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Low to Moderate Prenatal Alcohol Exposure and Neurodevelopmental Outcomes: A Narrative Review and Methodological Considerations. 中低度产前酒精暴露与神经发育结果:叙述性综述和方法论思考。
IF 6.8 1区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2023-03-16 eCollection Date: 2023-01-01 DOI: 10.35946/arcr.v43.1.01
Gretchen Bandoli, Shana Hayes, Erin Delker
<p><strong>Purpose: </strong>Although abstinence is recommended in pregnancy, many pregnancies are exposed to alcohol. Observational studies of the effects of low to moderate prenatal alcohol exposure (PAE) and neurodevelopmental outcomes have yielded inconsistent results, with some studies finding an increased risk of adverse neurobehavioral and cognitive outcomes, and other studies finding no changes or reduced risk of the same outcomes. The purpose of this narrative review is to summarize these inconsistencies and apply a methodological framework to discuss how different parameters contribute to the findings. The authors also provide recommendations on how to advance future research in this area.</p><p><strong>Search methods: </strong>The PubMed, Web of Science, and Embase databases were searched, along with reference lists of selected systematic reviews and meta-analyses. Search terms used were (infant or child or children or adolescent or offspring) AND (low or light or mild or moderate or low-to-moderate) AND (drinking or alcohol or drinks) AND (pregnancy or prenatal or fetal) AND (neurodevelopment or behavioral or psychological or cognitive or developmental) NOT (mice or rat or fish or animal) NOT (meta-analysis or review). Peer-reviewed original research studies were included if they analyzed associations between an exposure defined and characterized as low/light or moderate PAE with offspring neurodevelopmental outcomes. Animal studies, studies that did not provide clear cutoff points to classify PAE categories, studies lacking an abstinence control group, and studies that did not present a multivariable-adjusted measure of association were excluded.</p><p><strong>Search results: </strong>The searches identified 2,422 papers, with 36 papers meeting eligibility criteria. These studies were carried out across nine countries and included samples ranging from approximately 500 to 40,000 participants. Cognitive, academic, socioemotional, and behavioral outcomes were assessed from infancy through age 19.</p><p><strong>Discussion and conclusion: </strong>When the findings from the selected articles were summarized by geographic region, exposure definition, or neurodevelopmental outcome, no consistent observations or patterns emerged between low to moderate PAE and offspring outcomes. Although some studies found positive (i.e., beneficial) associations between low to moderate PAE and outcomes (primarily outcomes related to cognition) and others found negative (i.e., detrimental) associations (primarily for behavioral outcomes), most findings were null (i.e., showed no effect of PAE). The heterogeneity in study results is likely due to methodological issues, including residual confounding, effect measure modification, and exposure misclassification that make synthesis of studies difficult. Alternative study designs, including longitudinal trajectory analysis, sibling design, negative controls, and instrumental variable analyses, may reduce biases
目的:尽管建议孕妇禁酒,但许多孕妇还是会接触到酒精。关于中低度产前酒精暴露(PAE)和神经发育结果影响的观察性研究得出的结果并不一致,一些研究发现不良神经行为和认知结果的风险增加,而另一些研究则发现相同结果的风险没有变化或降低。本叙事性综述旨在总结这些不一致之处,并运用方法论框架来讨论不同参数是如何影响研究结果的。作者还就如何推进该领域的未来研究提出了建议:检索了 PubMed、Web of Science 和 Embase 数据库以及部分系统综述和荟萃分析的参考文献列表。使用的检索词为(婴儿或儿童或儿童或青少年或后代)和(低度或轻度或温和或中度或中低度)和(饮酒或酒精或饮料)和(妊娠或产前或胎儿)和(神经发育或行为或心理或认知或发育)而非(小鼠或大鼠或鱼或动物)而非(荟萃分析或综述)。经同行评审的原创性研究如果分析了被定义和定性为低/轻度或中度 PAE 的暴露与后代神经发育结果之间的关联,则将其纳入研究范围。动物研究、未提供明确PAE分类切点的研究、缺乏禁欲对照组的研究以及未提供经多变量调整的关联测量的研究均被排除在外:检索发现了 2422 篇论文,其中 36 篇符合资格标准。这些研究在九个国家进行,包含的样本从大约 500 到 40,000 名参与者不等。对婴儿期至 19 岁期间的认知、学业、社会情感和行为结果进行了评估:按地理区域、暴露定义或神经发育结果对所选文章的研究结果进行总结后发现,在中低 PAE 与后代结果之间没有出现一致的观察结果或模式。虽然一些研究发现中低浓度 PAE 与结果(主要是与认知相关的结果)之间存在正相关(即有益),而另一些研究则发现了负相关(即有害)(主要是行为结果),但大多数研究结果都是无效的(即显示 PAE 没有影响)。研究结果的异质性很可能是由于方法学问题造成的,包括残留混杂、效应测量修正和暴露误分类,这些问题使得研究难以综合。本文讨论了其他研究设计,包括纵向轨迹分析、同胞设计、阴性对照和工具变量分析,这些设计可能会减少偏差。迄今为止,轻度至中度 PAE 对神经发育的影响仍未得到解决;提高方法严谨性的研究将对该领域做出重要贡献。
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引用次数: 0
Identifying Prenatal Alcohol Exposure and Children Affected by It: A Review of Biomarkers and Screening Tools. 识别产前酒精暴露和受其影响的儿童:生物标志物和筛选工具的综述
IF 9.4 1区 医学 Pub Date : 2023-01-01 DOI: 10.35946/arcr.v43.1.03
Julie A Kable, Kenneth Lyons Jones

