Journal of studies on alcohol and drugs最新文献

Objective: Psychosocial stress increases the risk for subsequent episodes of alcohol use disorder (AUD) and drug use disorder (DUD), with most studies assessing stress exposure by questionnaire or interview methods. We developed an environmental risk score (ERS) using multiple classes of stressful life events (SLEs) obtained from national Swedish registries.

Method: We assessed, in the entire adult population of Sweden (N = 7,105,712), the occurrence of 51 categories of SLEs derived from registry information for the 6 months before September 1, 2010, and the risk for AUD and DUD registration over the subsequent 18 months. Weights for these two ERSs were obtained from a random half of our sample, and the relationship of ERS to AUD and DUD was evaluated in the second half.

Results: The ERS strongly predicted subsequent AUD and DUD episodes. Men were more sensitive to the pathogenic effect of the ERS than women. Those with prior episodes of AUD and DUD had larger absolute increases in ERS-associated AUD and DUD risk than those without previous episodes. Genetic risk for AUD and DUD was associated with greater sensitivity to the pathogenic effects of the ERS. A co-sibling control analysis suggested that a large proportion of the ERS-AUD and ERS-DUD associations were causal.

Conclusions: Valid measures of environmental risks that predispose to AUD and DUD can be assessed from SLEs obtained from high-quality national registry data. Importantly, this method avoids prior assessment problems of accurate dating and recall bias and can be performed in large samples.

Objective: This article describes the development of an online and text-messaging intervention aimed at augmenting protective behavioral strategies (PBS) utilization at the daily level among young adults engaged in alcohol and cannabis use. PBS, encompassing tips and strategies to moderate alcohol and cannabis use and reduce associated risks, have been integral components of personalized feedback interventions. The quality and consistency of PBS use have been underexplored in intervention frameworks.

Method: We describe six initial focus groups and 13 cognitive interviews that were conducted with young adults who use alcohol and cannabis to learn the motivations underpinning alcohol and cannabis PBS utilization, barriers impeding PBS use, and PBS use with high quality and consistency. This step served as the cornerstone for crafting targeted intervention strategies. Drawing from the insights from the focus groups and cognitive interviews, we developed an interactive online intervention and text message platform. We then conducted three additional focus groups and nine cognitive interviews with young adults who use alcohol and cannabis to gain insight into intervention content, and we implemented any needed changes.

Results: We present the final iteration of the intervention, which consisted of a brief, web-based intervention followed by text messages 3 days a week for 8 consecutive weeks, as well as two monthly daily-level summaries of behaviors reported across 8 weeks.

Conclusions: This article shares our process for designing an intervention using daily-level data, aimed at reducing alcohol and cannabis use among young adults and fostering quality and consistent use of PBS.

Objective: Hypertension is highly prevalent in primary care. Unhealthy alcohol use can impact its management and associated cardiovascular disease risks. Alcohol screening and brief intervention (ASBI) in primary care is effective for early intervention for unhealthy use, yet its effectiveness in heterogeneous populations in real-world settings remains unclear. Using electronic health records, we emulated a pragmatic clinical trial to evaluate the effects of receiving ASBI on drinking and blood pressure (BP) outcomes among primary care patients with hypertension and unhealthy alcohol use.

Method: This observational study identified 72,979 patients with hypertension who screened positive for unhealthy drinking between January 1, 2014, and December 31, 2017. We used a target trial framework to compare the effects of receiving ASBI (intervention) to not receiving brief intervention (comparison) on drinking (change in heavy drinking days and drinks/week) and BP outcomes (changes in diastolic and systolic BP) from baseline to 2- and 5-year follow-ups. Treatment effect estimates were obtained using inverse probability-weighted models.

Results: At 2 years, the intervention condition had about 0.2 fewer heavy drinking days and about 0.1 fewer drinks/week than the comparison condition. The intervention condition had an additional 0.5 mmHg and 0.7 mmHg decline in diastolic and systolic BP, and 8% and 6% higher odds of having a ≥3 mmHg reduction in diastolic and systolic BP, respectively, than the comparison condition. Between-group differences in both outcomes diminished at 5 years.

Conclusions: The modest changes in drinking and BP we found contribute to the emerging evidence that brief intervention may benefit broader health outcomes at the population level.

