Anxiety, Anxiety Sensitivity, and Perceived Stress as Predictors of Recent Drinking, Alcohol Craving, and Social Stress Response in Heavy Drinkers

Tobacco use, cirrhosis, and age are predictors of readiness to change and continued drinking following brief alcohol intervention in veterans

Alcohol use disorder is prevalent within the Veterans Health System, especially in patients being seen in hepatology clinics, and needs a point-of-care strategy. A brief alcohol intervention based on AUDIT-C (Alcohol Use Disorders Identification Test) may be needed for the management of hazardous alcohol intake, but feasibility is unclear. We aimed to define predictors of readiness to cease alcohol intake (0-10, 10 being ready to quit now) and continued drinking after using a brief alcohol intervention in veterans seen in hepatology clinics cross-sectionally and longitudinally over 6 months. A total of 414 men with liver disease (average age of 61 y old, 48% with cirrhosis, 31% with concomitant psychiatric conditions, 44% with tobacco use, and 14% with prior alcohol use disorder therapy) were approached. One hundred forty-four patients (35%) had a positive AUDIT-C (8.9 ± 4.0) and were given the brief intervention. Eighty of these patients (56%) had a high readiness to change, listing "wanting to improve health" and "prior success at reducing alcohol intake" as their most frequent reasons. On regression analysis, concomitant tobacco use was associated with a significantly lower readiness to quit alcohol score. On longitudinal follow-up at 6 months, 34 (23%) patients were still drinking. These patients were older and more likely to have concomitant diagnoses of cirrhosis and anxiety. Overall, we found that in a large cohort of veterans seen in hepatology clinics in routine practice, a brief intervention targeted at alcohol use is feasible. Older patients with concomitant tobacco use, cirrhosis, and anxiety may need more longitudinal attention to ensure that the initial interest in reducing problem drinking is sustained.

Stress and episodic future thinking: Effects on temporal window and alcohol demand

BACKGROUND

Stress maintains problematic alcohol use, so it is particularly important to identify interventions that effectively reduce the desire for alcohol even in the context of high stress. Reinforcer Pathology Theory suggests that stress increases alcohol demand by inducing short-term thinking. One intervention that targets this mechanism is episodic future thinking (EFT), which involves vividly imagining personal future events and has been shown to reduce short-term thinking and accompanying preferences for immediate rewards like alcohol. These shared mechanisms suggest that EFT may be particularly effective at reducing alcohol demand in the context of higher stress. This study first assessed the relationship of stress with preference for immediate rewards and alcohol demand, and the impact of EFT on preference for immediate rewards and alcohol demand. This study then tested whether EFT may be particularly effective in the context of higher stress.

METHODS

One hundred thirty-nine adults with problematic alcohol use completed an online survey through Amazon Mechanical Turk (MTurk), including self-report measures of past month stress and baseline momentary stress, an EFT or episodic recent thinking (ERT) procedure, a delay-discounting task, and an alcohol purchase task. Univariate correlations assessed the relationship of stress with delay discounting and alcohol demand intensity. Path analyses assessed hypothesized models relating EFT/ERT, stress, delay discounting, and demand intensity.

RESULTS

Consistent with Reinforcer Pathology Theory, higher baseline momentary stress was correlated with increased preference for immediate rewards. EFT intervention increased preference for delayed rewards, which contributed to decreased alcohol demand. However, the effect of EFT on delay discounting was not moderated by stress.

CONCLUSIONS

EFT does not appear uniquely effective at reducing desire for alcohol in the context of higher stress, but equally, EFT's efficacy was not significantly affected by stress level. Findings emphasize the opposing roles of state stress and EFT in the behavioral economics underlying problematic alcohol use.

Insights into Overlapping Brain Networks for Anxiety and Alcohol Use Disorders

Alcohol use disorder (AUD) is a debilitating condition affecting over 30 million Americans. AUD commonly co-occurs with other disorders, like other substance use disorders, trauma-related disorders, and anxiety disorders. Of the numerous co-occurring disorders, anxiety disorders are the most pervasive: anxiety disorders serve as a risk factor for developing AUD, emerge as co-occurring disorders that maintain alcohol drinking, and impede the effectiveness of treatments for AUD. Anxiety, therefore, shapes the development, course, and treatment of AUDs. AUDs can also increase anxiety, suggesting a complex, bidirectional relation between alcohol use and anxiety. The intersection of AUDs and anxiety is also supported by their overlapping neural circuits, specifically neural circuits involved in stress responding, reward processing, and cognitive control. The current review highlights findings from several decades of research on how anxiety impacts the brain and treatment outcomes in AUDs. We also provide important considerations for future research, with the goal of reducing the shame and burden of alcohol use for individuals with AUD and their families.

Emergency department-initiated oral naltrexone for patients with moderate to severe alcohol use disorder: A pilot feasibility study

OBJECTIVES

Alcohol use disorder (AUD) is the most common substance use disorder in the United States. Despite availability of four FDA-approved medications, fewer than 10% of patients are prescribed medication. This study aimed to evaluate the impact and feasibility of emergency department (ED)-initiated oral naltrexone in patients with moderate to severe AUD.

METHODS

This was a prospective, single-arm, open-label, nonrandomized clinical trial conducted a single ED. Consenting participants were adults with moderate to severe AUD who were provided a single 50-mg dose of oral naltrexone, a 14-day starter pack of naltrexone, and referral for treatment. Follow-up was conducted at 14 and 30 days post-ED visit. The primary outcome was engagement in formal addiction treatment. Secondary outcomes included alcohol consumption, craving, quality-of-life measures, satisfaction, and safety.

RESULTS

Of 761 patients screened, 21 enrolled and received at least one dose of naltrexone. At 14 days, 29% were engaged in treatment, increasing to 33% at 30 days. There was a decrease in the mean (±SD) number of drinks per day from 5.20 (±4.67) at baseline to 2.23 (±4.35) during the follow-up period (p = 0.078). There was a decrease in alcohol craving scores, with median scores dropping from 19 at baseline to 8.27 during the follow-up period (p < 0.001). Quality-of-life measures improved, with a statistically significant increase in the reported number of healthy days (p = 0.006) and decrease in depressive symptoms (p < 0.001). Reported side effects were mild and satisfaction with the screening process was high.

CONCLUSIONS

ED-initiated oral naltrexone is feasible and acceptable for patients with moderate to severe AUD. While engagement in treatment was moderate, significant reductions in alcohol craving and improvements in quality of life suggest potential benefits. Further research is warranted to confirm these findings.

Perceived discrimination and anxiety sensitivity in terms of alcohol consumption, alcohol-related problems, and drinking coping motives among racially/ethnically minoritized college students

Introduction: Across the college student population within the United States (U.S.), alcohol misuse is a problematic addictive behavior. However, there is limited knowledge about the social determinants of health and individual difference factors related to alcohol consumption, alcohol-related problems, and coping motives for drinking among racial/ethnic minority college students. The present study investigated the singular and interactive effects of perceived racial/ethnic discrimination and anxiety sensitivity in relation to alcohol consumption, alcohol-related problems, and coping motives for drinking among racial/ethnic minority university students. Methods: Participants included 734 (82.30% female, Mage = 21.85 years, SD = 4.53 years) university students. Results: Results demonstrated that perceived racial/ethnic discrimination and anxiety sensitivity were each statistically significant predictors for alcohol-related problems and coping motives for drinking, but not alcohol consumption. Discussion: This work highlights the importance of considering social determinants of health and anxiety sensitivity in efforts to better understand alcohol-related problems among minority university students.

