The consumption of cigarettes, coffee and sweets in detoxified alcoholics and its association with relapse and a family history of alcoholism

Sweet-liking and sugar supplementation as innovative components in substance use disorder treatment: A systematic review

OBJECTIVE

Substance use disorders are a major global public health concern. While a wide range of psychotherapies and pharmacotherapies are available for their treatment, efficacy is limited and many patients fail to benefit from these treatments. Like addictive substances, sugar seems to trigger the dopaminergic reward centre, and sweet-liking might be a modifier of substance use disorder treatment.

METHOD

Systematic review to summarize the role of sugar and sugar-liking in addiction and addiction treatment.

RESULTS

Evidence from both preclinical and clinical studies suggests that a certain portion of the population has a genetic predisposition for sweet-liking, which might be related to a higher risk for substance use and dependence. Regarding nicotine dependence, glucose supplementation prior to or during smoking cessation rapidly mitigates withdrawal symptoms and increases smoking abstinence rates during nicotine replacement therapy. In alcohol dependence, sweet-liking patients encounter more challenges in achieving abstinence than sweet-disliking patients. In addition, sweet-liking patients with high cravings demonstrate higher abstinence rates than sweet-disliking patients. Finally, sweet-liking is associated with successful outcomes of naltrexone treatment in patients with an alcohol use disorder.

CONCLUSION

These findings present promising new challenges and opportunities to fine-tune and optimize treatment protocols in addiction care.

Nutritional status changes in the treatment of substance use disorder: Relationship with substance craving

Tailored nutrition counseling enhances the efficacy of routine treatment for substance (alcohol/drugs) use disorders (SUDs). For this purpose, it is important to understand the current nutritional status of addicts and the changes in their nutritional status during the treatment process. Furthermore, the consumption of sweets to manage substance cravings is common among people with SUDs, but the evidence for the effectiveness of this practice is limited and conflicting. We therefore hypothesized SUD treatment would be associated with increases in appetite, nutrient intake, and anthropometric measurements in addicts, and that these changes, including changes in sweet consumption, would not be associated with decreased substance craving. Data for this prospective observational study were collected from 38 adult male patients who completed 21 days of inpatient SUD treatment. During the treatment, the participants' levels of appetite (P < 1.0 × 10-4), the frequency of main meals (P < 1.0 × 10-4), intake of macro- and micronutrients (P < .05 for each), and anthropometric measurements (P ≤ 5.9 × 10-4), significantly increased. Furthermore, it was found that the patients had a significant increase in sweets craving (P < 1.0 × 10-4) and sweets consumption (P = 1.2 × 10-3) during treatment. However, there was no significant difference between the individuals whose craving decreased and those whose craving did not decrease at the end of the treatment (P > .05 for both). The findings suggest the need to offer dietary counseling to individuals undergoing inpatient SUD treatment, given the substantial changes in nutritional status, and that increased consumption of sweets is not an effective strategy to reduce substance craving.

Prospective Associations between Attitudes toward Sweet Foods, Sugar Consumption, and Cravings for Alcohol and Sweets in Early Recovery from Alcohol Use Disorders

Sweet liking (heightened preference for highly-sweet solutions) is linked to Alcohol Use Disorder (AUD) and relapse, as well as attitudes towards sweet foods - use of sugar to cope with negative affect (sweet-cope), and impaired control over sweets consumption (sweet-control). This prospective analysis of individuals with AUD (N=26) participating in an Alcohol and Drug partial hospitalization program observed increases in self-reported sugar consumption and sweet craving from Time 1 (T1) to Time 2 (T2; 4 weeks later). Sweet-cope (T1) predicted T2 sweet craving. In an exploratory cross-lagged panel model, sweet-cope predicted sugar consumption and sweet craving at T1 and T2, and alcohol craving at T2. This pattern of results suggests the hypothesis that use of sugar to regulate negative affect may prove a novel, modifiable risk mechanism of the association between sweet liking and relapse. Sweet-cope may also prove an intervention target for improving nutrition and weight-related factors in early recovery. Future research in larger sample sizes is needed.

Daily associations between alcohol and sweets craving and consumption in early AUD recovery: Results from an ecological momentary assessment study

INTRODUCTION

Alcohol cravings can predict relapse in persons with alcohol use disorder (AUD). Consuming sweets is a commonly recommend strategy to quell alcohol cravings in early recovery from AUD, yet research is equivocal on whether consuming sweets mitigates alcohol cravings or relapse risk. The current study used ecological momentary assessment (EMA) data to examine real-time alcohol cravings, sweet cravings, and consumption of sweets among adults in early recovery from AUD.

