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Carlini LE, Fernandez AC, Mellinger JL. Sex and gender in alcohol use disorder and alcohol-associated liver disease in the United States: A narrative review. Hepatology 2024:01515467-990000000-00864. [PMID: 38683562 DOI: 10.1097/hep.0000000000000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
Over the last 20 years, there has been an alarming increase in alcohol use and AUD prevalence among women, narrowing the historical gender gap. Concurrently, there has also been a significant rise in alcohol-associated liver disease (ALD) prevalence, severity, and mortality among women. Despite this, there are no recent reviews that have sought to evaluate both sex and gender differences at the intersection of AUD and ALD. In this narrative review, we address the escalating rates of ALD and AUD in the United States, with a specific focus on the disproportionate impact on women. Sex and gender play an important and well-known role in the pathogenesis and epidemiology of ALD. However, sex and gender are also implicated in the development and prevalence of AUD, as well as in the treatment of AUD, all of which have important consequences on the approach to the treatment of patients with ALD and AUD. A better understanding of sex and gender differences in AUD, ALD, and the intersection of the 2 is essential to enhance prevention, diagnosis, and management strategies. These data underscore the urgent need for awareness and preventive efforts to mitigate the potential long-term health consequences.
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Affiliation(s)
- Lauren E Carlini
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anne C Fernandez
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jessica L Mellinger
- Department of Internal Medicine and Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
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2
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Tonetto S, Weikop P, Thomsen M. Nutritional ketosis as treatment for alcohol withdrawal symptoms in female C57BL/6J mice. Sci Rep 2024; 14:5092. [PMID: 38429369 PMCID: PMC10907582 DOI: 10.1038/s41598-024-55310-3] [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: 09/11/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
Upon both acute and prolonged alcohol intake, the brain undergoes a metabolic shift associated with increased acetate metabolism and reduced glucose metabolism, which persists during abstinence, putatively leading to energy depletion in the brain. This study evaluates the efficacy of ketogenic treatments to rescue psychiatric and neurochemical alterations during long-term alcohol withdrawal. Female mice were intermittently exposed to alcohol vapor or air for three weeks, during which mice were introduced to either a ketogenic diet (KD), control diet supplemented with ketone ester (KE) or remained on control diet (CD). Withdrawal symptoms were assessed over a period of four weeks followed by re-exposure using several behavioral and biochemical tests. Alcohol-exposed mice fed CD displayed long-lasting depressive-like symptoms measured by saccharin preference and tail suspension, as well as decreased norepinephrine levels and serotonin turnover in the hippocampus. Both KD and KE rescued anhedonia for up to three weeks of abstinence. KD mice showed higher latency to first immobility in the tail suspension test, as well as lower plasma cholesterol levels. Our findings show promising effects of nutritional ketosis in ameliorating alcohol withdrawal symptoms in mice. KD seemed to better rescue these symptoms compared to KE.
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Affiliation(s)
- Simone Tonetto
- Laboratory of Neuropsychiatry, Mental Health Center Copenhagen, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Copenhagen, Denmark
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia Weikop
- Center for Translational Neuromedicine, University of Copenhagen, Copenhagen, Denmark
| | - Morgan Thomsen
- Laboratory of Neuropsychiatry, Mental Health Center Copenhagen, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen, Copenhagen, Denmark.
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Laboratory of Neuropsychiatry, Mental Health Center Copenhagen, Copenhagen University Hospital - Mental Health Services CPH, Hovedvejen 17, 1., 2000, Frederiksberg, Denmark.
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3
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Fernández SD, Miranda JJF, Pastor FP, Muñoz FL. Gender and addiction and other mental disorders comorbidity: sociodemographic, clinical, and treatment differences. Arch Womens Ment Health 2023; 26:639-650. [PMID: 37540344 PMCID: PMC10491505 DOI: 10.1007/s00737-023-01353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high, but the details are uncertain in Spain. The objective of the present study was to know the prevalence of this comorbidity, as well as the pharmacological treatment, both in specific addiction treatment networks and in mental health networks, with a gender perspective. Observational, multicenter study, with a randomized sample, of patients under treatment for SUD or OMD in Spain (N = 1783). A specific questionnaire, collecting sociodemographic and clinical variables, diagnosed SUD and OMD, and prescribed psychotropic drugs, was completed by treating clinicians. Differences between females and males were searched. A high prevalence of OMD was found in those patients treated for their SUD (71%), and also of diagnoses of SUD (59%) in people treated for OMD. Significant relationships between addiction to certain substances and specific mental disorders were found (with no main differences between women and men). The treatments for OMD were very common in the addiction treatment networks, but that of SUDs in those patients treated in the mental health networks was less than expected. A high prescription of benzodiazepines was found. Women were less frequently diagnosed with cannabis, opioid, and especially cocaine use disorders, and they had fewer psychotic disorders and more affective, anxiety, sleep, and eating disorders, with the rest being the same, including personality disorders. Women had fewer treatments with agonists and more with antagonists, and more prescriptions of anxiolytics and antidepressants. This study provides preliminary information on the coexistence in routine clinical practice of addictive disorders and other mental disorders in Spain, and on the treatment provided, and shows differences in prevalence and clinical characteristics, and especially in treatment approaches between women and men. Thus, should be useful to adapt the treatment response with greater precision, and with a gender perspective.
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Affiliation(s)
- Silvia Díaz Fernández
- Asturian Mental Health Service Area V- Hospital Univ. Cabueñes, Servicio de Salud del Principado de Asturias (SESPA), Gijón, Spain.
- Asturian Institute on Health Research (Instituto para la Investigación Sanitaria del P° de Asturias-ISPA), Oviedo, Spain.
| | - Juan José Fernandez Miranda
- Asturian Mental Health Service Area V- Hospital Univ. Cabueñes, Servicio de Salud del Principado de Asturias (SESPA), Gijón, Spain
- Asturian Institute on Health Research (Instituto para la Investigación Sanitaria del P° de Asturias-ISPA), Oviedo, Spain
| | - Francisco Pascual Pastor
- Unidad de conductas adictivas, Servicio Valenciano de Salud (SVS), Alcoi, Spain
- PREVENGO, University Miguel Hernández, Elche, Spain
| | - Francisco López Muñoz
- Faculty of Health Sciences, University Camilo José Cela, Madrid, Spain
- Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute, Madrid, Spain
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Gilbert PA, Soweid L, Holdefer PJ, Kersten S, Mulia N. Strategies to maintain recovery from alcohol problems during the COVID-19 pandemic: Insights from a mixed-methods national survey of adults in the United States. PLoS One 2023; 18:e0284435. [PMID: 37068066 PMCID: PMC10109499 DOI: 10.1371/journal.pone.0284435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/01/2023] [Indexed: 04/18/2023] Open
Abstract
The COVID-19 pandemic has been associated with poorer mental health and, in some cases, increased alcohol consumption; however, little is known about the pandemic's effects on people in recovery from alcohol use disorder (AUD), especially how they have coped with novel stressors. Our mixed-methods study investigated strategies used to maintain recovery during the pandemic, with attention to variation by gender. We analyzed data obtained in fall 2020 from an online US national survey of adults with resolved AUD (n = 1,492) recruited from KnowledgePanel, a probability-based cohort of non-institutionalized adults maintained by Ipsos for internet-based research. Participants endorsed possible coping strategies on a 19-item choose-all-that-apply list, which were analyzed using chi-square tests. In addition, 1,008 participants provided text responses to an open-ended question about their strategies to maintain recovery during the pandemic, which were coded and analyzed using an inductive, thematic approach. The majority of our sample met criteria for severe lifetime AUD (72.9%), reported being in recovery more than five years (75.5%), and had never used specialty AUD services or mutual-help groups (59.7%). The ordering of the coping strategies was quite similar for women and men; however, the top strategy (talking with family and friends by phone, text, or video) was endorsed more frequently by women than men (49.7% vs. 36.1%; p < .001). Among qualitative themes, "staying connected" was the most common. It was dominated by statements about family, with women mentioning children more often than men. Among other themes, "cognitive strategies" mirrored established therapeutic modalities, and "active pursuits" aligned with many recent recommendations for service providers working with substance-using populations during the pandemic. A minority of participants invoked "willpower" for recovery or stated that pandemic restrictions helped by reducing exposure to relapse risks. These findings shed light on recovery mechanisms during the COVID-19 pandemic and suggest potential intervention targets to support recovery during other catastrophic events, such as natural disasters.
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Affiliation(s)
- Paul A. Gilbert
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Loulwa Soweid
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Paul J. Holdefer
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Sarah Kersten
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California, Unites States of America
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Wang D, Yin Y, Yuan W, Li B, Wang H, Hu J, Chen M, Gong Y, Yuan TF, Yu T. Post-error slowing predicts for relapse in individuals with alcohol use disorder. J Psychiatr Res 2023; 161:441-448. [PMID: 37059028 DOI: 10.1016/j.jpsychires.2023.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Relapse characterizes addiction. The cognitive phenotype underlying relapse in individuals with alcohol use disorder (AUD) remain unelucidated. Here we aimed to investigate the potential changes in behavioral adjustment in AUD, and the association with relapse. METHOD Forty-seven subjects with AUD at Shandong Mental Health Center completed the stop-signal task, the PACS, the Beck Depression Inventory and the State-Trait anxiety questionnaires. Thirty age-matched male healthy subjects served as the control group (HC). In the follow-up, twenty-one subjects remained abstinent, while twenty-six subjects relapsed. Independent sample t-test was applied to measure differences between two groups and logistic regression analysis was conducted to explore the potential predictors on relapse. RESULTS The results showed that there were significant differences in stop signal reaction time (SSRT) and trigger failure between the AUD and HC groups. Relapsed group showed longer post-error slowing (PES) when compared to the non-relapsed group. The PES could predict relapse in alcohol use disorder. CONCLUSION Individuals with AUD showed impaired inhibitory control, which may predict relapse.
