Alcohol and alcoholism最新文献

Background: Lithuania, a European country, has a history of high alcohol consumption per capita. To reduce harm, Lithuania has implemented the World Health Organization 'best buys' for alcohol control policies, notably two taxation policies in 2008 and 2017. Taxation may affect segments of the population differently; to explore this question, we investigated the effects on liver cirrhosis.

Aims: To analyze the effect of taxation on liver cirrhosis hospitalizations and mortality across four age groups in Lithuania.

Methods: Using a general additive mixed model, we tested taxation on monthly hospitalization and mortality rates between 2001 and 2022 (n = 264 months) across four age groups (young adults: 15-34, middle-aged adults: 35-54, older adults: 55-74, and seniors: 75+ years of age, respectively). We computed standardized hospitalizations and mortality rates (admissions and deaths per 100 000 people) based on summed counts of alcoholic liver disease and fibrosis and cirrhosis of the liver according to the International Classification of Diseases 10th Revision.

Findings: Taxation was associated with the largest downward trend in liver cirrhosis mortality among middle-aged and older adults, equivalent to two fewer deaths per 100 000 individuals. In older adults and seniors, taxation was associated with downward trends in hospitalizations, but effects were less robust.

Conclusion: Taxation may lead to decreases in liver cirrhosis mortality across all age groups but appears to be less consistently impactful for hospitalizations. Younger and middle-aged individuals may experience increased hospitalizations. Taxation appears to impact subsections of the population differently.

Background and aims: Despite the critical importance of alcohol abstinence for patients with advanced liver disease, rates of returning to alcohol remain high and engagement with relapse prevention interventions is low. This study explores the potential barriers to relapse prevention in these patients.

Methods: Semi-structured interviews were conducted with patients who had alcohol-related cirrhosis or alcohol-associated hepatitis. Interviews took place during a hospital admission. The study methodology was informed by a constructivist grounded theory approach.

Results: Thirty-three participants were recruited from two sites. Participants had a mean age of 52 (range 30-60) and there were 10 female participants (30%). Most participants were actively drinking alcohol at time of admission (n = 26) and 16 participants were interviewed during their index admission with alcohol-related liver disease.A renewed understanding of the health risk posed by future alcohol made participants confident that they would not return to alcohol use and participants felt that the most important factor in relapse prevention was their own motivation and willpower. However, many rejected the identity label of 'alcoholic' and drew a distinction between themselves and 'bad drinkers'. These factors combined to create a barrier to relapse prevention therapies, since participants felt these were neither appropriate nor necessary for them.

Conclusions: Enhanced self-efficacy, a belief in the importance of willpower, and a rejection of the alcoholic identity can together act to reduce engagement in relapse prevention in patients with advanced liver disease. Relapse prevention interventions should be reframed or redesigned to address these barriers.

Aims: Sexual trauma is a known risk factor for both sleep problems and alcohol use. Understanding the complex comorbidity of these three concerns, including potential factors that may mitigate or exacerbate their relationship, is important to improve clinical care. Religiosity may serve as a protective factor for trauma-related outcomes, alcohol use, and sleep quality but also may exacerbate the relationship between sexual trauma and alcohol use. The current study examined whether alcohol use mediates the relationship between sexual trauma and sleep problems and whether religiosity moderates this indirect effect.

Methods: Data from 158 participants (Mage = 43.8, SD = 12.0; 32.3% cisgender women, 67.7% cisgender men) were drawn from eligibility screening assessments from three studies on alcohol use and/or post-traumatic stress disorder. Data were analyzed using mediation and moderated mediation analyses.

Results: Alcohol use did not mediate the relationship between sexual trauma and sleep quality (95% Boot CI [-0.07, 0.95]). However, when considering the role of religiosity, formal religious practices (but not God consciousness) moderated the indirect effect of sexual trauma on sleep quality through alcohol use (β = 0.89, 95% Boot CI [0.21, 1.92]). Specifically, the conditional indirect effect was significant for individuals with high levels of formal religious practices relative to individuals with low or average levels.

Conclusions: Sexual trauma was associated with poorer sleep quality due to heavier alcohol use when individuals had higher levels of formal religious practices. Findings have implications for assessment and treatment of comorbid trauma histories, alcohol use, and sleep problems.NCT02884908; NCT04210713.

Background and aims: Preclinical research demonstrates that cannabidiol (CBD) attenuates alcohol-seeking behaviour and may have a neuroprotective effect against adverse alcohol consequences on the brain. This preliminary clinical study aimed to examine the effect of CBD on modulating neurometabolites in individuals with Alcohol Use Disorder (AUD).