Objective: Women who have experienced sexual assault report higher rates of alcohol use. Sexual objectification experiences, such as sexualized body gazes, gestures, commentary, and physical contact, have been linked with greater alcohol use and may represent a particular stressor for women who have experienced sexual assault, potentially leading to craving and alcohol use to cope. This study used a 3-week ecological momentary assessment design to test whether experiencing sexual objectification indirectly predicted the likelihood of later alcohol use through heightened craving. Further, because sexual minority women may be disproportionately targeted by objectification and are more likely to report alcohol misuse, we explored whether sexual minority women experienced more objectification than heterosexual women and, in turn, greater craving and alcohol use.

Method: Participants were 82 women who had experienced sexual assault and reported probable alcohol misuse and posttraumatic stress symptoms. Women were predominantly heterosexual and bisexual. Participants reported on daily objectification experiences and momentary craving each evening, as well as past-day alcohol use each morning. A multilevel structural equation model was estimated in Mplus.

Results: As hypothesized, there was an indirect effect of experiencing objectification on a given day on later alcohol use endorsement via greater alcohol craving. There was not an indirect effect of sexual minority identity on average alcohol use frequency via objectification and craving, but sexual minority women experienced greater average craving than heterosexual women.

Conclusions: Findings support daily objectification experiences as a novel proximal risk factor for heightened craving and drinking among sexual assault survivors with diverse sexual identities.

Objective: We investigated the association between the adherence to a repetitive transcranial magnetic stimulation (rTMS)-based treatment program and resting-state (RS) functional connectivity within two large-scale networks (i.e., the frontoparietal network [FPN] and the default mode network [DMN]) in a sample of patients with cocaine use disorder (CUD; N = 33; 32 males).

Method: Before starting the treatment protocol, each participant underwent a psychopathological assessment and an RS electroencephalography (EEG) recording. EEG connectivity analysis was performed using the exact Low-Resolution Brain Electromagnetic Tomography (eLORETA) software, comparing dropout patients (i.e., treatment program abandonment within 3 months) and adherence patients.

Results: Compared with the dropout group, the adherence group showed increased pre-treatment delta connectivity within the FPN (T = 4.562, p = .010, Cohen's d = 0.819) and the DMN (T = 4.045, p = .036, Cohen's d = 0.726). Multivariable Cox proportional hazard models showed that both DMN (hazard ratio [HR] = 0.41, p = .015) and FPN connectivity data (HR = 0.54, p = .007) were significantly related to prolonged treatment adherence. Increased functional connectivity within the FPN decreased the probability of dropout during the first 12 weeks of treatment (odds ratio = 0.36, p = .019).

Conclusions: Our results may reflect enhanced goal-driven cognitive integration in adherent patients. Providing effective neurophysiological predictors of treatment outcomes, such as relapse and dropout, could allow the timely implementation of additional support measures for CUD patients.

Objective: Theoretical models suggest that internalizing symptoms predispose individuals toward solitary drinking. However, data have not explicated whether longitudinal relations occur across or within individuals over time, which would have important yet distinct clinical implications. If relations exist across individuals, targeted prevention in individuals with higher internalizing symptoms may be most clinically effective. However, if relations exist within individuals, monitoring within-person deviations in internalizing symptoms and coupling increases in internalizing with adaptive interventions may prove most effective.

Method: Emerging adults (N = 448; 43.4% female; ages 21-25) with a history of past-month binge drinking at baseline reported on depressive, anxiety, stress symptoms (i.e., "internalizing symptoms") and solitary drinking frequency every 6 months over 2 years. Autoregressive multilevel models tested whether (a) individuals with higher internalizing symptoms reported more frequent solitary drinking across the span of 2 years, and (b) within-person deviations in internalizing symptoms covaried with (and prospectively predicted) within-person deviations in solitary drinking.

Results: Internalizing symptoms predicted more frequent solitary drinking at the between-person level. Within-person deviations in internalizing symptoms were positively contemporaneously correlated with deviations in solitary drinking. However, within-person deviations in internalizing symptoms at a given time point predicted within-person decreases in solitary drinking 6 months later.

Conclusions: Individuals with higher internalizing symptoms reported more frequent solitary drinking, yet within-person deviations in internalizing symptoms prospectively predicted decreases in solitary drinking. Findings suggest a complex, level-specific relation between internalizing symptoms and solitary drinking, which may have implications for preventive interventions.