Purpose: Early identification of prenatal alcohol exposure (PAE) and of those in need of services resulting from this exposure is an important public health concern. This study reviewed the existing literature on potential biomarkers and screening tools of PAE and its impact.

Search methods: Electronic databases were searched for articles published between January 1, 1996, and November 30, 2021, using the following search terms: ("fetal alcohol" or "prenatal alcohol" or "FASD" or "alcohol-related neurodevelopmental disorder" or "ARND" or "ND-PAE") and ("screening" or "identification" or "biomarker"). Duplicate articles were electronically eliminated. Titles and abstracts were reviewed for appropriateness, and selected articles were retrieved for further analysis. Additional articles were added that were referenced in the reviewed articles or identified from expert knowledge. Information about the characteristics of the sample, the biomarker or screening tool, and the predictive validity outcome data were abstracted. A narrative analysis of the studies was then performed on the data.

Search results: A total of 3,813 articles were initially identified, and 1,215 were removed as duplicates. Of the remaining articles, 182 were identified as being within the scope of the review based on title and abstract inspection, and 181 articles were successfully retrieved. Of these, additional articles were removed because they were preclinical (3), were descriptive only (13), included only self-report of PAE (42), included only mean group comparison (17), were additional duplicates (2), focused on cost analysis (9), missed predictive validity data (24), or for other reasons (23). The remaining articles (n = 48) were abstracted. An additional 13 manuscripts were identified from these articles, and two more from expert knowledge. A total of 63 articles contributed to the review.

Discussion and conclusions: Biomarkers and screening tools of PAE and its impact fall short of ideal predictive validity characteristics. Higher specificity than sensitivity was found for many of the biomarkers and screening tools used to identify PAE and its impact, suggesting that current methods continue to under-identify the full range of individuals impacted by PAE. Exceptions to this were found in recent investigations using microRNAs related to growth and vascular development, proteomic changes associated with PAE, and combinations of markers estimating levels of various cytokines. Replications of these findings are needed across other samples to confirm the limited data available. Future research on biomarkers and screening tools should attend to feasibility and scalability of implementation. This article also recommends a systematic process of evaluation to improve early identification of individuals impacted by PAE so that harm reduction and habilitative care efforts can be implemente

目的:早期识别产前酒精暴露(PAE)和因这种暴露而需要服务的人是一个重要的公共卫生问题。本研究综述了PAE潜在的生物标志物和筛选工具及其影响的现有文献。检索方法:在电子数据库中检索1996年1月1日至2021年11月30日之间发表的文章,使用以下检索词:(“胎儿酒精”或“产前酒精”或“FASD”或“酒精相关神经发育障碍”或“ARND”或“ND-PAE”)和(“筛选”或“鉴定”或“生物标志物”)。重复的文章以电子方式删除。审查标题和摘要的适当性,并检索选定的文章作进一步分析。在评审文章中引用或从专家知识中确定的其他文章被添加。提取有关样本特征、生物标志物或筛选工具以及预测有效性结果数据的信息。然后对数据进行研究的叙述性分析。搜索结果:最初总共确定了3,813篇文章,其中1,215篇被删除为重复。在剩余的文章中,通过标题和摘要检查,182篇文章被确定在审查范围内,181篇文章被成功检索。其中,额外的文章被删除,因为它们是临床前的(3),仅描述性的(13),仅包括PAE的自我报告(42),仅包括平均组比较(17),额外的重复(2),关注成本分析(9),错过预测效度数据(24),或其他原因(23)。对其余48篇文献进行摘要。从这些文章中确定了另外13份手稿,另外两份来自专家知识。共有63篇文章参与了本次综述。讨论与结论:PAE的生物标志物和筛选工具及其影响缺乏理想的预测效度特征。许多用于识别PAE及其影响的生物标志物和筛选工具的特异性高于敏感性,这表明目前的方法仍然不能充分识别受PAE影响的所有个体。在最近的研究中发现了例外,这些研究使用了与生长和血管发育相关的microrna,与PAE相关的蛋白质组学变化,以及估计各种细胞因子水平的标记组合。需要在其他样本中重复这些发现,以确认有限的可用数据。未来对生物标志物和筛选工具的研究应关注实施的可行性和可扩展性。本文还建议一个系统的评估过程,以提高早期识别受PAE影响的个人,以便实施减少伤害和康复护理工作。
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引用次数: 1
Reducing Prenatal Alcohol Exposure and the Incidence of FASD: Is the Past Prologue? 减少产前酒精暴露和FASD的发生率:是过去的序幕吗?
IF 9.4 1区 医学 Pub Date : 2023-01-01 DOI: 10.35946/arcr.v43.1.02
Grace Chang

