Epidemiology of DSM-5 Alcohol Use Disorder Results from the National Epidemiologic Survey on Alcohol and Related Conditions III JAMA Psychiatry This provides the much-needed epidemiology of Alcohol Use Disorder (AUD) using DSM-5. Although drawn from new data, this article provides the translational bridge from DSM-IVTR. Alcohol use disorder defined by DSM-5 criteria is a highly prevalent, highly comorbid, disabling disorder that often goes untreated in the United States; however, its meaning in the absence of the older diagnostic nomenclature, has needed anchoring in statistics. The NESARC-III data indicate the continuing need to educate the public and policy makers about AUD and its treatment alternatives, to destigmatize the disorder, and to encourage those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment.
Editor’s Comments William Haning, MD, FASAM, DFAPA Three of the articles referenced this week relate to the efficacy of screening techniques. Some readers will find outcomes that are disappointing, but there are also conclusions that demonstrate the epidemiological value of screening and the ability to consequently focus resources.
Tests of the Attachment and Clinical Issues Questionnaire as It Applies to Alcohol Dependence Journal of Addiction Medicine (free ASAM member resource) Although superficially appearing to discuss a psychological instrument, this article actually addresses a core concept in substance use disorders: interpersonal attachment. Many major theories tie the addictions to specific pathways and neurochemical systems evolutionarily implicated in food and social behavioral systems, and yet there is a paucity of instruments from the psychological level that can measure these important attachment, social, and emotional counterparts. Two studies were designed to examine whether the Attachment and Clinical Issues Questionnaire (ACIQ) could help fill this limitation in psychological measurement.
Integrating Substance Use Assessment in Health Care Substance Abuse and Mental Health Services Administration This introductory discussion of SBIRT (Screening, Brief Intervention, and Referral to Treatment) reminds the readership of the availability a short free course on its principles, available until the fall and offering CME. This walks practitioners through the process of assessing risky substance use, discussing health consequences, and referring patients to supports and treatments.
Teen Drinking Countered by Laws That Curb Adult Binge Drinking Boston University Medical Center The article describing this study provides examples of adult-focused alcohol consumption laws; and the impact of those laws on drinking by teenagers. It convincingly argues that the stringency of adult-focused laws vary significantly influences consumption of alcohol by youth. A first-of-its kind study, led by a multi-disciplinary research team at BMC and the BU School of Public Health (BUSPH), it reviewed data on 29 youth-specific and adult policies on drinking to establish scores characterizing each state's alcohol policy “environment.” Higher scores were given to states with more effective and better-implemented policies. The research team then related those policy scores to youth drinking data from states' Youth Risk Behavior Surveys from 1999 to 2011.
Submit an Innovative Tool or App to Prevent Opioid-Related Overdoses Substance Abuse and Mental Health Services Administration This offering employs a newly popular tool similar to a recent initiative seeking a better alcohol use monitoring device, and offers a $10,000 reward. As overdose is common among people who use illicit opioids such as heroin, and among those who misuse medications prescribed for pain, the Substance Abuse and Mental Health Services Administration (SAMHSA) invites developers to create an innovative, software-based solution that helps people understand what to do if a family member or friend overdoses on heroin or opioid pain medications.
Do Parents Play Different Roles in Drinking Behaviors of Male and Female Adolescents? A Longitudinal Follow-Up Study British Medical Journal This British study endeavored to determine the association between parental alcohol use attitudes and the consequent alcohol use by their children, segregated by gender. Its conclusions are very important for designing early-life interventions; but will not be surprising to many parents. In brief, sons do not listen to their mothers. Data were drawn from two cohorts in the Child and Adolescent Behaviours in Long-term Evolution project. 3972 students (1999 boys and 1973 girls) participated in the study.
Web-Based Alcohol Screening and Brief Intervention for University Students Journal of the American Medical Association This New Zealand study screened over 5000 students, ages 17-24 years. Among their conclusions: “A national web-based alcohol screening and brief intervention program produced no significant reductions in the frequency or overall volume of drinking or academic problems. There remains a possibility of a small reduction in the amount of alcohol consumed per typical drinking occasion.” This included a fully automated 5-month follow-up assessment that measured 6 primary outcomes: consumption per typical occasion, drinking frequency, volume of alcohol consumed, an academic problems score, and whether participants exceeded medical guidelines for acute harm (binge drinking) and chronic harm (heavy drinking).
