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INTRODUCTION: Alcoholism is a major global public health concern associated with numerous health conditions. Alcohol use has been a cultural part of several ethnic groups in Nepal. This study aimed to explore the qualitative dimension of alcohol use, its promoting factors, and consequences in Nepalese communities. METHODS: Qualitative study was conducted among 20 older adults belonging to the Magar community of Mathagadhi Rural Municipality, Lumbini Province, Nepal after acquiring ethical approval from Institutional Review Committee of CiST College (Reference number: 179/078/079). The data were analyzed using inductive thematic analysis, and themes were identified based on participants' responses to explore promoting factors for alcohol consumption along with its consequences. RESULTS: Traditional beliefs, cultural practices, and socioeconomic factors were the major contributors to alcohol misuse. Increased alcohol consumption during old age was perceived to be associated with body pain, tension, painful life events, and loneliness. CONCLUSIONS: A conflicting perception was observed, where some of the participants expressed the need to promote alcohol use as a part of their culture while some shared the view that the use of alcohol as a cultural practice should be limited. This study highlights the need for culturally appropriate interventions to address alcohol misuse among indigenous communities. Interventions should focus on addressing traditional beliefs and cultural practices that normalize alcohol consumption and the social and economic problems associated with alcohol misuse.
Assuntos
Consumo de Bebidas Alcoólicas , Pesquisa Qualitativa , Fatores Socioeconômicos , Humanos , Nepal/epidemiologia , Masculino , Feminino , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/etnologia , Idoso , Pessoa de Meia-Idade , Alcoolismo/etnologia , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Fatores Sociodemográficos , Povos Indígenas , Solidão/psicologia , Cultura , Idoso de 80 Anos ou maisRESUMO
The underlying neurobiology of alcohol use disorder (AUD) is complex and needs further unraveling, with one of the key mechanisms being the gut-brain peptide ghrelin and its receptor (GHSR). However, additional substrates of the ghrelin pathway, such as liver-expressed antimicrobial peptide 2 (LEAP2), an endogenous GHSR inverse agonist, may contribute to this neurobiological framework. While LEAP2 modulates feeding and reward through central mechanisms, its effects on alcohol responses are unknown. The aim of the present study was therefore to identify the impact of central LEAP2 on the ability of alcohol to activate the mesolimbic dopamine system and to define its ability to control alcohol intake. These experiments revealed that central LEAP2 (i.e. into the third ventricle) prevented the ability of alcohol to cause locomotor stimulation in male mice, suppressed the memory of alcohol reward and attenuated the dopamine release in the nucleus accumbens caused by alcohol. Moreover, central LEAP2 reduced alcohol consumption in both male and female rats exposed to alcohol for 6 weeks before treatment. However, the serum levels of LEAP2 were similar between high- and low- alcohol-consuming (male) rats. Furthermore, central LEAP2 lowered the food intake in the alcohol-consuming male rats and reduced the body weight in the females. Collectively, the present study revealed that central LEAP2 mitigates alcohol-related responses in rodents, contributing to our understanding of the ghrelin pathway's role in alcohol effects.
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Consumo de Bebidas Alcoólicas , Etanol , Núcleo Accumbens , Receptores de Grelina , Recompensa , Animais , Masculino , Ratos , Camundongos , Receptores de Grelina/agonistas , Núcleo Accumbens/efeitos dos fármacos , Núcleo Accumbens/metabolismo , Feminino , Etanol/farmacologia , Dopamina/metabolismo , Camundongos Endogâmicos C57BL , Alcoolismo , Grelina , Peptídeos Catiônicos AntimicrobianosRESUMO
BACKGROUND: Identifying problem drinking patterns across industries is essential for addressing drinking problems in the workforce. Still, it is not well understood how problem drinking differs across industries and whether it is associated with industry gender composition. This study aimed to measure the prevalence of problem drinking (PPD) across Swedish industries and investigate possible associations between gender-typed industries and problem drinking. METHODS: 9,155 current workers were selected from the Swedish Longitudinal Occupational Survey of Health (SLOSH) data collected in 2020. Participants' work industries were identified through the Swedish Standard Industrial Classification (SNI) codes. Seven gender-typed industry categories were created based on gender composition and main job activity in each industry. Self-reported problem drinking was measured using a slightly modified Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire and a cut-off score 2 was used to determine problem drinking. Poisson regression with robust standard errors was used to investigate the association between gender-typed industries and problem drinking. RESULTS: PPD in the workforce was 6.6%. Men (8.5%) had a higher prevalence than women (5.3%). Across industries, PPD varied from 2.3% in Water supply and waste management to 15.4% in Mining and quarrying. The highest prevalence for men was in Mining and quarrying (18.2%), whereas for women it was in Construction (11.1%). Within gender-typed industries, the highest PPD was in male-dominated Goods and Energy Production (7.7%), and the lowest was in female-dominated Health and Social Care (4.7%). In the regression analysis, both Education (aPR: 1.39, p = 0.03) and Labour-intensive Services (aPR: 1.39, p = 0.02) had higher adjusted prevalence ratios (aPR) compared with Health and Social Care. However, there was no significant difference in aPR among gender-typed industries when considering the gender composition of industries only. CONCLUSIONS: PPD in the Swedish workforce varied significantly across industries, with differences observed between men and women. Problem drinking differed between industries when categorized by gender composition and main job activity, but not when categorized by gender composition only. Future research should investigate how industry-specific psychosocial factors influence individual alcohol consumption.
