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Månsson A, Danielsson AK, Sjöqvist H, Glatz T, Lundin A, Wallhed Finn S. Pharmacotherapy for alcohol use disorder among adults with medical disorders in Sweden. Addict Sci Clin Pract 2024; 19:41. [PMID: 38764075 PMCID: PMC11103816 DOI: 10.1186/s13722-024-00471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/06/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Alcohol-attributable medical disorders are prevalent among individuals with alcohol use disorder (AUD). However, there is a lack of research on prescriptions of pharmacological treatment for AUD in those with comorbid conditions. This study aims to investigate the utilization of pharmacological treatment (acamprosate, disulfiram and naltrexone) in specialist care among patients with AUD and comorbid medical diagnoses. METHODS This was a descriptive register-based Swedish national cohort study including 132,728 adults diagnosed with AUD (N = 270,933) between 2007 and 2015. The exposure was alcohol-attributable categories of comorbid medical diagnoses. Odds ratios (OR) were calculated using mixed-effect logistic regression analyses for any filled prescription of acamprosate, disulfiram or oral naltrexone within 12 months post AUD diagnosis. RESULTS Individuals with comorbid alcohol-attributable medical diagnoses had lower odds of filling prescriptions for any type of AUD pharmacotherapy compared to those without such comorbidities. Cardiovascular (OR = 0.41 [95% CI: 0.39-0.43]), neurological (OR = 0.52 [95% CI: 0.48-0.56]) and gastrointestinal (OR = 0.57 [95% CI: 0.54-0.60]) diseases were associated with the lowest rates of prescription receipt. The presence of diagnoses which are contraindications to AUD pharmacotherapy did not fully explain the low prescription rate. CONCLUSION There is a substantial underutilization of AUD pharmacotherapy in patients with AUD and comorbid medical disorders in specialist care. Increasing the provision of pharmacotherapy to this group of patients is essential and may prevent morbidity and mortality. There is a need to further understand barriers to medical treatment both from the patient and prescriber perspective.
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Affiliation(s)
- Anastasia Månsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden.
| | - Anna-Karin Danielsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden
| | - Hugo Sjöqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden
| | - Toivo Glatz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Region, Stockholm, 171 77, Sweden
| | - Sara Wallhed Finn
- Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden
- Mottagningen för alkohol och hälsa, Stockholm Center for Dependency Disorders, Health Care Services, Riddargatan 1, 114 35, Stockholm, Sweden
- Unit of Clinical Alcohol Research (UCAR), University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
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Chang RY, Hsueh-Hua Ho S, Tsai HL, Koo M. Association of anxiety and depression with chronic liver diseases in patients with noncardiac chest pain: A cross-sectional study. Medicine (Baltimore) 2022; 101:e29620. [PMID: 35945771 PMCID: PMC9351862 DOI: 10.1097/md.0000000000029620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Causes of chest pain can vary from benign to life-threatening conditions, and in many cases not necessary of cardiac origin. A possible reason for noncardiac chest pain could be anxiety or depression caused by chronic liver diseases. The aim of this study was to investigate the association of anxiety and depression with chronic liver disease in patients with noncardiac pain. Patients with chest tightness or pain referred for treadmill exercise testing were recruited from a regional hospital in southern Taiwan. Medical records of the patients were used to define the presence and type of chronic liver disease. Multiple logistic regression analyses were conducted to assess the association of anxiety and depression with chronic liver disease. A total of 2537 patients with liver function test results and abdominal sonography data were analyzed, and 1965 patients showed a negative treadmill exercise testing. The mean age of these 1965 patients was 51.9 years and 54.2% were male. The prevalence of alcoholic liver disease, hepatitis B, hepatitis C, and fatty liver disease was 10.6%, 10.9%, 3.7%, and 27.0%, respectively. Results from multiple logistic regression analyses showed that the risk of anxiety (adjusted odds ratio [aOR] = 1.83, P < .001) and depression (aOR = 1.85, P < .001) was significantly higher in patients with alcoholic liver disease. Anxiety was significantly higher in patients with fatty liver disease (aOR = 1.30, P = .031), and the risk of depression was significantly higher in patients with chronic hepatitis C (aOR = 2.18, P = .005). In conclusion, in patients with noncardiac chest pain, alcoholic liver disease was significantly associated with anxiety and depression, while those with fatty liver and chronic hepatitis C were associated with anxiety and depression, respectively. Clinicians should be vigilant to these correlations in their practice.
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Affiliation(s)
- Rei-Yeuh Chang
- Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Min-Hwei Junior College of Health Care Management, Tainan City, Taiwan
| | | | - Han-Lin Tsai
- Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien, Taiwan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * Correspondence: Malcolm Koo, PhD, Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien 970302 Taiwan (e-mail: )
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3
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Allamani A, Voller F, Bravi S, Pepe P, Biffino M, Buscema PM, Maurelli G, Massini G, Einstein S, Manthey J, Rehm J. Alcohol Addiction: One Entity or Different Entities? A DSM-4-Based Attempt Toward a Geographicization of Alcohol Addiction and Abuse. Alcohol Alcohol 2022; 57:687-695. [PMID: 35596950 DOI: 10.1093/alcalc/agac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/12/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
AIM To examine whether in Europe perceptions of 'alcoholism' differ in a discrete manner according to geographical area. METHOD Secondary analysis of a data set from a European project carried out in 2013-2014 among 1767 patients treated in alcohol addiction units of nine countries/regions across Europe. The experience of all 11 DSM-4 criteria used for diagnosing 'alcohol dependence' and 'alcohol abuse' were assessed in patient interviews. The analysis was performed through Multiple Correspondence Analysis. RESULTS The symptoms of 'alcohol dependence' and 'alcohol abuse', posited by DSM-IV, were distributed according to three discrete geographical patterns: a macro-area mainly centered on drinking beer and spirit, a culture traditionally oriented toward wine and a mixed intermediate alcoholic beverage situation. CONCLUSION These patterns of perception seem to parallel the diverse drinking cultures of Europe.
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Affiliation(s)
| | - Fabio Voller
- Agenzia Regionale di Sanita' Toscana, Firenze 50141, Italy
| | - Stefano Bravi
- Agenzia Regionale di Sanita' Toscana, Firenze 50141, Italy
| | - Pasquale Pepe
- Agenzia Regionale di Sanita' Toscana, Firenze 50141, Italy
| | - Marco Biffino
- Epidemiologia, ASL Toscana Centro, Firenze 50135, Italy
| | - Paolo Massimo Buscema
- Department of Mathematical and Statistical Sciences, University of Colorado, Denver, CO 80204, USA.,Semeion Research Centre of Sciences of Communication, Rome 00128, Italy
| | - Guido Maurelli
- Semeion Research Centre of Sciences of Communication, Rome 00128, Italy
| | - Giulia Massini
- Semeion Research Centre of Sciences of Communication, Rome 00128, Italy
| | - S Einstein
- Institute for the Study of Substance Use and Misuse; Middle Eastern Summer Institute on Drug Use; Founding Editor, Substance Use & Misuse, 9380140, Israel
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden 01187, Germany.,Centre for Interdisciplinary Addiction Research, UKE Hamburg-Eppendorf, Hamburg 20246, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig 04103, Germany
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
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Gender Differences among Sardinians with Alcohol Use Disorder. J Clin Med 2021; 10:jcm10204688. [PMID: 34682808 PMCID: PMC8537954 DOI: 10.3390/jcm10204688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Sardinia is an Italian island in the Mediterranean characterized by secular isolation and the singular genetic characteristics of its inhabitants. Findings obtained in populations with diverse genetic make-up and cultural background indicate gender differences and/or similarities in drinking characteristics of patients with alcohol use disorder (AUD). Knowledge of these characteristics in AUD patients is useful to improve access to treatments. This paper investigated the drinking characteristics of 66 female and 282 male outpatients with AUD, born from 1937 to 1991, living in Sardinia, and compared their characteristics with those of AUD patients living in other countries. Most Sardinian patients were men, approximately 3 years younger than women; women consumed lower amounts of alcohol than men but did not differ from men in the severity of AUD. Men were more often single than women, while a higher proportion of women reported that their mother or spouse was affected by AUD. Anxiety and depression were more prevalent among women while a higher proportion of men were affected by substance use disorders. Women were older than men at the age of first drink, regular drinking, and onset of AUD, and progressed faster than men from regular use to AUD onset. Women did not differ from men in age at first request for care, and in the lapse from AUD onset to first request for care. Women and men waited for more than 8 and 9 years, respectively, before receiving medical treatment. Gender differences progressively decreased among younger patients. Although the scarce number of women in some cohorts limits the strength of these findings, drinking characteristics of Sardinian patients did not vary significantly from those of AUD patients living in other countries. These results suggest that the number of Sardinian women with AUD is increasing and services for treatment of AUD should (a) consider women’s specific needs, and (b) realize effective policies to reduce latency prior to accessing medical treatment for both men and women with AUD.