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Affiliation(s)
- Duanwei Wang
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Yuanyuan Yin
- School of Mental Healthy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Yuan
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Bin Li
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Hairong Wang
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Ji Hu
- School of Life Sciences, ShanghaiTech University, Shanghai, China
| | - Meng Chen
- Brain and Cognitive Neuroscience Research Center, Liaoning Normal University, Dalian, China
| | - Yuandong Gong
- Shandong Mental Health Center, Jinan, Shandong, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China.
| | - Tiangui Yu
- Shandong Mental Health Center, Jinan, Shandong, China.
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Buckner JD, Morris PE, Ferrie ML, Scherzer CR. Social Anxiety and Alcohol Use and Related Problems among Black Adults: Differential Roles of Motives by Sex. Subst Use Misuse 2023; 58:36-43. [PMID: 36382779 DOI: 10.1080/10826084.2022.2137813] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Black individuals who consume alcohol are at risk of experiencing alcohol-related problems. Psycho-sociocultural models of substance use posit that these individuals may continue to drink despite alcohol-related problems to cope with psychological distress. Emerging data indicate that social anxiety is one type of distress that may play an important role in drinking behavior among Black adults. Objectives: Yet despite evidence that drinking to cope varies as a function of sex among predominantly White samples, this is the first known study to test whether socially anxious Black women are similarly at risk for coping motivated drinking and its negative sequelae. Participants were 257 (75% female) Black undergraduates endorsing current alcohol use. Results: Among women and men, social anxiety was significantly related to more alcoholrelated problems and coping-depression and conformity motives. Among women (but not men), social anxiety was also significantly related to more coping-anxiety and greater typical drinking. Serial mediation analyses among women indicated that social anxiety was indirectly related to more alcohol problems via the serial effect of each of the relevant drinking motives (copinganxiety, coping-depression, conformity) and drinking frequency. Among men, social anxiety was indirectly related to alcohol problems via coping-depression and conformity motives. Conclusions/Importance: Findings highlight the importance of considering sex in research on psychosocial vulnerability factors associated with alcohol-related problems among Black adults.
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Affiliation(s)
- Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Paige E Morris
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Mara L Ferrie
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Caroline R Scherzer
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
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Meyer C, Schoettner K, Amir S. The effects of circadian desynchronization on alcohol consumption and affective behavior during alcohol abstinence in female rats. Front Behav Neurosci 2022; 16:1044783. [PMID: 36620855 PMCID: PMC9813852 DOI: 10.3389/fnbeh.2022.1044783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Disruption of circadian rhythmicity distorts physiological and psychological processes and has major consequences on health and well-being. A chronic misalignment within the internal time-keeping system modulates alcohol consumption and contributes to stress-related psychiatric disorders which are known to trigger alcohol misuse and relapse. While there is growing evidence of the deleterious impact of circadian disruption on male physiology and behavior, knowledge about the effect in females remains limited. The present study aims to fill the gap by assessing the relationship between internal desynchronization and alcohol intake behavior in female rats. Female Wistar rats kept under standard 24-h, 22-h light-dark conditions, or chronic 6-h advanced phase shifts, were given intermittent access to 20% alcohol followed by an extended alcohol deprivation period. Alcohol consumption under altered light-dark (LD) conditions was assessed and emotional behavior during alcohol abstinence was evaluated. Internally desynchronization in female rats does not affect alcohol consumption but alters scores of emotionality during alcohol abstinence. Changes in affective-like behaviors were accompanied by reduced body weight gain and estrous irregularities under aberrant LD conditions. Our data suggest that internal desynchronization caused by environmental factors is not a major factor contributing to the onset and progression of alcohol abuse, but highlights the need of maintaining circadian hygiene as a supportive remedy during alcohol rehabilitation.
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Sánchez-Peña JF, Jáñez-Álvarez M, Álvarez-Cotoli PG, García-Laredo E. Dual diagnosis in immigrant patients with alcohol use disorder: 2-years of follow-up treatment. ACTAS ESPANOLAS DE PSIQUIATRIA 2022; 50:276-286. [PMID: 36622715 PMCID: PMC10803857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 01/10/2023]
Abstract
There is a high prevalence of comorbid psychiatric disorders in alcohol abuse disorder. The presence of dual diagnosis in patients decreases the maintenance of abstinence and increases the likelihood of relapse, which makes treatment more complicated.
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9
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Liu Q, Leng P, Gu Y, Shang X, Zhou Y, Zhang H, Zuo L, Mei G, Xiong C, Wu T, Li H. The dose-effect relationships of cigarette and alcohol consumption with depressive symptoms: a multiple-center, cross-sectional study in 5965 Chinese middle-aged and elderly men. BMC Psychiatry 2022; 22:657. [PMID: 36284280 PMCID: PMC9594935 DOI: 10.1186/s12888-022-04316-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although association of depressive symptoms with cigarette or alcohol is well documented, the dose-response relationship between them is rarely studied. This study aims to evaluate dose-response relationships of cigarette and alcohol consumption with depressive symptoms in Chinese middle-aged and elderly men, providing evidence to guide cigarette and alcohol control. METHODS This multiple-center, cross-sectional study including 5965 Chinese men aged 40-79 years was conducted in 2013-2016 in China. Depressive symptoms were evaluated by Beck Depression Inventory-Short Form. History of cigarette smoking and alcohol drinking were collected with a structured questionnaire. Prevalence of depressive symptoms was compared depending on cigarette and alcohol consumption. Adjusted odds ratios (OR) and 95% confidence interval (CI) were estimated by binary logistic regression. Interpolation analysis was applied to test dose-effect relationships. RESULTS A parabolic-shaped relationship was observed between cigarette consumption and depressive symptoms. Compared to never smokers, 59.0% (OR = 1.59, 95% CI 1.30-1.94) and 29.0% (OR = 1.29, 95% CI 1.08-1.54) higher odds of depressive symptoms were observed in men smoking < 10 cigarettes/day and 10-20 cigarettes/day, whereas, similar odds of depressive symptoms among men smoking > 20 cigarettes/day (P = 0.092). An inverted J-shaped relationship was observed between alcohol consumption and depressive symptoms. Compared to never drinkers, a tendency of higher prevalence of depressive symptoms (OR = 1.16, 95% CI 0.99-1.36) was observed in men drinking < 140 g/week, and similar prevalence was observed in those drinking 140-280 g/week (P = 0.920), whereas, 29.4% (OR = 0.71, 95% CI 0.57-0.88) lower odds in men drinking > 280 g/week. CONCLUSIONS Associations of cigarette smoking and alcohol drinking with depressive symptoms differ with consumption in middle-aged and elderly men. Health-care providers should exercise great caution on depressive symptoms in conducting cigarette and alcohol control.
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Affiliation(s)
- Qian Liu
- grid.33199.310000 0004 0368 7223Center for Reproductive Medicine, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000 China ,grid.33199.310000 0004 0368 7223Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Pei Leng
- grid.33199.310000 0004 0368 7223Center for Reproductive Medicine, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000 China
| | - Yiqun Gu
- grid.453135.50000 0004 1769 3691National Health and Family Planning Key Laboratory of Male Reproductive Health, National Research Institute for Family Planning, Beijing, 100000 China
| | - Xuejun Shang
- Department of Andrology, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, 210093 China
| | - Yuanzhong Zhou
- grid.417409.f0000 0001 0240 6969School of Public Health, Zunyi Medical University, Zunyi, 563000 Guizhou China
| | - Huiping Zhang
- grid.33199.310000 0004 0368 7223Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China ,Wuhan Tongji Reproductive Medicine Hospital, Wuhan, 563000 China
| | - Liandong Zuo
- grid.413428.80000 0004 1757 8466Guangzhou Women and Children’s Medical Center, Guangzhou, 510000 China
| | - Guangan Mei
- Technical Guidance Institute of Shanxi Province Family Planning Commission, Xi’an, 710000 China
| | - Chengliang Xiong
- grid.33199.310000 0004 0368 7223Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China ,Wuhan Tongji Reproductive Medicine Hospital, Wuhan, 563000 China
| | - Tianpeng Wu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Honggang Li
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Wuhan Tongji Reproductive Medicine Hospital, Wuhan, 563000, China.
