Alcohol and alcoholism最新文献

Aims: Traditional longitudinal models of adolescent alcohol use often assume that within-person variability-the extent to which an individual's alcohol use fluctuates over time-is the same for everyone. However, in the real world, some adolescents show relatively stable patterns of use, while others fluctuate substantially across different measurement waves. To capture these individual differences, the present study applies a Bayesian hierarchical linear modeling approach that allows between-person differences in within-person variability.

Methods: This study compared 16 model variants that crossed the following features: within-person error variance (fixed or random), lag effect (present or absent), linear and quadratic effects (random linear and quadratic terms included or excluded), and transformation (probit-transformed or untransformed).

Results: The best-fitting model (DIC = -2,615; Deviance = -4,362) included a lag parameter, varying error terms, and random linear and quadratic effects for probit-transformed data. Notably, the average of the within-person standard deviation (${mu}_{sigma_j}$ = 0.231) was almost twice that of the varying intercept (${sigma}_{beta_{0j}}$ = 0.124), indicating substantial within-person variability in adolescent alcohol use across time.

Conclusions: Accounting for heterogeneous within-person variability and modeling alcohol use with a non-normal distribution significantly improved model-data fit and yielded extra insights into adolescents' alcohol use research. This approach allows researchers and practitioners to more accurately identify individuals with irregular or unstable drinking patterns, enhancing early detection and targeted intervention strategies.

Background: Alcohol use disorder (AUD) is common worldwide, but the proportion of patients receiving pharmacotherapy remains low. In Japan, patterns of pharmacotherapy initiation for AUD have not been fully characterized. Here, we quantified the cumulative incidence of pharmacotherapy initiation among patients newly diagnosed with AUD in Japan.

Methods: We conducted a descriptive study using a Japanese insurance claims database. We created annual cohorts of adults aged 20-64 years who were newly diagnosed with AUD during fiscal years (FYs) 2012-21. Cumulative incidence for pharmacotherapy initiation was estimated, with death treated as a competing risk.

Results: The study included 13 936 patients. Across FY 2012-21 cohorts, mean age was 43.3-44.8 years and men accounted for 72.6%-79.3% of each cohort. At cohort entry (Day 0), the cumulative incidence of pharmacotherapy initiation rose from 18.0% in FY 2012 to 35.2% in FY 2021. The 1-year corresponding cumulative incidences were 28.1% and 44.9%, respectively. Market approval of acamprosate (FY 2013) and nalmefene (FY 2018) and the publication of Japan's AUD treatment guideline (FY 2018) were each followed by marked year-on-year increases in pharmacotherapy initiation.

Conclusions: Although the observed incidence may have been inflated by Japan's reimbursement policy, which requires an AUD diagnosis before medication can be prescribed, pharmacotherapy initiation exceeded that reported in other countries and has increased steadily since FY 2012. Introduction of new drugs and guideline dissemination appear to have accelerated treatment initiation and substantially altered treatment practice. These findings can help clinicians and policy-makers close the persistent treatment gap.

Background: Early onset alcohol use, mental health problems, familial alcohol use, and adverse childhood experiences (ACEs) increase the likelihood of persistent alcohol-use disorders later in life. This study aimed to determine the relative influence of such risk factors when predicting adolescent alcohol treatment outcomes, an area overlooked in prior research.

Methods: Retrospective cross-sectional analysis using the National Drug Treatment Monitoring System, incorporating data from all publicly funded community alcohol services in England. The study included adolescents (aged 11-17) whose alcohol treatment took place between 1 April 2018 and 31 March 2023 (n = 2621). Logistic regression models tested for associations between predictors and key outcomes, including treatment non-completion and being non-abstinent at treatment completion. Predictors included demographics, treatment information, alcohol use, ACEs, care status, psychological, and socioeconomic factors.

Results: Significant predictors of not completing treatment: increased age; increased monthly drinking days; year of exit 2020-2021; Not in Education, Employment or Training (NEET) status and being placed on a child protection plan. NEET adolescents had double the incomplete treatment rate compared to the general cohort. Significant predictors of non-abstinent completion: increased age, monthly drinking days, units per drinking day, mental health treatment need, early onset use, affected by others' substance use, and illicit substance use.

Conclusions: Adolescents with higher alcohol or illicit substance use at treatment start, NEET status and/or child protection plan (care status indicating prior ACE exposure) have worse alcohol treatment outcomes. These groups are highlighted for tailored interventions which consider psychological and environmental challenges adolescents may be experiencing.