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Vasilieva SN, Simutkin GG, Schastnyy ED, Bokhan NA. Clinical-Dynamic Features of Affective Disorders Comorbid with Alcohol Dependence. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00234-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Lanquetin A, Leclercq S, de Timary P, Segobin S, Naveau M, Coulbault L, Maccioni P, Lorrai I, Colombo G, Vivien D, Rubio M, Pitel AL. Role of inflammation in alcohol-related brain abnormalities: a translational study. Brain Commun 2021; 3:fcab154. [PMID: 34396111 PMCID: PMC8361421 DOI: 10.1093/braincomms/fcab154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 12/19/2022] Open
Abstract
Brain abnormalities observed in alcohol use disorder are highly heterogeneous in nature and severity, possibly because chronic alcohol consumption also affects peripheral organs leading to comorbidities that can result in exacerbated brain alterations. Despite numerous studies focussing on the effects of alcohol on the brain or liver, few studies have simultaneously examined liver function and brain damage in alcohol use disorder, and even fewer investigated the relationship between them except in hepatic encephalopathy. And yet, liver dysfunction may be a risk factor for the development of alcohol-related neuropsychological deficits and brain damage well before the development of liver cirrhosis, and potentially through inflammatory responses. The use of animal models enables a better understanding of the pathophysiological mechanisms underlying liver–brain relationships in alcohol use disorder, and more particularly of the inflammatory response at the tissue, cerebral and hepatic levels. The objective of this translational study was to investigate, both in alcohol use disorder patients and in a validated animal model of alcohol use disorder, the links between peripheral inflammation, liver damage and brain alterations. To do this, we conducted an in vivo neuroimaging examination and biological measures to evaluate brain volumes, liver fibrosis and peripheral cytokines in alcohol use disorder patients. In selectively bred Sardinian alcohol-preferring rats, we carried out ex vivo neuroimaging examination and immunohistochemistry to evaluate brain and liver inflammatory responses after chronic (50 consecutive weeks) alcohol drinking. In recently abstinent and non-cirrhotic alcohol use disorder patients, the score of liver fibrosis positively correlated with subcortical regions volumes (especially in right and left putamen) and level of circulating proinflammatory cytokines. In Sardinian alcohol-preferring rats, we found macrostructural brain damage and microstructural white matter abnormalities similar to those found in alcohol use disorder patients. In addition, in agreement with the results of peripheral inflammation observed in the patients, we revealed, in Sardinian alcohol-preferring rats, inflammatory responses in the brain and liver were caused by chronic alcohol consumption. Since the liver is the main source of cytokines in the human body, these results suggest a relationship between liver dysfunction and brain damage in alcohol use disorder patients, even in the absence of major liver disease. These findings encourage considering new therapeutic strategies aiming at treating peripheral organs to limit alcohol-related brain damage.
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Affiliation(s)
- Anastasia Lanquetin
- Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
| | - Sophie Leclercq
- Institute of Neuroscience and Louvain Drug Research Institute, UCLouvain, Université Catholique de Louvain, Brussels, Belgium
| | - Philippe de Timary
- Institute of Neuroscience and Louvain Drug Research Institute, UCLouvain, Université Catholique de Louvain, Brussels, Belgium
| | - Shailendra Segobin
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | - Mikaël Naveau
- Normandie Univ UNICAEN, CNRS, UMS 3408, GIP Cyceron, Caen, France
| | - Laurent Coulbault
- Caen University Hospital, Biochemistry Department, Normandie University, UNICAEN, EA 4650, Caen, France
| | - Paola Maccioni
- Neuroscience Institute, Section of Cagliari, National Research Council of Italy, 09042 Monserrato, CA, Italy
| | - Irene Lorrai
- Neuroscience Institute, Section of Cagliari, National Research Council of Italy, 09042 Monserrato, CA, Italy
| | - Giancarlo Colombo
- Neuroscience Institute, Section of Cagliari, National Research Council of Italy, 09042 Monserrato, CA, Italy
| | - Denis Vivien
- Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.,Department of Clinical Research, CHU Côte de Nacre, Caen 14000, France
| | - Marina Rubio
- Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France.,Institut Universitaire de France (IUF), Paris 75231, France
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7
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Jiang H, Lange S, Tran A, Imtiaz S, Rehm J. Determining the sex-specific distributions of average daily alcohol consumption using cluster analysis: is there a separate distribution for people with alcohol dependence? Popul Health Metr 2021; 19:28. [PMID: 34098997 PMCID: PMC8186209 DOI: 10.1186/s12963-021-00261-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It remains unclear whether alcohol use disorders (AUDs) can be characterized by specific levels of average daily alcohol consumption. The aim of the current study was to model the distributions of average daily alcohol consumption among those who consume alcohol and those with alcohol dependence, the most severe AUD, using various clustering techniques. METHODS Data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used in the current analyses. Clustering algorithms were applied in order to group a set of data points that represent the average daily amount of alcohol consumed. Gaussian Mixture Models (GMMs) were then used to estimate the likelihood of a data point belonging to one of the mixture distributions. Individuals were assigned to the clusters which had the highest posterior probabilities from the GMMs, and their treatment utilization rate was examined for each of the clusters. RESULTS Modeling alcohol consumption via clustering techniques was feasible. The clusters identified did not point to alcohol dependence as a separate cluster characterized by a higher level of alcohol consumption. Among both females and males with alcohol dependence, daily alcohol consumption was relatively low. CONCLUSIONS Overall, we found little evidence for clusters of people with the same drinking distribution, which could be characterized as clinically relevant for people with alcohol use disorders as currently defined.
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Affiliation(s)
- Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
- Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, D-01187, Dresden, Germany
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, Moscow, Russian Federation, 119992
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
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Abstract
Investigation of the pathogenesis of alcoholism in humans using different methodological approaches has facilitated detection of important biological factors of consequent metabolic diseases, endocrine disorders, and other medical conditions, such as alcoholic cardiomyopathy, alcoholic hypertension, heart and vascular lesions, alcoholic liver disease, alcoholic pancreatitis, etc. Alcohol abuse leads to damage to the nervous system, which can result in neurological and mental disorders, including alcoholic polyneuropathy, psychosis, and alcohol dementia. The complexity and versatility of the harmful effects of regular alcohol consumption on the human body can be considered in the perspective of a chronobiological approach, because alcohol is chronotoxic to biological processes. As a rhythm regulator, melatonin exerts a wide range of different effects: circadian rhythm regulation, thermoregulation, sleep induction, antioxidant, immunomodulatory, and anti-stress ones. This review presents from a chronobiological perspective the impact of melatonin on alcohol intoxication in terms of mental disorders, sleep and inflammation, hepatic injury, and mitochondrial function. It discusses the main clinical effects of melatonin on alcohol injury and the main targets as a therapy for alcohol disorders. Chronobiological effects of ethanol are related to melatonin suppression that has been associated with, among others, cancer risk. Exogenous melatonin seems to be a promising hepato- and immune-protector due to its antioxidant and anti-inflammatory properties, which in combination with other medicines makes it useful to prevent alcoholic organ damage. The reason for the scientific interest in melatonin as a treatment for alcoholism is obvious; the number of cases of this pathology that gives rise to metabolic syndrome, and its subsequent transformation into steatohepatitis, liver fibrosis, and cirrhosis, is increasing worldwide. Melatonin not only exerts antioxidant effects but it exerts various other effects contributing to the management of liver conditions. This review discusses the interaction between normal and pathological processes caused by alcohol consumption and the relationship between alcohol and melatonin in these conditions.