Purpose: This narrative review summarizes and synthesizes the clinical trials and randomized clinical trials that evaluated selected and targeted approaches to reducing preconception and prenatal alcohol exposure (PAE) and alcohol-exposed pregnancy (AEP) since 2011.

Search methods: A professional hospital librarian completed the primary search using strategies specified within this review, resulting in 94 records returned in PubMed, Ovid MEDLINE, Clinical Key, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. The author completed two supplementary literature searches.

Search results: From the total of 238 records returned from the three searches, 217 records were eliminated. Elimination reasons included other medical problem (119); duplicate entry (34); no content/results (23); secondary analysis (16); focus on effects of PAE (9); treatment of childhood fetal alcohol spectrum disorders (FASD) (6); maternal risk factors (3); and other (7). The remaining 21 studies were included with four overarching themes: (1) case management efforts (n = 4); (2) preconception efforts to reduce AEP (n = 5); (3) motivational interviewing and screening, brief intervention, and referral to treatment (n = 2); and (4) use of technology to deliver the intervention (n = 10).

Discussion and conclusions: Case management and home visits did not appear to have strong current empirical support. Study limitations included small sample sizes and no comparison groups, whereas larger efforts did not demonstrate definitive advantages to justify this intensive approach. The studies of preconception efforts, all based on the Project CHOICES approach, had similar outcomes, with the reduction in AEP risk largely due to improved contraception in women of childbearing age who were sexually active and drank alcohol but were not pregnant. It is unknown whether these women refrained from alcohol use when they became pregnant. Two studies of motivational interviewing to reduce prenatal alcohol use did not demonstrate the efficacy of the intervention. Both were small, with less than 200 pregnant women combined; moreover, the study samples had low baseline levels of alcohol use, allowing little opportunity for improvement. Finally, studies evaluating the impact of technological approaches to reducing AEP were reviewed. These exploratory investigations had small sample sizes and provided preliminary evaluations of techniques such as text messages, telephone contact, computer-based screening, and motivational interviewing. The potentially promising findings may inform future research and clinical efforts. Future directions may include research to address the limitations of the evidence to date and should reflect the complexities of FASD that include the biological and social context associated with prenatal alcohol use.

