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Puja K. Parekh, Angela R. Ozburn, Colleen A. McClung
Alcohol 2015, Volume 49, pages 341-349
Decades of research supports the notion that there exists a bidirectional relationship between alcohol abuse and circadian rhythm disruptions. In their review of a number of recent studies providing strong evidence that circadian genes regulate several aspects of dopaminergic transmission, the authors discuss how neurotransmitter systems and reward circuitry are under circadian control and are modulated by drug and alcohol experience, as well as how specific circadian genes regulate drug and alcohol responses. Further studies of the interactions between alcohol, circadian rhythms, and circadian genes are warranted. Together with findings from recent investigations these could help to uncover new therapeutic targets and optimize timing of administration of existing therapies.
Sleep and use of alcohol and drug in adolescence. A large population-based study of Norwegian adolescents aged 16 to 19 years
Børge Sivertsen, Jens Christoffer Skogen, Reidar Jakobsen, Mari Hysing
Drug and Alcohol Dependence 2015, Volume 149, pages 180-186
The authors report on a large population-based study from Norway conducted in 2012 in which 9328 adolescents aged 16–19 years (54% girls) were surveyed. The main objective of the current study was to examine the association between a range of sleep problems and sleep behaviors, and use and misuse of alcohol and illicit drugs. The main findings from this study are that short sleep duration, sleep deficit, large bedtime differences and insomnia were significantly associated with higher odds of all measures of alcohol and drug use/misuse. The associations were in a dose–response manner, and were only partly attenuated by co-existing symptoms of depression, ADHD, and sociodemographic factors. Adolescent sleep problems have been linked to both higher rates of depressive symptoms, increased risk for school non-attendance and poor academic performance. Assessment of sleep could be included in assessment and interventions for alcohol and drug use, and an even broader perspective including mental health problems could be warranted when adolescents present with these behaviors.
Kirk J. Brower
Alcohol 2015, Volume 49, pages 417-427
This article focuses on assessing and treating insomnia that persists despite 4 or more weeks of sobriety in alcohol-dependent adults. Approximately one-quarter of alcohol-dependent patients will have persistent insomnia despite abstinence from alcohol. Poor sleep is associated with relapse, but the mechanism involved is unknown. The article includes practical information like questions which can help in determining the nature, severity, and potential causes of the symptoms; sleep hygiene guidelines; educational approaches; and an overview of behavioral therapies and pharmacotherapies.
Ninad S. Chaudhary, Kyle M. Kampman, Henry R. Kranzler, Michael A. Grandner, Swarnalata Debbarma, Subhajit Chakravorty
Addictive Behaviors 2015, Volume 50, pages 165-172
The authors investigated the association between insomnia and psychosocial problems from a qualitative and a quantitative perspective in a treatment-seeking sample of alcohol dependent subjects. Seventy-five percent of the participating subjects reported insomnia, and 61% of these subjects had insomnia that was moderate–severe in intensity (clinically significant insomnia). Subjects with moderate–severe insomnia were found to have significantly higher scores on the Short Index of Problems total score and on the social and impulse control sub-scales, as well as higher scores on the Addiction Severity Index for employment problems and conflicts with their spouses than others. The authors conclude that in actively drinking alcohol dependent subjects, the presence of insomnia was associated with recent psychosocial problems. Knowledge gained from these associations may help us to identify individuals at higher risk of recidivism and thus may aid in the development of a comprehensive treatment plan.
Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized trial
Maureen A. Walton, Stephen T. Chermack, Jean T. Shope, Raymond Bingham, Marc A. Zimmerman, Frederic C. Blow, Rebecca M. CunninghamWalton MA et al. JAMA 2010
A leading cause of mortality and morbidity in adolescents is violence, and adolescents seeking care in the emergency department are an important population for injury prevention based on increased risk for problems related to alcohol and violence. The objective of this US study was to assess the efficacy of single-session brief interventions addressing violence and alcohol among adolescents with self-reported alcohol use and aggression who sought acute general emergency department care. Data were collected for interventions delivered by a therapist or by stand-alone interactive animated program delivered by a computer. The authors found that brief interventions delivered by a therapist in this setting were associated with a clinically meaningful reduction in the occurrence of violence. To prevent severe peer aggression in 1 adolescent, only 8 at-risk adolescents (with past year alcohol use and aggression) would need to receive the brief intervention delivered by a therapist. At 6 months, participants in the therapist and computer conditions were less likely to report alcohol-related consequences than controls. Especially if designed to be easily incorporated into emergency department practice, these approaches can result in substantial public health benefits.