Introduction: Alcohol use disorder (AUD) poses a significant public health challenge. Despite the availability of effective pharmacological treatments, their use during hospitalization remains limited. This study aimed to evaluate the prevalence of medication for AUD (MAUD) during inpatient admissions and assess its association with subsequent emergency department (ED) visits and hospital readmissions.

Materials and methods: We conducted a retrospective cohort study using electronic health records from Stanford Health Care (SHC) between 2015 and 2023. Hospitalized adults with a documented diagnosis of AUD (n = 7560) were categorized based on whether they received acamprosate, naltrexone, or disulfiram during admission. Outcomes included ED visits and hospital readmissions at 3- and 12-month follow-up. High-dimensional propensity score (HdPS) matching was used to control for baseline confounders.

Results: Only 3% of patients with AUD received pharmacotherapy during hospitalization. After HdPS matching, we compared 131 patients who received MAUD to 131 patients who did not. No statistically significant differences were found in ED visits within 3 months (OR = .83; 95% CI: .45, 1.51) or 12 months (OR = .66; 95% CI: .39, 1.14), nor in hospital readmissions at 3 months (OR = .87; 95% CI: .47, 1.59) or 12 months (OR = .81; 95% CI: .58, 1.12).

Conclusions: MAUD was rarely administered during hospitalization, representing a critical missed opportunity for intervention. While effect estimates favored treated patients, limited sample size precluded definitive conclusions. Efforts to improve implementation of AUD pharmacotherapy in inpatient settings are warranted.

Observational data on glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown a reduction in alcohol use. In this review of three randomized controlled trials (RCTs) (n = 48-151), semaglutide reduced alcohol use, dulaglutide lowered alcohol intake in current drinkers, while exenatide had no significant effect on heavy drinking days. Large RCTs are needed to substantiate the role of GLP-1 RAs in treating alcohol use disorder.

Introduction: Policies mandating posting of signs warning of the risks of alcohol consumption during pregnancy (MWS-alcohol-pregnancy) are common in the United States Previous research suggests these policies are ineffective and relate to increased adverse infant and maternal outcomes. Research about MWS-alcohol-pregnancy using quasi-experiments is needed.

Materials and methods: This study uses Vital Statistics birth certificate data and commercial insurance claims data from Merative MarketScan® and policy data from NIAAA's Alcohol Policy Information System. We systematically selected a treatment (Texas) and comparison (Florida) state for a quasi-experimental examination of effects of an MWS-alcohol-pregnancy policy going into effect in 2007. Difference-in-difference models compared changes in birthweight, low-birthweight, and infant injuries consistent with maltreatment from pre- to post-policy change between the treatment and comparison state.

Results: Mean birthweight decreased 4.06 g more from pre- to post-periods in the treatment as compared to the comparison (average treatment effect on the treated [ATET] -4.06, 95% CI -7.02, -1.09) state. The difference in the pre- to post-policy change in low-birthweight in the treatment relative to the comparison state was not statistically significant (ATET .0 pp, 95% CI -.0, .0). The pre- to post-policy change in infant maltreatment was .5 percentage points greater in the treatment relative to the comparison state (ATET .5 pp, 95% CI .2, .8).

Conclusions: The MWS-alcohol-pregnancy policy was associated with lower birthweight and more infant maltreatment. This study provides further evidence that MWS-alcohol-pregnancy policies are mostly ineffective and possibly harmful.

Background: Exposure to alcohol advertisements and imagery is associated with alcohol initiation and use by adolescents and adults. The current study provides an update on the previously published article 'A content analysis of alcohol imagery in season 2 of The Kardashians' by exploring content in season 4 and estimating population exposure to this content.

Methods: A content analysis of alcohol content in all 10 episodes of season 4 of The Kardashians was undertaken, and alcohol content was measured using 1-min interval coding. The presence of alcohol in the following four categories was noted: (i) actual use, (ii) implied use, (iii) other alcohol reference, and (iv) brand appearances, with particular attention paid to appearances of the Kardashian-owned brand of tequila, 818. Population exposure to content in season 2 and season 4 was estimated using population estimates and viewing figures.

Results: Alcohol content and branding continue to be shown in season 4, with a significant increase in any alcohol content, other alcohol content, alcohol branding, and 818 branding in season 4 compared to season 2. The two series resulted in a combined 347 million 818 tequila-branded gross impressions to the UK population.