目的:本综述总结和综合了自2011年以来评估减少孕前和产前酒精暴露(PAE)和酒精暴露妊娠(AEP)的选择性和针对性方法的临床试验和随机临床试验。检索方法:一位专业的医院图书管理员使用本综述中指定的策略完成了初步检索,在PubMed、Ovid MEDLINE、Clinical Key、世界卫生组织国际临床试验注册平台和ClinicalTrials.gov中检索到94条记录。作者完成了两次补充文献检索。搜索结果:从三个搜索返回的总计238条记录中,删除了217条记录。排除原因包括其他医疗问题(119);重复条目(34);无内容/结果(23);二次分析(16);关注PAE的作用(9);治疗儿童胎儿酒精谱系障碍(FASD) (6);产妇危险因素(3);其余21项研究包括四个总体主题:(1)病例管理工作(n = 4);(2)概念前努力降低AEP (n = 5);(3)动机性访谈与筛查、简短干预和转诊治疗(n = 2);(4)使用技术来提供干预(n = 10)。讨论和结论:病例管理和家访似乎没有强有力的实证支持。研究的局限性包括样本量小,没有对照组,而更大的努力并没有显示出明确的优势来证明这种强化方法的合理性。对孕前努力的研究,都基于项目选择方法,得出了类似的结果,AEP风险的降低主要是由于性活跃、饮酒但未怀孕的育龄妇女的避孕措施得到改善。目前尚不清楚这些妇女在怀孕后是否戒酒。两项旨在减少产前酒精使用的动机性访谈研究并未证明干预的有效性。这两家机构的规模都很小,总共不到200名孕妇;此外,研究样本的酒精使用基线水平较低,几乎没有改善的机会。最后,对评价技术途径对降低AEP影响的研究进行了综述。这些探索性调查样本量较小,并提供了诸如短信、电话联系、基于计算机的筛选和动机访谈等技术的初步评估。这些潜在的有希望的发现可能为未来的研究和临床工作提供信息。未来的方向可能包括研究,以解决迄今为止证据的局限性,并应反映FASD的复杂性,包括与产前酒精使用相关的生物学和社会背景。
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引用次数: 1
Simultaneous Alcohol and Marijuana Use Among Young Adults: A Scoping Review of Prevalence, Patterns, Psychosocial Correlates, and Consequences. 青少年同时使用酒精和大麻:关于流行率、模式、社会心理相关因素及后果的范围综述。
IF 6.8 1区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2022-04-28 eCollection Date: 2022-01-01 DOI: 10.35946/arcr.v42.1.08
Christine M Lee, Brian H Calhoun, Devon Alisa Abdallah, Jessica A Blayney, Nicole R Schultz, Meg Brunner, Megan E Patrick
<p><strong>Background: </strong>Alcohol and marijuana are commonly used by young adults, and use of both substances, particularly at the same time, is prevalent among this population. Understanding the prevalence, patterns, correlates, and consequences of simultaneous alcohol and marijuana (SAM) use is important to inform interventions. However, this literature is complicated by myriad terms used to describe SAM use, including use with overlapping effects and same-day co-use.</p><p><strong>Objectives: </strong>This scoping review identifies and describes the peer-reviewed literature focused on SAM use by young adults and distinguishes simultaneous use from same-day co-use of alcohol and marijuana. This review also provides a narrative summary of the prevalence of SAM use, patterns of SAM and other substance use, psychosocial correlates, and consequences of SAM use.</p><p><strong>Eligibility criteria: </strong>This review is limited to papers written in English and published in peer-reviewed journals between January 2000 and August 2021. It includes papers assessing simultaneous use or same-day co-use of alcohol and marijuana among young adults ages 18 to 30. Review papers, qualitative interviews, experimental lab studies, policy work, toxicology or medical reports, and papers focused on neurological outcomes are excluded.</p><p><strong>Sources of evidence: </strong>PubMed, PsycINFO, and Web of Science databases were searched. Databases were selected and the search strategy developed in consultation with an information specialist.</p><p><strong>Charting methods: </strong>A data charting form was utilized to specify which information would be extracted from included papers. Eight categories of data were extracted: (1) research questions and hypotheses; (2) sample characteristics; (3) study procedures; (4) definition of SAM use; (5) prevalence of SAM use; (6) patterns of SAM and other substance use; (7) psychosocial correlates of SAM use; and (8) consequences of SAM use.</p><p><strong>Results: </strong>A total of 1,282 papers were identified through initial search terms. Through double-blind title/abstract screening and full-text review, the review was narrowed to 74 papers that met review inclusion criteria. Review of these papers demonstrated that SAM use was prevalent among young adults, particularly among those who reported heavier quantities and more frequent use of alcohol and marijuana. Enhancement-related motives for use were consistently positively associated with SAM use. SAM use was associated with greater perceived positive and negative consequences of alcohol and/or marijuana use. Inconsistencies in prevalence, patterns, correlates, and consequences were found between studies, which may be due to large variations in measurement of SAM use, populations studied, methodological design (e.g., cross-sectional vs. intensive longitudinal), and the covariates included in models.</p><p><strong>Conclusions: </strong>The literature on simultaneous
背景:酒精和大麻是青壮年的常用毒品,这两种毒品的使用,尤其是同时使用,在这一人群中非常普遍。了解同时使用酒精和大麻(SAM)的流行程度、模式、相关性和后果对于提供干预信息非常重要。然而,由于描述同时使用酒精和大麻(SAM)的术语繁多,包括具有重叠效果的使用和同一天同时使用,因此这方面的文献比较复杂:本范围界定综述确定并描述了同行评议的文献,这些文献主要关注青壮年使用 SAM 的情况,并对同时使用酒精和大麻与同一天共同使用酒精和大麻进行了区分。本综述还对吸食苯丙胺类兴奋剂的流行率、苯丙胺类兴奋剂和其他药物的使用模式、社会心理相关因素以及吸食苯丙胺类兴奋剂的后果进行了叙述性总结:本综述仅限于 2000 年 1 月至 2021 年 8 月间在同行评审期刊上发表的英文论文。其中包括评估 18 至 30 岁年轻人同时或在同一天共同使用酒精和大麻的论文。不包括评论性论文、定性访谈、实验性实验室研究、政策工作、毒理学或医学报告,以及关注神经系统结果的论文:对 PubMed、PsycINFO 和 Web of Science 数据库进行了检索。数据库的选择和搜索策略的制定均咨询了信息专家:使用数据图表表来说明将从收录的论文中提取哪些信息。共提取了八类数据:(1) 研究问题和假设;(2) 样本特征;(3) 研究程序;(4) SAM 使用的定义;(5) SAM 使用的流行程度;(6) SAM 和其他物质使用的模式;(7) SAM 使用的社会心理相关因素;以及 (8) SAM 使用的后果:通过最初的搜索条件,共找到 1,282 篇论文。通过双盲标题/摘要筛选和全文审查,审查范围缩小到 74 篇符合审查纳入标准的论文。对这些论文的审查表明,吸食苯丙胺类兴奋剂在年轻人中很普遍,尤其是在那些报告称饮酒和吸食大麻的数量更多和频率更高的年轻人中。与增强相关的使用动机一直与吸食苯丙胺类兴奋剂呈正相关。苯丙胺类兴奋剂的使用与对酒精和/或大麻使用的积极和消极后果的感知有关。不同研究之间在流行率、模式、相关性和后果方面存在不一致,这可能是由于对 SAM 使用的测量、研究人群、方法设计(如横断面与密集纵向)以及模型中包含的协变量存在很大差异:关于同时使用和当天共同使用酒精和大麻的文献迅速增加。在收录的 74 篇论文(61 篇关于同时使用酒精和大麻;13 篇关于同一天同时使用酒精和大麻)中,有 60 篇(47 篇关于同时使用酒精和大麻;13 篇关于同一天同时使用酒精和大麻)是在过去 5 年内发表的。为了了解潜在的干预目标,今后的研究需要重点关注吸食苯丙胺类兴奋剂如何带来急性风险,而不仅仅是与单独饮酒和吸食大麻相关的风险。
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引用次数: 0
Alcohol and the Adolescent Brain: What We've Learned and Where the Data Are Taking Us. 酒精与青少年大脑:我们学到了什么以及数据将把我们带向何方》(What We've Learned and Where the Data Are Taking Us)。
IF 6.8 1区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2022-04-07 eCollection Date: 2022-01-01 DOI: 10.35946/arcr.v42.1.07
Susan F Tapert, Sonja Eberson-Shumate