Young adult drinking during the COVID-19 pandemic: Examining the role of anxiety sensitivity, perceived stress, and drinking motives

Studies have shown that those high in anxiety were at increased risk for alcohol use during the COVID-19 pandemic. Tension reduction theory points to anxiety sensitivity (AS) as a potential risk factor. Drinking to cope may further increase this risk. During the pandemic, those high in AS may have experienced increased stress and drank to cope, which may have put them at risk for misusing alcohol. Objective: The current study tested the association between AS and alcohol outcomes, mediated by perceived stress and drinking motives, among young adults during the COVID-19 pandemic. Participants and Methods: Young adults (N = 143) self-reported on AS, perceived stress, drinking motives, and alcohol outcomes (i.e., use and problems). Results: A mediation analysis revealed that AS positively predicted alcohol problems, via coping motives, and positively predicted alcohol use, via perceived stress and enhancement/sociability motives. Conclusion: These results confirm AS-risk for young adult alcohol use during the pandemic and highlight perceived stress and drinking motives as mechanisms of risk.

Sex Differences in Mouse Models of Voluntary Alcohol Drinking and Abstinence-Induced Negative Emotion

Alcohol Use Disorder (AUD) is a growing problem worldwide, causing an incredible burden on health and the economy. Though AUD impacts people of all backgrounds and demographics, increasing evidence has suggested robust sex differences in alcohol drinking patterns and AUD-induced negative emotionality or hyperkatifeia. Rates of problematic drinking have significantly risen among women, and women face more severe negative emotional consequences in abstinence such as increased risk of comorbidity with an anxiety or mood disorder and more severe symptoms of depression. As such, a bevy of preclinical literature using contingent methods of alcohol (ethanol) consumption has amassed in recent years to better understand sex as a biological variable in alcohol drinking and abstinence-induced negative emotionality. Mice are widely used to model alcohol drinking, as they are conducive to genetic manipulation strategies, and many strains will voluntarily consume alcohol. Sex-specific results from these mouse studies, however, have been inconsistent. Therefore, this review aims to summarize the current knowledge on sex differences in AUD-related contingent ethanol drinking and abstinence-induced negative emotionality in mice. Various contingent mouse drinking models and negative emotional-based behavioral paradigms are introduced and subsequently discussed in the context of sex differences to show increasing indications of sex specificity in mouse preclinical studies of AUD. With this review, we hope to inform future research on potential sex differences in preclinical mouse models of AUD and provide mounting evidence supporting the need for more widespread inclusion of preclinical female subjects in future studies.

Sweet Taste Preference as a Moderator of Links Between Internalizing Symptoms and Alcohol Craving

OBJECTIVE

Strong positive links exist between mood, alcohol craving, and sweet taste preference. During alcohol abstinence, individuals have increased cravings for alcohol and sweets, in association with anxiety and depression symptoms. Research also suggests a substitution effect of alcohol with sweets. Thus, the present study examined the moderating role of sweet taste preference on links between anxiety and depression symptoms and alcohol craving.

METHOD

Participants were individuals (N = 91) with alcohol use disorder (AUD) enrolled in a partial hospitalization program. Participants completed baseline assessments of anxiety and depression symptoms, alcohol use and craving, and sweet taste preference.

RESULTS

We found significant correlations between symptoms of depression, anxiety, alcohol craving, and sweet taste preference. Sweet taste preference moderated links between both depression and anxiety symptoms with alcohol craving.

CONCLUSIONS

For those with low and moderate sweet taste preferences, internalizing symptoms appeared positively linked with alcohol craving. For those high in sweet taste preference, alcohol craving remained elevated regardless of anxiety symptoms but appeared to decrease with heightened depressive symptoms. Should future research replicate this finding using controlled research designs that demonstrate temporality and causality, tailored early AUD interventions may be justified based on individuals' levels of sweet taste preference.

An Analysis of Drinking Motives in the Maintenance of Co-Occurring Obsessive-Compulsive Symptoms and Alcohol Misuse

Objective: Despite the commonly observed co-occurrence of obsessive-compulsive symptoms (OCS) and substance use in clinical populations, few researchers have examined potential mechanisms which contribute to this relationship. This study assessed the mediating role of drinking motives in the relationship between OCS, alcohol consumption, and its resulting health risks among U.S. adults. Methods: Adult participants (n = 1966; Mage = 47.72, SD = 17.91; 76.30% female; 86.10% non-Hispanic White) sourced from Research Match answered an online questionnaire containing measures related to substance use and anxiety-related symptoms. Results: As hypothesized, there was a significant positive indirect path between OCS and both alcohol consumption and risky alcohol use through coping motives. However, there were also small indirect effects of OCS through social motivations for consumption and conformity motivations for risky alcohol use. Conclusions: These results add evidence that coping motives play a role in OCS and alcohol misuse and highlights the need to also consider drinking motives related to social facilitation and conformity in those with co-occurring OCS and alcohol misuse.

Examining the Mediating Role of Resilience and Life Satisfaction in the Relationship Between Anxiety Sensitivity and Perceived Stress

This study examines the mediation role of life satisfaction and resilience variables in the relationships between anxiety sensitivity and perceived stress. The data was collected with the Anxiety Sensitivity Index-3, Life Satisfaction Scale, Perceived Stress Scale, and Brief Psychological Resilience Scale from 347 university students (Mage = 23.15, SD = 5.15; 70% girls, 30% boys). The analyses were examined by structural equation modeling using AMOS 24. The findings suggest that students with high anxiety sensitivity and perceived stress have low resilience and life satisfaction levels. More importantly, resilience and life satisfaction were found to have partial mediation. As a result, it is seen that anxiety sensitivity has a significant effect on reducing perceived stress by increasing students' resilience and life satisfaction. Therefore, this situation facilitates decreased anxiety levels, greater satisfaction with life, and more robust mental health.

Potential Molecular Mechanisms of Alcohol Use Disorder with Non-Coding RNAs and Gut Microbiota for the Development of Superior Therapeutic Application

Many investigations have evaluated the expression of noncoding RNAs (ncRNAs) as well as their related molecular functions and biological machineries in individuals with alcohol dependence. Alcohol dependence may be one of the most prevailing psychological disorders globally, and its pathogenesis is intricate and inadequately comprehended. There is substantial evidence indicating significant links between multiple genetic factors and the development of alcohol dependence. In particular, the critical roles of ncRNAs have been emphasized in the pathology of mental illnesses, probably including alcohol dependence. In the comprehension of the action of ncRNAs and their machineries of modification, furthermore, they have emerged as therapeutic targets for a variety of psychiatric illnesses, including alcohol dependence. It is worth mentioning that the dysregulated expression of ncRNAs has been regularly detected in individuals with alcohol dependence. An in-depth knowledge of the roles of ncRNAs and m6A modification may be valuable for the development of a novel treatment against alcohol dependence. In general, a more profound understanding of the practical roles of ncRNAs might make important contributions to the precise diagnosis and/or actual management of alcohol dependence. Here, in this review, we mostly focused on up-to-date knowledge regarding alterations and/or modifications in the expression of ncRNAs in individuals with alcohol dependence. Then, we present prospects for future research and therapeutic applications with a novel concept of the engram system.

Exercising healthy behaviors: A latent class analysis of positive coping during the COVID-19 pandemic and associations with alcohol-related and mental health outcomes

OBJECTIVE

To identify latent classes of positive coping behaviors during the COVID-19 pandemic and examine associations with alcohol-related and mental health outcomes across participants with and without a history of alcohol use disorder (AUD).

METHODS

Baseline data from 463 participants who were enrolled in the NIAAA COVID-19 Pandemic Impact on Alcohol (C19-PIA) Study were analyzed. Latent class analysis (LCA) was applied to five positive coping behaviors during COVID-19: taking media breaks, taking care of their body, engaging in healthy behaviors, making time to relax, and connecting with others. Latent class differences and the moderating role of history of AUD on six alcohol-related and mental health outcomes were examined using multiple regression models.