Conclusions: This content is not recognized by the UK regulator Ofcom as product placement, as there is no product placement deal in place. The current study posits that, despite this, 818 tequila is receiving widespread exposure through inclusion in the programme, suggesting that regulation on other forms of brand inclusion should exist.

Aim: To understand the views and experiences of homeless adults who drink hazardously around alcohol use, alcohol harms and access to liver healthcare, and to quantify the prevalence of alcohol-related morbidity in this population.

Methods: A sample of homeless adults (aged 18+) who drink hazardously (AUDIT score ≥8) were recruited to complete a health and alcohol use survey. From this sample, a smaller sample was purposively selected for semi-structured interview. Participants were recruited via liver outreach clinics held in five homeless hostels/day-centres in Southampton. Using a critical realist approach, qualitative data were analyzed using reflexive thematic analysis and descriptive statistics produced for survey responses.

Results: Around 56 survey participants were recruited, 84% of whom had probable alcohol dependence and 18% a diagnosis of advanced liver fibrosis/cirrhosis. Themes identified from 10 interviews described the ubiquity of alcohol misuse and harms in the life-histories of people experiencing homelessness (PEH), the differing levels of understanding and risk recognition of alcohol-related harms, and how PEH rationalize hazardous drinking, despite the risks. Normalization of alcohol misuse and harms underlies these themes and likely contributes to feelings of fatalism and powerlessness to prevent these harms.

Conclusions: Normalization of alcohol-related harms may represent a barrier to timely engagement with healthcare and a mechanism driving greater likelihood of alcohol-related harms in PEH. Improving knowledge around alcohol-related harms and healthcare may help to counter the misperceptions of risk and fatalistic attitudes that normalization fosters. Such intervention may be particularly effective for PEH if targeted towards those accessing hostels and day-centres.

Aims: This exploratory study aimed to examine how virtual reality (VR) environments as an experimental tool can evoke and modulate alcohol craving among university students. Specifically, we investigated how exposure to a party scene with alcohol-related stimuli versus a relaxing environment influenced craving levels.

Methods: Thirty-seven university students were sequentially immersed in two VR scenarios-a party scene with alcohol cues and a nature-based relaxation scene. Craving was assessed at three time points using a VAS, and post-exposure using the Alcohol Urge Questionnaire (AUQ). A linear mixed-effects model tested the influence of time and individual predictors (age, Alcohol Use Disorders Identification Test [AUDIT-C], AUQ, Questionnaire on the Experience of Presence [QEP], sex) on craving dynamics.

Results: A linear mixed-effects model was used to examine craving trajectories across repeated measurement time points during the VR sessions. Craving did not significantly increase from baseline to midpoint (P = .06) and decreased significantly from midpoint to end (P = .002). Post-exposure AUQ scores as a state measure of craving were the only significant predictor of overall craving intensity (P < .001); age, sex, AUDIT-C, and sense of presence (QEP) had no significant effects.

Conclusions: VR environments can recreate real-life craving fluctuations, with increased urge in cue-rich settings and reduction in calming contexts. Our findings position VR as an experimental tool for studying craving dynamics; therapeutic efficacy was not assessed.

Background: A reinforcer pathology approach to alcohol use disorder (AUD) proposes that high alcohol reinforcing value (high alcohol demand) and overvaluation of immediate rewards (high discounting of future rewards) are critical determinants of problematic drinking. Applied to clinical settings, these indicators have not been examined as potential assessments for use in clinical practice. Toward that end, the current study examined whether reinforcer pathology indicators accurately classify individuals with AUD from recreational drinkers without AUD at levels that would meet clinical accuracy benchmarks.

Methods: In a case-control sample of 267 Canadian adults (180 meeting DSM-5 criteria for AUD), receiver operating characteristic (ROC) curves were constructed using reinforcer pathology indicators from an alcohol purchase task and a monetary delay discounting tasks.

Results: Analysis of the ROC curves revealed that three alcohol demand indices from the alcohol purchase task [i.e. Intensity (observed consumption when free), Omax (observed maximum expenditure), and α (a derived index of price-sensitivity)] significantly differed by groups and met established clinical benchmarks for diagnostic differentiation. While delay discounting significantly differed between groups, it did not meet benchmarks as a clinical differentiator.

Conclusions: This study provides evidence that behavioral economic measures of alcohol valuation accurately diagnostically discriminate individuals with AUD from recreational drinkers. Future work should consider utilizing other behavioral economic indices and validating these results in more diverse populations.