Clinical characteristics of alcohol combined with other substance use disorders in an American Indian community sample

HIGHLIGHTS

• Multi-substance use disorder was more prevalent than single use disorder.
• Alcohol was the most common drug followed by stimulants and cannabis.
• Multi-substance use disorder was more severe and had greater co-morbidity.

BACKGROUND:

Alcohol and other substance use disorders (SUD) pose major problems of morbidity and mortality in some American Indian communities, but little is known about the clinical characteristics, risk factors, and consequences of combined alcohol and other substance use disorders (multi-substance use disorder, MSUD) in those communities.

METHODS:

Using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), in a community sample of 876 American Indians, the clinical characteristics of lifetime DSM-5 moderate or severe alcohol use disorder alone (AUD alone) (n=146) and MSUD (defined as alcohol and ≥1 other SUD) (n=284) were evaluated and compared to 347 participants with no lifetime SUD (no SUD).

RESULTS:

The majority (57%) of participants with a SUD had multi-substance use disorder and 94% of those were with AUD. Stimulants (cocaine and/or amphetamine) and/or cannabis were the most common other SUDs. Participants with AUD alone were more likely to be male and have an earlier age of first alcohol intoxication than those with no SUD. Those with MSUD were more likely to have dropped out of high school, have antisocial personality disorder (ASPD) or conduct disorder (CD), have earlier ages of first alcohol intoxication and first use of cannabis and stimulants, an earlier age of onset of AUD, and more of several AUD symptoms than those with AUD alone, but the same temporal course and time to remission of AUD.

CONCLUSIONS:

MSUD is prevalent in this sample, is associated with multiple comorbidities and denotes a more severe alcohol syndrome than AUD alone.

Purchase full article at:   http://goo.gl/ma2Rmk

By:  Gilder DA1, Stouffer GM1, Lau P1, Ehlers CL2.

• 1Molecular and Cellular Neuroscience Department, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
• 2Molecular and Cellular Neuroscience Department, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA. