) on alcohol abstinence among people with HIV (PWH) and unhealthy alcohol use. In this multisite 24-week trial, we randomized PWH reporting untreated unhealthy alcohol use and with phosphatidylethanol (PEth) >20ng/mL to receive ISAT+CM or treatment as usual (TAU). Intervention: Step 1: Social worker-delivered CM; Step 2: Addiction physician management plus motivational enhancement therapy. Participants were advanced to step 2 at week 12 if they lacked evidence of abstinence over the prior 21 days. TAU: Health handout, and for those who met criteria for alcohol use disorder, a referral to substance use treatment. Primary outcome: self-reported abstinence over the past 21 days at week 24. We enrolled 120 PWH between January 5, 2018 and March 1, 2022. Mean age was 59 years, 96% were men, and 83% were Black. Eight percent were lost to follow-up. In the ISAT+CM group, 87% were advanced to Step 2. The posterior mean proportion of participants with self-reported abstinence at 24 weeks was higher among those randomized to ISAT+CM (posterior mean proportion 9% [95%CrI, 0%, 33%]) compared with TAU (posterior mean proportion 0.3 % [95%CrI, 0%, 4%]) (posterior mean treatment effect 9%, [95%CrI, 1%, 32%], the posterior probability of TAU being superior to ISAT+CM was <0.0001. ISAT+CM delivered in HIV clinics modestly increased self-reported 3-week abstinence among PWH. Our findings indicate a need for more effective treatments to promote abstinence and a potential role for ISAT+CM for reductions in alcohol use.

Pain and unhealthy alcohol use among people living with HIV: A prospective cohort study.

Unhealthy alcohol use is prevalent among people living with HIV/AIDS (PLWH) and contributes to impaired functioning, diminished quality of life, and poorer HIV outcomes. Common cooccurring conditions such as chronic pain may be associated with negative outcomes both directly and through its influence on unhealthy drinking itself. However, there is relatively little known about how pain influences unhealthy drinking among PLWH over time. The current study examined whether pain was associated with indices of unhealthy alcohol use, namely heavy drinking and alcohol use disorder (AUD) assessed 12 months later. The study sample (n = 207) was from the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) Cohort, a prospective cohort of PLWH with a history of illicit substance or unhealthy alcohol use. We conducted logistic regression analyses to examine the associations between pain and both heavy drinking and AUD status (DSM-5 criteria) (yes/no) over time. In secondary analyses, we examined whether pain was associated with greater AUD severity and whether pain interference was associated with heavy drinking and AUD outcomes. We found that pain at baseline was associated with greater odds of AUD [aOR = 2.29 (95% CI: 1.13, 4.64), p = 0.02] but not heavy drinking [aOR = 0.91 (95% CI: 0.44, 1.88), p = 0.79] at 12 months. Pain was also associated with more severe AUD. Analyses of pain interference showed similar results. Pain is prospectively associated with higher odds of AUD among PLWH with a substance/unhealthy alcohol use history. Providers should routinely address pain among PLWH to improve AUD outcomes.