Genotype Doesn’t Affect Response to Naltrexone for Alcohol Dependence Journal of the American Medical Association A genetic variation of the µ-opioid receptor did not predict response to naltrexone for the treatment of alcohol dependence, found a randomized trial including 221 alcohol-dependent people who were stratified by genotype. Based on previous preclinical research and encouraging clinical trial data, the researchers had hypothesized that the single-nucleotide polymorphism of the µ-opioid receptor gene (A+118G, Asn40Asp) would moderate response to naltrexone treatment.
General Practitioners Recognizing Alcohol Dependence: A Large Cross-Sectional Study in 6 European Countries Annals of Family Medicine For those in primary care, this study appears to vindicate the role of the general practitioner in identifying cases more clearly requiring intervention. Just as in the first Kasparof vs. Deep Blue computer chess match, general practitioners edged out the algorithm. Assessments from 13,003 general practitioners, and 9,098 interviews (8,476 joint number of interviewed patients with a physician’s assessment) were collected in 6 European countries. Alcohol dependence, comorbidities, and health service utilization were assessed by the general practitioner and independently using the Composite International Diagnostic Interview (CIDI) and other structured interviews. General practitioners were able to identify alcohol dependence, but the cases they identified differed from cases identified using the CIDI. The role of the CIDI
as the reference standard should be reexamined, as older alcohol-dependent patients with severe comorbidities seemed to be missed in this assessment.
Randomized Trial of Cognitive-Behavioral Therapy Versus Light Therapy for Seasonal Affective Disorder: Acute Outcomes The American Journal of Psychiatry Controlled RCT, N = 177: CBT-SAD and light therapy are comparably effective for SAD during an acute episode, and both may be considered as treatment options. Having a baseline comorbid diagnosis was associated with higher depression scores across all time points in both treatments. CBT-SAD and light therapy did not differ in remission rates based on the SIGH-SAD (47.6% and 47.2%, respectively) or the BDI-II (56.0% and 63.6%).
Ecology of Addiction Project Asks Whether Cities Make Us Sick ABC ‘Our environment is almost like a second skin,’ London-based landscape architect Johanna Gibbons says. Gibbons is one of the lead researchers in an ambitious project that hopes to determine whether the very nature of city living makes us more susceptible to risk taking. Specifically, she wants to find out whether living in cities causes addiction. This very creative APP-centered study design yielded additional important epistemological issues, involving the similarities between addictions. Its main findings include the observation that environment does not affect everyone in the same way.
Potential Role of Adolescent Alcohol Exposure-Induced Amygdaloid Histone Modifications in Anxiety and Alcohol Intake During Adulthood Neurobiology of Disease This is neuroanatomy made germane to understanding addiction. Binge drinking is common during adolescence and can lead to the development of psychiatric disorders, including alcoholism in adulthood. Here, the role and persistent effects of histone modifications during adolescent intermittent ethanol (AIE) exposure in the development of anxiety and alcoholism in adulthood were investigated. Its conclusion indicates enduring effects of AIE, and is striking: “These novel results indicate that AIE induces long-lasting effects on histone modifications and deficits in synaptic events in the amygdala, which are associated with anxiety-like and alcohol drinking behaviors in adulthood.”
Ask the PCSS-MAT Experts: Addressing Challenging Issues in Addiction Medicine: "Abstinence Based" Treatment Centers ASAM Please see the PCSS-MAT expert's comprehensive response to a recently submitted question, bearing on the availability of MAT (specifically, buprenorphine) in residential treatment facilities. Providers' Clinical Support System for Medication Assisted Treatment (PCSS-MAT) is a national training and mentoring project funded by the Substance and Mental Health Services Administration (SAMHSA) led by American Academy of Addiction Psychiatry (AAAP) in partnership with: American Osteopathic Academy of Addiction Medicine (AOAAM), American Psychiatric Association (APA) and American Society of Addiction Medicine (ASAM). See the PCSS-MAT expert's response to a recently submitted question.
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