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Affiliation(s)
- Natalia Kurhaluk
- Department of Biology, Institute of Biology and Earth Science, Pomeranian University in Słupsk, Słupsk, Poland
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9
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Glantz MD, Bharat C, Degenhardt L, Sampson NA, Scott KM, Lim CCW, Al-Hamzawi A, Alonso J, Andrade LH, Cardoso G, De Girolamo G, Gureje O, He Y, Hinkov H, Karam EG, Karam G, Kovess-Masfety V, Lasebikan V, Lee S, Levinson D, McGrath J, Medina-Mora ME, Mihaescu-Pintia C, Mneimneh Z, Moskalewicz J, Navarro-Mateu F, Posada-Villa J, Rapsey C, Stagnaro JC, Tachimori H, Ten Have M, Tintle N, Torres Y, Williams DR, Ziv Y, Kessler RC. The epidemiology of alcohol use disorders cross-nationally: Findings from the World Mental Health Surveys. Addict Behav 2020; 102:106128. [PMID: 31865172 PMCID: PMC7416527 DOI: 10.1016/j.addbeh.2019.106128] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/24/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Prevalences of Alcohol Use Disorders (AUDs) and Mental Health Disorders (MHDs) in many individual countries have been reported but there are few cross-national studies. The WHO World Mental Health (WMH) Survey Initiative standardizes methodological factors facilitating comparison of the prevalences and associated factors of AUDs in a large number of countries to identify differences and commonalities. METHODS Lifetime and 12-month prevalence estimates of DSM-IV AUDs, MHDs, and associations were assessed in the 29 WMH surveys using the WHO CIDI 3.0. RESULTS Prevalence estimates of alcohol use and AUD across countries and WHO regions varied widely. Mean lifetime prevalence of alcohol use in all countries combined was 80%, ranging from 3.8% to 97.1%. Combined average population lifetime and 12-month prevalence of AUDs were 8.6% and 2.2% respectively and 10.7% and 4.4% among non-abstainers. Of individuals with a lifetime AUD, 43.9% had at least one lifetime MHD and 17.9% of respondents with a lifetime MHD had a lifetime AUD. For most comorbidity combinations, the MHD preceded the onset of the AUD. AUD prevalence was much higher for men than women. 15% of all lifetime AUD cases developed before age 18. Higher household income and being older at time of interview, married, and more educated, were associated with a lower risk for lifetime AUD and AUD persistence. CONCLUSIONS Prevalence of alcohol use and AUD is high overall, with large variation worldwide. The WMH surveys corroborate the wide geographic consistency of a number of well-documented clinical and epidemiological findings and patterns.
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Affiliation(s)
- Meyer D Glantz
- Division of Epidemiology, Services, and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre (NDARC), UNSW, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), UNSW, Sydney, Australia
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Carmen C W Lim
- Queensland Centre for Mental Health Research and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Graca Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Giovanni De Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Brescia, Italy
| | - Oye Gureje
- FRCPsych, Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Yanling He
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hristo Hinkov
- National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Victor Lasebikan
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - John McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia; Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia; National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | | | | | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Charlene Rapsey
- PGDipClinPsych, University of Otago, Dunedin School of Medicine, Department of Psychological Medicine, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Hisateru Tachimori
- National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Nathan Tintle
- Department of Mathematics, Statistics and Computer Science, Dordt College, Sioux Center, Iowa, USA
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yuval Ziv
- Mental Health Services, Israeli Ministry of Health, 39 Yermiyahu St, Jerusalem 9101002, Israel
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Harmful alcohol use among acutely ill hospitalized medical patients in Oslo and Moscow: A cross-sectional study. Drug Alcohol Depend 2019; 204:107588. [PMID: 31590131 DOI: 10.1016/j.drugalcdep.2019.107588] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/03/2019] [Accepted: 08/09/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim was to estimate the prevalence of harmful alcohol use in relation to socio-demographic characteristics among acutely ill medical patients, and examine identification measures of alcohol use, including the alcohol biomarker phosphatidylethanol 16:0/18:1 (PEth). METHODS A cross-sectional study, lasting one year at one hospital in Oslo, Norway and one in Moscow, Russia recruiting acute medically ill patients (≥ 18 years), able to give informed consent. Self-reported data on socio-demographics, mental distress (Symptom Check List-5), alcohol use (Alcohol Use Disorder Identification Test-4 (AUDIT-4) and alcohol consumption past 24 h were collected. PEth and alcohol concentration were measured in whole blood. RESULTS Of 5883 participating patients, 19.2% in Moscow and 21.1% in Oslo were harmful alcohol users, measured by AUDIT-4, while the prevalence of PEth-positive patients was lower: 11.4% in Oslo, 14.3% in Moscow. Men in Moscow were more likely to be harmful users by AUDIT-4 and PEth compared to men in Oslo, except of those being ≥ 71 years. Women in Oslo were more likely to be harmful users compared to those in Moscow by AUDIT-4, but not by PEth for those aged < 61 years. CONCLUSIONS The prevalence of harmful alcohol use was high at both study sites. The prevalence of harmful alcohol use was lower when assessed by PEth compared to AUDIT-4. Thus, self-reporting was the most sensitive measure in revealing harmful alcohol use among all groups except for women in Moscow. Hence, screening and identification with objective biomarkers and self-reporting might be a method for early intervention.
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11
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Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet 2019; 394:781-792. [PMID: 31478502 DOI: 10.1016/s0140-6736(19)31775-1] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/30/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.
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Affiliation(s)
- Andre F Carvalho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia.
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12
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Treatment retention in a specialized alcohol programme after an episode of alcoholic hepatitis: Impact on alcohol relapse. J Psychosom Res 2019; 116:75-82. [PMID: 30654998 DOI: 10.1016/j.jpsychores.2018.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/27/2018] [Indexed: 12/20/2022]
Abstract
AIMS Alcoholic hepatitis (AH) is a life-threatening complication of alcohol use disorder (AUD). Alcohol abstinence is the main predictor of the long-term prognosis of AH. It is unknown whether AUD treatment retention (TR) after an AH episode impacts alcohol relapse and mortality or what baseline factors influence TR. METHODS Design: case-control study; Study population: hospitalized patients (1999-2012) with an episode of biopsy-proven AH were included (n = 120); Assessment: demographic and clinical data, the High-Risk Alcoholism Relapse (HRAR) scale, mortality and alcohol relapse were assessed through clinical records and telephone or personal interviews; Follow-up period: short-term and long-term TRs were assessed at 12 and 24 months, respectively. RESULTS The overall short-term and long-term TRs were 37% and 27.8%, respectively. The severity of liver disease at baseline predicted both short-term and long-term TR (OR 3.7 and 3.3, respectively), whereas HRAR >3 and a history of psychiatric disorders predicted long-term TR (OR 2.9 and 2.6, respectively). Moreover, HRAR >3 (OR 3.0) and previous treatment for AUD (OR 2.9) increased the risk of relapse in the short term. Importantly, receiving alcohol therapy in a centre different from the hospital where the patient was admitted was associated with increased risk of alcohol relapse over the long term (OR 5.4). CONCLUSION Experiencing an alcohol-related life-threatening complication is insufficient motivation to seek treatment for AUD. AUD treatment after an episode of AH is suboptimal, with a low TR rate, high risk of alcohol relapse and poor impact of treatment on alcohol relapse.