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Price JL, Bates ME, Pawlak AP, Uhouse SG, Todaro SM, Morgano J, Buckman JF. Use and perceived usefulness of a just-in-time resonance breathing intervention adjunct for substance use disorder: Contextual and physiological predictors. Front Psychiatry 2022; 13:945751. [PMID: 36159943 PMCID: PMC9490325 DOI: 10.3389/fpsyt.2022.945751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/29/2022] [Indexed: 11/20/2022] Open
Abstract
Craving for alcohol and other drugs is often described as a momentary hyperarousal state that interferes with one's ability to use top-down strategies. As such, it may be best interrupted 'in the moment' through bottom-up modulation. We recently reported that episodic resonance paced breathing (eRPB) delivered via mobile phone app as an add-on to outpatient treatment for substance use disorder (SUD) was effective at dampening craving over the course of an 8-week intervention (NCT#02579317). However, not all participants engaged with the eRPB app and there was high intra- and inter-individual variability in weekly ratings of usefulness. Here we examined baseline demographic, physiological, and psychiatric measures as well as time-varying exposure to positive, negative, and temptation craving triggers as predictors of frequency of eRPB app use and ratings of usefulness. Seventy-seven outpatient women were randomized to an eRPB (0.1 Hz) or a faster paced breathing sham (0.23 Hz) condition. Baseline measures were assessed within the first 3 weeks of treatment entry prior to randomization. App use frequency, ratings of usefulness, and trigger exposure were measured weekly throughout the intervention. Variables were entered into marginal means models with forward stepwise model selection and examined as predictors of use and usefulness. Frequent app use was associated with a lifetime alcohol use disorder (AUD) diagnosis (p = 0.026), higher ratings of usefulness (p < 0.001), and fewer exposures to positive triggers (e.g., celebration, socialization; p < 0.001). There was a trend-level association between frequency of app use and greater cardiovascular capacity at baseline (p = 0.088). Higher ratings of usefulness were associated with greater exposure to negative triggers (e.g,. loneliness, frustration; p < 0.001) and parasympathetic dysregulation at baseline (p = 0.05). A positive relationship between app use frequency and ratings of usefulness was present only in the eRPB group (p = 0.045). Matching ideal candidates and moments to an arousal modulation anti-craving intervention can help streamline screening and implementation of eRPB in the treatment of SUD. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT02579317, identifier NCT02579317.
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Affiliation(s)
- Julianne L. Price
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
- Department of Kinesiology and Health, Rutgers University—New Brunswick, Piscataway, NJ, United States
| | - Marsha E. Bates
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
- Department of Kinesiology and Health, Rutgers University—New Brunswick, Piscataway, NJ, United States
| | - Anthony P. Pawlak
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
| | - Sarah Grace Uhouse
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
- Department of Psychology, Rutgers University—New Brunswick, Piscataway, NJ, United States
| | - Sabrina M. Todaro
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
- Department of Psychology, College of Health Sciences, University of Rhode Island, South Kingstown, RI, United States
| | - Julie Morgano
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
| | - Jennifer F. Buckman
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
- Department of Kinesiology and Health, Rutgers University—New Brunswick, Piscataway, NJ, United States
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11
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Altman BR, Braun TD, Battle CL, Iacoi S, Stein MD, Abrantes AM. The indirect effect of negative emotionality via alcohol craving on abstinence self-efficacy among women in alcohol treatment. Addict Behav 2022; 132:107347. [PMID: 35561632 PMCID: PMC10260287 DOI: 10.1016/j.addbeh.2022.107347] [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: 12/17/2021] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 01/26/2023]
Abstract
Women with alcohol use disorder (AUD) often present to treatment with heightened negative emotionality, including negative affect, anxiety, stress, and depression. Negative emotionality might impact women's alcohol abstinence self-efficacy (AASE), or confidence in their ability to remain sober, which is an important predictor of treatment outcomes. It is also plausible that other variables, such as alcohol craving, influence AASE. The present work examined the indirect effect of negative emotionality on AASE via alcohol craving as a mediator cross-sectionally among a sample of women enrolled in AUD treatment reporting co-occurring depressive symptoms (N = 73). Participants completed baseline measures of negative emotionality (e.g. anxiety and depression symptoms, stress, negative affect), alcohol craving, and AASE. All indices of negative emotionality were positively correlated with each other and alcohol craving (r's ranging from 0.244 to 0.671) and all but depression were inversely associated with AASE (r's ranging from -0.341 to -0.234; p <.05). In separate simple mediation models, we found that alcohol craving mediated the association of each of the four measures of negative emotionality with AASE. Further longitudinal and experimental work is necessary to determine if teaching skills to cope with alcohol craving in the context of co-occurring negative emotionality might lead to better therapeutic outcomes.
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Affiliation(s)
- Brianna R Altman
- Alpert Medical School of Brown University, Providence, RI, United States
| | - Tosca D Braun
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States
| | - Cynthia L Battle
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States; Women & Infants Hospital of Rhode Island, Providence, RI, United States
| | | | | | - Ana M Abrantes
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States.
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12
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Abstract
Purpose of Review Substance use disorders (SUD) affect differentially women and men. Although the prevalence has been reported higher in men, those women with addictive disorders present a more vulnerable profile and are less likely to enter treatment than men. The aim of this paper is to present an overview of how sex and gender may influence epidemiology, clinical manifestations, social impact, and the neurobiological basis of these differences of women with SUD, based on human research. Recent Findings The differences in prevalence rates between genders are getting narrower; also, women tend to increase the amount of consumption more rapidly than men, showing an accelerated onset of the SUD (telescoping effect). In respect to clinical features, the most important differences are related to the risk of experience psychiatric comorbidity, the exposure to intimate partner violence, and the associated high risks in sexual and reproductive health; and those who are mothers and addicted to substances are at risk of losing the custody of children accumulating more adverse life events. Some of these differences can be based on neurobiological differences: pharmacokinetic response to substances, sensitivity to gonadal hormones, differences in neurobiological systems as glutamate, endocannabinoids, and genetic differences. Summary Specific research in women who use drugs is very scarce and treatments are not gender-sensitive oriented. For these reasons, it is important to guarantee access to the appropriate treatment of women who use drugs and a need for a gender perspective in the treatment and research of substance use disorders.
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Alcohol misuse and separation from military service: A dyadic perspective. Addict Behav 2020; 110:106512. [PMID: 32623237 DOI: 10.1016/j.addbeh.2020.106512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/14/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Alcohol misuse is a prevalent problem among military service members and their spouses. Service member alcohol misuse may contribute to poor job performance, legal infractions, and failure to meet physical standards. Spousal alcohol misuse may indicate problems with military life. However, limited information is available about how alcohol misuse in military families affects occupational outcomes, specifically military attrition. METHOD The current study examined 7,965 opposite sex married couples from the Millennium Cohort Family Study with one military and one civilian/veteran partner. Both partners reported on three measures of alcohol misuse (binge drinking, alcohol problems, and heavy weekly drinking). The associations between each partner's measures of alcohol misuse and subsequent military separation were evaluated using logistic regression. Sex, concordance of alcohol misuse, mental health, and service branch were explored as moderators. RESULTS In fully adjusted models, service member alcohol problems were directly related to military separation. Additionally, service member heavy weekly drinking was strongly associated with military separation among female service members but not male service members. Service member and spouse binge drinking interacted such that when only one partner reported binge drinking military separation was less likely, but both partners' binge drinking conveyed a marginally increased risk of military separation. CONCLUSIONS Prevalence of alcohol misuse was high among military families. Service member alcohol misuse was more strongly related to military separation than spouse alcohol misuse. Additionally, heavy weekly drinking among female service members may be an indicator of a significant issue that merits interventions aimed at retaining these service members.
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14
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The Impact of Mood and Subjective Intoxication on Hangover Severity. J Clin Med 2020; 9:jcm9082462. [PMID: 32752141 PMCID: PMC7465662 DOI: 10.3390/jcm9082462] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to investigate whether baseline mood and/or mood while drinking have an impact on alcohol hangover severity. A survey was held among N = 331 young adults (mean age = 23.6 years, range = 18-35 years). Demographics, alcohol consumption, subjective intoxication, and hangover severity were assessed for the past three days. In addition, mood (baseline, while drinking, and during hangover) was also assessed. N = 143 participants reported to be hungover on the day of assessment, N = 122 participants reported to have been hungover the previous day ('yesterday'), and N = 87 participants reported to have been hungover two days before the assessment ('2 days ago'). The analyses revealed that baseline mood and mood while drinking had no relevant effect on the amount of consumed alcohol and did not significantly contribute to hangover severity. However, hangover severity was associated with significantly increased negative affect, particularly with higher levels of subjective stress on the day of the hangover.
