Weeks Of Detoxification Research Articles

Could sluggish cognitive tempo be a risk factor for methamphetamine use disorder?

ABSTRACT Objective Methamphetamine use has risen significantly in the past decade. Sluggish Cognitive Tempo (SCT) is characterized by behaviors like excessive daydreaming, mental wandering, confusion, lethargy, and drowsiness. This study compares SCT during abstinence in individuals with methamphetamine use disorder (MUD) to the general population. Methods The study included 66 patients with MUD who completed at least 2 weeks of detoxification and had no other psychiatric diagnoses, and 49 healthy individuals with similar sociodemographic characteristics. Sociodemographic Data Form, SCT evaluation scale and the Brief Functionality Form (BFF) were administered to both patient and control groups, and Addiction Profile Index (API) applied to the patient group. Statistical analysis was performed using SPSS version 25. Results The SCT scores of the patient group (32.15 ± 12.298) were significantly higher than the scale scores of the control group (20.04 ± 7.303) (p < .001). Only the SCT value had a significant effect on the API value (p = .001) in the linear regression model, and each 1 unit increase in the SCT value caused a 0.089 unit increase in the API value. Conclusion The SCT score was significantly higher in individuals with MUD. SCT might predict addiction severity, suggesting self-medication as a motivation for addiction in this group.

Contaminant-induced oxidative stress underlies biochemical, molecular and fatty acid profile changes, in gilthead seabream (Sparus aurata L.)

Chemical contaminants such as heavy metals, polybrominated diphenyl ethers (PBDEs) and drugs, are constantly found in the marine environment determining the interest of the scientific community for their side effects on animal welfare, food safety and security. Few studies have analyzed the effects of mix of contaminants in fish, in terms of molecular and nutritional composition response, beside it is indispensable to think more and more on effect of contaminants along the food web system. In this study, Sparus aurata specimens were exposed for 15 days, by diet, to a mixture of carbamazepine (Cbz), polybrominated diphenyl ether-47 (PBDE-47) and cadmium chloride (CdCl2), at two doses (0.375 μg g-1 D1; 37.5 μg g-1 D2) (T15). After, fish were fed with a control diet, without contaminants mix, for other 15 days (T30). The study explored the effect on oxidative stress in the liver, analyzing specific molecular markers and effects on quality, by fatty acid profile and lipid peroxidation. Molecular markers involved in ROS scavenging, such as superoxide dismutase (sod), catalase (cat) and glutathione peroxidase (gpx) were evaluated by gene expression; as markers of quality and lipid peroxidation, the fatty acids (FAs) profile and the level of malondyaldeide (MDA) were assessed. Sod and cat genes underwent to up-regulation after 15 days of diet containing contaminants and showed down-regulation after the next 2 weeks of detoxification (T30). At T15, the FAs profile showed an increase of the saturated fatty acids (SFA), and a decrease of the polyunsatured fatty acids (PUFA). The MDA levels increased over time, indicating an ongoing radical damage. These results suggest that the effects of the contaminants can be perceived not only at molecular but also at nutritional level and that the molecular and biochemical markers adopted could be differently used to monitor the health of aquatic organisms in the marine environment.

Elevated transferrin saturation in individuals with alcohol use disorder: Association with HFE polymorphism and alcohol withdrawal severity.