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Rautiainen E, Ryynänen OP, Reissell E, Kauhanen J, Laatikainen T. Alcohol-related social and health service use patterns as predictors of death and remission in patients with AUD. J Subst Abuse Treat 2018; 96:65-74. [PMID: 30466551 DOI: 10.1016/j.jsat.2018.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Elina Rautiainen
- Institute of Public Health and Clinical Nutrition, PO Box 1627, FI-70211, University of Eastern Finland, Kuopio, Finland.
| | - Olli-Pekka Ryynänen
- Institute of Public Health and Clinical Nutrition, PO Box 1627, FI-70211, University of Eastern Finland, Kuopio, Finland; General Practice Unit, Kuopio University Hospital, Primary Health Care, PO Box 100, FI-70029 KUH, Kuopio, Finland
| | - Eeva Reissell
- National Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, PO Box 1627, FI-70211, University of Eastern Finland, Kuopio, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, PO Box 1627, FI-70211, University of Eastern Finland, Kuopio, Finland; National Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland; Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Tikkamäentie 16, 80210 Joensuu, Finland
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Villalbí JR, Espelt A, Suelves JM, Bosque-Prous M, Bartroli M, Brugal MT. A population based perspective of twenty years of specialized ambulatory treatment for alcohol use disorders in publicly financed clinics. Barcelona 1996-2015. J Subst Abuse Treat 2018; 92:11-16. [PMID: 30032939 DOI: 10.1016/j.jsat.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/11/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To provide information on persons treated for alcohol use disorders (AUD) over 20 years in a large city in a Southern European country and its trends, adding knowledge on the frequency of treatment from a population perspective. METHODS This is a study of the number of annual admissions to ambulatory addiction treatment centers funded by the public sector in Barcelona (Catalonia, Spain) for the years 1996-2015. Descriptive analyses of AUD admissions were conducted, comparing changes in the number of patients entering treatment by different independent variables across periods. For city residents, sex and age-specific population annual treatment initiation rates were estimated. RESULTS The number of ambulatory admissions to AUD treatment increased over the study period. There were about 2100 treatment admissions per year in 2011-2015, of which one fourth were women. About half of these patients had never been treated before for any substance use disorder. Annual rates of treatment initiation among city residents were 208 and 68 per 100,000 people aged 15 and older for men and women respectively, almost the double among 45-54 years old citizens. Rates of total AUD treatment admission increased moderately, but declined among younger adult men. CONCLUSIONS These figures provide a basic population-based estimation for formal AUD treatment use in a Southern European urban setting with services available free of charge. The development of ambulatory publicly funded addiction centers may have improved access to treatment for people with AUD. age-related changes in treatment admissions may either be related to trends in the population pattern of drinking or to changes in the city demographics.
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Affiliation(s)
- Joan R Villalbí
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, 08023 Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, C/ Melchor Fernández Almagro 3-5, 28029 Madrid, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, C/ Doctor Aiguader 80, 08003 Barcelona, Spain; Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, C/ Marina 27, 08005 Barcelona, Spain
| | - Albert Espelt
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, 08023 Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, C/ Melchor Fernández Almagro 3-5, 28029 Madrid, Spain; Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, C/ Marina 27, 08005 Barcelona, Spain; Facultat de Ciències de la Salut de Manresa, Universitat de Vic Universitat Central de Catalunya (UVicUCC), Av. Universitària, 46, 08242 Manresa, Spain.
| | - Josep M Suelves
- Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, C/ Marina 27, 08005 Barcelona, Spain; Agència de Salut Pública de Catalunya, C/ Roc Boronat 81-95, 08005 Barcelona, Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain
| | - Marina Bosque-Prous
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, 08023 Barcelona, Spain; Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, C/ Marina 27, 08005 Barcelona, Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain
| | - Montse Bartroli
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, 08023 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, C/ Doctor Aiguader 80, 08003 Barcelona, Spain
| | - M Teresa Brugal
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, 08023 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, C/ Doctor Aiguader 80, 08003 Barcelona, Spain; Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, C/ Marina 27, 08005 Barcelona, Spain
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O’Donnell A, Abidi L, Brown J, Karlsson N, Nilsen P, Roback K, Skagerström J, Thomas K. Beliefs and attitudes about addressing alcohol consumption in health care: a population survey in England. BMC Public Health 2018; 18:391. [PMID: 29562901 PMCID: PMC5863360 DOI: 10.1186/s12889-018-5275-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/08/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite robust evidence for their effectiveness, it has proven difficult to translate alcohol prevention activities into routine health care practice. Previous research has identified numerous provider-level barriers affecting implementation, but these have been less extensively investigated in the wider population. We sought to: (1) investigate patients' beliefs and attitudes to being asked about alcohol consumption in health care; and (2) identify the characteristics of those who are supportive of addressing alcohol consumption in health care. METHODS Cross-sectional household interviews conducted as part of the national Alcohol Toolkit Study in England between March and April 2017. Data were collected on age, gender, social grade, drinking category, and beliefs and attitudes to being asked about alcohol in routine health care. Unadjusted and multivariate-adjusted logistic regression models were performed to investigate associations between socio-demographic characteristics and drinking category with being "pro-routine" (i.e. 'agree completely' that alcohol consumption should be routinely addressed in health care) or "pro-personal" (i.e. 'agree completely' that alcohol is a personal matter and not something health care providers should ask about). RESULTS Data were collected on 3499 participants, of whom 50% were "pro-routine" and 10% were "pro-personal". Those in social grade C1, C2, D and E were significantly less likely than those in AB of being "pro-routine". Women were less likely than men to be "pro-personal", and those aged 35-44 or 65 years plus more likely to be "pro-personal" compared with participants aged 16-24. Respondents aged 65 plus were twice as likely as those aged 16-24 to agree completely that alcohol consumption is a personal matter and not something health care providers should ask about (OR 2.00, 95% CI 1.34-2.99). CONCLUSIONS Most adults in England agree that health care providers should routinely ask about patients' alcohol consumption. However, older adults and those in lower socio-economic groups are less supportive. Drinking status appears to have limited impact on whether people believe that alcohol is a personal matter and not something health care providers should ask about. REGISTRATION Open Science Framework ( https://osf.io/xn2st/ ).
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Affiliation(s)
- Amy O’Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Latifa Abidi
- Department of Health Promotion, Maastricht University, Maastricht, Limburg Netherlands
| | - Jamie Brown
- Research Department of Behavioural Science and Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nadine Karlsson
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Kerstin Roback
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Janna Skagerström
- Research and Development Unit, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
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16
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Hejazi MM, Bacha AO, Kaleemuddin M, Al-Abassi FA, Al-Alsieni AI, Kazmi I, Anwar F. Alteration of serum immunoglobins, C-reactive protein, vitamin D, and electrolyte by atenolol and amlodipine in stress-induced hypertensive rats. Mol Cell Biochem 2017; 445:99-103. [PMID: 29248973 DOI: 10.1007/s11010-017-3255-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/10/2017] [Indexed: 02/07/2023]
Abstract
The present study is designed for the assessment of various pathological changes like immunoglobins, C-reactive protein, vitamin D, sodium, potassium, calcium in stress-induced hypertensive rats. Albino Wistar rats of sex male were grouped into six. Each group consists of six animals. Groups were Group I (normal control), Group II (disease control), Group III (amlodipine control), Group IV (atenolol control), Group V (amlodipine treatment), and Group VI (atenolol treatment). Group II, V, and VI animals exposed to regular stress by placing them in cages individually and giving foot electric shocks (1 mA, 50 ms duration with 0.5-1 min of intervals regulated randomly by a computer) along with forced swimming (30 min) in order to induce hypertension in rats. This stress was given two times daily (morning and evening) for regular 15 days. Induction of hypertension was confirmed by measuring the tail arterial pressure of blood and angiotensin II. For next 1 month, Group III and V animals are treated with amlodipine with 1 mg/kg, s.c. dose while Group IV and VI animals were given 10 mg/kg, s.c. the dose of atenolol once daily. At the end of the experimental work, blood collected, rats sacrificed, and serum separated. Serum sodium, potassium, immunoglobins, C-reactive protein, vitamin D, and calcium were measured by semi-auto-analyzer. Stress-induced hypertension in rats produced altered serum sodium, potassium, immunoglobins, C-reactive protein, vitamin D, and calcium level which is restored by atenolol. Administration of amlodipine in animals without hypertension shows alteration in the level of immunoglobins, calcium, vitamin D, and electrolytes.