RESULTS

LCA revealed two latent classes: 83.4% High Positive Coping and 16.6% Low Positive Coping. Low Positive Coping was associated with higher levels of perceived stress, anxiety symptoms, and loneliness. A history of AUD was consistently associated with higher levels of alcohol-related and mental health outcomes. Significant interactions between Coping Latent Classes and history of AUD indicated that the associations of Low Positive Coping with problematic alcohol use, depressive symptoms, and drinking to cope motives were either stronger or only significant among individuals with a history of AUD.

CONCLUSIONS

Individuals with a history of AUD may be particularly vulnerable to depressive symptoms and alcohol-related outcomes, especially when they do not utilize positive coping strategies. The promotion of positive coping strategies is a promising avenue to address alcohol-related and mental health problems during a public health crisis and warrants future research.

GABAergic signaling in alcohol use disorder and withdrawal: pathological involvement and therapeutic potential

Alcohol is one of the most widely used substances. Alcohol use accounts for 5.1% of the global disease burden, contributes substantially to societal and economic costs, and leads to approximately 3 million global deaths yearly. Alcohol use disorder (AUD) includes various drinking behavior patterns that lead to short-term or long-lasting effects on health. Ethanol, the main psychoactive molecule acting in alcoholic beverages, directly impacts the GABAergic system, contributing to GABAergic dysregulations that vary depending on the intensity and duration of alcohol consumption. A small number of interventions have been developed that target the GABAergic system, but there are promising future therapeutic avenues to explore. This review provides an overview of the impact of alcohol on the GABAergic system, the current interventions available for AUD that target the GABAergic system, and the novel interventions being explored that in the future could be included among first-line therapies for the treatment of AUD.

Stressed, Lonely, and Overcommitted: Predictors of Lawyer Suicide Risk

Suicide is a significant public health concern, and lawyers have been shown to have an elevated risk for contemplating it. In this study, we sought to identify predictors of suicidal ideation in a sample consisting of 1962 randomly selected lawyers. Using logistic regression analysis, we found that high levels of work overcommitment, high levels of perceived stress, loneliness as measured by the UCLA loneliness scale, and being male were all significantly associated with an increased risk of suicidal ideation. These results suggest that interventions aimed at reducing work overcommitment, stress, and loneliness, and addressing gender-specific risk factors, may be effective in reducing the risk of suicidal ideation among lawyers. Further research is needed to expand upon these findings and to develop and test interventions specifically tailored to the needs of this population.

Embryonic ethanol exposure induces ectopic Hcrt and MCH neurons outside hypothalamus in rats and zebrafish: Role in ethanol-induced behavioural disturbances

Embryonic exposure to ethanol increases the risk for alcohol use disorder in humans and stimulates alcohol-related behaviours in different animal models. Evidence in rats and zebrafish suggests that this phenomenon induced by ethanol at low-moderate concentrations involves a stimulatory effect on neurogenesis and density of hypothalamic neurons expressing the peptides, hypocretin/orexin (Hcrt) and melanin-concentrating hormone (MCH), known to promote alcohol consumption. Building on our report in zebrafish showing that ethanol induces ectopic expression of Hcrt neurons outside the hypothalamus, we investigated here whether embryonic ethanol exposure also induces ectopic peptide neurons in rats similar to zebrafish and affects their morphological characteristics and if these ectopic neurons are functional and have a role in the ethanol-induced disturbances in behaviour. We demonstrate in rats that ethanol at a low-moderate dose, in addition to increasing Hcrt and MCH neurons in the lateral hypothalamus where they are normally concentrated, induces ectopic expression of these peptide neurons further anterior in the nucleus accumbens core and ventromedial caudate putamen where they have not been previously observed and causes morphological changes relative to normally located hypothalamic neurons. Similar to rats, embryonic ethanol exposure at a low-moderate dose in zebrafish induces ectopic Hcrt neurons anterior to the hypothalamus and alters their morphology. Notably, laser ablation of these ectopic Hcrt neurons blocks the behavioural effects induced by ethanol exposure, including increased anxiety and locomotor activity. These findings suggest that the ectopic peptide neurons are functional and contribute to the ethanol-induced behavioural disturbances related to the overconsumption of alcohol.

Longitudinal predictors of depression, anxiety, and alcohol use following COVID-19-related stress

The COVID-19 pandemic imposed profound effects on health and daily life, with widespread stress exposure and increases in psychiatric symptoms. Despite these challenges, pandemic research provides unique insights into individual differences in emotion and cognition that predict responses to stress, with general implications for understanding stress vulnerability. We examined predictors of responses to COVID-19-related stress in an online sample of 450 emerging adults recruited in May 2020 to complete questionnaires assessing baseline stress and psychiatric symptoms, rumination, cognitive reappraisal use and intolerance of uncertainty. Stress and symptoms were re-assessed 3 months later (N = 200). Greater pandemic-related stressful events were associated with increases in symptoms of depression, anxiety and alcohol use severity. Additionally, individual differences in emotional and cognitive styles emerged as longitudinal predictors of stress responses. Specifically, greater rumination predicted increased depression. Reduced cognitive reappraisal use interacted with stress to predict increases in alcohol use. An unexpected pattern emerged for intolerance of uncertainty, such that stress was associated with increases in depression for those high in intolerance of uncertainty but increases in alcohol use at relatively low levels of intolerance of uncertainty. These results highlight unique vulnerabilities that predict specific outcomes following stress exposure and offer potential prevention targets.

Associations between Mental Resilience, Mood, Coping, Personality, and Hangover Severity

Extensive research exists on relationships between psychological constructs and alcohol consumption. However, research on relationships with hangover severity remains limited. This study aimed to assess the associations between mental resilience, mood (i.e., depression, anxiety, and stress), coping, personality, and hangover severity. A total of N = 690 participants completed an online survey by answering questions regarding their demographics, alcohol use, hangover prevalence and severity, and several psychological assessments (Brief Resilience Scale, DASS-21, Brief Cope, and Brief Version of the Big Five Personality Inventory). Significant associations were found between hangover severity and mental resilience, mood, and avoidant coping. Higher levels of mental resilience were associated with less severe hangovers, whereas poorer mood was associated with more severe hangovers. No significant associations were found with personality traits. These findings demonstrate that several associations between psychological constructs and hangover severity exist and suggest a role of psychological factors in the pathology of the alcohol hangover. As our findings contrast with the results of previous studies that did not report an association between mental resilience and the presence and severity of hangovers, further research is warranted.

Effects of arousal modulation via resonance breathing on craving and affect in women with substance use disorder

BACKGROUND

Craving for alcohol and other drugs is a complex in-the-moment experience that involves within-person changes in physiological arousal and affect. We evaluated the utility of a just-in-time, self-administered resonance breathing smartphone application (app) to reduce craving and improve affect in women during outpatient treatment for substance use disorders (SUD).

METHODS

Women (N = 57) receiving outpatient addiction treatment were randomized to practice either cardiovascular resonance breathing (0.1 Hz/6 breaths per minute) or a sham (∼0.23 Hz/14 breaths per minute) in the face of urges over an 8-week intervention. Craving (Penn Alcohol Craving Scale) and affect (Positive and Negative Affect Scale) were collected weekly throughout the intervention. App data were uploaded weekly to assess frequency of use. Generalized Estimated Equations modeled craving and affect as a function of group randomization and app use frequency across the 8-week intervention.

FINDINGS

Higher levels of craving were associated with more frequent app use. The group X app use interaction was significant for craving. Frequent app use during the intervention phase was associated with lower craving levels in the resonance breathing group relative to the sham group over the 8-week intervention. There was no effect of app use frequency on affect measures.