Iron loading has been consistently reported in those with alcohol use disorder (AUD), but its effect on the clinical course of the disease is not yet fully understood. Here, we conducted a cohort study to examine whether peripheral iron measures, genetic variation in HFE rs1799945 and their interaction differed between 594 inpatient participants with alcohol use disorder (AUD) undergoing detoxification and 472 healthy controls (HC). We also assessed whether HFE rs1799945 was associated with elevated peripheral iron and can serve as a predictor of withdrawal severity. AUD patients showed significantly higher serum transferrin saturation than HC. Within the AUD group, transferrin saturation significantly predicted withdrawal symptoms (CIWA-Ar) and cumulative dose of benzodiazepine treatment during the first week of detoxification, which is an indicator of withdrawal severity. HFE rs1799945 minor allele carriers showed elevated transferrin saturation compared to non-carriers, both in AUD and healthy controls. Exploratory analyses indicated that, within the AUD cohort, HFE rs1799945 predicted CIWA withdrawal scores, and this relationship was significantly mediated by transferrin saturation. We provide evidence that serum transferrin saturation predicts alcohol withdrawal severity in AUD. Moreover, our findings replicated previous studies on elevated serum transferrin saturation in AUD and an involvement of HFE rs1799945 in serum transferrin saturation levels in both AUD and healthy controls. Future studies may use transferrin saturation measures as predictors for treatment or potentially treat iron overload to ameliorate withdrawal symptoms.

Increase in plasma CCL11 (Eotaxin-1) in patients with alcohol dependence and changes during detoxification

BackgroundAlcohol is known to modulate the immune system. Neuroinflammatory cytokine dysregulation plays an essential role in the pathophysiology of alcohol dependence (AD). Preclinical studies have indicated that alcohol consumption upregulates the pro-inflammatory cytokine CC motif ligand 11 (CCL11, also known as eotaxin-1). We examined CCL11 levels in patients with AD and in mice administered alcohol. MethodsThe plasma CCL11 levels of 151 patients with AD and 116 healthy controls were measured. In addition, we followed the CCL11 levels, alcohol cravings and psychological symptoms in patients with AD after 1 and 2 weeks of detoxification. Furthermore, we examined CCL11 changes in mice administered alcohol for 5 days. ResultsCCL11 levels were higher in patients with AD than in controls and declined during detoxification. CCL11 levels were positively correlated with AD severity (p < 0.001). Furthermore, mice exposed to alcohol exhibited a higher CCL11 level. The receiver operating characteristic curve revealed that a CCL11 level of 72.5 pg/mL could significantly differentiate patients with AD from controls (area under the curve: 0.77; p < 0.001). Reductions in CCL11 levels during detoxification were correlated with reductions in alcohol craving, depression, and anxiety. ConclusionsOur data from humans and mice suggest that chronic alcohol consumption is associated with an increase in CCL11 levels. CCL11 levels are correlated with AD severity and may be a potential indicator of AD. The CCL11 reduction after alcohol discontinuation is associated with alleviation of clinical symptoms. Collectively, our findings suggest that CCL11 is involved in the neurobiological mechanisms underlying AD.

The relationship between posttraumatic stress symptoms and craving in patients with substance use disorder attending detoxification

BackgroundSubstance use disorder (SUD) and posttraumatic stress disorder (PTSD) are highly comorbid. Self-medication hypothesis (SMH) is a seminal theory aiming to account for the relationship between these disorders. The current study examined hypotheses based on SMH in SUD patients during the very first days of detoxification. Based on SMH we expected a positive association between PTSD and craving concurrently as well as on each following day. MethodsA time series with 108 SUD patients used daily self-report questionnaires assessing PTSD symptom severity (PCL-5) and craving (MaCs) for six consecutive days. Daily associations between PTSD symptom severity and craving on the same and on the following day during the first week of detoxification were estimated using linear mixed models. ResultsThere was a significant decrease in PTSD symptom severity during detoxification (ß = -2.06, p < 0.001). Further, PTSD symptom severity predicted craving on the same day (ß = 0.36, p < 0.001) but did not predict craving on the next day (ß = -0.01, p = 0.82). ConclusionResults of the current study only partially support assumptions based on SMH, and points towards a more complex and reciprocal relationship between PTSD and SUD.

Ketogenic diet reduces alcohol withdrawal symptoms in humans and alcohol intake in rodents.

