Alcohol and alcoholism最新文献

Introduction: Despite a high prevalence of alcohol use disorder (AUD) in Canada, access to medication-based treatment remains poor. Therefore, our aim was to explore patterns of alcohol toxicity deaths in Ontario, Canada, circumstances surrounding death, prior healthcare interactions, and pharmacotherapy for AUD.

Methods: We conducted a population-based repeated cross-sectional study of alcohol toxicity deaths occurring between 1 January 2018 and 30 June 2022 in Ontario, Canada. We reported trends in deaths over time and determined demographic characteristics of decedents, circumstances surrounding death, and prior healthcare interactions. Among a subset of the cohort with an AUD diagnosis eligible for public drug benefits, we reported receipt of medications used to treat AUD before death.

Results: We identified 1346 alcohol toxicity deaths over the study period, at a median age of 42 years, with 73.8% occurring among men. The majority of alcohol toxicity deaths involved other substances, including opioids (75.2%), benzodiazepines (10.8%), and/or stimulants (45.2%). Half had an AUD (50.4%) and 62.7% had an opioid, benzodiazepine or stimulant use disorder. Among decedents who were public drug beneficiaries with an AUD (N = 361), only 3.6% were actively prescribed first-line AUD pharmacotherapies (naltrexone and/or acamprosate) at time of death.

Conclusions: We found that the majority of alcohol toxicity deaths in Ontario involved other non-alcohol substances. We also detected a high prevalence of prior healthcare encounters for substance use disorders (SUDs) and low prevalence of evidence-based AUD pharmacotherapy. This suggests a need for integrated treatment across concurrent SUDs and improved access to pharmacotherapies for AUD across Ontario.

Alcohol use disorder (AUD) is characterized by impaired inhibitory control, which plays a role in the continued consumption of alcohol and relapse despite harmful consequences. External environmental cues, such as alcohol-related advertisements, can aggravate cravings and influence drinking behavior; however, their impact on cognitive processes, including inhibitory control, remains unclear. This study investigated the effect of alcohol-related digital video commercials on inhibitory control in individuals with AUD. A total of 20 participants with AUD and 20 healthy control (HC) watched alcohol and neutral commercials while performing a cognitive task that measured inhibitory control. Consequently, drinking desire or the interference effects on inhibitory control induced by alcohol commercials showed no significant differences between the two groups. However, when the AUD group was subdivided by severity, the severe AUD subgroup exhibited significantly greater interference from alcohol-related commercials than the HC group. These results suggest that individuals with severe AUD may be particularly susceptible to alcohol-related cues presented in digital video commercials, highlighting that such advertisements potentially exacerbate their condition. Continued research using ecologically valid, real-world stimuli is essential to refine interventions aimed at reducing cue reactivity and improving treatment outcomes for individuals with AUD.

Introduction: Excessive alcohol use (EAU) elevates the risk of dementia through various mechanisms, yet its impact on the behavioural and psychological symptoms of dementia (BPSDs) remains uncertain.

Methods: In this exploratory cross-sectional analysis of baseline data from the Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov/NCT03672201), we included individuals with Alzheimer's disease and related dementias requiring BPSD treatment. We compared demographic characteristics and presentation of BPSDs (using the total and domain scores on the Neuropsychiatric Inventory-Clinician) in those with and without a lifetime history of EAU.

Results: Among 193 participants [mean (SD) age: 80.6 (9.7) years, male: 48.4%], those in the EAU group (n = 17) and in the comparator group (n = 176) had severe and comparable cognitive impairment, with a median Functional Assessment Staging Tool for Dementia score of 6e. Participants with EAU were significantly younger than comparators [mean age (SD): 72.9 (7.1) years vs. 81.4 (9.5) years] (t = -3.678, df = 181, P < .001), and were more frequently male (76.5% [13 of 17] vs. 46.6% [82 of 176]; P = .036). In a sensitivity analysis, there were no differences in the Neuropsychiatric Inventory-Clinician total or individual domain scores between those with EAU and a subsample of those without EAU matched for age, sex, and recruitment site.

Conclusion: This exploratory study found that among individuals with Alzheimer's disease and related dementias and BPSDs, lifetime history of EAU is more frequent in younger males. Future studies may further examine the impact of EAU in individuals with BPSDs.

Aims: To investigate the influence of health-oriented nutrient content claims (NCC; e.g. 140 calories) and a health warning label (HWL) depicting cancer risks on consumer product perceptions of ready-to-drink (RTD) alcoholic beverages, including potential differences in subgroups.

Methods: An online within-participants experiment was conducted among alcohol consumers ages 18-64 in Canada (n = 4689). Participants viewed the front panel of RTD alcoholic beverage containers according to four label conditions: (1) NCC vs. no label, (2) NCC + HWL vs. no label, (3) HWL vs. no label, (4) no label vs. no label. When viewing each pair, participants were asked to select which product they: (a) are interested in trying, and (b) buy to reduce health risks. Responses were assessed using generalized estimating equation and logistic regression models within the overall sample and subgroups, including gender, age group, education, alcohol use, and body weight intentions.