Methods: Twenty-two non-treatment seeking participants were randomized to receive 800 mg CBD or matched placebo/day in a crossover double-blind, randomized trial. Presence of GABA+, NAA, Glx, Cho, and glutathione (GSH) in the dorsal anterior cingulate cortex was measured using in vivo proton magnetic resonance spectroscopy (1H-MRS) in each session.

Results: There were no significant treatment effects across each of the neurometabolites (p's ≥ .28) but post hoc analyses revealed significant treatment effects when considering recent alcohol consumption. Specifically, CBD sessions were associated with significantly higher GSH (P < .001) and GLx (p = .001) concentrations relative to placebo sessions for participants who consumed alcohol the previous day while this effect was not observed in those who were abstinent. Similarly, GABA concentrations were significantly higher during CBD sessions and lower during placebo sessions for participants who consumed alcohol the previous day and this relationship was not observed for individuals who were abstinent the previous day (P = .0024).

Conclusion: The effect of CBD on modulating levels of neurometabolites may be contingent on recent alcohol consumption. These preliminary results suggest that CBD may regulate abnormal neurometabolite concentrations the day following alcohol consumption and thus may have a role in management of AUD.

Aims: Economic development leading a country from a low- to middle-income status is usually associated with increases in alcohol consumption and decreases in all-cause mortality, despite increases in alcohol-attributable mortality. We analyzed this tradition for India during the years 2000-19, with attention to alcohol policy.

Methods: Joinpoint analysis identified points of trend change and associated slopes for alcohol-attributable mortality and burden (disability-adjusted life years) between 2000 and 2019. Structural equation modeling assessed the relationship among adult alcohol per capita consumption, gross domestic product per capita at purchasing power parity (GDP-PPP per capita), alcohol-attributable mortality, and all-cause mortality, where mortality rates were log-transformed in the models. Pearson correlation was evaluated among study variables. Literature review examined alcohol policies in India.

Results: During the first decade between 2000 and 2019, a rapidly and steadily increasing GDP-PPP per capita was associated with marked increases in alcohol consumption and decreases in all-cause mortality, despite increasing alcohol-attributable mortality. After 2010, the economic growth still increased, but the increase in alcohol consumption halted, likely due to strong alcohol control policies in availability restrictions (dry states, dry periods, high legal purchasing age and restrictions in density, and purchasing hours), as well as a high tax share on final price.

Conclusion: Alcohol policies seem to have prevented further increases in alcohol consumption and attributable harm and thus should be upheld. Otherwise, increases in these harms will prevent India from fully reaping the health benefits of economic development.

Aim: To determine the generational metabolic and performance effects of first trimester alcohol exposure in a mouse model of prenatal alcohol exposure (PAE) that minimizes stress on the dam.

Methods: FVB/NJ male and female mice were mated and then fed either control or alcohol Lieber-DeCarli liquid diet the first 10 days of pregnancy. Offspring completed metabolic and physical assessments in adulthood.

Results: Despite no effects of PAE on body weight and body composition sex in adulthood, PAE differentially affected fat oxidation and respiratory exchange ratio between sexes, while carbohydrate metabolism, VO2, ambulation, and heat were not affected. PAE led to glucose intolerance at 90 min but no other differences in response to a glucose bolus. Neither male nor female PAE mice differed from control on physical performance tests, including grip strength, treadmill run to fatigue, and rotarod.

Conclusion: Consistent exposure to alcohol in the first trimester of pregnancy subtly affected fat metabolism differently between sexes and glucose clearance, although these alterations did not affect any other metabolic, physical, or compositional measures. Therefore, any long-lasting metabolic effects of PAE did not seem to impair physical performance on aerobic or strength-based exercise tests.

Introduction: Dividing participants of Temporary alcohol Abstinence Challenges (TACs) into subgroups can improve intervention effectiveness by identifying individuals who require extra support. In a previous study, participant subgroups were identified based on determinants of behaviour change, including drinking refusal self-efficacy, craving, and behavioural automaticity. However, the predictive value of these subgroups for TAC success remains unknown. This study examined their predictive value for (i) abstinence during a TAC and (ii) changes in drinking behaviour.

Methods: Data were analysed from 1800 Dutch TAC participants who completed baseline and eight-month follow-up questionnaires. Binary logistic regression assessed the effect of subgroup on abstinence. Ordinal and binary logistic regressions within Generalized Estimating Equation models examined subgroup effects on drinking behaviour changes, including drinking frequency, glasses per drinking day, and excessive volumes.

Results: TAC subgroups differed in abstinence and in changes in drinking frequency and glasses per drinking day on weekdays. 'Habitual drinkers with perceived control to refuse' and 'drinkers in control' were more likely to abstain during the challenge than 'ordinary drinkers', whereas 'drinkers not in control' were less likely to abstain. 'Drinkers in control' showed smaller reductions in drinking frequency and glasses per drinking day on weekdays compared with 'ordinary drinkers'. No significant differences were found in changes in excessive drinking volumes and glasses per drinking day on weekends.