Individuals with alcohol use disorder (AUD) show elevated brain metabolism of acetate at the expense of glucose. We hypothesized that a shift in energy substrates during withdrawal may contribute to withdrawal severity and neurotoxicity in AUD and that a ketogenic diet (KD) may mitigate these effects. We found that inpatients with AUD randomized to receive KD (n = 19) required fewer benzodiazepines during the first week of detoxification, in comparison to those receiving a standard American (SA) diet (n = 14). Over a 3-week treatment, KD compared to SA showed lower "wanting" and increased dorsal anterior cingulate cortex (dACC) reactivity to alcohol cues and altered dACC bioenergetics (i.e., elevated ketones and glutamate and lower neuroinflammatory markers). In a rat model of alcohol dependence, a history of KD reduced alcohol consumption. We provide clinical and preclinical evidence for beneficial effects of KD on managing alcohol withdrawal and on reducing alcohol drinking.

Accelerated Aging of the Amygdala in Alcohol Use Disorders: Relevance to the Dark Side of Addiction.

Here we assessed changes in subcortical volumes in alcohol use disorder (AUD). A simple morphometry-based classifier (MC) was developed to identify subcortical volumes that distinguished 32 healthy controls (HCs) from 33 AUD patients, who were scanned twice, during early and later withdrawal, to assess the effect of abstinence on MC-features (Discovery cohort). We validated the novel classifier in an independent Validation cohort (19 AUD patients and 20 HCs). MC-accuracy reached 80% (Discovery) and 72% (Validation). MC features included the hippocampus, amygdala, cerebellum, putamen, corpus callosum, and brain stem, which were smaller and showed stronger age-related decreases in AUD than HCs, and the ventricles and cerebrospinal fluid, which were larger in AUD and older participants. The volume of the amygdala showed a positive association with anxiety and negative urgency in AUD. Repeated imaging during the third week of detoxification revealed slightly larger subcortical volumes in AUD patients, consistent with partial recovery during abstinence. The steeper age-associated volumetric reductions in stress- and reward-related subcortical regions in AUD are consistent with accelerated aging, whereas the amygdalar associations with negative urgency and anxiety in AUD patients support its involvement in the "dark side of addiction".

Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways.

To provide insight into patient experiences of a general hospital-based alcohol specialist nurse intervention during alcohol detoxification, experiences of alcohol specialist nurse hospital-based follow-up appointments (Pathway A) as well as the experiences of patients who did not have access to this additional help post detoxification (Pathway B). A longitudinal qualitative study. A thematic analysis of semi-structured interviews (2016-2017) with 24 patient participants (N=12 in each pathway; purposive selection) 1-4weeks post-detoxification and at 3 and 6months, to identify patient experiences of these interventions. Participants gave accounts of how 'empathic' and 'straight talking' interactions with alcohol specialist nurses during detoxification helped them to 'open up' and orient towards change. After detoxification follow-up, outpatient appointments in the hospital setting were seen as supporting change in early recovery and engagement with a wider range of services. Those with no access to nurse follow-up described experiencing a 'void' in available help. Participants in both groups described barriers to engagement with community alcohol services, peer groups and access to help for mild-moderate mental health problems. Patient accounts indicate alcohol specialist nurse interventions during and after unplanned detoxification in a hospital setting can help orient patients towards change and support early recovery. Providing alcohol specialist nurse interventions in general hospitals offers one route to initiating recovery in alcohol-dependent patients. This has potential to improve the lives of those affected and to reduce related demands on hospital services, but further research is needed.

&lt;p&gt;An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification&lt;/p&gt;

BackgroundGiven that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use.Methods300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6–8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints.ResultsOf the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased.ConclusionAfter detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.

A naturalistic longitudinal analysis of post-detoxification outcomes in opioid-dependent patients.