Results: When asked to select the product to try and to reduce health risks, participants were more likely to select the product with NCC, compared to NCC + HWL or HWL. When NCC were present, women were more interested in trying the product and those trying to lose weight had higher odds of perceiving reduced health risks. No other characteristics were associated with label effects.

Conclusions: NCC on RTD alcohol products influenced product appeal and risk perceptions among consumers, particularly women and those trying to lose weight. Prohibiting NCC on alcohol packaging could be an effective policy strategy to prevent increased appeal and minimize consumer confusion about alcohol health risks.

Background: Preclinical research with animals suggests that a propensity to more rapidly adapt to the effects of alcohol could be an important neurobiological difference underlying alcohol use disorder (AUD). Research translating this work to humans is scarce. We tested whether adults' self-perceptions of rapidly developing alcohol tolerance following the onset of regular drinking was associated with increased risk of problematic alcohol use (using scores that excluded tolerance items), while controlling for several potentially important confounders.

Methods: Adults who reported current heavy drinking completed an online survey (N = 160; M(SD) = 32.24(9.30) years old; 56.3% Black, 43.8% White; 55% Female, 45% Male). Participants reported the extent to which "my tolerance to alcohol seemed to build up very quickly once I started drinking frequently." Initial subjective response was measured as the number of drinks to experience alcohol effects during the first five drinking experiences and acquired tolerance as the difference between current and initial subjective response. Participants reported on alcohol consequences and dependence symptoms using modified DSM-5 criteria (i.e. problematic alcohol use), past year alcohol consumption, and demographic characteristics.

Results: Hierarchical linear regression showed that perceived rapid tolerance growth was uniquely associated with problematic alcohol use (excluding tolerance symptoms) after controlling for initial subjective response, acquired tolerance, DSM-5-related tolerance, alcohol consumption, race, sex, and age.

Conclusions: Individuals who reported experiencing rapid tolerance growth when they started regularly drinking showed increased risk for problematic alcohol use. Future prospective research on this topic is warranted and could help uncover a novel risk factor for AUD.

Aims: Alcohol withdrawal syndrome (AWS) requires urgent treatment to prevent morbidity and mortality. In the acute care setting, medical toxicologists play a critical role in AWS management, including the use of gamma-aminobutyric acid agonists and adjunctive medications. We aim to introduce the addiction medicine community to this role by describing clinical presentation and treatment of patients with AWS in the Toxicology Investigators Consortium Core Registry.

Methods: Medical toxicologists from participating sites enter demographic, exposure, clinical presentation, and treatment data on all patients they evaluate into the Core Registry. This was a secondary analysis of registry patients evaluated for AWS from 2016 to 2022. Data were coded in a spreadsheet and analyzed using descriptive statistics.

Results: We included 1093 cases. Agitation and delirium/toxic psychosis were documented in 373 (34.1%) and 227 (20.8%) patients, respectively. Benzodiazepines were the most common gamma-aminobutyric acid agonist treatment (n = 539, 49.3%). There was an overall decrease in the use of benzodiazepines alone and increases in the use of phenobarbital, ketamine, and dexmedetomidine. Intubation was performed in 115 (10.5%) patients. Naltrexone, used for alcohol use disorder, was given in 88 (8.1%) cases. The absolute number of AWS cases increased during this period.

Conclusions: Use of benzodiazepines alone to manage AWS decreased while phenobarbital, ketamine, and dexmedetomidine use increased. Many patients had severe withdrawal manifestations, and some received alcohol use disorder treatment, suggesting that medical toxicologists see more severe cases in the acute care setting and have an opportunity to address the underlying use disorder.

Aims: Fetal alcohol spectrum disorders (FASDs), caused by prenatal alcohol exposure, represent a significant public health challenge. Despite their prevalence, prevention remains insufficient. This study explores knowledge gaps and barriers among gynaecologists, midwives, and addiction specialists, identifying opportunities for improvement.

Methods: An online survey investigated experiences of obstetric professionals and addiction specialists with pregnant women consuming alcohol, approaches to prevention, and needs for improved care in Bavaria, Germany, in 2022.

Results: Of 96 obstetric professionals and 123 addiction specialists, half had knowingly treated pregnant patients consuming alcohol. Fourteen percent of gynaecologists, 28% of midwives, and 15% of addiction specialists did not routinely ask pregnant women about alcohol use. Addiction specialists were more proactive, educating 80% of pregnant patients and 59% of those trying to conceive in high-risk substance use clientele. They also provided more detailed education on general risks (85% vs. 53%) and FASD (67% vs. 49%), compared to obstetric professionals. Providers desired educational materials and collaboration with FASD-experienced centres.