This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world's largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, "Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research," devoted to key topics within the field of alcohol research. This article is based on Dr. Tapert's presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift.

本文是美国国家酒精滥用和酒精中毒研究所(NIAAA)成立 50 周年纪念论文集的一部分。NIAAA 成立于 1970 年,最初隶属于美国国立精神卫生研究所,后来成为美国国立卫生研究院的一个独立研究所,如今是世界上最大的酒精研究资助机构。除了自己的校内研究项目外,NIAAA 还支持各种创新性的基础、转化和临床研究,以促进酒精使用障碍和酒精相关问题的诊断、预防和治疗。为庆祝周年纪念,NIAAA 举办了为期两天的研讨会,主题为 "酒精横跨生命周期:循证诊断、预防和治疗研究 50 年",专门讨论酒精研究领域的关键议题。本文根据塔佩特博士在此次活动中的发言整理而成。NIAAA 主任 George F. Koob 博士担任该论文集的编辑。
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引用次数: 0
Patterns of Cannabis and Alcohol Co-Use: Substitution Versus Complementary Effects. 大麻与酒精共用模式:替代效应与互补效应。
IF 6.8 1区 医学 Q1 SUBSTANCE ABUSE Pub Date : 2022-02-10 eCollection Date: 2022-01-01 DOI: 10.35946/arcr.v42.1.04
Rachel L Gunn, Elizabeth R Aston, Jane Metrik

Purpose: The purpose of this review is to discuss the literature regarding the concurrent use (co-use) of alcohol and cannabis and competing hypotheses as to whether cannabis acts as a substitute for (i.e., replacing the effects of alcohol, resulting in decreased use) or a complement to (i.e., used to enhance the effects of alcohol, resulting in increased use) alcohol. The impact of cannabis use on alcohol-related outcomes has received increased attention in the wake of ongoing legalization of cannabis for both medical and recreational purposes. Evidence for both hypotheses exists in the literature across a broad range of data collection methods and samples and is carefully reviewed here. In addition, various mechanisms by which cannabis may act as an alcohol substitute or complement are explored in depth with the goal of better understanding equivocal findings.