CONCLUSIONS

Women assigned to practice sham breathing who used the intervention frequently experienced elevations in craving that are commonly reported during outpatient SUD treatment. Women assigned to resonance breathing who used the intervention frequently did not experience such increases. Resonance breathing may be protective against triggers in outpatient treatment. Physiological mechanisms are discussed.

The cannabinoid receptor-1 gene interacts with stressful life events to increase the risk for problematic alcohol use

Problematic alcohol use is a major contributor to the global burden of death and disabilities, and it represents a public health concern that has grown substantially following the COVID-19 pandemic. The available treatment options remain limited and to develop better pharmacotherapies for alcohol misuse we need to identify suitable biological targets. Previous research has implicated the brain’s endocannabinoid system (ECS) in psychiatric and stress-related outcomes, including substance use and habituation to repeated stress. Moreover, genetic variants in the cannabinoid-1 receptor gene (CNR1; CB1R) have been associated with personality traits, which are in turn predictors of substance use disorders. To date, however, no human genome-wide association study has provided evidence for an involvement of the ECS in substance use outcomes. One reason for this ECS-related “missing heritability” may be unexamined gene-environment interactions. To explore this possibility, we conducted cross-sectional analyses using DNA samples and stress-exposure data from a longitudinal Swedish population-based study (N = 2,915). Specifically, we genotyped rs2023239, a functional C/T single nucleotide polymorphism in CNR1, previously reported to be associated with CNR1 binding in the brain, subjective reward following alcohol intake, and alcohol cue-elicited brain activation. Our two outcomes of interest were (i) problematic alcohol use based on the Alcohol Use Disorders Identification Test (AUDIT), and (ii) personality trait scores based on the Five Factor Model. We found no baseline association between rs2023239 and problematic alcohol use or personality traits. However, there was a clear trend for interaction between rs2023239’s risk allele (C) and stressful life events (SLEs) in both childhood and adulthood, which predicted problematic alcohol use. Although not significant, there was also some indication that the risk allele interacted with child SLEs to increase scores on neuroticism. Our study supports the notion that the ECS can affect alcohol intake behaviors by interacting with life adversities and is—to the best of our knowledge—the first to focus on the interaction between CNR1 and stressors in both childhood and adulthood in humans. Further studies are warranted to confirm these findings.

N6-substituated adenosine analog J4 attenuates anxiety-like behaviors in mice

RATIONALE

Withdrawal from chronic alcohol exposure produces various physical and mental withdrawal symptoms. Activation of adenosine receptors is known to inhibit withdrawal-induced excitation. However, limited studies investigate how adenosine analogs may prove helpful tools to alleviate alcohol withdrawal-related affective behaviors.

OBJECTIVES

This study aimed to investigate the effects of J4 compared with saline using the mice vapor or voluntary ethanol drinking model on behavioral endpoints representing ethanol-withdrawal negative emotionality commonly observed during abstinence from chronic alcohol use.

METHODS

We subjected C57BL/6 J mice to chronic intermittent ethanol (CIE) exposure schedule to investigate how 72-h withdrawal from alcohol alters affective-like behavior. Next, we determined how treatment with J4, a second-generation adenosine analog, influenced affective behaviors produced by alcohol withdrawal. Finally, we determined how J4 treatment alters voluntary ethanol drinking using the two-bottle-choice drinking paradigm.

RESULTS

Our results show that 72-h withdrawal from chronic intermittent ethanol exposure produces limited affective-like disturbances in male C57BL/6 J mice exposed to 4 cycles ethanol vapor. Most importantly, J4 treatment irrespective of ethanol exposure decreases innate anxiety-like behavior in mice.

CONCLUSIONS

Withdrawal from chronic intermittent ethanol exposure and subsequent behavioral testing 72 h later produces minimal affective-like behavior. J4 treatment did however reduce marble-burying behavior and increased time spent in open arms of the elevated plus maze, suggesting J4 may be useful as a general anxiolytic.

Predicting Anxiety from the Complex Interaction Between Masculinity and Spiritual Beliefs

Research suggests that adherence to traditional and hegemonic masculinities can be detrimental to men’s mental health. In particular, anxiety can result from the incongruence between idealised and lived experiences. Emerging research suggests that holding spiritual beliefs may protect against such anxiety. This Australian study investigated whether two aspects of spiritualism (Spiritual Openness and Spiritual Support) could moderate the relationship between four stereotypical masculine behaviours (Success Dedication, Restrictive Emotionality, Inhibited Affection and Exaggerated Self-Reliance and Control) and anxiety. A cross-sectional, correlational design, with a heterogeneous, Western community sample included 331 male participants aged 18–67 (M = 24.57, SD = 10.37). In partial support of the hypotheses, two significant moderation models were found. Both Spiritual Support and Spiritual Openness moderated the relationship between Exaggerated Self-Reliance and Control and anxiety. There were no significant moderations for Success Dedication, Restrictive Emotionality, and Inhibited Affection. Masculinity and spiritualism did not have significant direct effects on anxiety. These findings suggest that when working with men and their mental health, it may be important to consider the congruence between their behaviors and belief systems, as spirituality was only protective against anxiety where these beliefs were congruent with masculine self-reliance and control. It appears that the potential benefit of spirituality in reducing masculine anxiety is dependent on the man being more open to external supports, and having a lower need for control.

Sleep, psychiatric and socioeconomic factors associated with substance use in a large population sample: A cross-sectional study

Multiple elements modulate drug use, including sleep, which is increasingly being considered as an important contributor to substance use and abuse. The present study aimed to evaluate the association between sleep, psychiatric and socioeconomic/demographic factors and substance use in a large-scale representative sample from the city of São Paulo, Brazil. Data from the 2007 São Paulo Epidemiological Sleep Study (EPISONO) database were used. In the EPISONO study, volunteers underwent a polysomnographic exam and completed a series of questionnaires to assess objective and subjective sleep quality and associated comorbidities. Drug use was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Linear (univariate and multivariate) and logistic regressions were performed to identify factors associated with the use of the 4 most commonly used substances in the sample (tobacco, alcohol, cannabis and cocaine/crack). Structural equation models were used to establish theoretical networks to explain the relationship between sleep, psychiatric and socioeconomic factors and use of these substances. The logistic regression results showed that psychiatric symptoms, lower income, and poorer subjective sleep were the main factors associated with tobacco consumption; gender and occupational status with alcohol intake; age and occupation with cannabis use; and education with cocaine/crack use. The structural equation models partially supported these findings and identified significant effects of psychiatric symptoms on tobacco consumption, both directly and mediated by sleep. Our results reinforce previous findings concerning factors associated with generally misused substances and suggest that sleep should be considered as an important element in future substance use disorder studies.

Appropriate analyses of bimodal substance use frequency outcomes: a mixture model approach

Background: In addiction research, outcome measures are often characterized by bimodal distributions. One mode can be for individuals with low substance use and the other mode for individuals with high substance use. Applying standard statistical procedures to bimodal data may result in invalid inference. Mixture models are appropriate for bimodal data because they assume that the sampled population is composed of several underlying subpopulations.Objectives: To introduce a novel mixture modeling approach to analyze bimodal substance use frequency data.Methods: We reviewed existing models used to analyze substance use frequency outcomes and developed multiple alternative variants of a finite mixture model. We applied all methods to data from a randomized controlled study in which 30-day alcohol abstinence was the primary outcome. Study data included 73 individuals (38 men and 35 women). Models were implemented in the software packages SAS, Stata, and Stan.Results: Shortcomings of existing approaches include: 1) inability to model outcomes with multiple modes, 2) invalid statistical inferences, including anti-conservative p-values, 3) sensitivity of results to the arbitrary choice to model days of substance use versus days of substance abstention, and 4) generation of predictions outside the range of common substance use frequency outcomes. Our mixture model variants avoided all of these shortcomings.Conclusions: Standard models of substance use frequency outcomes can be problematic, sometimes overstating treatment effectiveness. The mixture models developed improve the analysis of bimodal substance use frequency.

