Integrated intervention program for alcoholism improves impulsiveness and disadvantageous reward processing/risk-taking

Family History and Alcohol Use Outcomes: Examining Transmission of Risk through Impulsivity and the Moderating Role of Organized Sports Participation

BACKGROUND

College students are at risk for alcohol misuse and those who participate in organized sports are at even higher risk. Family history of alcohol problems (FH) and impulsivity are well-documented risk factors for alcohol use outcomes, but no research has examined the role of organized sports participation in moderating these associations. This study examined the associations between FH, alcohol consumption and alcohol use disorder (AUD) symptoms, the role of UPPS-P (Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency impulsive behavior scale) impulsivity dimensions in mediating the association between FH and alcohol use outcomes, and whether these associations vary by students' organized sports participation.

METHOD

Participants (N = 3,959, 64.7% female, 51.8% White; Mean age = 18.48 years, SD = .40) were recruited from a large, public university and completed an online survey in the fall and spring semesters of their first year in college. Path analyses were conducted in Mplus.

RESULTS

FH was associated with higher levels of alcohol consumption and more AUD symptoms. Lack of premeditation, lack of perseverance, and negative urgency partially mediated the associations between FH and alcohol consumption and AUD symptoms. The association between negative urgency and AUD symptoms was stronger for organized sports participants.

CONCLUSIONS

Impulsivity dimensions are risk factors for both alcohol consumption and AUD symptoms and serve as important pathways for the transmission of risk between generations. Prevention and intervention efforts aimed at reducing problematic alcohol use should target impulsivity generally, and particularly negative urgency among college students who participate in organized sports.

Baclofen for alcohol use disorder

BACKGROUND

Alcohol use disorder (AUD) is one of the most widespread psychiatric disorders leading to detrimental consequences to people with this disorder and others. Worldwide, the prevalence of heavy episodic drinking (30-day prevalence of at least one occasion of 60 g of pure alcohol intake among current drinkers) is estimated at 20% and the prevalence of AUD at 5% of the adult general population, with highest prevalence in Europe and North America. Therapeutic approaches, including pharmacotherapy, play an important role in treating people with AUD. This is an update of a Cochrane Review first published in 2018.

OBJECTIVES

To evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search was 22 November 2021.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of at least four weeks' treatment duration and 12 weeks' overall study duration comparing baclofen for AUD treatment with placebo, no treatment or other treatments.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were 1. relapse, 2. frequency of use, 3. amount of use, 4. adverse events, 5. dropouts from treatment and 6. dropouts from treatment due to adverse events. Our secondary outcomes were 7. craving, 8. anxiety, 9. depression and 10. frequency of most relevant adverse events.

MAIN RESULTS

We included 17 RCTs (1818 participants) with a diagnosis of alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition or International Classification of Diseases 10th edition criteria. Mean age was 46.5 years and 70% were men. Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. We judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg). Compared to placebo, moderate-certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants. High-certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non-detoxified or those who received medium doses. There was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) -0.18, 95% CI -0.48 to 0.11; 13 studies, 840 participants; moderate-certainty evidence); number of drinks per drinking days (MD -0.45, 95% CI -1.20 to 0.30; 9 studies, 392 participants; moderate-certainty evidence); number of participants with at least one adverse event (RR 1.05, 95% CI 0.99 to 1.11; 10 studies, 738 participants; high-certainty evidence); dropouts (RR 0.88, 95% CI 0.74 to 1.03; 17 studies, 1563 participants; high-certainty evidence); dropouts due to adverse events (RR 1.39, 95% CI 0.89 to 2.18; 16 studies, 1499 participants; high-certainty evidence). These results were confirmed by subgroup analyses except than for the dropouts that resulted lower among participants who received high doses of baclofen and studies longer than 12 weeks. Compared to placebo, there was no difference in craving (SMD -0.16, 95% CI -0.37 to 0.04; 17 studies, 1275 participants), anxiety (MD -0.01, 95% CI -0.14 to 0.11; 15 studies, 1123 participants) and depression (SMD 0.07, 95% CI -0.12 to 0.27; 11 studies, 1029 participants). Concerning the specific adverse events, baclofen increases fatigue, dizziness, somnolence/sedation, dry mouth, paraesthesia and muscle spasms/rigidity. There was no difference in the other adverse events. Compared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low-certainty evidence); number of participants with at least one adverse event (RR 0.63, 95% CI 0.23 to 1.69; very low-certainty evidence); dropouts (RR 0.56, 95% CI 0.21 to 1.46; very low-certainty evidence); dropouts due to adverse events (RR 0.33, 95% CI 0.01 to 7.87; very low-certainty evidence) and craving (MD 5.80, 95% CI -11.84 to 23.44); and all the adverse events evaluated. Compared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low-certainty evidence) and decrease the number of participants with at least one adverse event (RR 0.35, 95% CI 0.15 to 0.80; 2 studies, 80 participants; very low-certainty evidence) but the evidence is very uncertain. One study (60 participants) found no difference between baclofen and naltrexone in the dropouts at the end of treatment (RR 1.00, 95% CI 0.32 to 3.10; very low-certainty evidence), craving (MD 2.08, 95% CI -3.71 to 7.87), and all the adverse events evaluated.

AUTHORS' CONCLUSIONS

Baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study.

Relationship of alcohol use pattern with locus of control and impulsivity: A cross-sectional study in hospitalized alcohol use disorder patients in Western India

Background:

Alcohol use disorders (AUDs) are increasing in developing countries like India and it has high relapse rates. Locus of control (LOC) and impulsivity can be important predictors of relapse and knowledge about them can help in management of AUD.

Method:

Cross-sectional analytical study of 116 indoor patients in tertiary care hospital, between ages 18 and 65 years diagnosed as AUD according to DSM-5, after acute detoxification was done. For interview, a sociodemographic sheet, Alcohol Use Disorder Identification Test, Drinking-Related Locus of Control Scale, and Barrett’s Impulsiveness Scale 11 scale (Gujarati versions) were used. Patients with complicated withdrawal and any other comorbid organic brain conditions were excluded. The data were analyzed using SPSS version 25.

Result:

Total participants consisted of 65% middle-aged (35–50 years) rural inhabitants. Eighty-six-percent of patients were employed and around 80% were educated >5^th standard. No association was found between sociodemographic variables and severity of alcohol use. Severity of alcohol use increased with more duration of alcohol consumption (P = 0.001). Patients being earlier aged for first intake of alcohol had a high external LOC (r = 0.209, P = 0.050). Patients with high external LOC (P = 0.003) and more impulsivity (P = 0.001) had more relapses (more numbers of attempts to quit alcohol). With increased external LOC (r = 0.315) and increased impulsivity (r = 0.716), severity of alcohol use also increased. As impulsivity increased, patients’ LOC was found more toward external side (P = 0.007) (r = 0.345).

Conclusion:

External LOC and impulsivity have a strong association with alcohol use. Patients with high external LOC and more impulsivity had early age of first intake, severe alcohol use, and more duration of alcohol consumption.