METHODS

We used EMA methods to follow 25 adults (n = 14 women, 56%; M. age 40, S.D. 10.68) recently discharged from a partial hospitalization program for AUD for 21 days. Prompts were sent to the participants for completion four times per day via a mobile app. EMA data were disaggregated prior to analysis to examine between- and within-person effects. A series of three mixed linear models tested: 1) the contemporaneous effect of sweet and alcohol cravings, 2) alcohol cravings predicting sweet consumption later in the day, and 3) sweet consumption predicting alcohol craving later in the day.

RESULTS

The results of the first model revealed alcohol cravings were associated with sweet cravings early in recovery. In the second model, no effect occurred between alcohol cravings earlier in the day predicting sweet consumption later in the day. The third model suggested consuming sweets earlier in the day predicted higher alcohol cravings later in the day.

DISCUSSION

Sweet craving and consumption are associated with alcohol cravings among adults in early recovery from AUD. These findings suggest consuming sweets may increase alcohol cravings. If future studies can replicate this result, consuming sweets in early recovery may emerge as a potential risk for relapse in this population.

Andrographis paniculata and Its Main Bioactive Ingredient Andrographolide Decrease Alcohol Drinking and Seeking in Rats Through Activation of Nuclear PPARγ Pathway

BACKGROUND AND AIMS

Andrographis paniculata is an annual herbaceous plant which belongs to the Acanthaceae family. Extracts from this plant have shown hepatoprotective, anti-inflammatory and antidiabetic properties, at least in part, through activation of the nuclear receptor Peroxisome Proliferator-Activated Receptor-gamma (PPAR γ). Recent evidence has demonstrated that activation of PPARγ reduces alcohol drinking and seeking in Marchigian Sardinian (msP) alcohol-preferring rats.

METHODS

The present study evaluated whether A. paniculata reduces alcohol drinking and relapse in msP rats by activating PPARγ.

RESULTS

Oral administration of an A. paniculata dried extract (0, 15, 150 mg/kg) lowered voluntary alcohol consumption in a dose-dependent manner and achieved ~65% reduction at the dose of 450 mg/kg. Water and food consumption were not affected by the treatment. Administration of Andrographolide (5 and 10 mg/kg), the main active component of A. paniculata, also reduced alcohol drinking. This effect was suppressed by the selective PPARγ antagonist GW9662. Subsequently, we showed that oral administration of A. paniculata (0, 150, 450 mg/kg) prevented yohimbine- but not cues-induced reinstatement of alcohol seeking.

CONCLUSIONS

Results point to A. paniculata-mediated PPARγactivation as a possible therapeutic strategy to treat alcohol use disorder.

Is craving a risk factor for substance use among treatment-seeking individuals with alcohol and other drugs use disorders? A meta-analytic review

BACKGROUND

It is still unclear whether craving should be considered a key risk factor for substance-use behaviors (SUB) among treatment-seeking individuals with alcohol (AUD) and other drugs use disorders. Therefore, this study aims at clarifying this topic using a meta-analytic approach.

METHODS

Cohen's d was computed as effect size (ES) measure. Heterogeneity of ESs was computed using the Q statistic and I² index. The analyses also evaluated the impact assessment length on ESs. Furthermore, proximal effects of craving on SUB were compared to distal ones. The diagnoses of specific substance use disorders (SUDs), together with assessment instruments and research design were considered as additional moderators.

RESULTS

Thirty-six independent studies were included for a total of 4868 treatment-seeking individuals with SUDs. Patients who used substances showed slightly higher levels of craving than abstinent ones. The heterogeneity of results was large and significant. The length of period of assessment was positively related to ESs. The analyses highlighted no differences between pooled ESs of proximal and distal impacts of craving on SUB. The diagnoses of SUDs were significant moderators. Considering AUD, assessment instruments and research design were additional moderators.

CONCLUSIONS

Craving is a modest time-dependent proximal and distal risk factor for SUB among individuals with SUDs. Both the frequency of craving episodes and a heightened reactivity to craving cues are largely associated to SUB among individuals with AUD. Future studies should evaluate the mediating and moderating roles of self-regulatory mechanisms on the relationship between craving and SUB.

Combined alcoholic and non-alcoholic steatohepatitis

While metabolic syndrome and alcohol consumption are the two main causes of chronic liver disease, one of the two conditions is often predominant, with the other acting as a cofactor of morbimortality. It has been shown that obesity and alcohol act synergistically to increase the risk of fibrosis progression, hepatic carcinogenesis and mortality, while genetic polymorphisms can strongly influence disease progression. Based on common pathogenic pathways, there are several potential targets that could be used to treat both diseases; based on the prevalence and incidence of these diseases, new therapies and clinical trials are needed urgently.

Alcohol use disorder relapse factors: A systematic review

A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.