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15
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Holzhauer CG, Hildebrandt T, Epstein E, McCrady B, Hallgren KA, Cook S. Mechanisms of change in female-specific and gender-neutral cognitive behavioral therapy for women with alcohol use disorder. J Consult Clin Psychol 2020; 88:541-553. [PMID: 32068418 DOI: 10.1037/ccp0000492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In a randomized trial for women with alcohol use disorders (AUD), the efficacy of Female-Specific Cognitive Behavioral Therapy (FS-CBT) was compared with Gender-Neutral CBT (GN-CBT; Epstein et al., 2018). The current study examined whether putative mechanisms of change differed between treatment conditions, using a novel statistical approach. Both treatments were hypothesized to work by increasing use of alcohol-related coping skills (coping) and confidence to abstain from drinking (confidence), but FS-CBT additionally targeted female-salient mechanisms: anxiety, depression, sociotropy (i.e., overinvestment in others' opinion of oneself), autonomy, and social networks supportive of abstinence. METHOD Ninety-nine women with AUD (55 in GN-CBT, 44 in FS-CBT) completed self-report assessments at baseline and 0, 6, and 12 months posttreatment. Multilevel vector autoregression estimation was used to analyze associations between putative mechanisms of change, and network models of those associations were generated using network analysis. RESULTS Across conditions, higher confidence and coping were directly associated with less drinking; autonomy was directly and indirectly associated with drinking. Additionally, network analysis indicated that although variation in depression was associated with change in other variables specifically for GN-CBT, sociotropy was associated with change specifically in FS-CBT. CONCLUSIONS Women receiving CBT-AUD changed their drinking through increased confidence to abstain and greater use of coping skills. Autonomy played a central role in behavior change across treatment conditions. Participants receiving treatment tailored to women also changed through decreases in sociotropy and increases in social support for abstinence. For women who received standard CBT, changes in depression were important to clinical improvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Cathryn Glanton Holzhauer
- Division of Addiction Psychiatry, Department of Psychiatry, University of Massachusetts Medical School
| | | | - Elizabeth Epstein
- Division of Addiction Psychiatry, Department of Psychiatry, University of Massachusetts Medical School
| | - Barbara McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Sharon Cook
- Center of Alcohol Studies, Rutgers University
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Martino F, Caselli G, Fiabane E, Felicetti F, Trevisani C, Menchetti M, Mezzaluna C, Sassaroli S, Albery IP, Spada MM. Desire thinking as a predictor of drinking status following treatment for alcohol use disorder: A prospective study. Addict Behav 2019; 95:70-76. [PMID: 30856546 DOI: 10.1016/j.addbeh.2019.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 10/27/2022]
Abstract
Research has indicated that craving is one of the strongest predictors of treatment outcome and relapse in Alcohol Use Disorders (AUD) but there is little consensus on the factors that may influence its activation and escalation. Research has also shown that desire thinking is an important cognitive process which may exacerbate craving in problem drinkers. The aim of present study was to explore, for the first time, the role of desire thinking in prospectively predicting relapse, craving and binge drinking in patients receiving treatment for AUD. One hundred and thirty-five patients admitted to two rehabilitation centres and two outpatient services for addiction and mental health problems were administered baseline, treatment completion and three months follow-up measures of anxiety and depression, AUD severity, binge drinking frequency, craving and desire thinking. Results indicated that the verbal perseveration component of desire thinking at treatment completion was the only significant predictor of relapse at follow-up over and above baseline AUD severity and binge drinking frequency. Furthermore, the imaginal prefiguration component of desire thinking and craving levels at treatment completion were found to predict craving levels at follow-up independently of AUD severity and binge drinking frequency at baseline. Finally, both the imaginal prefiguration and verbal perseveration components of desire thinking at treatment completion were found to be the only predictors of binge drinking frequency at follow-up independently of AUD severity and binge drinking frequency at baseline. Treatments for AUD should aim to reduce desire thinking in people to enhance clinical outcomes and reduce relapse risk.
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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18
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Cost-effectiveness of individual versus group female-specific cognitive behavioral therapy for alcohol use disorder. J Subst Abuse Treat 2019; 100:1-7. [PMID: 30898323 DOI: 10.1016/j.jsat.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/07/2019] [Accepted: 02/06/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the relative cost-effectiveness of individual female-specific cognitive behavioral therapy (I-FS-CBT) versus group female-specific cognitive behavioral therapy (G-FS-CBT). METHODS This cost-effectiveness study is based on a randomized controlled trial in which 155 women seeking treatment for alcohol use disorder at an academic outpatient clinic were randomized to 12 manual-guided sessions of I-FS-CBT (n = 75) or G-FS-CBT (n = 80). The primary patient outcomes were the number of drinking days and the number of heavy drinking days during the 12-week treatment and 1-year follow-up periods. All cost data (including resource utilizations) were collected prospectively alongside the trial. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were used to determine the cost-effectiveness of I-FS-CBT relative to G-FS-CBT. Results are presented from the provider perspective. RESULTS During the 12-week treatment period, G-FS-CBT is likely to be cost-effective when the threshold value to decision-makers of one fewer drinking day (or one fewer day of heavy drinking) is less than $141 (or $258), and I-FS-CBT is likely to be cost-effective if the threshold is greater than $141 (or $258). During the 1-year follow-up period, G-FS-CBT is likely to be cost-effective when the threshold value to decision-makers of one fewer drinking day (or one fewer day of heavy drinking) is less than $54 (or $169), and I-FS-CBT is likely to be cost-effective if the threshold is greater than $54 (or $169). The results are robust to sensitivity analyses on several key cost parameters. CONCLUSIONS Compared to I-FS-CBT, G-FS-CBT holds promise as a cost-effective approach, in both the short run and the long run, for improving drinking outcomes of women with alcohol use disorder.
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Karpyak VM, Geske JR, Hall-Flavin DK, Loukianova LL, Schneekloth TD, Skime MK, Seppala M, Dawson G, Frye MA, Choi DS, Biernacka JM. Sex-specific association of depressive disorder and transient emotional states with alcohol consumption in male and female alcoholics. Drug Alcohol Depend 2019; 196:31-39. [PMID: 30660937 DOI: 10.1016/j.drugalcdep.2018.12.010] [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: 07/06/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND We assessed the impact of comorbid depression and anxiety disorders as well as positive and negative emotional states on alcohol consumption in alcohol dependent men and women. METHODS Per day alcohol consumption during 90 days before enrolment was assessed by the Time Line Follow Back (TLFB) in 287 men and 156 women meeting DSM-IV-TR criteria for alcohol dependence. Propensity to drink in negative/positive emotional states was assessed using the Inventory of Drug Taking Situations (IDTS). Psychiatric comorbidities, including major depressive disorder (MDD), substance-induced depression (SID), anxiety disorders (AnxD), or substance-induced anxiety (SIA) were identified by Psychiatric Research Interview of Substance and Mood Disorders (PRISM). RESULTS In the combined group, increased number of drinks per day and number of heavy drinking days correlated with increased IDTS scores (all p < 0.0001), while the lifetime history of MDD was associated with fewer drinking days (p = 0.045) but not average number of drinks per day. Male sex was associated with higher alcohol consumption per day (p < 0.0001), but not with the number of drinking days (p > 0.05). Lifetime MDD history was associated with less drinking days (p = 0.0084) and less heavy drinking days (p = 0.021) in alcohol dependent men, while current MDD was associated with higher alcohol use per day in alcohol dependent women (p = 0.044). CONCLUSIONS Our findings suggest that emotional states and lifetime MDD history have sex-specific impact on alcohol use in alcohol dependent men and women. The mechanisms underlying these findings and their relevance to treatment outcomes need to be examined in future studies.
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Affiliation(s)
- Victor M Karpyak
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Jennifer R Geske
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Michelle K Skime
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - George Dawson
- Hazelden Betty Ford Foundation, Center City, MN, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Doo-Sup Choi
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Joanna M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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20
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Stohs ME, Schneekloth TD, Geske JR, Biernacka JM, Karpyak VM. Alcohol Craving Predicts Relapse After Residential Addiction Treatment. Alcohol Alcohol 2019; 54:167-172. [DOI: 10.1093/alcalc/agy093] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/04/2018] [Accepted: 12/26/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew E Stohs
- Department of Psychiatry and Behavioral Health, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Jennifer R Geske
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Victor M Karpyak
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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21
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Peltier MR, Verplaetse TL, Mineur YS, Petrakis IL, Cosgrove KP, Picciotto MR, McKee SA. Sex differences in stress-related alcohol use. Neurobiol Stress 2019; 10:100149. [PMID: 30949562 PMCID: PMC6430711 DOI: 10.1016/j.ynstr.2019.100149] [Citation(s) in RCA: 226] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 01/12/2023] Open
Abstract
Rates of alcohol use disorder (AUD) have increased in women by 84% over the past ten years relative to a 35% increase in men. This substantive increase in female drinking is alarming given that women experience greater alcohol-related health consequences compared to men. Stress is strongly associated with all phases of alcohol addiction, including drinking initiation, maintenance, and relapse for both women and men, but plays an especially critical role for women. The purpose of the present narrative review is to highlight what is known about sex differences in the relationship between stress and drinking. The critical role stress reactivity and negative affect play in initiating and maintaining alcohol use in women is addressed, and the available evidence for sex differences in drinking for negative reinforcement as it relates to brain stress systems is presented. This review discusses the critical structures and neurotransmitters that may underlie sex differences in stress-related alcohol use (e.g., prefrontal cortex, amygdala, norepinephrine, corticotropin releasing factor, and dynorphin), the involvement of sex and stress in alcohol-induced neurodegeneration, and the role of ovarian hormones in stress-related drinking. Finally, the potential avenues for the development of sex-appropriate pharmacological and behavioral treatments for AUD are identified. Overall, women are generally more likely to drink to regulate negative affect and stress reactivity. Sex differences in the onset and maintenance of alcohol use begin to develop during adolescence, coinciding with exposure to early life stress. These factors continue to affect alcohol use into adulthood, when reduced responsivity to stress, increased affect-related psychiatric comorbidities and alcohol-induced neurodegeneration contribute to chronic and problematic alcohol use, particularly for women. However, current research is limited regarding the examination of sex in the initiation and maintenance of alcohol use. Probing brain stress systems and associated brain regions is an important future direction for developing sex-appropriate treatments to address the role of stress in AUD.