Dysregulation of Nociceptin/Orphanin FQ and Dynorphin Systems in the Extended Amygdala of Alcohol Preferring Marchigian Sardinian (msP) Rats

Previous studies have shown that genetically selected Marchigian Sardinian alcohol-preferring (msP) rats consume excessive amounts of ethanol to self-medicate from negative moods and to relieve innate hypersensitivity to stress. This phenotype resembling a subset of alcohol use disorder (AUD) patients, appears to be linked to a dysregulation of the equilibrium between stress and antistress mechanisms in the extended amygdala. Here, comparing water and alcohol exposed msP and Wistar rats we evaluate the transcript expression of the anti-stress opioid-like peptide nociceptin/orphanin FQ (N/OFQ) and its receptor NOP as well as of dynorphin (DYN) and its cognate κ-opioid receptor (KOP). In addition, we measured the transcript levels of corticotropin-releasing factor (CRF), CRF receptor 1 (CRF1R), brain-derived neurotrophic factor (BDNF) and of the tropomyosin receptor kinase B receptor (Trk-B). Results showed an innately up-regulation of the CRFergic system, mediating negative mood and stress responses, as well as an inherent up-regulation of the anti-stress N/OFQ system, both in the amygdala (AMY) and bed nucleus of the stria terminalis (BNST) of msP rats. The up-regulation of this latter system may reflect an attempt to buffer the negative condition elicited by the hyperactivity of pro-stress mechanisms since results showed that voluntary alcohol consumption dampened N/OFQ. Alcohol exposure also reduced the expression of dynorphin and CRF transmissions in the AMY of msP rats. In the BNST, alcohol intake led to a more complex reorganization of these systems increasing receptor transcripts in msP rats, along with an increase of CRF and a decrease of N/OFQ transcripts, respectively. Moreover, mimicking the effects of alcohol in the AMY we observed that the activation of NOP receptor by intracerebroventricular administration of N/OFQ in msP rats caused an increase of BDNF and a decrease of CRF transcripts. Our study indicates that both stress and anti-stress mechanisms are dysregulated in the extended AMY of msP rats. The voluntary alcohol drinking, as well as NOP agonism, have a significant impact on neuropeptidergic systems arrangement, bringing the systems back to normalization.

Attentional Bias, Alcohol Craving, and Anxiety Implications of the Virtual Reality Cue-Exposure Therapy in Severe Alcohol Use Disorder: A Case Report

Aims: Attentional bias (AB), alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder (AUD). The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy (VR-CET) to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content. Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance misuse. The protocol consisted of six VR-CET booster sessions and two assessment sessions (pre- and post-VR-CET) over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality (VR) exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking (ET) and VR technologies at different time points. Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB. Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed.

Effect of Transcutaneous Auricular Vagus Nerve Stimulation on Protracted Alcohol Withdrawal Symptoms in Male Alcohol-Dependent Patients

Protracted alcohol withdrawal symptoms (PAWS), characterized by the presence of substance-specific signs and symptoms (including anxiety, irritability, mood instability, insomnia, and cravings), make alcohol abstinence difficult and increase the risk of relapse in recovering alcoholics. The goal of this study was to evaluate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on PAWS and plasma brain-derived neurotrophic factor (BDNF), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and leptin levels in patients with alcohol dependency. A total of 114 patients with alcohol dependence were randomly divided into two groups: the treatment group and the control group. The patients in the treatment group were treated with taVNS of the bilateral auricular concha using an ear vagus nerve stimulator. The Pennsylvania Alcohol Craving Scale was used to evaluate the extent of craving for alcohol. The Self-Rating Anxiety Scale and Self-Rating Depression Scale (SDS) were used to evaluate the extent of anxiety and depression symptoms, respectively. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Enzyme-linked immunosorbent assay was used to measure plasma BDNF, IL-6, TNF-α, and leptin levels. The results showed that the SDS and PSQI scores were significantly lower in the treatment group than in the control group. Moreover, compared with the control group, the average BDNF levels in the treatment group were significantly increased. These results suggest that taVNS could improve the depression symptoms and sleep quality in alcohol-dependent patients after withdrawal, which might be related to the upregulation of plasma BDNF levels.

Chronic Ethanol Exposure Potentiates Cholinergic Neurotransmission in the Basolateral Amygdala

Chronic intermittent ethanol (CIE) exposure dysregulates glutamatergic and GABAergic neurotransmission, facilitating basolateral amygdala (BLA) pyramidal neuron hyperexcitability and the expression of anxiety during withdrawal. It is unknown whether ethanol-induced alterations in nucleus basalis magnocellularis (NBM) cholinergic projections to the BLA mediate anxiety-related behaviors through direct modulation of GABA and glutamate afferents. Following 10 days of CIE exposure and 24 h of withdrawal, we recorded GABAergic and glutamatergic synaptic responses in BLA pyramidal neurons with electrophysiology, assessed total protein expression of cholinergic markers, and quantified acetylcholine and choline concentrations using a colorimetric assay. We measured α₇ nicotinic acetylcholine receptor (nAChR) dependent modulation of presynaptic function at distinct inputs in AIR- and CIE-exposed BLA coronal slices as a functional read-out of cholinergic neurotransmission. CIE/withdrawal upregulates the endogenous activity of α₇ nAChRs, facilitating release at both GABAergic' local' interneuron and glutamatergic synaptic responses to stria terminalis (ST) stimulation, with no effect at GABAergic lateral paracapsular cells (LPCs). CIE caused a three-fold increase in BLA acetylcholine concentration, with no changes in α₇ nAChR or cholinergic marker expression. These data illustrate that α₇ nAChR-dependent changes in presynaptic function serve as a proxy for CIE-dependent alterations in synaptic acetylcholine levels. Thus, cholinergic projections appear to mediate CIE-induced alterations at GABA/glutamate inputs.

Investigating the link between serum concentrations of brain-derived neurotrophic factor and behavioral measures in anxious alcohol-dependent individuals

Brain-derived neurotrophic factor (BDNF) plays a role in different neurophysiological processes, including those involved in alcohol- and anxiety-related behaviors. Preclinical and clinical studies indicate that chronic excessive alcohol use leads to a downregulation of BDNF production in the periphery and in the brain. In addition, a decrease in BDNF concentrations in the blood has been reported to be associated with increased anxiety levels. Non-treatment-seeking alcohol-dependent individuals with high trait anxiety were studied to assess whether serum BDNF concentrations may be linked to self-reported levels of alcohol drinking, anxiety, and other behavioral measures. Participants had a current diagnosis of alcohol dependence, high trait anxiety score, and were not seeking treatment for alcohol dependence or anxiety. A fasting blood sample was collected from each participant and serum BDNF was measured using an enzyme-linked immunosorbent assay (ELISA). Behavioral data were collected on the same day, including measures of alcohol drinking, craving, dependence severity, and anxiety. Bivariate correlations were run between BDNF levels and behavioral measures. Serum BDNF concentrations were negatively correlated with average drinks per drinking days (r = -0.41, p = 0.02) and positively correlated with obsessive-compulsive drinking scale (r = 0.48, p = 0.007) and state-trait anxiety inventory (r = 0.52, p = 0.003) scores. These findings shed light on the possible role of the BDNF system in the neurobiology of alcohol- and anxiety-related behaviors.