Patient-provider concordance with behavioral change goals drives measures of motivational interviewing consistency
Laws MB et al. Patient Educ Couns 2015
There is an extensive evidence base for the effectiveness of motivational interviewing (MI) in behavioral counseling by trained practitioners. However, evaluation of MI techniques in regular medical practice has been more limited. The authors present data addressing the relationship between patient concordance with provider behavioral change goals and measured MI consistency from two studies of primary care, study participants were people with HIV. Studies of behavioral change counseling by trained MI practitioners have supported the effect of clinician talk in evoking client change talk. However, this may not be as feasible in the context of medical encounters with lightly trained providers. The study findings suggest that medical providers should be mindful that it is more difficult to maintain MI consistency with resistant patients, while this is precisely the situation in which MI technique is posited to be most useful. Training in MI for medical providers should emphasize this point. However, it may be that MI as such is not really applicable to very brief conversations with resistant patients, and that medical encounters require a modified approach.
Tanner-Smith EE et al.
J Subst Abuse Treat 2015
The authors performed a meta-analysis synthesizing findings from 185 experimental and quasi-experimental independent study samples that examined the effects of brief alcohol interventions on alcohol-related outcomes for adolescents and young adults who were not seeking treatment. The study results indicate that participants who received brief alcohol interventions reduced their alcohol consumption between 1.0 and 1.3 drinking days per month, relative to control participants, who reported an average of 6.2 drinking days per month at baseline. The effects of brief alcohol interventions persisted for up to 1 year after the end of the interventions. Although the magnitude of the effects is generally modest, the brevity and low cost of these interventions allow them to be applied on a relatively large scale where they may add incrementally to the influences that deter risky drinking among youth. Even modest reductions in alcohol consumption may have lasting benefits for youth during these critical developmental periods where progression to alcohol use disorders begins.
Satre DD et al. J Subst Abuse Treat 2013
The authors examined the efficacy of a motivational interviewing (MI) intervention to reduce hazardous drinking and drug use among depression patients as an adjunct to usual care in an outpatient psychiatry clinic setting. The intervention consisted of one 45-minute in-person motivational interviewing session followed by two 15-minute telephone “booster” sessions. At three months, patients who had received MI intervention were significantly less likely than controls to report any hazardous drinking in the prior 30 days: 60.0% vs. 81.8%. No impact was found for the intervention on cannabis use or depression symptoms. The study findings have implications for the development of appropriate alcohol interventions, which are integral to the delivery of effective psychiatric services, in which patients frequently present with alcohol and drug use in addition to major depression.
Relationships among independent major depressions, alcohol use, and other substance use and related problems over 30 years in 397 families
Marc A. Schuckit, Tom L. Smith, Jelger KalmijnSchuckit MA et al. J Stud Alcohol Drugs 2013
There is ample evidence of important relationships between heavy drinking and mood changes as well as between alcohol use disorders and major depressive episodes. However, the mechanisms that underlie these relationships and the clinical implications of these syndromes are complex. The authors present data from a 30-year longitudinal study of almost 400 families where careful efforts were made to identify independent depressions separately from substance-induced depressions. The study showed a relatively high prevalence of alcohol-induced versus independent major depressive episodes in individuals with alcohol abuse or dependence (data collected from male probands). This finding is important to clinicians because the clinical course, overall prognoses, and optimal treatments for these induced conditions are different from independent depressive episodes.
Depression outcome in alcohol dependent patients: An evaluation of the role of independent and substance-induced depression and other predictors
Foulds JA et al. J Affect Disord 2015
The authors conducted a trial in which 138 outpatients with alcohol dependence and major depression participated. Patients were prescribed naltrexone and randomized to citalopram or placebo for 12 weeks, followed by a 12-week naturalistic outcome phase. Alcohol dependent patients whose depression was categorized as substance-induced showed greater improvement in depression during treatment compared to those with independent depression. However this appears to be mainly because they reduced their drinking more. The authors conclude that regardless of whether depression is believed to be independent or substance-induced, alcohol reduction should be prioritized as the first step in treating depression in all actively drinking, alcohol dependent patients
Integration and sustainability of alcohol screening, brief intervention, and pharmacotherapy in primary care settings
Steven M. Ornstein, Peter M. Miller, Andrea M. Wessell, Ruth G. Jenkins, Lynne S. Nemeth, Paul J. NietertJournal of Studies on Alcohol and Drugs 2013, Volume 74, pages 598–604
The purpose of this study was to assess the impact of a practice-based quality improvement approach on alcohol screening, brief interventions (SBI) and use of medication for alcohol use disorders (AUDs) in adult patients with diagnoses of hypertension and/or diabetes, two conditions which are especially sensitive to alcohol. This approach (PPRNet-TRIP) combines audit and feedback, practice site visits for academic detailing and participatory planning, and network meetings to share “best practice” approaches. The study results showed that a more intensive intervention is more effective than passive dissemination of guidelines, electronic health record tools, and audit and feedback on alcohol SBI and use of medications for AUDs, and that its impact is sustained for at least 1 year after it ends. A third finding of the study was that adoption of prescribing medications for AUDs occurs more slowly than SBI. The authors conclude that the PPRNet-TRIP model is effective in improving and maintaining improvement in alcohol screening and brief intervention for patients with diabetes and/or hypertension in primary care settings.