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Affiliation(s)
- Moayad Mustafa Hejazi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ala Osman Bacha
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Kaleemuddin
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad A Al-Abassi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulbasit I Al-Alsieni
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia. .,Glocal School of Pharmacy, Glocal University, Sahranpur, Uttar Pradesh, 247121, India.
| | - Firoz Anwar
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.
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Zambon A, Airoldi C, Corrao G, Cibin M, Agostini D, Aliotta F, Movalli M, Biondini F, Bizzi P, Zucchi G, Cerizza G, Dattola A, Marmora A, Vittadini G, Girardi F, Liberto L, Hinnenthal I, Sodano AJ, Vizzuso P, Majolino E, Mioni D, Pedretti L, Ranaletti P, Forghieri M, Spolaor G, Giorgi I. Prevalence of Polysubstance Abuse and Dual Diagnosis in Patients Admitted to Alcohol Rehabilitation Units for Alcohol-Related Problems in Italy: Changes in 15 Years. Alcohol Alcohol 2017; 52:699-705. [DOI: 10.1093/alcalc/agx061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/21/2017] [Indexed: 11/13/2022] Open
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de Weert-van Oene GH, Termorshuizen F, Buwalda VJA, Heerdink ER. Somatic health care utilization by patients treated for substance use disorders. Drug Alcohol Depend 2017; 178:277-284. [PMID: 28686985 DOI: 10.1016/j.drugalcdep.2017.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Patients with substance use disorder (SUD) are frequently suffering from co-occurring somatic disorders, increasing the risk of mortality. Somatic health care utilization (sHCU) often remains unknown to the physician during SUD treatment. This paper analyses sHCU and associated costs among patients in SUD treatment compared to matched, non-substance dependent controls. METHODS Health care utilization data on 4972 SUD patients were matched to 19,846 controls by gender, birth year and ethnic origin. Subcategories of patients were formed based on SUD and on co-morbid psychiatric disorder. Data on sHCU during the year prior to the last treatment contact (the 'index date') for both patients and their matched controls were extracted from a health insurance database. RESULTS Patients had a higher sHCU (with increased associated costs) than controls, especially when alcohol dependence was involved. In particular, sHCU for cardiovascular, respiratory, infectious diseases, injuries and accidents was increased among patients. However, the use of preventive medication, such as lipid-lowering drugs, is lower among SUD patients. Co-morbidity of psychiatric disorders led to further increase of sHCU, whereas patients with comorbid non-affective psychotic disorder (NAPD) showed lower sHCU and costs. CONCLUSION Patients with SUD overall have a high sHCU, associated with high costs. There are indications that SUD patients have less access to preventive medication. Patients with comorbid NAPD are at risk of possible underutilization of somatic health care. Furthermore, we conclude that these larger administrative databases allow for comparisons between various diagnostic categories.
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Affiliation(s)
| | - Fabian Termorshuizen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands.
| | - Victor J A Buwalda
- Novadic-Kentron Substance Dependence Treatment Center, PO Box 243, 5260 AE, Vught, The Netherlands.
| | - Eibert R Heerdink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands.
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Bräker AB, Soellner R. Is Drinking Contagious? An Analysis of the Collectivity of Drinking Behavior Theory Within a Multilevel Framework. Alcohol Alcohol 2017; 52:692-698. [PMID: 29016725 DOI: 10.1093/alcalc/agx050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 07/18/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Astrid B Bräker
- University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany
| | - Renate Soellner
- University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany
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Schwarzinger M, Thiébaut SP, Baillot S, Mallet V, Rehm J. Alcohol use disorders and associated chronic disease - a national retrospective cohort study from France. BMC Public Health 2017; 18:43. [PMID: 28732487 PMCID: PMC5521064 DOI: 10.1186/s12889-017-4587-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 07/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence on diseases caused by or associated with alcohol use disorders (AUDs) has been based on two meta-analyses including rather dated studies. The objective of this contribution was to estimate the risks of all-cause mortality and alcohol-attributable disease categories depending on a diagnosis of AUDs in a national sample for France. METHODS In a national retrospective cohort study on all inpatient acute and rehabilitation care patients in Metropolitan France 2008-2012 (N = 26,356,361), AUDs and other disease categories were identified from all discharge diagnoses according to standard definitions, and we relied on in-hospital death for mortality (57.4% of all deaths). RESULTS 704,803 (2.7%) patients identified with AUDs had a threefold higher risk of death (HR = 2.98; 95% CI: 2.96-3.00) and died on average 12.2 years younger (men: 10.4, 95% CI: 10.3-10.5; women: 13.7, 95% CI: 13.6-13.9). AUDs were associated with significantly higher risks of hospital admission for all alcohol-attributable disease categories: digestive diseases, cancers (exception: breast cancer), cardiovascular diseases, dementia, infectious diseases, and injuries. Elevated risks were highest for liver diseases that were associated with about two-third of deaths in patients with AUDs (men: 64.3%; women: 71.1%). CONCLUSIONS AUDs were associated with marked premature mortality and higher risks of alcohol-attributable disease categories. Our results support the urgent need of measures to reduce the burden of AUDs.
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Affiliation(s)
- Michaël Schwarzinger
- Translational Health Economics Network (THEN), 39 quai de Valmy, 75010 Paris, France
| | | | - Sylvain Baillot
- Translational Health Economics Network (THEN), 39 quai de Valmy, 75010 Paris, France
| | - Vincent Mallet
- Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, (UMR-S1016), CNRS (UMR 8104), Paris, France
- Institut Pasteur, Centre d’Immunologie Humaine (UMS20), Paris, France; Hepatology, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Cochin Port-Royal, Paris, France
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8 Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8 Canada
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
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Nalmefene in Alcohol Use Disorder Subjects with Psychiatric Comorbidity: A Naturalistic Study. Adv Ther 2017; 34:1636-1649. [PMID: 28540656 DOI: 10.1007/s12325-017-0546-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Nalmefene is the first drug to be approved for reducing alcohol consumption in alcohol use disorder (AUD) patients at high drinking risk. In real-world settings, there is a high prevalence of concurrent psychiatric disorders in AUD subjects, with associated increased morbidity and worse prognosis. This study evaluated the use of nalmefene in AUD patients with stabilized psychiatric comorbidity previously treated unsuccessfully for alcohol dependence, and assessed craving reduction and safety. METHODS Sixty-five AUD outpatients treated with as-needed 18 mg nalmefene for 24 weeks were included. Primary outcome measures were: changes in heavy drinking days (HDDs) and total alcohol consumption (TAC, g/day). Secondary outcome measures were: changes in drinking risk level and craving (obsessive-compulsive drinking scale and visual analogue scale for craving). RESULTS Forty-two AUD subjects (64.6%) had one or more stabilized psychiatric comorbidity. There was a significant reduction in HDDs, TAC and craving measures (p < 0.001), with no differences between subjects with and without psychiatric comorbidity. Nalmefene was safe and well tolerated in all patients. CONCLUSION As-needed nalmefene reduced drinking and craving in AUD subjects with and without psychiatric comorbidity. These findings suggest that nalmefene is a valid therapeutic option in real-world clinical settings, where comorbid conditions are common, and has the potential to engage AUD patients who may otherwise not have sought help. FUNDING Lundbeck Italia S.P.A.