Discussion: Prevention currently focuses on high-risk populations but is often insufficient. In the general population, the lack of awareness and prevention leaves room for improvement. Addiction specialists prioritize high-risk groups, providing detailed education. Obstetric professionals deliver less comprehensive information to mostly lower-risk populations. Prevention strategies need to incorporate education for the general population and systematic screening in healthcare.

Conclusion: Alcohol use in pregnancy remains underestimated, and education of women in low- and high-risk populations is still insufficient. Our findings highlight missed opportunities for proactive prevention extending beyond pregnancy, addressing broader audiences, and fostering collaboration among providers.

Aims: Alcohol consumption is associated with socioeconomic disadvantage, but causality is unclear. We used Mendelian randomisation (MR) to estimate the effect of alcohol consumption on socioeconomic and employment-related outcomes.

Methods: We conducted observational analyses and two-sample MR analyses using 230 775 working-age participants (aged 40+) of White British ethnicity/ancestry (54.5% male) from the UK Biobank.

Outcomes: employment status (employed vs not; employed vs sickness/disability, unemployment, retirement or caring for home/family); weekly hours worked (among employed); deprivation (Townsend Deprivation Index); highest educational attainment; and household income.

Exposures: alcohol consumption (units per week), hazardous alcohol consumption assessed by Alcohol Use Disorder Identification Test-C score and Alcohol use disorder (AUD).

Results: MR analyses suggested that alcohol exposure increased the risk of living in a more deprived area. A unit per week increase in alcohol consumption increased deprivation by 0.31 deciles (95% CI: 0.10, 0.52). A unit increase in liability for AUD increased deprivation by 0.09 deciles (95% CI: 0.02, 0.16). Findings, and often effect directions, differed by sex. In men, increased alcohol consumption decreased household income and increased the risk of not being in paid employment and unemployment. In women, increased alcohol consumption decreased the risk of not being in paid employment, retirement, and caring for home/family. Effects were generally more detrimental for men than women. This is especially evident for not being in paid employment, household income, and deprivation.

Conclusions: Alcohol consumption may increase the risk of living in deprived neighbourhoods. It may have deleterious effects on employment (including unemployment) and income, but these differ strongly by sex, largely affecting men.

Aims: Safety and tolerability data from the first open-label feasibility study of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for alcohol use disorder was recently published. This paper presents a Bayesian analysis of the impact of MDMA-assisted psychotherapy on treatment success, defined as 2-level reduction in the World Health Organization (WHO) drinking risk at the 3 months follow-up. We also examined the impact on drinking behavior and psychosocial measures at 3 months compared to baseline.

Methods: Fourteen participants with a diagnosis of alcohol use disorder who had recently undergone detoxification completed an eight-week course of ten psychotherapy sessions, including two sessions with MDMA. Measures assessing drinking behavior, quality of life, sleep, self-compassion, and empathy were collected. Bayesian analysis using flat and skeptical priors was performed to determine treatment success defined as a 2-level reduction in WHO drinking risk.

Results: Bayesian analysis suggested that the probability of a 2-level reduction in WHO drinking risk from baseline to 3 months post-treatment is 55%-63%, based upon either a flat or skeptical prior respectively. We present preliminary findings suggesting reductions in alcohol craving (measured by the Penn Alcohol Craving Scale and Obsessive Compulsive Drinking Scale) and improvements in sleep and aspects of psychosocial functioning at 3 months follow-up compared to baseline.

Conclusions: The Bayesian analysis provides a useful harm reduction endpoint interpretation of drinking in terms of a 2-level reduction in WHO drinking risk. Further findings provide preliminary insights into the potential impact of MDMA-assisted psychotherapy on quality of life and well-being in addition to reductions in drinking. ClinicalTrials.gov ID: NCT04158778.

Background: As a serious public health problem, alcoholic cardiomyopathy (ACM) has caused a heavy burden of disease.

Methods: To summarize and deeply analyze the development trend of ACM at the global, regional, and national levels in the past 30 years, this study used the age-period-cohort model to analyze the age, period, and cohort effects of the prevalence, deaths, and disability-adjusted life years (DALYs) of ACM.

Results: The results found that the overall time trend of ACM prevalence, deaths, and DALYs had been decreasing worldwide, but the opposite trend was observed in some countries and regions. The disease burden of male ACM patients was significantly higher than that of female patients. Moreover, the ASRs of prevalence, deaths, and DALYs for ACM were positively correlated with sociodemographic index levels. Finally, this study predicted that ACM prevalence will continue to decline over the next 10 years, while death rates and DALYs are expected to increase.

Conclusions: Overall, the results of this study provided an insightful, up-to-date global perspective on time trends in ACM-related disease burden, shedding light on the inadequacy of ACM prevention, control, and intervention programs at multiple levels.