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Affiliation(s)
| | | | - Yann S. Mineur
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Ismene L. Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
- VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Kelly P. Cosgrove
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Marina R. Picciotto
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Sherry A. McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
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22
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Ehlers CL, Gilder DA, Gizer IR, Wilhelmsen KC. Indexing the 'dark side of addiction': substance-induced affective symptoms and alcohol use disorders. Addiction 2019; 114:139-149. [PMID: 30153346 PMCID: PMC6320236 DOI: 10.1111/add.14431] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/13/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS The emergence of negative affective symptoms during the course of alcohol use disorders (AUDs) (e.g. 'dark side' symptoms) has been suggested theoretically; however, the description of their occurrence is limited. This study operationalized two negative affect symptoms and tested the strength of association between these phenotypes and (1) indicators of the clinical course of the severity of AUD, (2) comorbid Axis I psychiatric disorders, suicidal behaviors and trait neuroticism and (3) whether participants reported drinking to relieve the negative affective symptoms. DESIGN A retrospective cross-sectional study was used to evaluate associations, using logistic regression, between the two negative affective symptoms and clinical measures of AUD severity and progression as well as comorbidity with other psychiatric disorders and conditions, adjusted for demographic characteristics. SETTING US community-based studies. PARTICIPANTS A total of 2568 individuals with AUDs obtained from larger population studies that targeted individuals of European American (n = 1663), Mexican American and American Indian (n = 905) ancestry. MEASUREMENTS Semi-Structured Assessment for the Genetics of Alcoholism was used to ascertain the two 'dark side' phenotypes, clinical diagnoses, the clinical course of AUD and associated symptoms. The two phenotypes were: (1) being anxious or depressed when trying to cut down or stop drinking and (2) experiencing disabling depression for more than 24 hours while drinking. FINDINGS Both phenotypes were found to be rare in mild and moderate use disorder and highly prevalent in severe AUDs. Having an independent anxiety or affective disorder and elevated scores on trait neuroticism were also associated significantly with the occurrence of both symptoms, as was alcohol 'craving', elevated treatment-seeking, suicidal behaviors and drinking to relieve the symptoms. CONCLUSIONS Affective symptoms are common in severe alcohol use disorders are associated with a history of independent affective/anxiety disorders, neuroticism and suicidal behaviors; and may promote further heavy drinking.
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Affiliation(s)
- Cindy L Ehlers
- Department of Neurosciences, The Scripps Research Institute, La Jolla, CA, USA
| | - David A Gilder
- Department of Neurosciences, The Scripps Research Institute, La Jolla, CA, USA
| | - Ian R Gizer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Kirk C Wilhelmsen
- Departments of Genetics and Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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23
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Palma-Álvarez RF, Rodríguez-Cintas L, Abad AC, Sorribes M, Ros-Cucurull E, Robles-Martínez M, Grau-López L, Aguilar L, Roncero C. Mood Disorders and Severity of Addiction in Alcohol-Dependent Patients Could Be Mediated by Sex Differences. Front Psychiatry 2019; 10:343. [PMID: 31214056 PMCID: PMC6554686 DOI: 10.3389/fpsyt.2019.00343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 05/01/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Alcohol dependence is highly prevalent in the general population; some differences in alcohol use and dependence between women and men have been described, including outcomes and ranging from biological to social variables. This study aims to compare the severity of alcohol dependence with clinical and psychopathological characteristics between sexes. Methods: A cross-sectional descriptive study was conducted in alcohol-dependent outpatients; the recruitment period was 7 years. The assessment of these patients was carried out by obtaining sociodemographic characteristics and using the Semi-structured Clinical Interview for Axis I and II (SCID-I and SCID-II), European version of the Addiction Severity Index (EuropASI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI) scales. Variables were compared and analyzed. Results: The sample was composed of 178 patients (74.2% males and 25.8% females) with a mean age of 46.52 ± 9.86. No sociodemographic differences were found between men and women. Females had a higher rate of suicide attempts and depression symptoms at the treatment onset. When results of EuropASI were compared, females had worse psychological and employment results than males. According to consumption variables, males had an earlier onset of alcohol use, had more regular alcohol use, and develop alcohol dependence earlier than females. Conclusions: According to results, there are sex-dependent differences (severity and other variables such as mood or suicide) in alcohol dependence. Thus, this may implicate the need of future specific research and treatment programs based on the specific necessities of each sex.
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Affiliation(s)
- Raul F Palma-Álvarez
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònomade Barcelona, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònomade Barcelona, Barcelona, Spain
| | - Alfonso C Abad
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
| | - Marta Sorribes
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
| | - Elena Ros-Cucurull
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònomade Barcelona, Barcelona, Spain
| | | | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònomade Barcelona, Barcelona, Spain
| | - Lourdes Aguilar
- Psychiatry Service, Salamanca University Health Care Complex, Institute of Biomedicine, University of Salamanca, Salamanca, Spain
| | - Carlos Roncero
- Psychiatry Service, Salamanca University Health Care Complex, Institute of Biomedicine, University of Salamanca, Salamanca, Spain
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Soccol KLS, Terra MG, Padoin SMDM, Ribeiro DB, Siqueira DFD, Canabarro JL. Motivos do abuso de substâncias psicoativas por mulheres assistidas em Centro de Atenção Psicossocial. Rev Gaucha Enferm 2018; 39:e20170281. [DOI: 10.1590/1983-1447.2018.20170281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 07/02/2018] [Indexed: 09/01/2023] Open
Abstract
Resumo OBJETIVO Compreender os motivos atribuídos por mulheres ao abuso de substâncias psicoativas. MÉTODO Abordagem qualitativa de natureza fenomenológica. Foram entrevistadas 12 mulheres usuárias de substâncias psicoativas em tratamento no Centro de Atenção Psicossocial álcool e drogas, no Sul do Brasil. As entrevistas foram realizadas entre maio e junho de 2013. Os dados foram interpretados à luz da Fenomenologia Social de Alfred Schütz. RESULTADOS O abuso de substâncias psicoativas é motivado pela influência das pessoas com as quais as mulheres mantêm um relacionamento ou com as quais conviveram. Ainda, as perdas e os conflitos familiares vivenciados também foram como um estopim para o abuso de substâncias psicoativas. CONCLUSÃO A assistência à saúde das mulheres necessita atender além das demandas, na medida em que deve levar em consideração a história de vida dessas mulheres.
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25
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Price CJ, Thompson EA, Crowell SE, Pike K, Cheng SC, Parent S, Hooven C. Immediate effects of interoceptive awareness training through Mindful Awareness in Body-oriented Therapy (MABT) for women in substance use disorder treatment. Subst Abus 2018; 40:102-115. [PMID: 29949455 DOI: 10.1080/08897077.2018.1488335] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Sensory information gained through interoceptive awareness may play an important role in affective behavior and successful inhibition of drug use. This study examined the immediate pre-post effects of the mind-body intervention Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to women's substance use disorder (SUD) treatment. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation. Methods: Women in intensive outpatient treatment (IOP) for chemical dependency (N = 217) at 3 community clinics in the Pacific Northwest of the United States were recruited and randomly assigned to one of 3 study conditions: MABT + treatment as usual (TAU), women's health education (WHE) +TAU (active control condition), and TAU only. At baseline and 3 months post-intervention, assessments were made of interoceptive awareness skills and mindfulness, emotion regulation (self-report and psychophysiological measures), symptomatic distress (depression and trauma-related symptoms), and substance use (days abstinent) and craving. Changes in outcomes across time were assessed using multilevel mixed-effects linear regression. Results: Findings based on an intent-to-treat approach demonstrated significant improvements in interoceptive awareness and mindfulness skills, emotion dysregulation (self-report and psychophysiology), and days abstinent for women who received MABT compared with the other study groups. Additional analyses based on participants who completed the major components of MABT (at least 75% of the intervention sessions) revealed these same improvements as well as reductions in depressive symptoms and substance craving. Conclusions: Findings that interoceptive training is associated with health outcomes for women in SUD treatment are consistent with emerging neurocognitive models that link interoception to emotion regulation and to related health outcomes, providing knowledge critical to supporting and improving SUD treatment.
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Affiliation(s)
- Cynthia J Price
- a Department of Biobehavioral Nursing and Health Informatics , University of Washington , Seattle , Washington , USA
| | - Elaine A Thompson
- b Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
| | - Sheila E Crowell
- c Department of Psychology , University of Utah , Salt Lake City , Utah , USA
| | - Kenneth Pike
- b Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
| | - Sunny C Cheng
- d Nursing and Healthcare Leadership Program , University of Washington , Tacoma , Washington , USA
| | - Sara Parent
- a Department of Biobehavioral Nursing and Health Informatics , University of Washington , Seattle , Washington , USA
| | - Carole Hooven
- b Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
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Oliva F, Nibbio G, Vizzuso P, Jaretti Sodano A, Ostacoli L, Carletto S, Picci RL. Gender Differences in Anxiety and Depression before and after Alcohol Detoxification: Anxiety and Depression as Gender-Related Predictors of Relapse. Eur Addict Res 2018; 24:163-172. [PMID: 30016803 PMCID: PMC6172794 DOI: 10.1159/000490046] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The aim of this prospective study was to estimate gender differences in anxiety, depression, and alcohol use severity among patients with alcohol use disorder (AUD) before and after detoxification program and within 12 months after discharge. METHODS AUD severity, state and trait anxiety, and depression were assessed in 187 patients entering an inpatient alcohol detoxification program. Follow-up assessments were performed at 6 and 12 months after discharge. A between- and within-subjects analyses explored gender differences. The predictive value of anxiety and depression for alcohol relapse was analyzed by logistic and linear regression in both genders. RESULTS Females had higher levels of anxiety and depression than males both at admission and after discharge. Trait anxiety and depression significantly increased 6 months after discharge in males and females respectively. Both state and trait anxiety levels at the 6-month follow-up predicted alcohol relapse at the 12-month follow-up in males. Conversely, in females, depression level at the 6-month follow-up was a predictor of relapse at the 12-month follow-up. CONCLUSIONS In both genders, the psychopathological dimension that showed the most significant worsening at 6-month follow-up (i.e., anxiety in males and depression in females) was found to be a significant predictor of relapse at the 12-month follow-up.