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Indústrias , Humanos , Suécia/epidemiologia , Masculino , Feminino , Adulto , Prevalência , Pessoa de Meia-Idade , Indústrias/estatística & dados numéricos , Fatores Sexuais , Adulto Jovem , Alcoolismo/epidemiologia , Estudos Longitudinais , Ocupações/estatística & dados numéricos , AdolescenteRESUMO
Topicality: Providing assistance to patients with polytrauma, in a state of alcohol intoxication, complicated by alcoholic delirium, is a serious problem when providing anesthesia care and, in particular, choosing drugs for sedation. Considering the severity of mechanical damage, complications associated with alcohol intoxication and serious biochemical disorders of the body, namely carbohydrate, lipid metabolism, electrolyte changes, on which the activity of all systems depends, it is necessary to study the influence on the course of these processes, depending on the choice of their medicinal corrections. PURPOSE: The purpose of the work is to choose a sedation method to improve the results of treatment of patients with polytrauma and alcohol withdrawal, based on the study of changes in carbohydrate metabolism indicator. MATERIALS AND METHODS: The paper analyzes the results of a study of 80 patients with polytrauma and chronic alcohol intoxication with a state of alcohol withdrawal, complicated by alcoholic delirium, who received intensive therapy in the 12-bed department of anesthesiology and intensive therapy for patients with combined trauma of the KNP «Kharkiv City Clinical Hospital of Emergency Medical Care¼ named after Prof. O. I. Meschaninov¼ KhMR. All patients were diagnosed with polytrauma (thoracic and/or abdominal trauma: rib fractures, hemo-, pneumothorax, hematomas of the liver or spleen, fracture of the bones of the waist, and/or upper and/or lower limbs, fracture of the pelvis). In the course of the research, to achieve the goal, the main indicators of carbohydrate metabolism were determined, which were evaluated by the content of key metabolites: glucose, pyruvic acid, lactate. The study was conducted on the 1st, 3rd and 7th day of hospitalization of the patients. RESULTS AND DISCUSSION: In all traumatized patients with alcohol withdrawal syndrome and alcoholic delirium with the use of dexmedetomidine for sedation (group 1) and in patients who were used as sedatives, diazepam and haloperidol (group 2), changes in these parameters were observed in the blood, compared to healthy people of the control group. As for the glucose content in the blood of the patients of the 1st group, on the first day, persistent hyperglycemia was observed in them 1.7 times higher than this indicator in healthy people. Next, patients' blood glucose levels were determined on the 3rd and 7th day after hospitalization. Glucose content on the 3rd day decreased by 9.4% compared to the level determined on the first day. On the 7th day, the content of glucose in the blood decreased to normal values, which is 26.5% lower compared to the content of glucose in the blood on the first day. In the 2nd group of patients, where diazepam and haloperidol were used on the first day, hyperglycemia was also observed - 1.9 times higher than this indicator in the control group of healthy individuals. On the third day, the level of glucose in the blood decreased by 6%. And on the 7th day, it decreased by 20.5%. Thus, hyperglycemia was observed in the blood of victims with alcohol withdrawal syndrome, complicated by delirium during hospitalization, on the 3rd day of hospitalization (first and second groups) and on the 7th day in patients of the second group, which indicates violation of carbohydrate metabolism and the development of hypoxia, with impaired liver and pancreas function. In accordance with the aim and objectives of the study, the blood content of the main metabolites of glucose metabolism - pyruvate and lactate - was also studied upon admission to the hospital and one week after treatment, which made it possible to comprehensively assess possible carbohydrate metabolism disorders and characterize the features of the body's energy supply in the combination of polytrauma and withdrawal alcohol, complicated by alcoholic delirium. According to the results of the research, there is an increase in the content of lactate and pyruvate in patients with polytrauma against the background of chronic alcoholism compared to healthy people. When analyzing the content of lactate in the blood of patients with polytrauma and alcohol withdrawal syndrome, complicated by alcoholic delirium upon admission to the intensive care unit, a significant increase of this indicator was observed by 97.1% and 113.0%, respectively, in patients of the first and second groups. One week after the intensive therapy, the patients of the 1st group had a significant decrease in the lactate content in the blood - by 13% (Ð <0.0001) compared to the content of this indicator at the time of admission to the hospital. In the blood of the patients of the 2nd group, on the 7th day, the lactate content remained unchanged, and by 106.3% it