To provide an assessment of outcomes in a cohort of opioid-dependent patients post-detoxification. This study employed an observational longitudinal cohort design. Patients who completed detoxification in the three major Drug Dependency Units in Ireland during a 14-month period were included in the study (n = 143). Patients opting for one of the three pathways post-detoxification (inpatient aftercare, outpatient aftercare or no formal aftercare) were assessed in the final week of detoxification and followed up after 3, 6 and 9 months. The primary outcome was abstinence following detoxification. A Cox (adjusted) model indicated participants who opted for outpatient aftercare treatment lapsed/relapsed at a rate of 52% higher than the inpatient aftercare group (hazard ratio = 1.52, 95% confidence interval 0.75-3.08, P = 0.24). Moreover, time to lapse/relapse was considerably shorter for the no formal aftercare group (hazard ratio = 7.68, 95% confidence interval 4.30-13.73, P = 5.75 × 10-12 ). Abstinence rates for outpatient aftercare and inpatient aftercare are about equal after 9 months. Patients who opt for aftercare post-detoxification have significantly better outcomes at follow up when compared to no formal aftercare. In addition, patients' intention to attend aftercare affected their outcomes regardless of eventual treatment path.

Neurotrophic factors in women with crack cocaine dependence during early abstinence: the role of early life stress.

Neurotrophic factors have been investigated in the pathophysiology of alcohol and drug dependence and have been related to early life stress driving developmental programming of neuroendocrine systems. We conducted a follow-up study that aimed to assess the plasma levels of glial cell line-derived neurotrophic factor (GDNF), brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), neurotrophin-3 (NT3) and neurotrophin-4/5 (NT4/5) in crack users during 3 weeks of early abstinence in comparison with healthy controls. We performed a comprehensive clinical assessment in female inpatients with crack cocaine dependence (separated into 2 groups: participants with (CSA+) and without (CSA-) a history of childhood sexual abuse) and a group of nonuser control participants. Our sample included 104 women with crack cocaine dependence and 22 controls; of the women who used crack cocaine, 22 had a history of childhood sexual abuse and 82 did not. The GDNF plasma levels in the CSA+ group increased dramatically during 3 weeks of detoxification. In contrast, those in the CSA- group showed lower and stable levels of GDNF under the same conditions. Compared with the control group, BDNF plasma levels remained elevated and NGF levels were reduced during early abstinence. We found no differences in NT3 and NT4/5 between the patients and controls. However, within-group analyses showed that the CSA+ group exhibited higher levels of NT4/5 than the CSA- group at the end of detoxification. Some of the participants were using neuroleptics, mood stabilizers or antidepressants; our sample included only women; memory bias could not be controlled; and we did not investigate the possible confounding effects of other forms of stress during childhood. This study supports the association between early life stress and peripheral neurotrophic factor levels in crack cocaine users. During early abstinence, plasmastic GDNF and NT4/5 were the only factors to show changes associated with a history of childhood sexual abuse.

Differences in Executive Functions and Problem Solving Styles of Protracted Sober and Relapsed Alcohol-dependent Patients

In this study, it is aimed to compare the executive functioning and problem solving styles of relapsed alcoholdependent and protracted sober patients and to evaluate the potential clinical factors that act on the duration of sobriety. Fifty-six male patients meeting the DSM-IV alcohol dependence criteria included in the study. All patients were in sobriety period, classified as 32 of them in acute sobriety (relapsed after a maximum period of 6 months sobriety and just completed 3 weeks of detoxification) and 24 of them as protracted sobriety group (sober for a minimum period of 12 months). To evaluate the executive functions and problem solving styles Stroop test, Hanoi Tower Test and Problem Solving Inventory were applied. No significant differences found between two groups regarding executive functions. The protracted sobers were found to use “reflective” and “planfulness” styles more than the relapsed group. There was not any correlation between executive function and cumulative drinking, length of sobriety, educational status, age, alcohol dependency in the family, duration of illness, the amount of daily drinking, and amount of hospitalization. It is concluded that problem solving styles may play a role in staying sober as the “reflective” and “planfulness” styles were being used significantly more in the protracted sober group. Executive functioning which had been shown to be distorted in alcohol-dependent patients did not differ in relapsed and protracted sobriety. Further studies are needed to receive these results to be a determinant in the duration of sobriety.