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Abstract
INTRODUCTION Two rapidly acting antidepressive treatment forms, namely, electroconvulsive therapy (ECT) and ketamine, possibly share a common mechanism of action primarily involving alterations of neurotransmission (glutamate and γ-aminobutyric acid levels). Because patients receiving ketamine and with a coexistent family history of an alcohol use disorder (AUD) seem to benefit from consistent and longer lasting antidepressive effects, we hypothesized better treatment response in ECT patients with an own history or a family history of an AUD. METHOD One hundred forty-one psychiatric inpatients with a major depressive episode, who were treated with ECT, were enrolled into this retrospective study. Age, sex, family or personal history of alcohol or benzodiazepine use disorder, ECT response data, and ECT treatment-related data were collected and analyzed with ordinal logistic regression and Fisher exact tests. RESULTS Twenty-one percent of all patients had their own history of an AUD, 11% had their own history of a benzodiazepine use disorder, and 11% reported on a positive family history of alcohol or benzodiazepine use disorder. The logistic regression analyses revealed that only patient's own history of an AUD predicts a better ECT response (P = 0.031; odds ratio, 2.1; Fisher exact test, P = 0.006). CONCLUSIONS Within the limitations of a retrospective study, a history of an AUD seems to be a positive predictor for an ECT response in patients experiencing a major depressive episode, which has not been found in 2 earlier studies. Findings are in line with neurobiological hypotheses of excitatory/inhibitory neurotransmitter changes with ketamine and ECT.
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Jurado-Barba R, Duque A, López-Trabada JR, Martínez-Gras I, García-Gutiérrez MS, Navarrete F, López-Muñoz F, Jiménez-Arriero MÁ, Ávila C, Manzanares J, Rubio G. The Modulation of the Startle Reflex as Predictor of Alcohol Use Disorders in a Sample of Heavy Drinkers: A 4-Year Follow-Up Study. Alcohol Clin Exp Res 2017; 41:1212-1219. [PMID: 28494516 DOI: 10.1111/acer.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 04/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies demonstrated that patients with alcohol use disorders (AUDs) show altered startle reflex responses to alcohol-related stimuli. However, there is little information about the role of these altered responses in the development of AUDs. This study examined the startle reflex response to different visual stimuli and the role of these patterns in the development of AUDs in a 4-year follow-up. METHODS Two hundred and thirty-nine (nondependent) heavy-drinking participants were selected. In the baseline period, the startle reflex responses to alcohol-related, aversive, appetitive, and neutral pictures were assessed. Startle reflex responses to these pictures were used as predictive variables. Status drinking (alcohol dependence and nondependence) assessed at 4-year follow-up was used as outcome measure. RESULTS At the 4-year follow-up assessment, 46% of participants fulfilled DSM-IV alcohol abuse or dependence criteria. Alcohol dependence status was predicted by an attenuated startle reflex response to alcohol-related and aversive pictures. CONCLUSIONS This study revealed that an attenuated modulation of startle reflex response to alcohol-related and aversive stimuli could be used as a clinical marker to predict the development of AUDs in participants with previous alcohol consumption.
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Affiliation(s)
- Rosa Jurado-Barba
- Research Institute Hospital 12 de Octubre (i + 12), Madrid, Spain.,Camilo José Cela University , Madrid, Spain
| | - Almudena Duque
- Pontifical University of Salamanca , Salamanca, Spain.,Complutense University of Madrid , Madrid, Spain
| | | | - Isabel Martínez-Gras
- University Hospital 12 de Octubre , Madrid, Spain.,Biomedical Research Center Network for Mental Health (CIBERSAM) , Madrid, Spain
| | - María Salud García-Gutiérrez
- Instituto de Neurociencias , Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS) , Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | - Francisco Navarrete
- Instituto de Neurociencias , Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS) , Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | | | - Miguel Ángel Jiménez-Arriero
- Research Institute Hospital 12 de Octubre (i + 12), Madrid, Spain.,University Hospital 12 de Octubre , Madrid, Spain.,Biomedical Research Center Network for Mental Health (CIBERSAM) , Madrid, Spain
| | | | - Jorge Manzanares
- Instituto de Neurociencias , Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS) , Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | - Gabriel Rubio
- Complutense University of Madrid , Madrid, Spain.,University Hospital 12 de Octubre , Madrid, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS) , Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
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24
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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25
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Rolland B, Paille F, Gillet C, Rigaud A, Moirand R, Dano C, Dematteis M, Mann K, Aubin HJ. Pharmacotherapy for Alcohol Dependence: The 2015 Recommendations of the French Alcohol Society, Issued in Partnership with the European Federation of Addiction Societies. CNS Neurosci Ther 2016; 22:25-37. [PMID: 26768685 DOI: 10.1111/cns.12489] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The latest French good practice recommendations (GPRs) for the screening, prevention, and treatment of alcohol misuse were recently published in partnership with the European Federation of Addiction Societies (EUFAS). This article aims to synthesize the GPRs focused on the pharmacotherapy of alcohol dependence. METHODS A four-member European steering committee defined the questions that were addressed to an 18-member multiprofessional working group (WG). The WG developed the GPRs based on a systematic, hierarchical, and structured literature search and submitted the document to two review processes involving 37 French members from multiple disciplines and 5 non-French EUFAS members. The final GPRs were graded A, B, or C, or expert consensus (EC) using a reference recommendation grading system. RESULTS The treatment of alcohol dependence consists of either alcohol detoxification or abstinence maintenance programs or drinking reduction programs. The therapeutic objective is the result of a decision made jointly by the physician and the patient. For alcohol detoxification, benzodiazepines (BZDs) are recommended in first-line (grade A). BZD dosing should be guided by regular clinical monitoring (grade B). Residential detoxification is more appropriate for patients with a history of seizures, delirium tremens, unstable psychiatric comorbidity, or another associated substance use disorder (grade B). BZDs are only justified beyond a 1-week period in the case of persistent withdrawal symptoms, withdrawal events or associated BZD dependence (grade B). BZDs should not be continued for more than 4 weeks (grade C). The dosing and duration of thiamine (vitamin B1) during detoxification should be adapted to nutritional status (EC). For relapse prevention, acamprosate and naltrexone are recommended as first-line medications (grade A). Disulfiram can be proposed as second-line option in patients with sufficient information and supervision (EC). For reducing alcohol consumption, nalmefene is indicated in first line (grade A). The second-line prescription of baclofen, up to 300 mg/day, to prevent relapse or reduce drinking should be carried out according to the "temporary recommendation for use" measure issued by the French Health Agency (EC). During pregnancy, abstinence is recommended (EC). If alcohol detoxification is conducted during pregnancy, BZD use is recommended (grade B). No medication other than those for alcohol detoxification should be initiated in pregnant or breastfeeding women (EC). In a stabilized pregnant patient taking medication to support abstinence, the continuation of the drug should be considered on a case-by-case basis, weighing the benefit/risk ratio. Only disulfiram should be always stopped, given the unknown risks of the antabuse effect on the fetus (EC). First-line treatments to help maintain abstinence or reduce drinking are off-label for people under 18 years of age and should thus be considered on a case-by-case basis after the repeated failure of psychosocial measures alone (EC). Short half-life BZDs should be preferred for the detoxification of elderly patients (grade B). The initial doses of BZDs should be reduced by 30 to 50% in elderly patients (EC). In patients with chronic alcohol-related physical disorders, abstinence is recommended (EC). Any antidepressant or anxiolytic medication should be introduced after a psychiatric reassessment after 2-4 weeks of alcohol abstinence or low-risk use (grade B). A smoking cessation program should be offered to any smokers involved in an alcohol treatment program (grade B).