Changes in Nutrition-Related Behaviors in Alcohol-Dependent Patients After Outpatient Detoxification: The Role of Chocolate

BACKGROUND

Previous studies have reported changes in nutrition-related behaviors in alcohol-dependent patients after alcohol detoxification, but prospective studies assessing the effects of these changes on maintaining abstinence are lacking.

OBJECTIVES

To assess changes in craving and consumption of chocolate and other sweets over time up to six months after outpatient alcohol detoxification treatment and to detect differences in abstinent versus nonabstinent patients.

METHODS

One hundred and fifty alcohol-dependent patients were included in this prospective observational study. Participants completed self-report questionnaires on nutrition-related behaviors and craving before detoxification treatment (baseline, t1), one week (t2), one month (t3), and six months later (t4).

RESULTS

Significant changes in craving for and consumption of chocolate as well as in craving for other sweets were observed over time. Increases were most prominent within the first month. Patients who remained abstinent until t3 consumed three times more chocolate than nonabstainers. One quarter of the patients switched from being rare (t1) to frequent (t3) chocolate eaters, and 84% of these remained abstinent until t3. No significant correlations were found between craving for alcohol and craving for or consumption of chocolate or other sweets.

CONCLUSIONS/IMPORTANCE

In the first month after outpatient alcohol detoxification treatment, significant changes in nutrition-related behaviors were observed. These changes were not associated with alcohol craving. For a subgroup, increasing the frequency of chocolate consumption might be a temporary protective factor with respect to alcohol relapse.

Drug use is associated with elevated food consumption in college students

Higher food consumption, particularly of sweets, has been reported by substance-dependent persons in various stages of treatment but no investigation of substance use and actual food consumption has been conducted in non-dependent persons. Sixty-two male and female college students completed the Core Alcohol and Drug Survey and the amount of each of six snack foods (including both sweet and savory items) they consumed were measured. Participants also rated appetite before and after eating and rated the pleasantness of and desire to eat each food. Hierarchical multivariate regression revealed that, while controlling for the influence of BMI and intermeal interval, frequency and breadth of substance use significantly predicted elevated food consumption and elevated ratings of hunger and desire to eat. Furthermore, the link between breadth of drug use and food consumption was mediated by higher desire to eat and not by pleasantness of the food. The relationship between substance use and eating behavior may not be restricted only to those in recovery or treatment for persons diagnosed with substance use disorders.

Sweet preferences and analgesia during childhood: effects of family history of alcoholism and depression

AIM

To determine whether depression and family history of alcoholism are associated with heightened sweet preferences in children, before they have experienced alcohol or tobacco and at a time during the life-span when sweets are particularly salient. Design Between- and within-subject experimental study.

PARTICIPANTS

Children, 5-12 years old (n = 300), formed four groups based on family history of alcohol dependence up to second-degree relatives [positive (FHP) versus negative (FHN)] and depressive symptoms as determined by the Pictorial Depression Scale [depressed (PDEP) versus non-depressed (NDEP)].

MEASUREMENTS

Children were tested individually to measure sucrose preferences, sweet food liking and, for a subset of the children, the analgesic properties of sucrose versus water during the cold pressor test.

FINDINGS

The co-occurrence of having a family history of alcoholism and self-reports of depressive symptomatology was associated significantly with a preference for a more concentrated sucrose solution, while depressive symptomatology alone was associated with greater liking for sweet-tasting foods and candies and increased pain sensitivity. Depression antagonized the analgesic properties of sucrose.

CONCLUSIONS

While children as a group innately like sweets and feel better after eating them, the present study reveals significant contributions of family history of alcoholism and depression to this effect. Whether the heightened sweet preference and the use of sweets to alleviate depression are markers for developing alcohol-related problems or responses that are protective are important areas for future research.

A smoking ban in public places increases the efficacy of bupropion and counseling on cessation outcomes at 1 year

INTRODUCTION

Legal restrictions have contributed to the decline in smoking prevalence in several European countries. We investigated the impact of the Italian 2005 indoor smoking ban on the efficacy of counseling alone or in combination with bupropion for smoking cessation.

METHODS

Before and after the introduction of the ban (2001-2006), 550 smokers were enrolled in the smoking cessation program in Rome and were asked to choose between a 6-week group counseling therapy (GCT) given alone or in combination with 7 weeks of daily bupropion. Follow-up was completed 12, 26, and 52 weeks after the quit day. Due to the observational nature of the study, we used propensity scores to match 138 and 290 subjects (pre-/postban) in the bupropion- and GCT-only groups, respectively.