exceeded this biochemical indicator in the blood of the control group. Hyperpyruvatemia was also observed - when entering the hospital in patients of the 2nd group, the content was 55.4% higher compared to healthy people, remained elevated after a week of treatment - by 30.1%, and did not return to normal values. In the patients of the first group, upon admission to the hospital, the pyruvate content in the blood was 53.0% higher compared to the control group, and on the 7th day it significantly decreased by 18.9%, but did not reach the values of the control group (remained at 24, 1% higher compared to the control). The cause of hyperpyruvatemia and hyperlactatemia in patients may also be a violation of their enzymatic transformation into decay products. Lactate is the final product of anaerobic oxidation of glucose, it is formed due to the transformation of pyruvate, under the conditions of action of the lactate dehydrogenase enzyme in conditions of hypoxia. An important indicator of the state of carbohydrate metabolism, namely the balance of anaerobic and aerobic processes in the body, is the lactate / pyruvate ratio, which in the control group was 14.33 [13.82; 14.49]. In the patients of the first group, an increase in this ratio was observed - and it was 18.46 [18.3; 20.59] and 19.81 [18.96; 21,17] upon admission to the intensive care unit and one week after treatment, respectively. Practically the same value of this ratio was observed in patients of the second group - 19.65 [18.97; 22.3] and 22.73 [21.32 23.91], respectively, according to the time of intensive therapy. The latest figures indicate the restructuring of the energy supply of body tissues during the stay of patients in the intensive care unit. CONCLUSIONS: Thus, in patients with polytrauma and alcohol withdrawal syndrome, complicated by alcoholic delirium, there is an intensification of the processes of anaerobic glycolysis, which is evidenced by an increase in the content of pyruvate, lactate, the lactate/pyruvate ratio, and is accompanied by a hypoxic state. When comparing the terms of stay in the intensive care unit, it was determined that the use of dexmedetomidine for the treatment of alcoholic delirium compared to benzodiazepines allows reducing the time of intensive care by 34 hours. Thus, in group 2, the duration of intensive therapy for alcoholic delirium was 89 [82-96.2] hours, while in group 1 it was reduced to 55 [52.2-59.8] (p=0.020427). In addition, it was found that the consumption of drugs by patients was different. During the first day, it was 20 [20-30] mg in group 1, and 40 [40-50] mg in group 2. The groups also differed significantly in terms of the total dose of the drug during intensive therapy, so in patients of group 1, the total consumption was 30 [30-40] mg, in group 2 - 80 [80-90] mg (p=0.033011).
Assuntos
Delirium por Abstinência Alcoólica , Hipnóticos e Sedativos , Traumatismo Múltiplo , Humanos , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/metabolismo , Masculino , Hipnóticos e Sedativos/uso terapêutico , Hipnóticos e Sedativos/administração & dosagem , Adulto , Pessoa de Meia-Idade , Delirium por Abstinência Alcoólica/sangue , Feminino , Metabolismo dos Carboidratos/efeitos dos fármacos , Intoxicação Alcoólica/metabolismo , Intoxicação Alcoólica/complicações , Intoxicação Alcoólica/sangue , Glicemia/metabolismo , Dexmedetomidina , Alcoolismo/complicações , Alcoolismo/metabolismoRESUMO
AIMS: We conducted a proof-of-concept randomized controlled trial of the mu-opioid receptor antagonist, naltrexone, augmented with the alpha-1 adrenergic receptor antagonist, prazosin, for alcohol use disorder in veterans. We sought a signal that the naltrexone plus prazosin combination regimen would be superior to naltrexone alone. METHODS: Thirty-one actively drinking veterans with alcohol use disorder were randomized 1:1:1:1 to naltrexone plus prazosin (NAL-PRAZ [n = 8]), naltrexone plus placebo (NAL-PLAC [n = 7]), prazosin plus placebo (PRAZ-PLAC [n = 7]), or placebo plus placebo (PLAC-PLAC [n = 9]) for 6 weeks. Prazosin was titrated over 2 weeks to a target dose of 4 mg QAM, 4 mg QPM, and 8 mg QHS. Naltrexone was administered at 50 mg QD. Primary outcomes were the Penn Alcohol Craving Scale (PACS), % drinking days (PDD), and % heavy drinking days (PHDD). RESULTS: In the NAL-PRAZ condition, % reductions from baseline for all three primary outcome measures exceeded 50% and were at least twice as large as % reductions in the NAL-PLAC condition (PACS: 57% vs. 26%; PDD: 51% vs. 22%; PHDD: 69% vs. 15%) and in the other two comparator conditions. Standardized effect sizes between NAL-PRAZ and NAL-PLAC for each primary outcome measure were >0.8. All but one participant assigned to the two prazosin containing conditions achieved the target prazosin dose of 16 mg/day and maintained that dose for the duration of the trial. CONCLUSION: These results suggest that prazosin augmentation of naltrexone enhances naltrexone benefit for alcohol use disorder. These results strengthen rationale for an adequately powered definitive randomized controlled trial.