The physiological responses to acute stress in alcohol-dependent patients: A systematic review

Dysregulation of physiological stress reactivity plays a key role in the development and relapse risk of alcohol dependence. This article reviews studies investigating physiological responses to experimentally induced acute stress in patients with alcohol dependence. A systematic search from electronic databases resulted in 3641 articles found and after screening 62 articles were included in our review. Studies are analyzed based on stress types (i.e., social stress tasks and nonsocial stress tasks) and physiological markers (i.e., the nervous system, the endocrine system, somatic responses and the immune system). In studies applying nonsocial stress tasks, alcohol-dependent patients were reported to show a blunted stress response compared with healthy controls in the majority of studies applying markers of adrenocorticotropic hormone and cortisol. In studies applying social stress tasks, findings are inconsistent, with less than half of the studies reporting altered physiological stress responses in patients. We discuss the impact of duration of abstinence, comorbidities, baseline physiological arousal and intervention on the discrepancy of study findings. Furthermore, we review evidence for an association between blunted physiological stress responses and the relapse risk among patients with alcohol dependence.

Depressive and Anxiety Symptoms Predict Obsessive and Compulsive Cravings among Depressed Alcoholics

Objectives

Alcohol craving is often associated with mood symptoms and predicts alcohol use in individuals with alcohol dependence. However, little is known about the impact of mood symptoms on alcohol craving in comorbid mood disorders and alcohol dependence. This study examines the predictive value of depressive and anxiety symptoms for obsessive and compulsive aspects of alcohol craving in adults with comorbid Major Depressive Disorder (MDD) and Alcohol Dependence.

Methods

Fifty-five adults (47% female; mean age of 39.35 (SD=8.80)) with DSM-IV diagnoses of comorbid MDD and alcohol dependence were prospectively assessed over a six-month period. They completed the Hamilton Rating Scales for Depression and Anxiety, the Alcohol Timeline Followback, the Obsessive Compulsive Drinking Scale (OCDS), the Alcohol Dependence Scale (ADS), and the Addiction Severity Index (ASI). The linear mixed model analyses for repeated measures was used to test weather depressive and anxiety symptoms predict OCDS subscale scores.

Results

Depressive and anxiety symptoms were strongly associated with obsessive and compulsive subscales of the OCDS. Baseline ASI-alcohol scores were associated with both the obsessive and compulsive and with the obsessive subscale scores in the predictive model including depressive symptoms, and that including anxiety symptoms respectively.

Conclusions

Results suggest that depressive and anxiety symptoms predict obsessive and compulsive aspects of alcohol craving in adults with comorbid MDD and alcohol dependence. Assessing the severity of depressive and anxiety symptoms and alcohol use in this population may identify those more likely to experience intense alcohol craving states and at increased risk of relapse.

Anxiety Sensitivity Prospectively Predicts Increased Acute Posttraumatic Stress and Related Symptoms After Sexual Assault

Anxiety sensitivity is a potential risk factor for posttraumatic stress symptoms (PTSS) and has been hypothesized to contribute to PTSS development. However, few prospective studies have evaluated whether anxiety sensitivity predicts PTSS. In a subsample of 48 women sexual assault survivors enrolled as part of a larger prospective observational study, elevated anxiety sensitivity measured via a brief assessment 1 week after experiencing a sexual assault was concurrently associated with PTSS at 1 week and prospectively predicted PTSS 6 weeks after the event, with small-to-medium effect sizes, η2 p = .10, even after covarying for trauma history. Heightened anxiety sensitivity at 1-week postevent also interacted with time to predict anxiety and depression both before and after sexual assault, with medium-to-large effect sizes, ηp 2 = .21- .24. This is consistent with research linking anxiety sensitivity to PTSS, but this was the first prospective study of which we are aware to demonstrate that anxiety sensitivity in the acute posttrauma period predicts PTSS among women who have recently experienced sexual assault. Future research should use the full Anxiety Sensitivity Index to replicate findings in a larger sample and explore whether targeting anxiety sensitivity could mitigate the development of PTSS in this vulnerable population.

Predictors of Changes in Alcohol Craving Levels during a Virtual Reality Cue Exposure Treatment among Patients with Alcohol Use Disorder

BACKGROUND/OBJECTIVE

Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes from admission to discharge in outpatients with alcohol use disorder (AUD) undergoing treatment-as-usual (TAU), or treatment-as-usual supplemented with virtual reality cue-exposure therapy (TAU + VR-CET).

METHOD

A prospective cohort study was conducted amongst 42 outpatients with AUD (n = 15 TAU + VR-CET and n = 27 TAU) from a clinical setting. Changes in the levels of alcohol craving between admission and discharge were assessed with the Multidimensional Alcohol Craving Scale. Sociodemographic characteristics (age, gender, education, and socioeconomic and civil status), cognitive-affective behavioral patterns (AUD severity, abstinence duration, psychiatric comorbidity, state anxiety, attentional bias, and substance use), and type of treatment (TAU + VR-CET and only TAU) were also evaluated.

RESULTS

The TAU + VR-CET group showed greater changes of improvement in the levels of alcohol craving than the TAU group (χ2 = 10.996; p = 0.001). Intragroup changes in alcohol craving from pre to post-treatment were significant in the TAU + VR-CET group (χ2 = 13.818; p = 0.003) but not within the TAU group (χ2 = 2.349; p = 0.503). The odds of an improvement in any of the craving levels between pre- and post-test was 18.18 (1/0.055) times higher in the TAU + VR-CET group with respect to the TAU group. The use of illicit drugs in the month prior to the test increased the odds of having a positive change by 18.18 (1/0.055) with respect to not having consumed.

CONCLUSIONS

Including VR-CET in TAU programs may provide benefits in the treatment of AUDs mainly among patients with intense alcohol craving and individuals having used illicit substances prior to treatment.

Perceived Social Discrimination, Socioeconomic Status, and Alcohol Consumption among Chinese Adults: A Nationally Representative Study

Perceived social discrimination in China has significant effects on drinking behavior. This finding was reached through multivariate logistic regression analysis of a sample of 22,566 adults in the 2016 China Family Panel Studies (CFPS). This was a cross-sectional study conducted with computer-assisted face-to-face interviews to assess alcohol drinking problems and associated factors among Chinese adults. The proportion of adults prone to alcoholism tends to be higher in eastern than central China, and higher in central than western China. Furthermore, gender discrimination and delays in government interactions as a result of unfair treatment have a positive and significant effect on individuals’ drinking. The alcohol consumption rate among Chinese men is about 13 times that of Chinese women. Additionally, older people have a stronger tendency to drink alcohol. In terms of education, those with lower education levels are more prone to alcoholism than those with higher education levels. Regarding marital status, those who are married are more prone to alcoholism than those who are not. Further, those who have been diagnosed with a chronic disease within the past six months are less prone to alcoholism than those without such diagnosis. People with an annual income between 50,000 and 150,000 yuan are more prone to alcoholism than those with an income under 50,000 yuan. Groups that have experienced unequal treatment in public services are also more prone to alcoholism than those who do not suffer such unequal treatment.

The effect of self-perceived stress, the history of smoking and drinking on weight status in Chinese adults - evidence from the 2015 China Health and Nutrition Survey: A cross-sectional study in Chongqing, China

Being overweight and obese is a serious public health issues in China. However, the effects of substance use and mental factors on weight changes remain unclear. In this study, we aimed to investigate the association among self-perceived stress, history of smoking and drinking, and weight status by using data from the China Health and Nutrition Survey in 2015.A total of 8028 adults were selected from China Health and Nutrition Survey in 2015. The self-reported data primarily included sociodemographic data, self-perceived stress scores, and history of smoking and drinking. Physical measurements including height and weight were logged to calculate body mass index. Multivariate and multinomial regression models were used to estimate effects of substance and perceived stress on weight status.The prevalence of underweight and overweight/obese people were 4.52% and 51.51% in Chinese adults, respectively. Adults with high perceived stress were negatively associated with being overweight and obese (OR = 0.80, 95% CI = 0.66-0.97 in the middle level and OR = 0.69, 95%CI = 0.55-0.88 in the high level). Adults with history of smoking had low risk of being overweight/obese (OR = 0.71, 95% CI = 0.62-0.82). Adults with history of drinking had high risk of overweight/obese (OR = 1.22, 95% CI = 1.06-1.40). In addition, the association between drinking and overweight/obese was affected by different levels of perceived stress (OR = 1.15, 95%CI = 0.83-1.59 in low-stress group and OR = 1.42, 95%CI = 1.04-1.94 in high-stress group).The effects of self-perceived stress and history of smoking as well as drinking on weight status were significant in this study. The government and healthcare policymakers should strengthen early psychological factor and behavioral intervention to decrease the prevalence of abnormal-weight status.