General practitioners recognizing alcohol dependence: A large cross-sectional study in 6 European countries
Jürgen Rehm, Allaman Allamani, Roberto Della Vedova, Zsuzsanna Elekes, Andrzej Jakubczyk, et al.Annals of Family Medicine 2015 Volume 13, pages 28-32.
The aim of this study was to compare how alcohol dependence is recognized in primary care facilities in 6 European countries based on the reference standard for assessing alcohol use disorders, the World Health Organization Composite International Diagnostic Interview (CIDI). Study results showed that, although the physician assessment and the assessment by CIDI yielded a similar prevalence, they identified different patient populations. Fewer than one-fifth of the cases were identified by both methods – diagnosis by GP only and CIDI only. A major finding of this study is that the CIDI was not as successful as a physician in identifying cases of alcohol dependence in older patients, which raises the questions about validity of CIDI and its status as a reference standard. The physicians in the study were able to detect cases of alcohol dependence in need of treatment. The detection and intervention rates of GPs could be improved by routinely checking patients’ alcohol consumption, much as they do for hypertension, by suggesting options for reduction, and by intervening if certain thresholds are crossed. The authors see no reason why primary care physicians could not conduct most treatments for less severe cases of alcohol dependence.
Prevention and screening, brief intervention, and referral to treatment for substance use in primary care
Primary Care: Clinics in Office Practice 2014, Volume 41, pages 185–213
In this article on the role primary care can play related to substance use, attention is paid to tobacco, alcohol, cannabis, and the nonmedical use of prescription opioid medications. The focus is on the US, where more than 85,000 deaths per year are attributable to alcohol consumption, making it the third leading cause of preventable death in the country. Next to underlining the importance of screening, brief intervention, and referral to treatment (SBIRT), the article offers practical information like the AUDIT-C questionnaire, guidelines for alcohol use, selected screening instruments, and the 5 As of behavioral counseling. Among other conclusions in the article, brief interventions, when provided by primary care clinicians, have been found to lessen alcohol consumption, reduce hospital days and health care costs, and decrease mortality.
Opportunities for prevention of alcohol-related death in primary care: Results from a population-based cross-sectional study
Margaret Morris, David Johnson, David S. Morrison
Alcohol 2012, Volume 46, pages 703–707
Deaths and hospital admissions for alcohol-related conditions have risen steeply in the United Kingdom such that they now represent a significant public health problem. The authors found that all adults who died as a result of alcohol in the study area, Greater Glasgow, had at least one physical or biochemical sign of alcohol abuse but there was often no evidence that assessment, treatment and referral reflected evidence-based guidance. Health services have an important role to contribute in identifying and managing alcohol disorders and more work is needed to exploit the opportunities to deliver evidence-based treatments for these patients.
Generalized anxiety disorder is under-recognized in clinical practice in patients with alcohol dependence in France
Violaine Charriau, M'hammed Elyakoubi, Bruno Millet, Dominique Drapier, Didier Robin, Romain Moirand
Alcohol 2013, Volume 47, pages 15–19
Generalized anxiety disorder and alcohol dependence frequently occur together and there is a strong and significant association between the two. However, in their study, the authors found that generalized anxiety disorder in alcohol-dependent patients was under-recognized. The most important implication for clinical practice is that under-diagnosis leads to the absence of a specific treatment of this disorder, which could in turn cause relapses of alcohol, used as an auto-medication. Generalized anxiety disorder is a chronic disabling disorder, which complicates the evolution of alcohol dependence and for which codified therapeutic strategies do exist.