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Antagonistas de Receptores Adrenérgicos alfa 1 , Alcoolismo , Quimioterapia Combinada , Naltrexona , Antagonistas de Entorpecentes , Prazosina , Estudo de Prova de Conceito , Humanos , Naltrexona/uso terapêutico , Naltrexona/administração & dosagem , Prazosina/uso terapêutico , Prazosina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Alcoolismo/tratamento farmacológico , Antagonistas de Entorpecentes/uso terapêutico , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Antagonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Feminino , Adulto , Resultado do Tratamento , Veteranos , Método Duplo-CegoRESUMO
BACKGROUND: Alcohol use disorders (AUDs) contribute significantly to the global disease burden in terms of morbidity and mortality. While effective treatment options exist, engagement with care remains a challenge, impacting treatment outcomes and resource allocation, particularly in resource-constrained settings. In this review, we aim to systematically examine and synthesize the evidence on interventions targeting initiation of and adherence to treatment for AUDs. METHODS: A search was conducted on six electronic databases (MEDLINE, PsycINFO, Embase, Global Health, CINAHL and CENTRAL) using search terms under the following concepts: alcohol use disorders, initiation/adherence, treatments, and controlled trial study design. Due to the heterogeneity in intervention content and outcomes among the included studies, a narrative synthesis was conducted. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. RESULTS: The search yielded 32 distinct studies testing eleven categories of interventions. 23 out of 32 studies reported effectiveness of interventions in improving at least one initiation or adherence outcome, with 11 studies reporting an improvement in at least one outcome related to drinking, and four studies reporting improvements in at least one measure of well-being or disability. Community Reinforcement Approach and Family Training (CRAFT) emerged as a prominent approach for treatment initiation, contingency management for adherence, and motivational interviewing (MI) for both treatment initiation and adherence. CONCLUSION: Integrating initiation and adherence interventions into AUD treatment services holds immense potential for optimizing client outcomes and fostering overall well-being. However, generalizability of these strategies remains uncertain owing to the lack of studies conducted in low- and middle-income countries. Addressing this gap is crucial for enhancing global access to effective treatments for AUDs.
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Transtornos Relacionados ao Uso de Álcool , Humanos , Transtornos Relacionados ao Uso de Álcool/terapia , Alcoolismo/terapia , Entrevista Motivacional/métodos , Cooperação do PacienteRESUMO
AIMS: This study aimed to investigate acamprosate and naltrexone dispensing patterns in Australia. METHODS: A 10% representative sample of medications subsidized by the Australian Pharmaceutical Benefits Scheme (PBS) was used to identify individuals who were dispensed naltrexone or acamprosate between January 2006 and December 2023. Data were used to examine concurrent dispensing, medication switching and treatment episode length, as well as changes in prevalence and incidence over time. RESULTS: During the study, we identified 22 745 individuals with a total of 117 548 dispensed prescriptions (45.3% naltrexone, 43.0% acamprosate, and 11.7% concurrent dispensing). Alcohol pharmacotherapy dispensing occurred in 1354 per 100 000 individuals. It is estimated that 2.9% of individuals with an alcohol use disorder in Australia are receiving a PBS-listed pharmacological treatment. For both pharmacotherapies, individuals were most likely to be male (60.0%) and 35-54 years of age (56.0%). Individuals were more likely to switch from acamprosate to naltrexone rather than the reverse. From 2006 and 2023, the number of prevalent individuals treated with an alcohol pharmacotherapy significantly increased, driven mainly the use of naltrexone, which more than doubled over the study period. Incident naltrexone-treated individuals were more likely to remain on treatment for the recommended minimum 3-month period compared to acamprosate treated individuals, although overall dispensing for at least 3 months was low (5.1%). CONCLUSIONS: In Australia between 2006 and 2023, rates of naltrexone dispensing have substantially increased, while acamprosate dispensing showed minimal changes. However, the use of alcohol pharmacotherapies remains low compared with the likely prevalence of alcohol use disorders.
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Acamprosato , Dissuasores de Álcool , Alcoolismo , Naltrexona , Humanos , Acamprosato/uso terapêutico , Austrália/epidemiologia , Masculino , Feminino , Naltrexona/uso terapêutico , Pessoa de Meia-Idade , Adulto , Dissuasores de Álcool/uso terapêutico , Alcoolismo/tratamento farmacológico , Alcoolismo/epidemiologia , Adulto Jovem , Idoso , AdolescenteRESUMO
Alcohol-related research in Botswana has rarely used a socio-ecological approach. This article presents a phenomenological in-depth analysis drawn from community mapping interviews (n = 23) collected among community leaders and service providers in one village in Botswana. The socio-ecological approach guided our research and analysis. This paper explored the influence of alcohol misuse within the cultural, familial, practices and legal frameworks in Botswana. Findings revealed patterns in alcohol misuse over time, the influence of alcohol misuse within different ecological systems, and their response to alcohol patterns as three global themes are discussed. The findings showed that alcohol misuse remains a major public health problem that trickles down from the community, and family systems to an individual, when there are with limited resources to address the alcohol misuse that exists. Recommendations to address alcohol misuse in Botswana include providing alcohol-free recreational places, more research on alcohol harm, and educating communities about alcohol harm.