Outpatient Detoxification Completion and One-Month Outcomes for Opioid Dependence: A Preliminary Study of a Neuropsychoanalytic Treatment in Pain Patients and Addicted Patients

The current practice in the United States is to maintain patients with opioid dependence on opioids. A case series approach was used to investigate the results of outpatient detoxification/opioid-free treatment using a neuropsychoanalytic paradigm. Detoxification involved a single dose of buprenorphine, adjunctive medications, and intensive neuropsychoanalytic psychotherapy. Depression, attention deficit hyperactivity disorder (ADHD), and nicotine dependence were treated with bupropion. Low-dose naltrexone was used to remedy hypothesized low endogenous opioid tone. In the study, 92% of subjects completed one week of detoxification. By selfreport, 60% were still sober one month into treatment. When divided into a group who met the DSM–IV criteria for opioid dependence because of withdrawal, tolerance, and inability to cut down or stop opioid medications only (the “Pain Group”) and a group who met more than these three criteria (the “Addicted Group”), there were significant differences in maintaining abstinence. In addition, the Addicted Group were much more likely to be depressed and to have borderline personality disorder. All cases of ADHD and all drug dream reports were in the Addicted Group. The conclusion of the study was that neuropsychoanalytic treatment of addiction (including complete abstinence from opioids and neuropsychoanalytic interventions) may be a viable approach to opioid-use disorder. Current DSM criteria for diagnosis of addiction to opioids may incorrectly include a subgroup who are unable to stop the drug only because of inability to endure the withdrawal syndrome. With the neuropsychoanalytic approach, they appear to tolerate withdrawal and stay off opioids. Further investigation is required to compare this neuropsychoanalytic paradigm to other treatments.

Are you Sleeping? Pilot Comparison of Self-Reported and Objective Measures of Sleep Quality and Duration in an Inpatient Alcoholism Treatment Program

Sleep disturbances are common among alcohol-dependent individuals and can increase risk of relapse. The current study compares subjective and objective measures of sleep quality and duration and describes the prevalence of baseline sleep disturbances in an inpatient population of alcoholics undergoing their first week of detoxification. At baseline, the PSQI revealed that 79% of participants were above the cutoff score (≥5) for clinically meaningful sleep disturbances (mean = 12.57, SD = 4.38). Actigraphy results revealed that average sleep efficiency was 75.89%. Sleep efficiency scores were significantly correlated with self-reported sleep efficiency (P = 0.04, r = 0.47). Sleep duration measured by the actigraphy watches was not significantly correlated with self-reported sleep duration (P = 0.65, r = 0.10). Ongoing assessment of sleep disturbances may be a valuable tool for informing the development of customized sleep interventions in a similar inpatient alcohol treatment sample.

Development and validation of a quality of life instrument for patients with drug dependence: Comparisons with SF-36 and WHOQOL-100

AimOur goal was to develop a self-administered quality of life scale for patients with drug addiction/dependence (QOL-DA) and compare it with the SF-36 and the WHOQOL-100. MethodsEmploying theory and methodology of rating scale construction, a self-administered quality of life instrument for individuals with drug dependence QOL-DA was developed and evaluated utilizing responses from 212 drug-dependent subjects at the Kunming Municipal Mandatory Detoxification and Rehabilitation Center in China. Quality of life was measured using the SF-36, WHOQOL-100 and QOL-DA three times during the detoxification. ResultsTest–retest reliability in the domains of physical function, psychological function, social function and toxicity were 0.82, 0.64, 0.78, and 0.76, respectively. Cronbach's coefficient α for the 4 domains was 0.87, 0.89, 0.93 and 0.86, respectively. Correlations and factor analysis showed good construct validity. Criterion-related and convergent validity was confirmed by using the SF-36 and the WHOQOL-100 simultaneously. The instrument does show the change in QOL after two weeks of detoxification with higher standardized response mean higher than that of SF-36 and WHOQOL-100. ConclusionThe instrument developed has good validity, reliability and better responsiveness than instruments currently used, and can be employed effectively to measure the quality of life of individuals with drug dependence.