Search methods: This review includes articles that were identified from a search for studies on alcohol and cannabis co-use, with a specific focus on studies exploring complementary versus substitution aspects of co-use. Search terms were included in Google Scholar, PsycINFO, MEDLINE, and Web of Science. Eligible studies were those that measured alcohol and cannabis co-use in human samples in laboratory, survey, or ecological momentary assessment studies, or that directly referenced substitution or complementary patterns of use.

Search results: Search results returned 650 articles, with 95 meeting inclusion criteria.

Discussion and conclusions: Results of this review reveal compelling evidence for both substitution and complementary effects, suggesting nuanced yet significant distinctions across different populations examined in these studies. Several mechanisms for the impact of cannabis use on alcohol-related outcomes are identified, including patterns and context of co-use, timing and order of use, cannabinoid formulation, pharmacokinetic interactions, and user characteristics (including diagnostic status), all of which may influence substitution versus complementary effects. This review will inform future research studies examining this topic in both clinical and community samples and aid in the development of treatment and prevention efforts targeting those populations most vulnerable to negative consequences of co-use. Finally, this review highlights the need for additional research in more diverse samples and the use of mixed-methods designs to examine both pharmacological and contextual influences on co-use.

目的:本综述旨在讨论有关同时使用(共同使用)酒精和大麻的文献,以及关于大麻是作为酒精的替代品(即取代酒精的作用,导致使用减少)还是作为酒精的补充品(即用于增强酒精的作用,导致使用增加)的相互竞争的假设。随着用于医疗和娱乐目的的大麻不断合法化,大麻使用对酒精相关结果的影响受到越来越多的关注。关于这两种假设的证据存在于各种数据收集方法和样本的文献中,本文将对其进行仔细回顾。此外,还深入探讨了大麻可能作为酒精替代品或补充品的各种机制,目的是更好地理解模棱两可的研究结果:本综述包括通过搜索有关酒精和大麻共同使用的研究而确定的文章,特别侧重于探讨共同使用的互补性与替代性方面的研究。搜索关键词包括 Google Scholar、PsycINFO、MEDLINE 和 Web of Science。符合条件的研究是那些在实验室、调查或生态学瞬间评估研究中对人类样本中的酒精和大麻共同使用情况进行测量的研究,或者那些直接提及替代或互补使用模式的研究:搜索结果共检索到 650 篇文章,其中 95 篇符合纳入标准:本综述的结果揭示了替代效应和互补效应的有力证据,表明这些研究对不同人群进行了细致入微但意义重大的区分。确定了使用大麻对酒精相关结果产生影响的几种机制,包括共同使用的模式和背景、使用的时间和顺序、大麻素配方、药代动力学相互作用以及使用者特征(包括诊断状态),所有这些都可能影响替代效应和互补效应。本综述将为今后在临床和社区样本中对这一主题进行的研究提供信息,并有助于针对最容易受到共同使用负面影响的人群开展治疗和预防工作。最后,本综述强调有必要在更多样化的样本中开展更多研究,并使用混合方法设计来检查药物和环境对共同使用的影响。
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引用次数: 0
Fetal Alcohol Spectrum Disorders: Awareness to Insight in Just 50 Years. 胎儿酒精谱系障碍:从意识到洞察仅仅50年。
IF 9.4 1区 医学 Pub Date : 2022-01-01 DOI: 10.35946/arcr.v42.1.05
Michael E Charness

This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world's largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, "Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research," devoted to key topics within the field of alcohol research. This article is based on Dr. Charness' presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift.