RESULTS

Covariate balance in the two matched samples was adequate for all variables except "coffee consumption" in the GCT-only group. The regression adjusted odds ratios indicated that the introduction of the ban resulted in 52% reduced odds of continued smoking at 12 months among the GCT + bupropion group and 41% reduced odds in the GCT-only group. We observed that the ban was associated with both increased 12-month abstinence rates and motivation to quit. In a mediation analysis, we determined that the total effect of the smoking ban on the abstinence rate was reduced after controlling for motivation, which confirmed that motivation was a partial mediator.

DISCUSSION

The introduction of an indoor smoking ban improved the efficacy of smoking cessation treatments by possibly providing a setting that increased the level of motivation to stop smoking.

Requirement of central ghrelin signaling for alcohol reward

The stomach-derived hormone ghrelin interacts with key CNS circuits regulating energy balance and body weight. Here we provide evidence that the central ghrelin signaling system is required for alcohol reward. Central ghrelin administration (to brain ventricles or to tegmental areas involved in reward) increased alcohol intake in a 2-bottle (alcohol/water) free choice limited access paradigm in mice. By contrast, central or peripheral administration of ghrelin receptor (GHS-R1A) antagonists suppressed alcohol intake in this model. Alcohol-induced locomotor stimulation, accumbal dopamine release and conditioned place preference were abolished in models of suppressed central ghrelin signaling: GHS-R1A knockout mice and mice treated with 2 different GHS-R1A antagonists. Thus, central ghrelin signaling, via GHS-R1A, not only stimulates the reward system, but is also required for stimulation of that system by alcohol. Our data suggest that central ghrelin signaling constitutes a potential target for treatment of alcohol-related disorders.

Ethanol-associated cues produce general pavlovian-instrumental transfer

BACKGROUND

Conditioned stimuli are thought to play an important role in maintaining ethanol use and inducing relapse. Therefore, understanding the mechanisms through which such stimuli trigger ethanol seeking is of interest in the study and treatment of alcoholism.

METHODS

This series of experiments examined the impact of ethanol-associated cues on ethanol-seeking behavior using a Pavlovian-instrumental transfer design. Rats received Pavlovian training in which an auditory stimulus predicted ethanol (10%) delivery. In a separate instrumental training phase, animals were trained to press a lever for ethanol. In the test phase, the impact of the stimulus on instrumental performance was assessed in extinction by presenting the stimulus while animals were free to perform the lever-press response. Experiment 2 assessed the selectivity of the transfer effect; rats received training with 2 auditory stimuli which predicted either ethanol or sucrose (2%) delivery and were trained to perform 2 instrumental responses, one earning ethanol and the other earning sucrose. Finally, Experiment 3 examined the selectivity of PIT using 2 natural rewards (sucrose and polycose).

RESULTS

The results from Experiment 1 show that ethanol supports excitatory conditioning and that ethanol-associated cues facilitate instrumental performance for ethanol. When the selectivity of the transfer effect was examined in Experiment 2, the ethanol-paired stimulus was found to have a general excitatory effect on reward-seeking behavior, affecting both ethanol-directed and sucrose-directed responding equally. In contrast, the sucrose-paired stimulus had a selective effect, elevating sucrose-directed responding only. Experiment 3 confirms that selective transfer is observed when 2 natural rewards are used to reinforce responding.

CONCLUSIONS

These data provide further evidence that ethanol-associated cues can drive ethanol-seeking behaviors. Because ethanol-associated cues also enhanced seeking behavior for a nonalcohol reward, these results additionally suggest that the modulation of reward-directed behaviors by cues associated with ethanol versus natural rewards may rely on different behavioral and neural mechanisms.

Nicotine dependence is associated with compulsive alcohol craving

AIMS

To investigate a possible association of nicotine dependence and alcohol craving.

DESIGN

A prospective cross-sectional study on patients diagnosed with alcohol dependence.

SETTING

Detoxification unit of a regional psychiatric hospital.

PARTICIPANTS

A total of 127 smoking male patients were included in the study at admission for detoxification from alcohol.

MEASUREMENTS

The Fagerström Test for Nicotine Dependence (FTND) was used to assess the severity of nicotine dependence while the Obsessive Compulsive Craving Scale (OCDS) was used to measure alcohol craving. The OCDS was assessed at admission and after 7 days of withdrawal treatment, distinguishing the total score, the obsessive and the compulsive subscale.

FINDINGS

Spearman's correlation revealed a significant association between the extent of alcohol craving and the FTND score (day 0, n = 127: OCDS total score r = 0.238, P = 0.007; OCDS compulsive score r = 0.280, P = 0.001; day 7; n = 94: OCDS total score r = 0.212, P = 0.040; OCDS compulsive score r = 0.225, P = 0.029).

CONCLUSIONS

The severity of nicotine dependence is associated with higher craving in alcohol-dependent patients. These results point towards shared pathophysiological mechanisms in alcohol craving and nicotine addiction.