Conclusions: This study demonstrated the predictive value of subgroups for abstinence but found limited predictive value for changes in drinking behaviour after the challenge. Future research could explore personalized support to optimize behaviour change.

Aims: Alcohol related cognitive impairment (ARCI) impacts an individual's ability to engage in treatment thus may result in poorer outcomes. We aimed to describe outcomes in a legacy cohort of patients with ARCI, identified in an acute hospital setting.

Method: We conducted a retrospective review of a cohort of patients who underwent screening for ARCI between 1 April 2017 and 31 March 2018. Those identified with alternative causes of cognitive impairment were excluded. The Montreal Cognitive Assessment Tool (MoCA©) was utilized to determine presence, and severity, of cognitive impairment. These patients were referred to a multi-disciplinary meeting (MDT) and an out-patient clinic. Mortality was recorded at 3 years. Cox-regression analysis was undertaken and, Kaplan Meier (KM) plots were prepared to visualize the data.

Results: A total of 210 patients met criteria for ARCI screening. Multi-variate analysis found an association between ARCI and mortality at 3 years, Hazard Ratio (HR) 1.732 (p = .019). Co-existent Chronic Liver disease (CLD) increased this association, HR 1.722 (p = .020) but CLD in isolation did not increase mortality risk, HR 1.223 (p = .401). Severe ARCI had the strongest mortality association (p = <.001). Subsequent engagement with the ARCI care pathway improved outcomes, HR .324; (p = .008).

Conclusion: ARCI, identified by a simple, bed-side test is significantly associated with early mortality. This relationship is more marked in the presence of liver disease. The more severe the ARCI, the stronger relationship with death by 3 years. The cohort mean age was 52, a decade younger than the expected age at diagnosis of cognitive impairment in the general population.

Objective: Many genetic studies of psychiatric disorders rely on participants to mail in DNA samples. Differences in who returns a sample may affect the generalizability of these studies, but little attention has focused on possible differences between participants who do and do not provide samples. The present study compared participants with severe lifetime alcohol use disorder (AUD) who did and did not return saliva DNA samples.

Methods: N = 3927 individuals were recruited through Facebook for a genome-wide association study of severe AUD. Participants completed an online survey and agreed to provide a saliva DNA sample by mail. Survey measures included: demographics, quantity and frequency of recent alcohol and tobacco use, impulsivity, and personality. Participants who returned the saliva kit (n = 2412) were compared to those who did not provide DNA samples (n = 1515) were compared using univariate Chi-square and t-tests.

Results: The sample was predominantly White (88.3%) and female (64.0%). DNA providers were more likely than non-providers to report graduate-level education. DNA providers were also less likely to report recent cigarette smoking and scored higher on measures of conscientiousness, perseverance, and premeditation. Using multivariate regression, the most parsimonious model found that being male, a non-smoker, and endorsing perseverance was associated with providing DNA.

Conclusions: In an online sample of individuals with severe AUD, participants who did not provide DNA samples showed multiple demographic and psychosocial differences from those who did provide samples. These findings may have implications for generalizability and suggest that further research is needed.

Introduction: Empirical evidence of the buffering effect of social capital and its underlying psychosocial mechanisms on socio-economic inequalities in alcohol use disorder (AUD) symptoms is limited. As socio-economic disadvantages often go together with deficits in resources and considering social capital's beneficial effects on health, we hypothesized a stronger buffering (at high scores) and a cumulative disadvantaged effect (at low scores) of social capital on AUD symptoms among people reporting higher socio-economic disadvantage compared with their more advantaged counterparts. Additionally, we investigated whether this moderation effect was associated with drinking motives.

Method: Three-hundred and sixty-five young adults participated in a cross-sectional online questionnaire measuring all model variables. First, we tested a moderation model, including AUD symptoms (DV), perceived socio-economic disadvantage (IV), and social capital (moderator). Secondly, we tested a moderated mediation model, additionally including drinking motives as mediators of the moderation effect tested in the first model.

Results: In the case of high social capital, young adults reporting higher socio-economic disadvantage reported fewer AUD symptoms than their advantaged counterparts, which was associated with their lower endorsement of coping, enhancement, and social motives. When social capital was low, those reporting higher socio-economic disadvantages showed higher AUD symptoms than their advantaged counterparts, which was associated with their higher endorsement of coping motives only.

Conclusion: Social capital can buffer (at high levels) or aggravate (at low levels) socio-economic inequalities in AUD symptoms, and drinking for coping, enhancement, and social motives may explain why this happens.