Alcohol Craving and Psychiatric Disorders Among Current Drinkers

BACKGROUND AND OBJECTIVES

Previous research has shown that alcohol craving is associated with psychiatric comorbidities. However, no population studies have examined the odds of psychiatric disorders in cravers and noncravers. The purpose of this study was to investigate current prevalence rates and odds ratios of psychiatric disorders among alcohol drinkers with and without alcohol craving in a population-based sample. We also compared four craving groups (cravers with and without alcohol use disorder [AUD], noncravers with and without AUD) for psychiatric comorbidities.

METHODS

The study data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). A subset of the NESARC sample (N = 22 000) who reported alcohol use during the past 12 months was included. Prevalence rates of psychiatric disorders were compared among current drinkers with alcohol craving (N = 900) and without alcohol craving (N = 21 500).

RESULTS

Cravers had higher prevalence rates of current psychiatric disorders than noncravers. Even after adjustment for other psychiatric disorders including AUD, cravers had significantly higher odds of any substance use disorder (adjusted odds ratio [AOR], 9.01), any mood disorder (AOR, 1.78), any anxiety disorder (AOR, 1.86), and any personality disorder (AOR, 1.92) than noncravers. Interestingly, cravers without AUD had even higher rates of any anxiety disorder and any personality disorder than noncravers with AUD.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Alcohol craving is associated with a higher prevalence of various psychiatric disorders. These findings suggest that alcohol craving may be related to transdiagnostic features that are present across various psychiatric disorders. (Am J Addict 2021;30:34-42).

Problem drinking, wellbeing and mortality risk in Chinese men: findings from the China Kadoorie Biobank

AIMS

To assess the associations of problem drinking with wellbeing and mortality in Chinese men.

DESIGN

Population-based prospective cohort study.

SETTING

Ten diverse areas across China.

PARTICIPANTS

A total of 210 259 men aged 30-79 years enrolled into China Kadoorie Biobank between 2004 and 2008.

MEASUREMENTS

Self-reported alcohol intake and indicators of problem drinking (i.e. drinking in the morning, unable to stop drinking, unable to work due to drinking, negative emotions after drinking, having shakes after stopping drinking) were assessed by questionnaire at baseline, along with stressful life events (e.g. divorce, income loss, violence) and wellbeing-related measures (e.g. life satisfaction, sleep problems, depression, anxiety). Problem drinking was defined as reporting at least one of the drinking problem indicators. Follow-up for mortality and hospitalized events was through linkage to death registries and national health insurance systems. Multivariate logistic regression models assessed cross-sectional relationships between problem drinking and stressful life events/wellbeing. Cox proportional hazards regression models estimated prospective associations of problem drinking with mortality/hospitalized events.

FINDINGS

A third of men were current regular drinkers (i.e. drank alcohol at least weekly), 24% of whom reported problem drinking: 8% of all men. Experience of stressful life events in the past 2 years, especially income loss [odds ratio (OR) = 1.86, 95% confidence interval (CI) = 1.45-2.39], was associated with increased problem drinking. Compared with low-risk drinkers (i.e. intake < 200 g/week, no reported problem drinking or habitual heavy drinking episodes), men with problem drinking had poorer self-reported health, poorer life satisfaction and sleep problems, and were more likely to have symptoms of depression and anxiety. Men with two or more problem drinking indicators had an approximately twofold higher risk for all-cause mortality as well as mortality and morbidity from external causes (i.e. injuries), respectively, and 15% higher risk for any hospitalization, compared with low-risk drinkers (all P < 0.01).

CONCLUSION

Eight per cent of men in China are problem drinkers, and this is associated with significantly increased risk of physical and mental health problems and premature death.

Dynorphin and its role in alcohol use disorder

The dynorphin / kappa opioid receptor (KOR) system has been implicated in many aspects that influence neuropsychiatric disorders. Namely, this system modulates neural circuits that primarily regulate reward seeking, motivation processing, stress responsivity, and pain sensitivity, thus affecting the development of substance and alcohol use disorder (AUD). The effects of this system are often bidirectional and depend on projection targets. To date, a majority of the studies focusing on this system have examined the KOR function using agonists and antagonists. Indeed, there are studies that have examined prodynorphin and dynorphin levels by measuring mRNA and tissue content levels; however, static levels of the neuropeptide and its precursor do not explain complete and online function of the peptide as would be explained by measuring dynorphin transmission in real time. New and exciting methods using optogenetics, chemogenetics, genetic sensors, fast scan cyclic voltammetry are now being developed to detect various neuropeptides with a focus on opioid peptides, including dynorphin. In this review we discuss studies that examine dynorphin projections in areas involved in AUD, its functional involvement in AUD and vulnerability to develop AUD at various ages. Moreover, we discuss dynorphin's role in promoting AUD by dysregulation motivation circuits and how advancements in opioid peptide detection will further our understanding.

Evidence of a Relationship Between Plasma Leptin, Not Nesfatin-1, and Craving in Male Alcohol-Dependent Patients After Abstinence

The goal of this study was to determine whether the plasma leptin, nesfatin-1, cortisol, brain-derived neurotrophic factor (BDNF), and inflammatory cytokines could be used as potential biomarkers for the degree of craving in the alcohol-dependent patients after 1 month of abstinence. A total of 83 patients with alcohol use disorder (AUD) and 61 healthy subjects were assessed. Patients with AUD were selected from Department of Material Dependence, Anhui Mental Health Center, and subjects in the control group were selected from healthy volunteers. The Alcohol Urge questionnaire Scale (AUQ) was used to evaluate the extent of craving for alcohol, and the Michigan Alcoholism Screening Test (MAST), the Fagerstrom Test for Nicotine Dependence (FTND), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS) were also assessed in patients with AUD. Enzyme-Linked Immunosorbent Assay (ELISA) was used for the measurement of plasma leptin, nesfatin-1, cortisol, BDNF, Interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) levels. Compare with healthy controls, the average leptin, leptin/BMI, IL-6, CRP, and TNF-α levels in patients with AUD were significantly increased, while the BDNF levels were significantly decreased. Moreover, the partial correlational analysis showed that the AUQ scores of the alcohol-dependent patients were positively correlated with the plasma leptin levels (r = 0.613, P < 0.001), rather than nesfatin-1 (r = 0.066, P = 0.569) after controlling for age as covariate. Furthermore, plasma nesfatin-1 levels were found to be correlated with the SDS scores (r = 0.366, P = 0.001) in the AUD group. In addition, plasma leptin levels were positively associated with the plasma IL-6 (r = 0.257, P = 0.033), CRP (r = 0.305, P = 0.011), and TNF-α (r = 0.311, P = 0.009) levels, and negatively associated with the BDNF levels (r = -0.245, P = 0.042) in patients with AUD. These results suggest that plasma leptin, but not nesfatin-1, might be a potential biomarker for the degree of craving in alcohol-dependent patients after 1 month of abstinence, the mechanism of which might be related to the dysfunction of the inflammatory cytokines and BDNF levels.

Discrimination, Stress and Reactivity to Alcohol Cues

Introduction: Our study investigated whether discrimination affects psychologi-cal/physiological stress and alcohol craving.

