Alcohol and alcoholism最新文献

Aims: Alcohol-related harm occurs at lower levels than previously recognized, warranting a need to identify mediators to reduce alcohol-associated risk in increased-risk drinkers. Stages of change (SOC) have been used to assess motivation for health behaviour alteration. The primary aim was to explore distribution on SOC among medical inpatients when comparing low-risk, increased-risk, and high-risk consumers as defined by Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). Our secondary aim was to assess the distribution of SOC when consumption was stratified with a biomarker of alcohol use-phospatidylethanol 16:0/18:1.

Methods: Cross-sectional study with three participating hospitals. Recruiting consecutive medical inpatients ≥18 years with regular alcohol consumption as screened by score ≥2 on the first question in AUDIT-C (N = 888). AUDIT-C score and SOC were assessed by questionnaires, and phospatidylethanol concentration in a blood sample. Odds ratios and the 95% confidence intervals were calculated through a univariate logistic regression analysis for each variable, and multivariable logistic regression models were then fit to calculate the adjusted odds ratio and 95% confidence interval.

Results: Distributions of SOC differed between the three risk-groups. Distribution of SOC was comparable whether assessed by phospatidylethanol or AUDIT-C.

Conclusions: Increased-risk consumers constitute the majority of those in action-the only stage associated with consecutive reduction in drinking. Potentially, these results can aid in reducing perceived barriers among health care professionals in screening and offering health advice to those with increased-risk consumption and inform further research on mediators in this subgroup.

Aims: This study sought to understand the subjective individual and collective benefits of alcohol use for transgender and gender diverse (TGD) people in the UK.

Methods: A cross-sectional survey, co-produced with a TGD community advisory group, was open for responses from 1 February until 31 March 2022. Respondents were UK-based TGD adults who reported current or historical alcohol use. Those included in this sub-sample (n = 295) provided a valid response to one of two open-ended questions (OQ) concerning the subjective benefits of alcohol to TGD individuals (OQ1) and the perceived role of alcohol in UK TGD communities (OQ2). Data from these questions were collated (n = 455 responses) and coded using thematic analysis.

Results: An overarching theme was identified, 'belonging', under which two themes were developed to answer each question. For individuals, alcohol enhanced intimacy and relieved pain, and was described to have a role in bringing the TGD community together and facilitating gender exploration and affirmation.

Conclusion: TGD people experience a range of benefits from using alcohol, attributable to its anxiolytic and analgesic properties. Many respondents felt alcohol had a specific role in their communities, associated with the relative safety of alcohol-serving venues for TGD people.

This study employs an instrumental-variable approach to examine how county-level job shares influence the alcohol use among the working-aged individuals in the USA. Higher job shares in finance and other services are associated with a greater risk of binge drinking and alcohol use disorder, whereas higher shares in the construction and trade sectors appear to confer protective effects.

Obsessive Compulsive Drinking Scale score, but not Montreal Cognitive Assessment score, was associated with the Hanil Alcohol Insight Scale score, in inpatients after alcohol detoxification. Disentangling the complex links between these key clinical dimensions need more detailed studies of insight according to the different deficit in cognitive functions observed in patients with alcohol-related cognitive impairment, as social cognition or meta-cognition.

Background: Unhealthy alcohol use is prevalent among persons with HIV (PWH) and is associated with adverse outcomes, but is underestimated partly due to use of self-reported measures prone to underreporting. Phosphatidylethanol (PEth) is a direct measure of past month alcohol consumption but is costly. We assessed whether lab and health data representing alcohol-associated physiologic changes could be leveraged with machine learning to predict PEth-measured high-risk alcohol use among PWH.

Methods: We pooled baseline data from two studies among PWH in Uganda that measured PEth (N = 988), and classified PEth as no/low/moderate (PEth <200 ng/ml) or high-risk (PEth ≥200 ng/ml). We split the data into training (n = 790) and testing (n = 198) sets, imputing missing data separately for each. We conducted supervised learning with 29 predictors from lab (e.g. complete blood count, liver enzymes) and other health (e.g. age, sex, blood pressure) data using LASSO logistic regression, extreme gradient boosted decision trees, and random forests. We identified the optimal model via the largest area under the curve (AUC).

Results: A LASSO regression with 17 predictors was the optimal model (cross-validated AUC in the Training Set = 0.751, 95% confidence interval [CI]: 0.718-0.784; AUC in Testing Set = 0.795, 95% CI: 0.723-0.852).

Conclusions: This study suggests that a combination of lab and health data is useful for identifying individuals engaging in high-risk alcohol use (PEth ≥200 ng/ml). Algorithms including other indirect markers of alcohol use (e.g. gamma glutamyltransferase) may improve identification of high-risk alcohol use, which could be useful in research and clinical settings where PEth testing is unavailable.

Objective: Marriage is associated with improved health and alcohol outcomes, yet prior research has often combined diverse non-marital relationships, obscuring whether benefits are unique to marriage or a result of strong interpersonal relationships. This study examines whether marriage, compared to cohabitation, exclusive dating, or being single, is associated with alcohol use disorder (AUD) remission and whether this varies by sex and partner drinking.

Method: Participants were adults from the Collaborative Study on the Genetics of Alcoholism Lifespan Study (n = 1494; 54.4% female) who met criteria for lifetime DSM-5 AUD. Multivariate logistic regression models examined the association between marital status and remission. Subsequent models tested interactions among marital status, partner drinking, and sex. Predicted remission prevalence was estimated using marginal standardization and compared across groups on an additive scale using prevalence differences (PD).