本文是纪念美国国家酒精滥用和酒精中毒研究所(NIAAA)成立50周年纪念活动的一部分。NIAAA成立于1970年,最初是国家精神卫生研究所的一部分,后来成为国家卫生研究所的一个独立研究所,今天是世界上最大的酒精研究资助机构。除了自己的内部研究项目外,NIAAA还支持所有创新的基础、转化和临床研究,以推进酒精使用障碍和酒精相关问题的诊断、预防和治疗。为了庆祝周年纪念日,NIAAA举办了为期两天的研讨会,“酒精在生命中的作用:50年的循证诊断、预防和治疗研究”,致力于酒精研究领域的关键话题。这篇文章是根据Charness博士在会议上的发言写成的。NIAAA主任George F. Koob博士担任该杂志的编辑。
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引用次数: 3
Relationships of Cannabis Policy Liberalization With Alcohol Use and Co-Use With Cannabis: A Narrative Review. 大麻政策自由化与酒精使用和与大麻共同使用的关系:叙述审查。
IF 9.4 1区 医学 Pub Date : 2022-01-01 DOI: 10.35946/arcr.v42.1.06
Rosalie Liccardo Pacula, Rosanna Smart, Marlene C Lira, Seema Choksy Pessar, Jason G Blanchette, Timothy S Naimi

Purpose: The liberalization of cannabis policies has the potential to affect the use of other substances and the harms from using them, particularly alcohol. Although a previous review of this literature found conflicting results regarding the relationship between cannabis policy and alcohol-related outcomes, cannabis policies have continued to evolve rapidly in the years since that review.

Search methods: The authors conducted a narrative review of studies published between January 1, 2015, and December 31, 2020, that assessed the effects of cannabis policies on the use of alcohol in the United States or Canada.

Search results: The initial search identified 3,446 unique monographs. Of these, 23 met all inclusion criteria and were included in the review, and five captured simultaneous or concurrent use of alcohol and cannabis.

Discussion and conclusions: Associations between cannabis policy liberalization and alcohol use, alcohol-related outcomes, and the co-use of alcohol and cannabis were inconclusive, with studies finding positive associations, no associations, and negative associations. Although several studies found that cannabis policy liberalization was associated with decreases in alcohol use measures, these same studies showed no impact of the cannabis policy on cannabis use itself. The lack of a consistent association was robust to subject age, outcome measure (e.g., use, medical utilization, driving), and type of cannabis policy; however, this may be due to the small number of studies for each type of outcome. This paper discusses several notable limitations of the evidence base and offers suggestions for improving consistency and comparability of research going forward, including a stronger classification of cannabis policy, inclusion of measures of the alcohol policy environment, verification of the impact of cannabis policy on cannabis use, and consideration of mediation effects.

目的:大麻政策的自由化有可能影响到其他物质的使用及其危害,特别是酒精。尽管先前对这一文献的审查发现,关于大麻政策与酒精相关后果之间关系的结果相互矛盾,但自那次审查以来,大麻政策继续迅速发展。检索方法:作者对2015年1月1日至2020年12月31日期间发表的研究进行了叙述性回顾,这些研究评估了大麻政策对美国或加拿大酒精使用的影响。搜索结果:最初的搜索确定了3,446个独特的专著。其中23人符合所有纳入标准并列入审查,5人同时或同时使用酒精和大麻。讨论和结论:大麻政策自由化与酒精使用、酒精相关后果以及酒精和大麻共同使用之间的关联尚无定论,研究发现有积极关联、无关联和消极关联。虽然几项研究发现,大麻政策自由化与减少酒精使用措施有关,但这些研究表明,大麻政策对大麻使用本身没有影响。缺乏一致的关联与受试者年龄、结果测量(例如,使用、医疗利用、驾驶)和大麻政策类型有关;然而,这可能是由于每种结果的研究数量较少。本文讨论了证据基础的几个显著局限性,并为今后提高研究的一致性和可比性提出了建议,包括对大麻政策进行更严格的分类,纳入酒精政策环境措施,验证大麻政策对大麻使用的影响,以及考虑中介效应。
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引用次数: 11
The Synaptic Interactions of Alcohol and the Endogenous Cannabinoid System. 酒精与内源性大麻素系统的突触相互作用。
IF 9.4 1区 医学 Pub Date : 2022-01-01 DOI: 10.35946/arcr.v42.1.03
Sarah A Wolfe, Valentina Vozella, Marisa Roberto

Purpose: A growing body of evidence has implicated the endocannabinoid (eCB) system in the acute, chronic, and withdrawal effects of alcohol/ethanol on synaptic function. These eCB-mediated synaptic effects may contribute to the development of alcohol use disorder (AUD). Alcohol exposure causes neurobiological alterations similar to those elicited by chronic cannabinoid (CB) exposure. Like alcohol, cannabinoids alter many central processes, such as cognition, locomotion, synaptic transmission, and neurotransmitter release. There is a strong need to elucidate the effects of ethanol on the eCB system in different brain regions to understand the role of eCB signaling in AUD.

Search methods: For the scope of this review, preclinical studies were identified through queries of the PubMed database.