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Affiliation(s)
- Benjamin Rolland
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Service d'Addictologie, CHRU de Lille, INSERM U1171, Univ Lille, Lille, France
| | - François Paille
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Service d'Addictologie, CHU de Nancy, Vandœuvre-lès-Nancy, Nancy, France
| | - Claudine Gillet
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Centre d'Addictologie, Hôpital Villemin, Nancy, France
| | - Alain Rigaud
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Pôle d'addictologie, EPSM Marne, Châlons-en-Champagne et Reims, Reims, France.,Association Nationale de Prévention en Alcoologie et Addictologue (ANPAA), Paris, France
| | - Romain Moirand
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,CHU de Rennes, Unité d'Addictologie, Rennes, France.,INSERM, UMR 991, Rennes, France
| | - Corine Dano
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Service d'Addictologie, CHU d'Angers, Angers, France
| | - Maurice Dematteis
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Clinique d'Addictologie, CHU de Grenoble, Université Grenoble Alpes, Grenoble, France
| | - Karl Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,EUFAS Scientific Secretariat Professor Antoni Gual (MD; PhD), Clinic Hospital of Barcelona, Addictive Behaviors Unit, Barcelona, Spain
| | - Henri-Jean Aubin
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,EUFAS Scientific Secretariat Professor Antoni Gual (MD; PhD), Clinic Hospital of Barcelona, Addictive Behaviors Unit, Barcelona, Spain.,Département de Psychiatrie et d'Addictologie, INSERM U1178, Hôpital Paul Brousse, APHP Villejuif, Villejuif, France
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Miquel L, Gual A, Vela E, Lligoña A, Bustins M, Colom J, Rehm J. Alcohol Consumption and Inpatient Health Service Utilization in a Cohort of Patients With Alcohol Dependence After 20 Years of Follow-up. Alcohol Alcohol 2016; 52:227-233. [DOI: 10.1093/alcalc/agw075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
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Rehm J. How should prevalence of alcohol use disorders be assessed globally? Int J Methods Psychiatr Res 2016; 25:79-85. [PMID: 27133364 PMCID: PMC6877138 DOI: 10.1002/mpr.1508] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/03/2015] [Accepted: 03/15/2016] [Indexed: 10/21/2022] Open
Abstract
Alcohol is a major risk factor for global burden of disease, and alcohol use disorders make up a considerable portion of this burden. Up to now, prevalence of alcohol use disorders has been estimated based on general population surveys with the Composite International Diagnostic Interview (CIDI) as the gold standard for assessment. However, three major problems have been identified with the current conceptualization of alcohol use disorders and its measurement via CIDI: cultural specificity of key criteria measured such as loss of control; lack of convergence of diagnoses identified by CIDI with clinically relevant diagnoses in primary health care; and impact of stigma on measurement. As a solution, it is proposed to measure alcohol use disorders via heavy drinking over time, with thresholds taken from the European Medicines Agency (60 and more grams on average per day of pure alcohol for men, and 40+ grams for women). Current data on level of drinking (per capita consumption) assessed via taxation and other means allow for a measure of less bias. If these thresholds are considered too low and there is more emphasis on need for specialized treatment, then thresholds for very heavy drinking can be taken as alternatively (100+, and 60+ grams per day pure alcohol for men and women, respectively). Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Institute of Medical Science (IMS), Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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28
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Rosón B, Corbella X, Perney P, Santos A, Stauber R, Lember M, Arutyunov A, Ruza I, Vaclavik J, García L, Pujol R, Stauber R, Vogel W, Vaclavik J, Gajdová J, Smrzova A, Liberdová A, Cibickova L, Plasek J, Svarcova T, Salupere R, Lember M, Rosón B, Guillem MN, Fernández-Sola J, Zapatero A, Monte R, Puerta RB, Gamallo R, Durán C, Perney P, Ouakli A, Oziol E, Bastide D, Tourneaire P, Allard G, Cros H, Piala JM, Quere I, Condouret S, Ruža I, Funka K, Zarina L, Barata J, Gonsalves O, Santos A, Oliveira N, Yakushin S, Petrovicheva L, Sleptsov A, Arutyunov A, Mitkhat G, Marusenko I. Prevalence, Clinical Characteristics, and Risk Factors for Non-recording of Alcohol Use in Hospitals across Europe: The ALCHIMIE Study. Alcohol Alcohol 2016; 51:457-64. [DOI: 10.1093/alcalc/agv142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/30/2015] [Indexed: 11/14/2022] Open
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29
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Validation of a new patient-reported outcome instrument of health-related quality of life specific to patients with alcohol use disorder: the Alcohol Quality of Life Scale (AQoLS). Qual Life Res 2015; 25:1549-60. [DOI: 10.1007/s11136-015-1190-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
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30
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Maremmani I, Cibin M, Pani PP, Rossi A, Turchetti G. Harm Reduction as "Continuum Care" in Alcohol Abuse Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:14828-41. [PMID: 26610535 PMCID: PMC4661682 DOI: 10.3390/ijerph121114828] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/08/2015] [Accepted: 11/17/2015] [Indexed: 01/14/2023]
Abstract
Alcohol abuse is one of the most important risk factors for health and is a major cause of death and morbidity. Despite this, only about one-tenth of individuals with alcohol abuse disorders receive therapeutic intervention and specific rehabilitation. Among the various dichotomies that limit an effective approach to the problem of alcohol use disorder treatment, one of the most prominent is integrated treatment versus harm reduction. For years, these two divergent strategies have been considered to be opposite poles of different philosophies of intervention. One is bound to the search for methods that aim to lead the subject to complete abstinence; the other prioritizes a progressive decline in substance use, with maximum reduction in the damage that is correlated with curtailing that use. Reduction of alcohol intake does not require any particular setting, but does require close collaboration between the general practitioner, specialized services for addiction, alcohology services and psychiatry. In patients who reach that target, significant savings in terms of health and social costs can be achieved. Harm reduction is a desirable target, even from an economic point of view. At the present state of neuroscientific knowledge, it is possible to go one step further in the logic that led to the integration of psychosocial and pharmacological approaches, by attempting to remove the shadows of social judgment that, at present, are aiming for a course of treatment that is directed towards absolute abstention.
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Affiliation(s)
- Icro Maremmani
- Vincent P. Dole Dual Disorders Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56126, Italy.
- Association for the Application of Neuroscientific Knowledge to Social Aims, AU-CNS, Pietrasanta, Lucca 55045, Italy.
- De Lisio Institute of Behavioral Sciences, Pisa 56126, Italy.
| | - Mauro Cibin
- Mental Health and Addictive Behaviors Department, Local Health Authority, Venice 30010, Italy.
| | - Pier Paolo Pani
- Social and Health Services, Health District 8 (Local Health Authority), Cagliari 09121, Italy.
| | | | - Giuseppe Turchetti
- Institute of Management, ©Scuola Superiore Sant'Anna, Pisa 56126, Italy.