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População Rural , Humanos , Botsuana/epidemiologia , Masculino , Feminino , Alcoolismo/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Pessoa de Meia-IdadeRESUMO
AIMS: This study described the burden of alcohol-related morbidity and mortality among those who had been enrolled in residential treatment for drug use disorders in Denmark and investigated whether self-reported information on alcohol use provided at treatment admission can be used to assess risk for future serious alcohol-related harms. METHODS: At baseline (entry in drug use disorder treatment during 2000-10), clients completed a European adaptation of the Addiction Severity Index-5. We tracked 4981 clients through 2018 using multiple national registers to identify fully (100%) alcohol-attributable hospital contacts and deaths. RESULTS: The death rate due to fully alcohol-attributable causes was 411 per 100 000 person-years, with an average of 0.18 fully alcohol-attributable hospital contacts per person-year. Using the Addiction Severity Index-5 alcohol composite score as a predictor in an adjusted competing risks regression model, a higher score was associated with a higher risk of alcohol-related death. The alcohol composite score was a significant predictor of alcohol-related hospital contacts in an adjusted recurrent events model. CONCLUSIONS: A substantial proportion of people originally identified as experiencing drug use disorders have alcohol problems that need to be monitored and managed to prevent serious complications. By demonstrating the predictive power of self-reported data, our study concludes that the Addiction Severity Index-5 can be used to identify individuals with drug use disorders at risk for severe long-term alcohol-related health outcomes.
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Tratamento Domiciliar , Transtornos Relacionados ao Uso de Substâncias , Humanos , Dinamarca/epidemiologia , Masculino , Feminino , Adulto , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Pessoa de Meia-Idade , Estudos de Coortes , Alcoolismo/mortalidade , Alcoolismo/reabilitação , Alcoolismo/complicações , Alcoolismo/epidemiologia , Transtornos Relacionados ao Uso de Álcool/mortalidade , Transtornos Relacionados ao Uso de Álcool/reabilitação , Autorrelato , Adulto JovemRESUMO
Several parameters affect our brain's neuronal system and can be identified by analyzing electroencephalogram (EEG) signals. One of the parameters is alcoholism, which affects the pattern of our EEG signals. By analyzing these EEG signals, one can derive information regarding the alcoholic or normal stage of an individual. Many road accident cases around the world, including drinking and driving scenarios, which result in loss of life, have been reported. Another reason for such incidents is that riders avoid wearing helmets while driving two-wheelers. Many road accident cases involving two-wheelers, including drinking, driving, overspeeding, and nonwearing helmets, have been reported. Therefore, to solve such issues, the present work highlights the features of an intelligent model that can predict the alcoholism level of the subject, wearing of a helmet, vehicle speed, location, etc. The system is designed with the latest technologies and is smart enough to make decisions. The system is based on multilayer perceptron, histogram of oriented gradients (HoG) feature extraction, and random forest to make decisions in real time. The accuracy of the proposed method is approximately 95%, which will reduce the fatality rate due to road accidents. The system is tested under different working environments, i.e., indoor and outdoor, and satisfactory outcomes are observed.
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Acidentes de Trânsito , Condução de Veículo , Eletroencefalografia , Internet das Coisas , Humanos , Acidentes de Trânsito/prevenção & controle , Eletroencefalografia/métodos , Masculino , Adulto , Dispositivos de Proteção da Cabeça , Alcoolismo , FemininoRESUMO
INTRODUCTION: Smoking is negatively related to mental health, but there is a paucity of research on the relationship between the use of smokeless tobacco, such as snus, and mental health outcomes, especially in people with alcohol use disorders (AUD). The aim of the present study was to examine the development of mental distress and quality of life (QoL) among AUD patients in treatment who did or did not use snus. METHOD: The study included 128 AUD patients (27% female) from three rehabilitation clinics in Eastern Norway who were interviewed at admission, at 6 weeks, and after 6 months. Patients were asked about their mental health-related problems, alcohol, and substance use, QoL, and physical activity. Information about tobacco use was gathered with the questions "Do you smoke cigarettes?" and "Do you use snus?", with follow-up questions "How often?". RESULT: There were 39 current snus users (31%), of which 20 were also current smokers (dual users). Seventy-five patients (59%) were smokers only, and only 14 (11%) patients were abstainers. Those who used snus only had a lower severity of dependence score than the other groups (p < 0.05). The dual use group reported lower QoL than the no tobacco use group. In a regression model adjusted for sex and age, smokers and dual users, but not users of snus, had higher levels of mental distress and poorer QoL compared to nontobacco users (p < 0.05). There were no differences between tobacco groups at follow-ups. CONCLUSION: In this study, among AUD patients, snus users reported QoL and mental distress close to that of non-smokers, indicating a lower problem load among snus users compared to smokers. IMPLICATIONS: Previous studies have shown conflicting results regarding the potential harm reduction effect of snus use among patients with AUD who smoke regarding their tobacco use, quality of life and mental health problems. This study suggests that snus use could also be a viable alternative to smoking for patients with addictions.