Method: Participants (N = 92) were asked to recall and write about (a) a neutral, (b) a negative, or (c) a discriminatory experience in the past and then completed a cue-reactivity procedure assessing their alcohol craving. In addition, we assessed levels of perceived stress before and after the discrimination manipulation, chronic substance use and craving, prior perceived discrimination, and strength of racial/ethnic identity.

Results: Results revealed a small effect in which the discrimination condition increased alcohol cue-elicited craving relative to the other conditions. Chronic craving moderated effects of discrimination on cortisol levels. Self-reported stress levels were increased in the discrimination and negative memory conditions relative to baseline. Strength of racial identity served as a protective factor for substance abuse in those who reported chronic high levels of discrimination.

Discussion: We discussed the direct link established between acute exposure to discrimination and craving, and experimental evidence for the relationship between discrimination and self-reported stress, but also addressed potential limitations of this work. It is further discussed how some individual differences factors (e.g., chronic craving) predict physiological stress in discriminatory settings. This work underscored the role of racial identity as a protective factor against alcohol abuse in individuals reporting high levels of discrimination.

Moderate emotional reactions to stressful life events are associated with lowest risk of increased alcohol consumption: evidence from the Whitehall II study

BACKGROUND

Research investigating the associations between stress-related negative emotions and alcohol consumption often assumes a linear dose-response relationship. Based on the current theories of emotions, we questioned this assumption and hypothesized that both very low and very high levels of negative emotional response (NER) to stressful life events are related to increased alcohol consumption.

METHODS

We used data from Phases 1 (1985-88) and 2 (1989-90) of the British Whitehall II study. At both phases, participants reported on their alcohol consumption, recent stressful events and the NER to the events. Two thousand and sixteen participants without recent stressful events at baseline were selected. Logistic regression was used to model the association between emotional response at baseline and increased frequency of alcohol consumption between the two phases.

RESULTS

The likelihood of increased alcohol consumption increased with the number of recent stressful events. Among participants with at least one event, 17% increased alcohol consumption, compared with 14% of those who reported no events. Participants with average NER were at lowest risk (14%) of increasing alcohol consumption after major life events. Those with highest NER were significantly more likely to increase alcohol consumption (20%) than those with average NER, but the difference between those with highest NER and those with lowest NER (17%) was not statistically significant.

CONCLUSIONS

Increases in alcohol consumption following stressful events are least likely if people experience moderate levels of NER to events. Negative emotions in moderate doses should not be regarded as a risk factor for unhealthy behaviours, but rather a potentially protective factor.

Altered oscillatory brain dynamics of emotional processing in young binge drinkers

Heavy episodic drinking, also termed binge drinking, is commonly practiced by young adults. It is accompanied by a range of cognitive, affective, and social problems, but the neural dynamics underlying changes in emotional functions is poorly understood. To investigate the behavioral and brain indices of affective processing as a function of binge drinking, young, healthy participants (23.3 ± 3.3 years) were assigned to two groups (n = 32 each) based on their drinking habits. Binge drinking (BD) participants reported drinking heavily with at least five binge episodes in the last 6 months, whereas light drinkers (LD) reported no more than one binge episode in the last 6 months. Participants provided subjective ratings of emotionally evocative images with negative, positive, erotic, and neutral themes mostly selected from the International Affective Picture System (IAPS). Electroencephalography (EEG) signal was recorded with a 64-channel system and analyzed in theta frequency band (4-7 Hz) with Morlet wavelets. Subjective ratings of the IAPS pictures were equivalent across both groups. However, affective modulation of event-related theta power both during early appraisal and later integrative processing stages was attenuated in BD, particularly those engaging in high-intensity drinking. These findings suggest that binge drinking is associated with altered neurophysiological indices of affective functions that are reflected in lower theta responsivity to emotions. The blunted long-range cortico-cortical and corticolimbic integration is consistent with compromised affective functions in alcohol use disorder. These findings may have implications for diagnostic and intervention strategies in heavy alcohol users.

The interactive effects of perceived peer drinking and personality profiles on adolescent drinking: a prospective cohort study

AIMS

(1) To classify Australian adolescents according to their alcohol consumption trajectories; and (2) to assess the direct and interactive effects of perceived peer drinking (PPD) and personality on adolescent drinking.

DESIGN

Prospective cohort study comprising secondary analysis of six waves of prospective data (collected between 2014 and 2016) from the control arm of the Climate Schools Combined Study.

SETTING

Nineteen schools across three Australian states.

PARTICIPANTS

A total of 1492 socio-demographically diverse students (mean age at baseline: 13.47; 68% female; 82% born in Australia).

MEASUREMENTS

Alcohol consumption trajectories were assessed using self-reported sipping of alcohol, full standard drink consumption, binge drinking and quantity and frequency of alcohol consumption. One item assessed PPD and personality was assessed using the Substance Use Risk Profile Scale.

FINDINGS

Eight hundred and sixty-four (58%) adolescents consumed alcohol across the study period. Four drinking trajectories were identified: abstaining (n = 513; reference group); onset (n = 361; initiated after baseline); persistent (n = 531; initiated prior to baseline); and decreasing (n = 50; consumed alcohol at baseline but ceased or decreased thereafter). A significant PPD × anxiety sensitivity (AS) interaction affected probability of belonging to the onset (P < 0.001) and persistent (P = 0.003) trajectories. The effect of PPD on probability of belonging to the onset trajectory was only significant when adolescents reported low [95% confidence interval (CI) = 1.464-2.646, P < 0.001], but not high AS. The effect of PPD on probability of belonging to the persistent drinking trajectory was stronger at low (95% CI = 2.144-3.283, P < 0.001), compared with high (95% CI = 1.440-2.308, P < 0.001) AS.

CONCLUSIONS

In Australian adolescents, self-reported drinking onset and persistent drinking appear to be more strongly associated with perceived peer drinking in those with low anxiety sensitivity than those with high anxiety sensitivity.

Tobacco smoke and ethanol during adolescence: Both combined- and single-drug exposures lead to short- and long-term disruption of the serotonergic system in the mouse brain

The impairment of the serotonergic system contributes to nicotine and ethanol effects on mood, suggesting that this system is targeted by each of these drugs and that co-exposure possibly worsens the disruption. Here, we tested this hypothesis in an adolescent mice model of tobacco smoke and/or ethanol exposure. From postnatal day (PN) 30-45, Swiss mice were exposed to one of the following: 1) tobacco smoke (SMK; research cigarettes 2R1F, whole-body exposure, 8 h/daily); 2) ethanol (ETOH; 2 g/kg i.p., every other day); 3) SMK + ETOH; 4) Control (VEH). At PN45 (end-of-exposure), hippocampal serotonin transporter (5 H TT) binding was increased in SMK and decreased in ETOH male mice. At PN50 (short-term deprivation), cortical 5 H TT was reduced in all drug-exposed mice. In the hippocampus, similar deficits were identified in females. In both brain regions, the effects of SMK + ETOH deprivation on 5 H TT were equivalent to the damage caused by either drug. At PN50, hippocampal 5 H T1A receptor binding was reduced in ETOH and SMK + ETOH mice. Similar results were observed in the male cortex. In females, deficits were identified in SMK mice. In both brain regions, SMK + ETOH 5 H T1A deficits reflected the summation of SMK and ETOH outcomes. At PN75 (long-term deprivation), there was a late-emergent increase in cortical 5 H T1A binding in SMK mice, while cortical 5 H T2 receptor binding was similarly increased in SMK and SMK + ETOH groups. Adolescent SMK and/or ETOH serotonergic impairment is sex-dependent and most evident during short-term deprivation. SMK + ETOH deprivation evokes serotonergic disruption that is at least equivalent to that caused by either drug alone.