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31
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Rehm J, Anderson P, Manthey J, Shield KD, Struzzo P, Wojnar M, Gual A. Alcohol Use Disorders in Primary Health Care: What Do We Know and Where Do We Go? Alcohol Alcohol 2015; 51:422-7. [DOI: 10.1093/alcalc/agv127] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/20/2015] [Indexed: 11/14/2022] Open
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Rehm J. Commentary on Cherpitel et al. (2015): Improving global estimates of alcohol-attributable injury. Addiction 2015; 110:1733-4. [PMID: 26471156 DOI: 10.1111/add.13138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/21/2015] [Indexed: 12/21/2022]
Abstract
The analyses by Cherpitel and colleagues on alcohol-injury risk relations will help to improve global estimates of the alcohol-attributable injury burden by supplying more specific and empirically based risk relations. However, several issues still need to be addressed: generalizability, heterogeneity of drinkers, mortality outcomes and the quantification of causal impact.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH) Toronto Canada
- Institute of Medical Science (IMS)University of Toronto Canada
- Institute for Clinical Psychology and PsychotherapyTU Dresden Germany
- Department of PsychiatryUniversity of Toronto Canada
- Dalla Lana School of Public HealthUniversity of Toronto Canada
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33
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Rehm J, Manthey J, Struzzo P, Gual A, Wojnar M. Who receives treatment for alcohol use disorders in the European Union? A cross-sectional representative study in primary and specialized health care. Eur Psychiatry 2015; 30:885-93. [PMID: 26647862 DOI: 10.1016/j.eurpsy.2015.07.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alcohol use disorders (AUDs) are highly prevalent in Europe, but only a minority of those affected receive treatment. It is therefore important to identify factors that predict treatment in order to reframe strategies aimed at improving treatment rates. METHODS Representative cross-sectional study with patients aged 18-64 from primary health care (PC, six European countries, n=8476, data collection 01/13-01/14) and from specialized health care (SC, eight European countries, n=1762, data collection 01/13-03/14). For descriptive purposes, six groups were distinguished, based on type of DSM-IV AUD and treatment setting. Treatment status (yes/no) for any treatment (model 1), and for SC treatment (model 2) were main outcome measures in logistic regression models. RESULTS AUDs were prevalent in PC (12-month prevalence: 11.8%, 95% confidence interval (CI): 11.2-12.5%), with 17.6% receiving current treatment (95%CI: 15.3-19.9%). There were clear differences between the six groups regarding key variables from all five predictor domains. Prediction of any treatment (model 1) or SC treatment (model 2) was successful with high overall accuracy (both models: 95%), sufficient sensitivity (model 1: 79%/model 2: 76%) and high specificity (both models: 98%). The most predictive single variables were daily drinking level, anxiety, severity of mental distress, and number of inpatient nights during the last 6 months. CONCLUSIONS Variables from four domains were highly predictive in identifying treatment for AUD, with SC treatment groups showing very high levels of social disintegration, drinking, comorbidity and functional losses. Earlier intervention and formal treatment for AUD in PC should be implemented to reduce these high levels of adverse outcomes.
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Affiliation(s)
- J Rehm
- Centre for Addiction and Mental Health, 33, Russell Street, Toronto, ON M5S 2S1, Canada; Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155, College Street, 6th floor, Toronto, ON M5T 3M7, Canada; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1, King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250, College Street, 8th floor, Toronto, ON M5T 1R8, Canada; Institute of Clinical Psychology and Psychotherapy & Centre of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - J Manthey
- Institute of Clinical Psychology and Psychotherapy & Centre of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| | - P Struzzo
- Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074 Monfalcone, GO, Italy; University of Trieste, Department of Life Sciences, Via Weiss 2, 34128 Trieste, Italy
| | - A Gual
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Rosselló 149, 08036 Barcelona, Catalonia, Spain; Red de Trastornos Adictivos (RTA-RETICS), Instituto de Salud Carlos III, Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - M Wojnar
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland; Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
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Laramée P, Leonard S, Buchanan-Hughes A, Warnakula S, Daeppen JB, Rehm J. Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis. EBioMedicine 2015; 2:1394-404. [PMID: 26629534 PMCID: PMC4634361 DOI: 10.1016/j.ebiom.2015.08.040] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/26/2015] [Accepted: 08/29/2015] [Indexed: 01/08/2023] Open
Abstract
Background Alcohol dependence (AD) carries a high mortality burden, which may be mitigated by reduced alcohol consumption. We conducted a systematic literature review and meta-analysis investigating the risk of all-cause mortality in alcohol-dependent subjects. Methods MEDLINE, MEDLINE In-Process, Embase and PsycINFO were searched from database conception through 26th June 2014. Eligible studies reported all-cause mortality in both alcohol-dependent subjects and a comparator population of interest. Two individuals independently reviewed studies. Of 4540 records identified, 39 observational studies were included in meta-analyses. Findings We identified a significant increase in mortality for alcohol-dependent subjects compared with the general population (27 studies; relative risk [RR] = 3.45; 95% CI [2.96, 4.02]; p < 0.0001). The mortality increase was also significant compared to subjects qualifying for a diagnosis of alcohol abuse or subjects without alcohol use disorders (AUDs). Alcohol-dependent subjects continuing to drink heavily had significantly greater mortality than alcohol-dependent subjects who reduced alcohol intake, even if abstainers were excluded (p < 0.05). Interpretation AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption. A systematic review and meta-analysis were performed to investigate mortality risk in alcohol-dependent individuals. Alcohol dependence was associated with significantly higher mortality risk vs the general population, and vs alcohol abuse. Alcohol-dependent people with reduced alcohol consumption lowered their mortality risk, even if abstinence was not reached.
Individuals with alcohol dependence have a high risk of disease, disability or death. Treatment has traditionally focused on promoting abstinence, although some alcohol-dependent individuals would prefer to continue drinking in a controlled manner. By statistically combining results from previously published studies identified in a systematic literature review, we have shown that mortality among alcohol-dependent individuals is three to four times higher than in the general population. We have also found that individuals with alcohol dependence can reduce their risk of death by reducing alcohol consumption, even if they do not achieve abstinence.
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Affiliation(s)
- Philippe Laramée
- Université Claude Bernard Lyon I, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France ; Lundbeck SAS, 37-45, Quai du Président Roosevelt, Issy-les-Moulineaux, 92445 Paris, France
| | - Saoirse Leonard
- Costello Medical Consulting, City House, 126-130 Hills Road, Cambridge, CB2 1RE, UK
| | - Amy Buchanan-Hughes
- Costello Medical Consulting, City House, 126-130 Hills Road, Cambridge, CB2 1RE, UK
| | - Samantha Warnakula
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, UK
| | - Jean-Bernard Daeppen
- University Alcohol Treatment Centre, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada ; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada ; Klinische Psychologie und Psychotherapie, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
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Lachenmeier DW, Gill JS, Chick J, Rehm J. The total margin of exposure of ethanol and acetaldehyde for heavy drinkers consuming cider or vodka. Food Chem Toxicol 2015; 83:210-4. [DOI: 10.1016/j.fct.2015.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/14/2015] [Accepted: 05/11/2015] [Indexed: 11/16/2022]
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Probst C, Manthey J, Martinez A, Rehm J. Alcohol use disorder severity and reported reasons not to seek treatment: a cross-sectional study in European primary care practices. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:32. [PMID: 26264215 PMCID: PMC4534056 DOI: 10.1186/s13011-015-0028-z] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/24/2015] [Indexed: 12/04/2022]
Abstract
Background Alcohol use disorders are among the mental disorders with the lowest treatment rates. Increasing the treatment rates requires insight on the reasons why patients do not seek treatment. This study examined self-reported reasons for not seeking treatment and their association with alcohol use disorder severity among primary health care patients diagnosed with an alcohol use disorder. Methods Alcohol use disorders, health service utilization, and reasons for not seeking treatment were assessed via interviews on regionally representative samples of primary care patients from 6 European countries (Italy, Germany, Hungary, Latvia, Poland and Spain, total N = 9,098). Additionally, general practitioners had to fill in a questionnaire assessing their patients’ alcohol use and alcohol use disorders. A multinomial logistic regression was performed to investigate the association between reasons for not seeking treatment and alcohol use disorder severity. Results Of 1,008 patients diagnosed with an alcohol use disorder (via general practitioner or patient interview) in the past 12 months, the majority (N = 810) did not receive treatment and 251 of those gave a reason for not seeking treatment. The most frequent reason was ‘lack of problem awareness’ (55.3 % of those who responded), the second most common response was ‘stigma or shame’ (28.6 %), followed by ‘encounter barriers’ (22.8 %) and ‘cope alone’ (20.9 %). The results indicated lower probabilities of reporting ‘denial’ and higher probabilities to report ‘encounter barriers’ as alcohol use disorders severity increases. However, both trends were discontinued for patients with severe alcohol use disorders. Conclusions Particularly at lower levels of alcohol use disorder severity, a lack of problem awareness prevents patients from seeking treatment. Routinely alcohol consumption monitoring in primary care practices could help primary and secondary prevention of alcohol use disorders and increase treatment coverage. Electronic supplementary material The online version of this article (doi:10.1186/s13011-015-0028-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Probst
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. .,Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Jakob Manthey
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Alicia Martinez
- Department of Addiction, Hospital Clínic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain.
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. .,Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. .,Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. .,Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, ON M5S 1A8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.
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