Assuntos
Qualidade de Vida , Tabaco sem Fumaça , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Seguimentos , Noruega , Alcoolismo/reabilitaçãoRESUMO
BACKGROUND: Previous studies have established a connection between adverse childhood experiences (ACE) and alcohol use disorder (AUD), both of which are associated with alterations in grey matter volume (GMV) and cortical thickness (CT). The current study aimed to assess the neurobiological impact of ACE specifically in the context of AUD, as well as the role of maltreatment type (i.e., abuse or neglect) and timing. METHODS: Structural MRI data were collected from 35 adults with AUD (mean age: 40; 31% female) and 28 healthy controls (mean age: 36; 61% female). ACE were assessed retrospectively using the Childhood Trauma Questionnaire, and the Maltreatment and Abuse Chronology interview. Global and regional GMV and CT were estimated using voxel- and surface-based morphometry. RESULTS: Relative to the healthy controls, the AUD group had significantly reduced CT in the left inferior frontal gyrus, left circular sulcus of the insula and subcentral gyrus and sulci (cluster C1), and in the central sulcus and precentral gyrus (cluster C2). Within the AUD group, a reduction of CT in cluster C1 was significantly associated with higher severity of ACE and AUD. Type and timing analyses revealed a significant association between higher levels of abuse at ages 13 to 15 and reduced CT in cluster C1 within the AUD group. CONCLUSIONS: In adults with AUD, abuse experienced during early adolescence is associated with reduced CT in regions involved in inhibitory control, indicating the potential relevance of cognitive pathways in the association between ACE and AUD. Longitudinal studies are needed to confirm and expand upon current findings.
Assuntos
Experiências Adversas da Infância , Alcoolismo , Córtex Cerebral , Substância Cinzenta , Imageamento por Ressonância Magnética , Humanos , Feminino , Masculino , Adulto , Alcoolismo/diagnóstico por imagem , Alcoolismo/patologia , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos de Casos e Controles , Espessura Cortical do Cérebro , Sobreviventes Adultos de Maus-Tratos Infantis , Maus-Tratos Infantis/psicologia , Adultos Sobreviventes de Eventos Adversos na InfânciaRESUMO
BACKGROUND: Unhealthy alcohol use represents a significant risk for morbidity and mortality among people living with HIV (PLWH), in part through its impact on HIV management. Chronic pain, a common comorbidity, exacerbates suboptimal engagement in the HIV care continuum and has reciprocal detrimental effects on alcohol outcomes. There are no integrated, accessible approaches that address these comorbid conditions among PLWH to date. This paper describes a research study protocol of an integrated telehealth intervention to reduce unhealthy drinking and chronic pain among PLWH (Motivational and Cognitive-Behavioral Management for Alcohol and Pain [INTV]). METHODS: Two-hundred and fifty PLWH with unhealthy drinking and chronic pain will be recruited nationally via online advertisement. Informed consent and baseline assessments occur remotely, followed by 15 days of ecological momentary assessment to assess alcohol use, chronic pain, functioning, and mechanisms of behavior change. Next, participants will be randomized to either the INTV or Control (CTL) condition. Individuals in both conditions will meet with a health counselor through videoconferencing following randomization, and those in the INTV condition will receive 6 additional sessions. At 3- and 6-months post-baseline, participants will complete outcome assessments. It is hypothesized that the INTV condition will result in reduced unhealthy alcohol use and pain ratings compared to the CTL condition. CONCLUSION: This protocol paper describes a randomized controlled trial which tests the efficacy of a novel, integrated telehealth approach to reduce unhealthy alcohol use and chronic pain for PLWH, two common comorbid conditions that influence the HIV treatment cascade. GOV IDENTIFIER: NCT05503173.
Assuntos
Dor Crônica , Infecções por HIV , Telemedicina , Adulto , Feminino , Humanos , Masculino , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/terapia , Alcoolismo/terapia , Dor Crônica/terapia , Terapia Cognitivo-Comportamental/métodos , Avaliação Momentânea Ecológica , Infecções por HIV/complicações , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
AIMS: This study examined differential changes in alcohol use during the COVID-19 pandemic among adults with unhealthy alcohol use. METHODS: Among 62 924 adults identified with unhealthy alcohol use in primary care prepandemic (1 January 2019 to 29 February 2020), changes in alcohol use during the pandemic (1 March 2020 to 30 June 2022) were examined using electronic health record data from Kaiser Permanente Northern California. Outcomes were changes in heavy drinking days in the past three months (HDDs) and overall consumption (drinks/week), including continuous and categorical measures. Differences in outcomes by sex, age, race/ethnicity, and alcohol use disorder (AUD) were examined. RESULTS: On average, drinking was reduced by 3.0 HDDs (in the past three months) (SD = 18.4) and 4.1 drinks/week (SD = 12.2), but women, certain age groups, White patients, and patients without AUD had smaller decreases than their counterparts. Overall, 9.1% increased, 34.4% maintained, and 56.5% decreased HDDs, and 20.2% increased, 19.8% maintained, and 60.1% decreased drinks/week. Women, patients aged ≥35 years, White patients, and patients with AUD had higher odds of increasing versus decreasing HDDs, and maintaining versus decreasing, compared to their counterparts. Patients aged 18-20 years, White patients, and patients without AUD had higher odds than their counterparts of increasing versus decreasing drinks/week. Women, patients aged 18-20 years, Asian/Pacific Islander, and Latino/Hispanic patients had higher odds of maintaining versus decreasing drinks/week. CONCLUSIONS: While alcohol use decreased overall among this sample of primary care patients with unhealthy drinking prepandemic, certain subgroups were more likely to increase drinking, suggesting a greater risk of alcohol-related problems.