Anne-Pascale Le Berre, Géraldine Rauchs, Renaud La Joie, Shailendra Segobin, Florence Mézenge, Céline Boudehent, François Vabret, Fausto Viader, Francis Eustache, Anne-Lise Pitel, Hélène Beaunieux
Psychiatry Research 2013, Volume 213, pages 202–209
The main objective of this study was to gain a better understanding of the potential contribution of macrostructural brain abnormalities to why some alcoholic patients have difficulty changing their drinking behavior even when they are inpatients at clinical treatment entry. Taken as a group, the alcoholic inpatients participating in the study were found to have widespread gray matter abnormalities on MRI. The study results suggest that as a consequence of their brain volume deficits and associated impairment of critical abilities such as decision making, executive functions and social cognition skills, some alcohol dependent patients may not be able to attend a regular treatment in an addiction department. It may be relevant to favour brain recovery of patients with lower motivation by extending the period they spend without alcohol before being admitted to an Addiction department.
Krista M. Lisdahl, Rachel Thayer, Lindsay M. Squeglia, Tim M. McQueeny, Susan F. Tapert
Psychiatry Research 2013; Volume 211, pages 17–23
In this study, the authors found that increased binge drinks during the past 3 months significantly predicted smaller bilateral cerebellar gray matter and left hemisphere cerebellar white matter volumes, and marginally predicted smaller right hemisphere white matter cerebellar volume as assessed by high-resolution MRI in a sample of 106 normally developing 16- to 19-year olds. Gender did not moderate these effects. Given the high rates of binge drinking in teens and emerging adults, these findings highlight an important public health concern. Interventions geared towards lowering damaging patterns of binge alcohol use in teens and young adults that have shown evidence of efficacy need to be implemented more aggressively to prevent long-term neuronal damage, and to ensure optimal brain health and cognitive functioning in youth.
Edythe D. London, Steven M. Berman, Parvenah Mohammadian, Terrie Ritchie, Mark A. Mandelkern, Mary K.W. Susselman, Florian Schlagenhauf, Ernest P. Noble
Psychiatry Research: Neuroimaging 2009, Volume174, pages 163–170
Positron emission tomography with [F-18] fluorodeoxyglucose (FDG) was used in this study to assess regional cerebral glucose metabolism as a measure of relative brain activity while the study participants performed a vigilance task. The study participants, six A1+ and six A1− men, drank ethanol (0.75 ml/kg) or placebo beverages on each of two days. The study results showed lower anxiety and fatigue after ethanol in A1+ men, compared with higher anxiety and fatigue in A1− men, which strongly supports the hypothesis that ethanol is more reinforcing in A1 carriers. Alcohol-induced negative reinforcement may explain the greater risk for alcoholism associated with the A1 allele.
Nabi Zorlu, Fazil Gelal, Ali Kuserli, Ebuzer Cenik, Ercan Durmaz, Aybala Saricicek, Seref Gulseren
Psychiatry Research: Neuroimaging 2013, Volume 214, pages 382–388
The authors of this study used Tract Based Spatial Statistics (TBSS) to assess white matter changes in 17 inpatient alcohol dependent patients (ADP) who had been abstinent for at least 2 weeks before testing and diffusion tensor imaging scanning compared with 16 healthy controls. To measure decision-making in the study participants the Iowa Gambling Task (IGT) was used. Four significant clusters were found in which fractional anisotropy was significantly lower in ADP than in control subjects, including the corpus callosum and parietal, occipital and frontal regions. The authors found significant correlations between the widespread disruption of white matter integrity and impaired IGT performance. These results might help to explain observed decision making deficits in ADP.
AMPA receptors in post-mortem brains of Cloninger type 1 and 2 alcoholics: A whole-hemisphere autoradiography study
Olli Kärkkäinen, Jukka Kupila, Merja Häkkinen, Virpi Laukkanen, Erkki Tupala, Hannu Kautiainen, Jari Tiihonen, Markus Storvik
Psychiatry Research: Neuroimaging 2013, Volume 214, pages 429–434
The authors examined densities of AMPA receptors from human post-mortem brain regions in Cloninger type 1 and 2 alcoholics and non-alcoholic controls by whole-hemi-sphere autoradiography. [3H] AMPA binding was found to be significantly increased in type 2 alcoholics in the anterior cingulate cortex (ACC) when compared to controls. The study results support the idea that in type 2 alcoholics, some altered function in the ACC reflects a dysfunction in optimal-decision making and reward-related learning processes; such a dysfunction could be one of the neural changes leading to the addiction and impulsive behaviour already seen with type 2 alcoholics at an early age.
Part 1 of lecture series Alcohol dependence and sleep disruption
Part 2 of lecture series Alcohol dependence and sleep disruption
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