Results: Married individuals had greater predicted prevalence of remission, particularly compared to those who were exclusively dating (PD = 9.2, P = .020). Married females whose partners were average alcohol consumers (PD = 12.20, q = .049) or abstinent (PD = 17.98, q = .017), and married males whose partners had above average alcohol consumption (PD = 25.30, q = .049) had greater predicted prevalence of remission compared to their counterparts who were in non-marital committed relationships.

Conclusion: The findings suggest differences in marital status and relationship factors may indicate increased risk and challenges in sustaining remission and highlight potential caveats of marital status as a protective factor. This emphasizes the need to consider these factors in designing treatment strategies.

Background: Alcohol Use Disorder (AUD) drives significant morbidity through alcohol-related liver disease. Accurate AUD identification in electronic health records is critical for research and care delivery, yet International Classification of Diseases (ICD) code-based algorithms miss many cases while manual review is impractical at scale. Computable phenotypes (CPs) integrating structured and unstructured EHR data offer a scalable solution.

Methods: Using University of Florida Health's Integrated Data Repository covering two million patients, we developed AUD CPs through a two-step process. First, candidate cohorts were identified using AUD-related ICD codes, medications, and keyword searches across structured and unstructured data. Second, rule-based combinations were iteratively refined through manual chart review. Final algorithms were evaluated against gold-standard chart review, measuring sensitivity, positive predictive value (PPV), and F1-score, then validated in an independent testing set and an external dataset.

Results: The F1-optimized CP achieved an F1-score of .87 (sensitivity: .98, PPV: .78) in the testing set, while the precision-optimized CP achieved PPV of .9 (sensitivity: .68, F1-score: .77). Minimal performance attenuation between training and testing sets demonstrated robustness and generalizability. Both CPs substantially outperformed restricted AUD-specific ICD code-based approaches.

Conclusions: CPs integrating structured and unstructured EHR data enable accurate, reproducible AUD identification, surpassing traditional AUD-specific ICD-based methods. This approach facilitates efficient cohort construction for clinical research, public health surveillance, and quality improvement initiatives targeting AUD and its consequences, addressing a critical gap in identifying patients who may benefit from screening and intervention.

Aims: This study aimed to identify (i) the number of alcohol care teams (ACTs) in England, (ii) the characteristics of patients supported by ACTs, and (iii) the service structure and care components offered by ACTs.

Methods: All acute hospitals (i.e. those providing short-term high-dependency medical care) in England were approached to complete a survey of alcohol care provision. Surveys were completed through researcher-guided interviews by staff familiar with the hospital's alcohol provision. It featured questions on service structure, patient characteristics, service functions, and policies. Data collection took place between May and October 2023.

Results: Of 170 hospitals approached, 122 completed a survey and 80 reported having an ACT. Most ACT patients were male (mean 64.1%; 95% confidence interval (CI) 61.8-66.4), white (mean 79.2%; 95% CI 75.1-83.4), aged 45-54 (mean 27.8%; 95% CI 25.0-30.5), and experiencing severe alcohol dependence (mean 66.2%; 95% CI 36.8-95.7). Most services had a clinical lead but only 58% funded this role. Fifty-nine percent of services operated 7 days per week. Most services reported identification and brief advice, though it was rarely systematized. Nearly all supported medically assisted alcohol withdrawal, though a quarter of patients did not complete medically assisted alcohol withdrawal before discharge.

Conclusions: ACT numbers increased significantly between 2019 and 2024. They offer a clinical service to highly vulnerable and complex patients. There is significant variation in ACT operational models, training, and leadership which will impact the effectiveness of identification strategies and management of patients with comorbid alcohol use disorder within acute medical settings.

Latent class analysis for Australians (n = 500) who drink at high-risk levels and use alcohol home delivery found: Class 1) high-risk drinking, with infrequent home delivery, and Class 2) alcohol-dependence, with frequent delivery. Class 2 had higher odds of alcohol-related harms, delivery while intoxicated, and delivery to continue drinking sessions. Liquor regulation requires protections to reduce online sales to vulnerable populations.

Aims: Phenotyping approaches aim to understand heterogeneity in alcohol use disorder (AUD) using neurofunctional domains that are critical to the development and maintenance of the disease. This study explored sex-based differences across stages of the addiction cycle among adults with severe AUD.

Methods: This secondary data analysis from the genes, addiction, and personality study includes adults who met criteria for severe AUD (lifetime). Sociodemographic, substance use history, and behavioral variables were collected via cross-sectional survey. Using the three-stage addiction cycle framework, neurofunctional-related factors were selected as proxy measures: Big Five Inventory Short Form Neuroticism Scale and DSM-5 Major Depressive Disorder (MDD) (withdrawal/negative affect), Short UPPS-P Impulsive Behavior Scale and DSM-5 AUD craving item (preoccupation/anticipation), response to alcohol during the first five times drinking, and DSM-5 AUD withdrawal item (binge/intoxication). Sex differences were assessed using Chi square tests, t-tests, and Mann-Whitney U test.

Results: Participants (N = 5745; 34% male, 66% female) were predominately white (88%) and middle-aged (44 ± 14 years). Many reported polysubstance use (64.2%). Females were significantly more likely to have a MDD diagnosis and higher neuroticism scores than males. Females had significantly higher scores in negative urgency and lack of premeditation while males had higher sensation seeking scores. Males were more likely to have lower sensitivity to alcohol and endorse drinking to relieve withdrawal symptoms than females.

Conclusions: Using a sex-informed approach is critical for the development and validation of AUD phenotyping tools as well as integration of phenotyping into AUD clinical trials.