Assuntos
Consumo de Bebidas Alcoólicas , Alcoolismo , COVID-19 , Humanos , COVID-19/epidemiologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , California/epidemiologia , Adulto Jovem , Idoso , Estudos Prospectivos , Adolescente , Fatores Etários , Atenção Primária à Saúde/estatística & dados numéricos , PandemiasRESUMO
BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) is commonly used in clinical settings to assess the severity of alcohol-related problems, with the effectiveness of alcohol reduction interventions varying across this spectrum. In a recent study, we demonstrated that a 12-week intervention involving the provision of free non-alcoholic beverages reduced alcohol consumption among heavy drinkers for up to 8 weeks post-intervention. However, it remains unclear whether this effect was consistent across different AUDIT score ranges. Therefore, this secondary analysis aimed to examine whether the severity of alcohol-related problems, as indicated by AUDIT scores, influences the effectiveness of non-alcoholic beverage provision in reducing alcohol consumption. METHODS: This was a single-center, open-label, randomized, parallel-group study. Participants were Japanese individuals who frequently consumed large quantities of alcohol (at least 40 g/day for men and 20 g/day for women) but were not diagnosed with alcohol dependence. Participants were randomly assigned to either an intervention or control group. The intervention group received free non-alcoholic beverages once every 4 weeks over a 12-week period (24 bottles of 350 mL per case, up to three cases per session, for a total of three sessions). Alcohol and non-alcoholic beverage consumption over the previous 4 weeks was tracked using a drinking diary. For this secondary analysis, participants were categorized into four groups based on their AUDIT scores (group 1: ≤ 7 points, group 2: 8-11 points, group 3: 12-14 points, and group 4: ≥ 15 points), and changes in alcohol consumption were compared across these groups in both the intervention and control participants. RESULTS: The provision of non-alcoholic beverages significantly increased non-alcoholic beverage consumption in all groups. However, alcohol consumption was significantly reduced in the intervention groups compared to controls only in groups 1-3. The reduction in alcohol consumption was less pronounced in groups 3 and 4 compared to group 1 (both, p < 0.05). Importantly, the provision of non-alcoholic beverages did not lead to an increase in alcohol consumption, even among individuals with higher AUDIT scores. CONCLUSIONS: These findings suggest that individuals with higher AUDIT scores may experience a reduced benefit from a 12-week non-alcoholic beverage intervention in terms of alcohol consumption reduction. Nevertheless, this intervention appears to be a safe and effective strategy for reducing alcohol consumption in heavy drinkers who do not have alcohol dependence. TRIAL REGISTRATION: UMIN UMIN000047949. Registered 4 June 2022.
Assuntos
Consumo de Bebidas Alcoólicas , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Bebidas , Resultado do Tratamento , Alcoolismo , JapãoRESUMO
BACKGROUND: This study aimed to explore the association between the emotional impact of COVID-19 and emotional eating and the risk of alcohol use disorder among Peruvian health science students. METHODS: We conducted a cross-sectional analytical study in which an online questionnaire was administered to 456 health science interns from four cities in Peru. We used the COVID-19 Emotional Impact Profile questionnaire, Mindful Eating Questionnaire, and Alcohol Use Disorders Identification Test. Spearman's correlations were calculated and two multiple linear regression models were developed. RESULTS: 68.4% of the participants were emotional eaters and 8.6% reported low-risk levels of alcohol use disorder. Based on the results of the first model, the overall emotional impact of COVID-19, being overweight or obese, depression and anxiety levels, and living with only one parent were factors associated with emotional eating. The results of the second model showed that the level of depression, living with just one parent, living alone, sex, and number of months as an intern were factors associated with the risk of alcohol use disorder. CONCLUSIONS: To reduce emotional eating and the risk of alcohol use disorder among interns, universities should implement interventions aimed at reducing the emotional impact of COVID-19 and provide nutritional counseling.