Search results: This search yielded 459 articles. Clinical studies and papers irrelevant to the topic of this review were excluded.

Discussion and conclusions: The endocannabinoid system includes, but is not limited to, cannabinoid receptors 1 (CB1), among the most abundantly expressed neuronal receptors in the brain; cannabinoid receptors 2 (CB2); and endogenously formed CB1 ligands, including arachidonoylethanolamide (AEA; anandamide), and 2-arachidonoylglycerol (2-AG). The development of specific CB1 agonists, such as WIN 55,212-2 (WIN), and antagonists, such as SR 141716A (rimonabant), provide powerful pharmacological tools for eCB research. Alcohol exposure has brain region-specific effects on the eCB system, including altering the synthesis of endocannabinoids (e.g., AEA, 2-AG), the synthesis of their precursors, and the density and coupling efficacy of CB1. These alcohol-induced alterations of the eCB system have subsequent effects on synaptic function including neuronal excitability and postsynaptic conductance. This review will provide a comprehensive evaluation of the current literature on the synaptic interactions of alcohol exposure and eCB signaling systems, with an emphasis on molecular and physiological synaptic effects of alcohol on the eCB system. A limited volume of studies has focused on the underlying interactions of alcohol and the eCB system at the synaptic level in the brain. Thus, the data on synaptic interactions are sparse, and future research addressing these interactions is much needed.

目的:越来越多的证据表明,内源性大麻素(eCB)系统参与了酒精/乙醇对突触功能的急性、慢性和戒断效应。这些ecb介导的突触效应可能有助于酒精使用障碍(AUD)的发展。酒精暴露引起的神经生物学改变类似于慢性大麻素(CB)暴露引起的改变。像酒精一样,大麻素改变了许多中枢过程,如认知、运动、突触传递和神经递质释放。为了理解eCB信号在AUD中的作用,有必要阐明乙醇对不同脑区eCB系统的影响。检索方法:对于本综述的范围,通过PubMed数据库查询确定临床前研究。搜索结果:这次搜索产生了459篇文章。与本综述主题无关的临床研究和论文被排除在外。讨论和结论:内源性大麻素系统包括但不限于大麻素受体1 (CB1),它是大脑中表达最丰富的神经元受体之一;大麻素受体2 (CB2);和内源性形成的CB1配体,包括花生四烯乙醇酰胺(AEA);anandamide)和2-花生四烯醇甘油(2-AG)。开发特异性CB1激动剂,如WIN 55,212-2 (WIN)和拮抗剂,如SR 141716A(利莫那班),为eCB研究提供了强大的药理学工具。酒精暴露对eCB系统具有脑区域特异性影响,包括改变内源性大麻素(例如,AEA, 2-AG)的合成,其前体的合成以及CB1的密度和偶联效力。这些酒精诱导的eCB系统的改变对突触功能有后续影响,包括神经元兴奋性和突触后传导。这篇综述将对目前关于酒精暴露和eCB信号系统突触相互作用的文献进行全面评估,重点是酒精对eCB系统的分子和生理突触效应。有限数量的研究集中在大脑突触水平上酒精和eCB系统的潜在相互作用上。因此,突触相互作用的数据是稀疏的,未来的研究解决这些相互作用是非常必要的。
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引用次数: 10
Alcohol's Negative Emotional Side: The Role of Stress Neurobiology in Alcohol Use Disorder. 酒精的消极情绪面:应激神经生物学在酒精使用障碍中的作用。
IF 9.4 1区 医学 Pub Date : 2022-01-01 DOI: 10.35946/arcr.v42.1.12
Rajita Sinha

This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world's largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, "Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research," devoted to key topics within the field of alcohol research. This article is based on Dr. Sinha's presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift.

本文是纪念美国国家酒精滥用和酒精中毒研究所(NIAAA)成立50周年纪念活动的一部分。NIAAA成立于1970年,最初是国家精神卫生研究所的一部分,后来成为国家卫生研究所的一个独立研究所,今天是世界上最大的酒精研究资助机构。除了自己的内部研究项目外,NIAAA还支持所有创新的基础、转化和临床研究,以推进酒精使用障碍和酒精相关问题的诊断、预防和治疗。为了庆祝周年纪念日,NIAAA举办了为期两天的研讨会,“酒精在生命中的作用:50年的循证诊断、预防和治疗研究”,致力于酒精研究领域的关键话题。这篇文章是根据Sinha博士在会议上的发言写成的。NIAAA主任George F. Koob博士担任该杂志的编辑。
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引用次数: 3
期刊
Alcohol Research : Current Reviews
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