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Affiliation(s)
- Francesco Oliva
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy,*Francesco Oliva, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, IT-10043 Orbassano (Italy), E-Mail
| | - Gabriele Nibbio
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Paola Vizzuso
- Hospital Complex “Fatebenefratelli,”, San Maurizio Canavese, Italy
| | | | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Sara Carletto
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Rocco Luigi Picci
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
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Epstein EE, McCrady BS, Hallgren KA, Cook S, Jensen NK, Hildebrandt T. A randomized trial of female-specific cognitive behavior therapy for alcohol dependent women. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 32:1-15. [PMID: 29154553 DOI: 10.1037/adb0000330] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This study compared Female-Specific Cognitive Behavioral Therapy (FS-CBT) to evidence-based, gender-neutral CBT (GN-CBT; Epstein & McCrady, 2009) for women with alcohol use disorder (AUD). Women (N = 99) with AUD, mean age 48, were randomly assigned to 12 outpatient manual-guided sessions of FS-CBT (n = 44) or GN-CBT (n = 55). Women were assessed at baseline and 3, 9 and 15 months after baseline for drinking and for specific issues common among women with AUD. A FS-CBT protocol was developed that was discriminable on treatment integrity ratings from GN-CBT. No treatment condition differences were found in treatment engagement, changes in drinking, alcohol-related coping, abstinence self-efficacy, motivation to change, or constructs directly targeted in FS-CBT (sociotropy, autonomy, depression, anxiety). Women in both conditions were highly engaged and satisfied with treatment, and reported significant reductions in drinking and changes in desired directions for all other variables except social support for abstinence. In the year following treatment, women in the FS-CBT but not in the CBT condition reported an increase in percentage of abstainers in their social networks (0.69% per month, SE = 0.21, p = .002). The value and appeal of female-specific programming in AUD treatment has been established in the wider literature (Epstein & Menges, 2013), and the current study provides support for the use of the Female-Specific Cognitive Behavioral Therapy (FS-CBT) manual as an option that may yield outcomes similar to standard gender-neutral CBT for women with AUD. Future research should examine whether FS-CBT enhances treatment utilization for women. (PsycINFO Database Record
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Affiliation(s)
| | - Barbara S McCrady
- Center of Alcohol Studies, Rutgers, The State University of New Jersey
| | - Kevin A Hallgren
- Center of Alcohol Studies, Rutgers, The State University of New Jersey
| | - Sharon Cook
- Center of Alcohol Studies, Rutgers, The State University of New Jersey
| | - Noelle K Jensen
- Center of Alcohol Studies, Rutgers, The State University of New Jersey
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Riley AL, Hempel BJ, Clasen MM. Sex as a biological variable: Drug use and abuse. Physiol Behav 2017; 187:79-96. [PMID: 29030249 DOI: 10.1016/j.physbeh.2017.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/15/2017] [Accepted: 10/07/2017] [Indexed: 01/11/2023]
Abstract
The study of sex as a biological variable is a necessary emphasis across a wide array of endpoints, including basic neuroscience, medicine, mental health, physiology and behavior. The present review summarizes work from clinical and preclinical populations on sex differences in drug use and abuse, ranging from initiation to escalation/dysregulation and from drug cessation/abstinence to relapse. These differences are analyzed in the context of the addiction cycle conceptualization of Koob and his colleagues and address patterns of drug use (binge/intoxication), motivation underlying its use (withdrawal/negative affect) and likelihood and causes of craving and relapse of drug taking (preoccupation/anticipation). Following this overview, an assessment of the basis for the reported sex differences is discussed in the context of the affective (rewarding and aversive) properties of drugs of abuse and how such properties and their balance vary with sex and contribute to drug intake. Finally, the interaction of sex with several experiential (drug history) and subject (age) factors and how these interactions affect reward and aversion are discussed to highlight the importance of understanding such interactions in predicting drug use and abuse. We note that sex as a biological variable remains one of critical evaluation and that such investigations of sex differences in drug use and abuse continue and be expanded to assess all facets of their mediation, including these affective properties, how their balance may be impacted by the multiple conditions under which drugs are taken and how this overall balance affects drug use and addiction vulnerability.
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Affiliation(s)
- Anthony L Riley
- Psychopharmacology Laboratory, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave, NW, Washington, D.C. 20016, USA.
| | - Briana J Hempel
- Psychopharmacology Laboratory, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave, NW, Washington, D.C. 20016, USA
| | - Matthew M Clasen
- Psychopharmacology Laboratory, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave, NW, Washington, D.C. 20016, USA
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Nalpas B, Perney P. Use of Psychoactive Medication in Short- and Long-term Abstainers from Alcohol. Alcohol Alcohol 2017; 52:447-452. [DOI: 10.1093/alcalc/agx018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
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Peripheral immune factors are elevated in women with current or recent alcohol dependence and associated with altered mood and memory. Drug Alcohol Depend 2017; 176:71-78. [PMID: 28525828 PMCID: PMC5538367 DOI: 10.1016/j.drugalcdep.2017.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/21/2017] [Accepted: 02/23/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND The adverse effects of alcohol on brain function result, in part, from inflammatory processes. The sex-specific neuropsychiatric consequences and inflammatory status of active alcohol dependence and early remission from dependence have not been investigated. METHODS Neuropsychiatric symptoms, inflammatory factors, and liver enzymes were compared in a prospective cohort study of adults with (n=51) or without (n=31) a current or recent history of alcohol dependence. RESULTS Neuropsychiatric profiles were similar in adults with current or recent alcohol dependence regardless of sex. In male and female participants measures of depression (female p<0.05, male p<0.001), anxiety (female p<0.001, male p<0.001), and memory complaints (female p<0.001, male p<0.05) were elevated, relative to non-dependent controls. Significant sex×alcohol dependence history interactions were observed for plasma levels of tissue inhibitor of metalloproteinase 1 (TIMP-1) and brain derived neurotrophic factor (BDNF), with women in the alcohol dependent group exhibiting increased levels of both analytes (p<0.05) relative to controls. Positive correlations between TIMP-1 levels and measures of depression (r2=0.35, p<0.01), anxiety (r2=0.24, p<0.05) and memory complaints (r2=0.44, p<0.01) were found in female, but not male, participants. CONCLUSIONS Though neuropsychiatric profiles were similar for men and women with current or recent alcohol dependence, plasma factors associated with increases in depression, anxiety, and memory impairment differed and support the need to tailor treatments based on sex.
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Crowell SE, Price CJ, Puzia ME, Yaptangco M, Cheng SC. Emotion dysregulation and autonomic responses to film, rumination, and body awareness: Extending psychophysiological research to a naturalistic clinical setting and a chemically dependent female sample. Psychophysiology 2017; 54:713-723. [PMID: 28251663 DOI: 10.1111/psyp.12838] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 12/18/2016] [Indexed: 11/30/2022]
Abstract
Substance use is a complex clinical problem characterized by emotion dysregulation and daily challenges that can interfere with laboratory research. Thus, few psychophysiological studies examine autonomic and self-report measures of emotion dysregulation with multidiagnostic, chemically dependent samples or extend this work into naturalistic settings. In this study, we used a within-subject design to examine changes in respiratory sinus arrhythmia (RSA), electrodermal activity (EDA), and self-reported affect across three tasks designed to elicit distinct psychophysiological and emotional response patterns. We also examined emotion dysregulation as a moderator of psychophysiological responses. Participants include 116 women with multiple comorbid mental health conditions enrolled in substance use treatment, many of whom also reported high emotion dysregulation. Participants were assessed in the treatment setting and completed three tasks: watching a sad movie clip, rumination on a stressful event, and a mindful interoceptive awareness meditation. Multilevel models were used to examine changes from resting baselines to the tasks. During the film, results indicate a significant decrease in RSA and an increase in EDA. For the rumination task, participants showed a decrease in RSA but no EDA response. For the body awareness task, there was an increase in RSA and a decrease in EDA. Emotion dysregulation was associated with differences in baseline RSA but not with EDA or with the slope of response patterns across tasks. Self-reported affect was largely consistent with autonomic patterns. Findings add to the literature on emotion dysregulation, substance use, and the translation of psychophysiological measurements into clinical settings with complex samples.