Assuntos
COVID-19 , Emoções , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , Feminino , Peru/epidemiologia , Masculino , Estudos Transversais , Adulto , Adulto Jovem , Inquéritos e Questionários , SARS-CoV-2 , Alcoolismo/psicologia , Alcoolismo/epidemiologia , Depressão/psicologia , Depressão/epidemiologia , Fatores de Risco , Comportamento Alimentar/psicologia , Ansiedade/psicologia , Ansiedade/epidemiologiaRESUMO
The modern pace of life, increased susceptibility to stressors, and easy access to psychoactive substances have contributed to the increase in the number of people addicted to alcohol. Alcoholism has serious and life-threatening consequences, one of which is brain damage causing morbid jealousy, otherwise known as Othello syndrome. The disease, currently classified as a subtype of delusional disorder, manifests itself in groundless and dangerous judgments about a partner's sexual infidelity. People with Othello syndrome constantly believe in their partner's infidelity despite inadequate evidence of it. Patients become aggressive toward their partners as well as themselves, which is why in a fit of anger they can commit murder or suicide. Othello syndrome can occur as a symptom of an underlying mental illness, but it is most often associated with brain damage caused by chronic alcohol use. Antipsychotic drugs and serotonin reuptake inhibitors are used in pharmacotherapy. Targeted treatment using the neuropeptide oxytocin, which modulates the transmitter systems responsible for disease symptoms, is also being considered. The use of oxytocin seems groundbreaking, but it remains at the research stage. The treatment of addictions and primary diseases, as well as long-term cognitive-analytic psychotherapy, also have a huge impact. Othello syndrome is a life-threatening disease with an insidious course and serious consequences. This article aims to review the manifestations of morbid jealousy, including delusional disorder, and the association with alcoholism.
Assuntos
Alcoolismo , Ciúme , Humanos , Alcoolismo/complicações , Delusões/etiologiaRESUMO
Cumulative evidence suggests that zebrafish is a useful model in psychiatric research. Weighted Gene Co-expression Network Analysis (WGCNA) enables the reduction of genome-wide expression data to modules of highly co-expressed genes, which are hypothesized to interact within molecular networks. In this study, we first applied WGCNA to zebrafish brain expression data across different experimental conditions. Then, we characterized the different co-expression modules by gene-set enrichment analysis and hub gene-phenotype association. Finally, we analyzed association of polygenic risk scores (PRSs) based on genes of some interesting co-expression modules with alcohol dependence in 524 patients and 729 controls from Galicia, using competitive tests. Our approach revealed 34 co-expression modules in the zebrafish brain, with some showing enrichment in human synaptic genes, brain tissues, or brain developmental stages. Moreover, certain co-expression modules were enriched in psychiatry-related GWAS and comprised hub genes associated with psychiatry-related traits in both human GWAS and zebrafish models. Expression patterns of some co-expression modules were associated with the tested experimental conditions, mainly with substance withdrawal and cold stress. Notably, a PRS based on genes from co-expression modules exclusively associated with substance withdrawal in zebrafish showed a stronger association with human alcohol dependence than PRSs based on randomly selected brain-expressed genes. In conclusion, our analysis led to the identification of co-expressed gene modules that may model human brain gene networks involved in psychiatry-related traits. Specifically, we detected a cluster of co-expressed genes whose expression was exclusively associated with substance withdrawal in zebrafish, which significantly contributed to alcohol dependence susceptibility in humans.
Assuntos
Alcoolismo , Encéfalo , Redes Reguladoras de Genes , Estudo de Associação Genômica Ampla , Peixe-Zebra , Animais , Encéfalo/metabolismo , Alcoolismo/genética , Humanos , Herança Multifatorial , Modelos Animais de Doenças , Expressão Gênica/genéticaRESUMO
OBJECTIVE: Negative affect and affect variability figure prominently in models of addictive behaviors but are not without controversy. Negative affect variability may better capture a mechanism of behavior change in alcohol use disorder (AUD) treatment because it contains information about affect regulation, a common clinical target. The aims of this study are to examine the change in: (a) trajectory of negative affect variability, (b) association of negative affect variability and abstinence, and (c) association of negative affect variability and heavy drinking during AUD treatment. METHOD: This article is a secondary analysis of data drawn from a randomized clinical trial. N = 181 participants diagnosed with Diagnostic and Statistical Manual of Mental Disorders, fifth edition AUD (Mage = 50.8, SDage = 10.6; 51.4% female) received 12 sessions of Cognitive Behavioral Coping Skills Therapy for AUD. Participants completed one daily diary prompt per day for 84 consecutive days. Each day, participants reported on negative affect and number of alcoholic drinks consumed the previous day. Time-varying effect models examined changes in negative affect variability and its associations with abstinence and heavy drinking. RESULTS: Negative affect variability decreased throughout treatment. The positive association between negative affect variability and heavy drinking became nonsignificant (decoupled) midway through treatment. The inverse association between negative affect variability and daily abstinence became nonsignificant (decoupled) at approximately day 75 of 84. When mean levels of NA were added as a covariate, the effects were in the same direction but no longer statistically significant. CONCLUSION: Reductions in negative affect variability may capture an important change mechanism of behavioral treatments for AUD because it contains information about affect regulation as compared with mean levels of negative affect. Negative affect variability warrants further consideration as a mechanism of behavior change. (PsycInfo Database Record (c) 2024 APA, all rights reserved).