IGF-I and IGFBP-3 before and after inpatient alcohol detoxification in alcohol-dependent subjects

SummaryBackgroundIt is unclear whether alcohol detoxification has an effect on factors that are involved in growth, metabolic functions and cell proliferation. Alcohol abuse is associated with low IGF-I levels that tend to rise after alcohol withdrawal. There is a paucity of studies on the course of IGFBP-3 (the main binding protein for IGF-I) after alcohol detoxification.Material/MethodsWe prospectively assessed IGF-I and IGFBP-3 changes at the time of admission and after 4 to 6 weeks of detoxification in an inpatient alcohol detoxification facility in 118 alcohol-dependent subjects given a regular hospital diet. No participants dropped out of the study.ResultsChanges in IGF-I after alcohol detoxification showed a marked dimorphism in altered hepatic biochemistry upon admission, with a rise in those with normal liver enzymes upon admission (p=0.016, Kruskall-Wallis) and a drop in those with elevated liver enzymes upon admission (p=0.05); the latter was noted in subjects that had consumed alcohol close to the time of admission. Overall, however, IGF-I and IGFBP-3 were within normal limits for most subjects both upon admission and after alcohol detoxification; no significant differences were detected among the examined parameters in men vs. women, and there were no significant correlations of IGF-I, IGFBP-3 or the IGF-I/IGFBP-3 molar ratio with BMI or age.ConclusionsRegardless of hepatic enzymes’ elevation, alcohol detoxification had overall slight effects on IGF-I and IGFBP-3.

Effect of Detoxification on Liver Stiffness Assessed by Fibroscan® in Alcoholic Patients

The aims of this study were to determine whether alcohol consumption or cessation influences transient elastography (TE) measurements and whether TE is a useful tool to monitor alcoholic patients. Twenty-three consecutive heavy drinkers (20 men and 3 women; mean age 47.2 years) admitted for a 7-day hospitalization for alcohol detoxification were included. On admission (D0), a detailed medical history was taken and the following laboratory tests were performed [aspartate aminotransferase (ASAT), gamma glutamyltransferase (γGT), and carbohydrate-deficient transferrin (CDT) levels, and Fibroscan(®)]. All examinations were repeated on D8, D30, and D60. Variation in the median Fibroscan value of >20% was considered significant. After 1 week of detoxification, the % variation in TE was -21.67 ± -27.6%. The median variation in TE between D8 and D60 was -20% in the abstinent group and 32% in the relapse group (p = 0.007). An increase in proportion of patients with a significant decrease in TE was observed with an increased duration of abstinence: 41.7% at D8 and 66.7% at D60. TE values were significantly correlated with ASAT, γGT, and CDT at D0 and D8, and with ASAT and γGT at D60. TE in alcoholics is influenced by major variations in the biochemical activity of the disease. The kinetics of variation of TE suggest that this method may be useful to assess alcohol abuse and control.

Alterations in Oxidative Stress Status During Early Alcohol Withdrawal in Alcoholic Patients