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Affiliation(s)
- Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Cynthia J Price
- Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle, Washington, USA
| | - Megan E Puzia
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Mona Yaptangco
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Sunny Chieh Cheng
- Psychosocial and Community Health Department, University of Washington School of Nursing, Seattle, Washington, USA
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Fiabane E, Ottonello M, Zavan V, Pistarini C, Giorgi I. Motivation to change and posttreatment temptation to drink: a multicenter study among alcohol-dependent patients. Neuropsychiatr Dis Treat 2017; 13:2497-2504. [PMID: 29042778 PMCID: PMC5633278 DOI: 10.2147/ndt.s137766] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An inpatient 28-day rehabilitation program for alcohol dependence is focused on detoxification, enhancing motivation to change, and coping strategies for the management of emotional distress and temptation to drink. The aims of the present study were to investigate 1) changes over time in motivation to change, anxiety, and depression in individuals undergoing residential rehabilitation treatment for alcohol addiction, and 2) which pretreatment factors are associated with posttreatment temptation to drink. METHODS We assessed 432 patients diagnosed with alcohol dependence based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) consecutively recruited from seven residential rehabilitation centers in Northern Italy. Patients were assessed by means of self-report questionnaires at the beginning of rehabilitation (pretreatment) and before their hospital discharge (posttreatment) regarding motivation to change and self-efficacy (motivation assessment of change - alcoholism version), readiness to change and temptation to drink (visual analog scales), and depression and anxiety (cognitive behavioral assessment - outcome evaluation). RESULTS Results showed an overall improvement in motivation to change and a significant reduction over time in depression and anxiety levels for the total sample, particularly patients with low baseline level of temptation to drink. Multivariate linear regression analysis revealed that significant predictors of posttreatment temptation to drink were polysubstance dependence (p<0.001), readiness to change (p=0.01), and self-efficacy (p=0.05). CONCLUSION Inpatients' rehabilitation for alcohol dependence is associated with an overall improvement in motivation to change and a significant reduction of psychological distress. Treatments for alcohol-dependent patients should focus on motivation to change, negative moods, and relapse prevention strategies for the management of craving.
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Affiliation(s)
- Elena Fiabane
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia
| | - Marcella Ottonello
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa.,Department of Medicine, PhD Program in Advance Sciences and Technologies in Rehabilitation Medicine and Sport, Università di Tor Vergata, Rome
| | | | - Caterina Pistarini
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa
| | - Ines Giorgi
- Psychology Unit, ICS Maugeri Spa SB, Scientific Institute of Pavia, Pavia, Italy
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Abstract
Introducción. Durante décadas, las investigaciones sobre el alcoholismo se hicieron con muestras formadas casi exclusivamente por varones; sin embargo, el creciente interés por las necesidades de las mujeres que presentan esta problemática ha generado un aumento de los estudios sobre las diferencias de género en los trastornos por consumo de alcohol.Objetivo. Obtener una visión actualizada de las características diferenciadoras del alcoholismo en mujeres.Materiales y métodos. Revisión de la literatura en las bases de datos PsycINFO y Medline entre los años 2004 y 2014.Resultados. Los estudios revisados muestran diferencias de género en la edad de inicio del consumo, el curso clínico, los factores de riesgo, la presencia de comorbilidad psicopatológica y la demanda de tratamiento.Conclusiones. Las mujeres presentan una mayor edad de inicio del consumo de alcohol y una historia de consumo más corta hasta que desarrollan problemas. Entre los factores de riesgo de consumo se observa mayor frecuencia de acontecimientos traumáticos —como maltrato y abuso sexual infantil— y convivencia con una pareja alcohólica. Las mujeres con problemas de alcoholismo también presentan mayor prevalencia de síntomas depresivos y ansiedad y menor uso de los servicios asistenciales.
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Wang PW, Lin HC, Yang YHC, Hsu CY, Chung KS, Wu HC, Yen CF. Gender and Age Effects on the Trajectory of Depression in Opioid Users during Methadone Maintenance Treatment. Front Psychiatry 2017; 8:288. [PMID: 29321749 PMCID: PMC5733537 DOI: 10.3389/fpsyt.2017.00288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Both heroin use and depression are significant health problems. Methadone maintenance treatment (MMT) can be of great benefit to heroin users. However, changes in the level of depression in heroin users during MMT are not clear. Gender and age are also important factors in the development of depression, and whether gender and age moderate changes in depression in heroin users during MMT warrants further study. This study aimed to explore: (1) the trajectory of depression in opioid users during MMT and (2) the moderating effects of gender and age on the trajectory of depression in opioid users receiving MMT. METHOD A total of 294 intravenous heroin users were recruited into this 9-month observational study. The level of depression was measured at the intake interview and at follow-up interviews every 3 months. A latent growth model was used to analyze the trajectory of the level of depression among the participants. RESULTS Depression improved rapidly during the first 3 months of MMT and slowly after the first 3 months in both the female and male heroin users. There was no gender difference in the level of depression at each follow-up point. The level of depression in the female heroin users decreased faster than that in the male heroin users. In addition, the level of depression in the younger heroin users decreased faster than that in the older subjects. CONCLUSION Depression in female and younger heroin users improved more rapidly than in male and older subjects, respectively.
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Affiliation(s)
- Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Chi Lin
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Chih-Yao Hsu
- Department of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Kuan-Sheng Chung
- Department of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Hung-Chi Wu
- Department of Community Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Karpyak VM, Biernacka JM, Geske JR, Abulseoud OA, Brunner MD, Chauhan M, Hall‐Flavin DK, Lewis KA, Loukianova LL, Melnyk GJ, Onsrud DA, Proctor BD, Schneekloth TD, Skime MK, Wittkopp JE, Frye MA, Mrazek DA. Gender-specific effects of comorbid depression and anxiety on the propensity to drink in negative emotional states. Addiction 2016; 111:1366-75. [PMID: 27009547 PMCID: PMC4940218 DOI: 10.1111/add.13386] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/23/2015] [Accepted: 03/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Depression and anxiety are often comorbid with alcoholism and contribute to craving and relapse. We aimed to estimate the prevalence of life-time diagnoses of major depressive disorder (MDD), substance-induced depression (SID), anxiety disorder (AnxD) and substance-induced anxiety (SIA), the effects of these comorbidities on the propensity to drink in negative emotional states (negative craving), and test whether these effects differ by sex. DESIGN Secondary analyses of baseline data collected in a single-arm study of pharmacogenetic predictors of acamprosate response. SETTING Academic medical center and affiliated community-based treatment programs in the American upper mid-west. PARTICIPANTS A total of 287 males and 156 females aged 18-80 years, meeting DSM-IV criteria for alcohol dependence. MEASUREMENTS The primary outcome measure was 'propensity to drink in negative emotional situations' (determined by the Inventory of Drug Taking Situations) and the key predictors/covariates were sex and psychiatric comorbidities, including MDD, SID, AnxD and SIA (determined by Psychiatric Research Interview of Substance and Mood Disorders). FINDINGS The prevalence of the MDD, SID and AnxD was higher in females compared with males (33.1 versus 18.4%, 44.8 versus 26.4% and 42.2 versus 27.4%, respectively; P < 0.01, each), while SIA was rare (3.3%) and did not differ by sex. Increased propensity to drink in negative emotional situations was associated with comorbid MDD (β = 6.6, P = 0.013) and AnxD (β = 4.8, P = 0.042) as well as a SID × sex interaction effect (P = 0.003), indicating that the association of SID with propensity to drink in negative emotional situations differs by sex and is stronger in males (β = 7.9, P = 0.009) compared with females (β = -6.6, P = 0.091). CONCLUSIONS There appears to be a higher prevalence of comorbid depression and anxiety disorders as well as propensity to drink in negative emotional situations in female compared with male alcoholics. Substance-induced depression appears to have a sex-specific effect on the increased risk for drinking in negative emotional situations in males.
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Affiliation(s)
| | - Joanna M. Biernacka
- Department of Psychiatry and PsychologyMayo ClinicRochesterMNUSA,Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | | | - Osama A. Abulseoud
- Department of Psychiatry and PsychologyMayo ClinicRochesterMNUSA,Chemistry and Drug Metabolism, IRPNational Institute on Drug Abuse, National Institutes of HealthBaltimoreMDUSA
| | | | - Mohit Chauhan
- Addiction Recovery ServicesMayo Clinic Health SystemAustinMNUSA,Piedmont Medical CenterRock HillSCUSA
| | | | - Kriste A. Lewis
- Department of Psychiatry and PsychologyMayo ClinicRochesterMNUSA,Regions HospitalSt PaulMNUSA
| | | | - George J. Melnyk
- Department of PsychiatryMayo Clinic Health System—Franciscan HealthcareLa CrosseWIUSA
| | - David A. Onsrud
- Department of Family MedicineMayo Clinic Health System—Franciscan HealthcareLa CrosseWIUSA
| | - Brian D. Proctor
- Department of PsychiatryMayo Clinic Health System—Franciscan HealthcareLa CrosseWIUSA
| | | | | | | | - Mark A. Frye
- Department of Psychiatry and PsychologyMayo ClinicRochesterMNUSA
| | - David A. Mrazek
- Department of Psychiatry and PsychologyMayo ClinicRochesterMNUSA
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Erol A, Karpyak VM. Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations. Drug Alcohol Depend 2015; 156:1-13. [PMID: 26371405 DOI: 10.1016/j.drugalcdep.2015.08.023] [Citation(s) in RCA: 541] [Impact Index Per Article: 60.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 01/16/2023]
Abstract
AIMS To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences. METHODS MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence. RESULTS Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women. CONCLUSIONS Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.
