Alcohol and alcoholism最新文献

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.

Aims: Alcohol-associated liver disease (ALD) and alcohol use disorder (AUD) are interconnected and highly prevalent. Integrating substance use disorder (SUD) treatment into medical clinics may increase access to specialized care and improve liver-related outcomes.

Methods: A scoping review and quantitative analysis were completed on published literature before 4 September 2024. Included articles described SUD treatment integrated in medical settings for adults with liver disease and alcohol use. Specific focus in the analysis was placed on integrations that utilized telehealth formats, facilitated access to medications for AUD (MAUD), and intervened in liver transplant populations.

Results: Twenty-three full-length manuscripts and 10 conference abstracts met the inclusion criteria. Fourteen articles discussed MAUD access in ALD populations. Nine utilized telehealth interventions, and 12 focused on pre- and post-liver transplant populations considered high-risk for returning to alcohol use. Nine full-length manuscripts were included in a quantitative analysis, which showed a 9.7% risk difference (95% CI: 5.9-13.4) in any alcohol use, favoring integrated care over treatment as usual.

Conclusions: Integrated care for AUD and concurrent ALD populations can effectively reduce returns to alcohol use and be successfully integrated in a medical setting. The core ingredient of such interventions was the inclusion of an addiction medicine specialist into a medical setting, rather than an outside referral. Strategic telehealth utilization can further reduce geographic and specialty-specific barriers to SUD care in medically ill populations. More consensus is needed on key components, processes, and optimal outcomes for such integrated programs for people with concurrent liver disease and AUD.

Aims: Health-oriented marketing claims commonly and increasingly feature on alcohol products and target younger consumers. This study aimed to test effects of such claims on young adults' alcohol product perceptions and intended consumption.

Methods: Australian young adults aged 18-24 (N = 1009) viewed 10 alcohol products in an online experiment comprising two between-subjects conditions (no claim control, claim) and five within-subjects conditions (low sugar/carb, low calorie, natural, organic, and preservative free). Products were identical between conditions (including labelled alcohol and energy content) except for the presence or absence of claims. Participants rated their perceptions and reported their intended consumption of each product.

Results: Overall, participants perceived alcohol products displaying health-oriented marketing claims as significantly healthier, less harmful to health, lower in sugar and kilojoules, and more suitable for weight management and a healthy diet than identical products without claims (P = .005-P < .001), but claims did not affect intentions to consume products in the next fortnight. These effects were consistent across most individual claims. However, participants intended to consume a higher number of cans/bottles of products featuring 'natural' claims (P = .032) and of products displaying any health-oriented marketing claim in the minority of instances (19.4%) when they did not view the back label featuring nutrition information (P = .031).

Conclusions: Health-oriented marketing claims commonly displayed on alcohol products lead young adults to misperceive those products as healthier on many dimensions even in the presence of information to the contrary. There is a need to strengthen the regulation of alcohol labelling and marketing by prohibiting these misleading claims.

Background and objectives: This study investigated the relationship between executive functions and alcohol use among Turkish university students, with a specific focus on the moderating effects of perceived social support and perceived stress.

Methods: Data were collected from 504 students (435 women, 69 men) via an online survey conducted between January and March 2025. Participants completed self-report instruments measuring executive functions, perceived social support, perceived stress, and alcohol use risk (BAPI-K). Descriptive analyses were conducted in IBM SPSS Statistics, while structural equation modeling and moderation analyses were performed in RStudio using the lavaan and interactions packages.

Results: Executive functions were significantly and negatively associated with alcohol use (P < .001). Although the direct effects of perceived social support and perceived stress on alcohol use were not significant, both variables significantly moderated the relationship between executive functions and alcohol use. Specifically, a stronger negative association between executive functions and alcohol use emerged when perceived social support was low and perceived stress was high.

Conclusions: The findings suggest that the protective impact of executive functions on alcohol use depends on students' psychosocial context. Interventions aiming to reduce alcohol use should not only enhance executive functioning but also address levels of social support and stress. Integrating these psychosocial components may improve the effectiveness of prevention strategies targeting university student populations.

Background: A low subjective response to alcohol predicts increased consumption and risk for alcohol use disorder (AUD). While self-report tools like the self-rated effects of alcohol (SRE) questionnaire assess this, biological correlates remain understudied. This study investigates the relationship between SRE scores, serum phosphate (se-P), and other alcohol related measures using data from one experimental and two clinical cohorts.

Material and methods: Participants from three cohorts completed the SRE questionnaire. Blood samples were collected to measure alcohol use biomarkers and other blood measures like se-P. Statistical analyses assessed relationships between SRE scores and biochemical measures across groups.

Results: AUD patients had higher SRE lately scores (mean 6.74) than blood donors (3.08), and higher se-P (1.23 mmol/L vs. 1.05). SRE scores correlated positively with se-P in both the experimental group (r = 0.507, P = .027) and blood donors (r = 0.377, P = .011), but not in AUD patients. Prolactin correlated with SRE scores where measured.

Discussion: This study confirmed a positive correlation between se-P and SRE scores in non-AUD groups, possibly supporting a link between se-P and presystemic alcohol metabolism. No such relationship was found in AUD patients, possibly due to nutritional supplementation of phosphate and other nutrients. The observed association between prolactin and SRE in both observational groups was unexpected. Overall, these findings further indicate that se-P may play a role in alcohol metabolism, especially presystemic alcohol metabolism, but further research and replication are needed to clarify mechanisms.