Alcohol-induced oxidative stress is the result of the combined production of reactive oxygen species [ROS; e.g. malondialdehyde (MDA), an index of lipid peroxidation] and impairment of antioxidant defenses [e.g. superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX), which are involved in the elimination of ROS]. Little is known about the oxidative stress markers among patients with alcohol dependence in Taiwan. This study aimed to investigate serial alterations of various oxidative stress markers during early detoxification in alcoholic patients. We enrolled 121 inpatients who fulfilled the DSM-IV-TR criteria for alcohol dependence, and 19 healthy controls. Fasting serum MDA level and antioxidant activity, including SOD, CAT and GPX, were measured at baseline in both groups, and after 1 and 2 weeks of detoxification in alcoholic patients. MDA level in alcoholics was higher at baseline than in healthy controls. It decreased after 1 week of detoxification, and normalized at week 2. SOD and GPX activities remained significantly lower throughout the 2-week period. CAT activity in alcoholics was comparable to that in the controls at baseline, but decreased at week 1 of detoxification, and was significantly lower than that in the controls after 2 weeks. Moreover, baseline MDA level was correlated with baseline CAT activity in alcoholics; the magnitude of the decrease in MDA level was correlated with the decrease in CAT activity following the 1-week detoxification. The findings suggest severe oxidative stress and weakened antioxidant activity in alcoholic patients, and limited changes in oxidative stress in the early stages of alcohol withdrawal.

Depression and Social Phobia Secondary to Alcohol Dependence

Background: According to the self-medication hypothesis, individuals with depression and anxiety disorders use alcohol to control their symptoms and subsequently become dependent. Conversely, alcohol dependence disorder (ADD) can cause or exacerbate psychiatric disorders. This study analyzed the characteristics of depression and social phobia secondary to ADD. (1) What is their functional impact? (2) Are they independent or associated conditions? (3) Do they completely remit in abstinent individuals? (4) Is the remission of one disorder associated with the remission of the other disorder? Methods: Sixty-four inpatients with ADD were evaluated with depression and anxiety disorder scales upon admission to hospital and after 5 weeks of detoxification. Results: Baseline comparisons differentiated patients with a Hamilton Rating Scale for Depression (HDRS) score >35 (n = 50; 78%) from those with an HDRS score ≤35 by higher levels of generalized anxiety and lower global functioning. Patients with generalized social phobia [Leibowitz Social Anxiety Scale (LSAS) score >60: n = 20; 31.2%] were not distinguishable from those with an LSAS score ≤60 by depressive and anxiety disorder symptoms. In postdetoxification assessment, patients who remitted from depression (HDRS score <7: n = 35; 54.6%) had a lower generalized anxiety and marginally higher levels of hypochondriasis compared to nonremitter subjects (HDRS score ≧7). Patients who remitted from social phobia (LSAS score <30: n = 32; 50%) did not significantly differ from nonremitter subjects in depressive and anxiety disorder symptoms. Generalized anxiety (Hamilton Rating Scale for Anxiety) and hypochondriasis (Whiteley Index) were the significant predictors of global functioning (Global Assessment Scale). Conclusions: Depression and social phobia secondary to ADD are independent conditions that do not completely remit after cessation of drinking. Specific treatments are needed to reduce residual depressive and anxiety symptoms in abstinent alcoholics.

An in vivo Study of the Relationship between Craving and Reaction Time during Alcohol Detoxification Using the Ecological Momentary Assessment

To study cognitive interference associated with craving for alcohol, the Ecological Momentary Assessment (EMA) method was used to measure the relationship between craving and reaction time. A secondary aim was the study of the predictive factors for craving during alcohol detoxification. The EMA enables both repeated measures of craving in a natural setting and the recording of reaction time without the patient being aware of this. Craving for alcohol, reaction time, sadness and anxiety were recorded 8 to 12 times a day, over three weeks of detoxification in 14 alcoholics (n=1767 measures), on an electronic diary issuing random prompts. Mixed models were used for statistical analysis (alpha=5%, 1-beta=88%). Reaction time was significantly increased in univariate analysis when a craving episode occurred but this difference did not persist after multivariate analysis. Craving episodes were more frequent and intense than previously reported. Predictive factors of craving during detoxification were: age, gender, sadness, anxiety and the number of previous detoxifications. Antidepressants, anti-craving medications but not benzodiazepines were negatively associated to craving.