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Affiliation(s)
- Almila Erol
- Department of Psychiatry, Ataturk Education and Research Hospital, Basinsitesi, Izmir 35250, Turkey; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, 200 First Stret SW, Rochester, MN, 55905, USA.
| | - Victor M Karpyak
- Department of Psychiatry, Ataturk Education and Research Hospital, Basinsitesi, Izmir 35250, Turkey.
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Associations of prodynorphin sequence variation with alcohol dependence and related traits are phenotype-specific and sex-dependent. Sci Rep 2015; 5:15670. [PMID: 26502829 PMCID: PMC4621530 DOI: 10.1038/srep15670] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/01/2015] [Indexed: 12/17/2022] Open
Abstract
We previously demonstrated that prodynorphin (PDYN) haplotypes and single nucleotide polymorphism (SNP) rs2281285 are associated with alcohol dependence and the propensity to drink in negative emotional states, and recent studies suggest that PDYN gene effects on substance dependence risk may be sex-related. We examined sex-dependent associations of PDYN variation with alcohol dependence and related phenotypes, including negative craving, time until relapse after treatment and the length of sobriety episodes before seeking treatment, in discovery and validation cohorts of European ancestry. We found a significant haplotype-by-sex interaction (p = 0.03), suggesting association with alcohol dependence in males (p = 1E-4) but not females. The rs2281285 G allele increased risk for alcohol dependence in males in the discovery cohort (OR = 1.49, p = 0.002), with a similar trend in the validation cohort (OR = 1.35, p = 0.086). However, rs2281285 showed a trend towards association with increased negative craving in females in both the discovery (beta = 10.16, p = 0.045) and validation samples (OR = 7.11, p = 0.066). In the discovery cohort, rs2281285 was associated with time until relapse after treatment in females (HR = 1.72, p = 0.037); in the validation cohort, it was associated with increased length of sobriety episodes before treatment in males (beta = 13.49, p = 0.001). Our findings suggest that sex-dependent effects of PDYN variants in alcohol dependence are phenotype-specific.
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Fattore L. Reward processing and drug addiction: does sex matter? Front Neurosci 2015; 9:329. [PMID: 26483620 PMCID: PMC4586272 DOI: 10.3389/fnins.2015.00329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Liana Fattore
- CNR Institute of Neuroscience-Cagliari, National Research Council-Italy, and Centre of Excellence "Neurobiology of Dependence," Cittadella Universitaria di Monserrato, University of Cagliari Cagliari, Italy
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Pettes T, Kerr T, Voon P, Nguyen P, Wood E, Hayashi K. Depression and sexual risk behaviours among people who inject drugs: a gender-based analysis. Sex Health 2015; 12:224-30. [PMID: 25982173 PMCID: PMC4651847 DOI: 10.1071/sh14200] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/27/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Although many people who inject drugs (PID) contend with comorbidities, including high rates of mental illness, limited attention has been given to the differences in comorbidities among men and women or the potential links between psychiatric disorders and HIV risk behaviours. We sought to longitudinally examine associations between depression and HIV-related sexual risk behaviours among PID, stratified by gender. METHODS Data were derived from a prospective cohort of PID in Vancouver, Canada between December 2005 and November 2009. Using generalised estimating equations, we examined the relationship between depressive symptoms and two types of sexual HIV risk behaviours: engaging in unprotected sex; and having multiple sexual partners. All analyses were stratified by self-reported gender. RESULTS Overall, 1017 PID participated in this study, including 331 (32.5%) women. At baseline, women reported significantly higher depressive symptoms than men (P<0.001). In multivariate generalised estimating equations analyses, after adjustment for potential social, demographic and behavioural confounders, more severe depressive symptomology remained independently associated with engaging in unprotected sex [adjusted odds ratio (AOR)=1.62, 95% confidence interval (CI): 1.18-2.23] and having multiple sexual partners (AOR=1.54, 95% CI: 1.09-2.19) among women, but was only marginally associated with having multiple sexual partners among men (AOR=1.18, 95% CI: 0.98-1.41). CONCLUSIONS These findings call for improved integration of psychiatric screening and treatment services within existing public health initiatives designed for PID, particularly for women. Efforts are also needed to address sexual risk-taking among female PID contending with clinically significant depression.
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Affiliation(s)
- Tyler Pettes
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Pauline Voon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Hitschfeld MJ, Schneekloth TD, Ebbert JO, Hall-Flavin DK, Karpyak VM, Abulseoud OA, Patten CA, Geske JR, Frye MA. Female smokers have the highest alcohol craving in a residential alcoholism treatment cohort. Drug Alcohol Depend 2015; 150:179-82. [PMID: 25746235 DOI: 10.1016/j.drugalcdep.2015.02.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/22/2015] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cigarette smoking among female and male alcoholics has not been extensively studied as a factor related to intensity of alcohol craving during residential treatment and corresponding sobriety length. METHODS This retrospective cohort study assessed self-reported sobriety outcomes in patients with alcohol dependence at 3-month intervals over 12 months after completion of a 30-day residential treatment program. Demographic and clinical variables were collected including smoking status, alcohol craving utilizing the Penn Alcohol Craving Scale (PACS), and alcohol relapse. Statistical analyses included Chi-square, ANOVA, Tukey's test, Kaplan-Meier plots and Cox proportional hazards models as appropriate. RESULTS Of the 761 alcohol-dependent study subjects, 355 (47%) were current smokers. Alcohol craving intensity was higher in smoking females compared to nonsmoking females (p=0.0096), smoking males (p<0.0001), and nonsmoking males (p<0.0001). Smoking status-by-sex interaction was not associated with post-treatment relapse. After controlling for other variables, higher PACS scores at admission were associated with higher probability of relapse (p=0.0003). CONCLUSIONS In this study, female alcoholic smokers experienced the highest level of alcohol craving in an alcohol treatment setting. Interestingly, this did not translate into higher rates of post-treatment relapse. Further research is warranted to explore the neurobiological basis for sex differences in this highly prevalent comorbidity.
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Affiliation(s)
- Mario J Hitschfeld
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Mental Health Service, Sotero Del Rio Hospital, Avenida Concha y Toro 3459, Puente Alto, Santiago, Chile
| | - Terry D Schneekloth
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | - Jon O Ebbert
- Department of Medicine, Nicotine Dependence Center, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Daniel K Hall-Flavin
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Victor M Karpyak
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Osama A Abulseoud
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Christi A Patten
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Jennifer R Geske
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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Cuellar-Barboza AB, Frye MA, Grothe K, Prieto ML, Schneekloth TD, Loukianova LL, Hall-Flavin DK, Clark MM, Karpyak VM, Miller JD, Abulseoud OA. Change in consumption patterns for treatment-seeking patients with alcohol use disorder post-bariatric surgery. J Psychosom Res 2015; 78:199-204. [PMID: 25258356 DOI: 10.1016/j.jpsychores.2014.06.019] [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: 04/11/2014] [Revised: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study is to describe the clinical phenotype of alcohol use disorder (AUD) treatment-seeking patients with Roux-en-Y Gastric Bypass Surgery (RYGB) history; and to compare it to AUD obese non-RYGB controls. METHODS Retrospective study of electronic medical records for all patients 30-60years treated at the Mayo Clinic Addiction Treatment Program, between June, 2004 and July, 2012. Comparisons were performed with consumption patterns pre-RYGB and at time of treatment; excluding patients with AUD treatments pre-RYGB. RESULTS Forty-one out of 823 patients had a RYGB history (4.9%); 122 controls were selected. Compared to controls, the RYGB group had significantly more females [n=29 (70.7%) vs. n=35 (28.7%) p<0.0001]; and met AUD criteria at a significantly earlier age (19.1±0.4 vs. 25.0±1years old, p=0.002). On average, RYGB patients reported resuming alcohol consumption 1.4±0.2years post-surgery, meeting criteria for AUD at 3.1±0.5years and seeking treatment at 5.4±0.3years postoperatively. Pre-surgical drinks per day were significantly fewer compared to post-surgical consumption [2.5±0.4 vs. 8.1±1.3, p=0.009]. Prior to admission, RYGB patients reported fewer drinking days per week vs. controls (4.7±0.3 vs. 5.5±1.8days, p=0.02). Neither RYGB, gender, age nor BMI was associated with differential drinking patterns. CONCLUSION The results of this study suggest that some patients develop progressive AUD several years following RYGB. This observation has important clinical implications, calling for AUD-preventive measures following RYGB. Further large-scale longitudinal studies are needed to clarify the association between RYGB and AUD onset.
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Affiliation(s)
- Alfredo B Cuellar-Barboza
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States; Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Karen Grothe
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Miguel L Prieto
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States; Facultad de Medicina, Departamento de Psiquiatría, Universidad de los Andes, Santiago, Chile
| | - Terry D Schneekloth
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Larissa L Loukianova
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Daniel K Hall-Flavin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Victor M Karpyak
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Joseph D Miller
- Department of Pharmacology, The American University of the Caribbean School of Medicine, United States
| | - Osama A Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States.
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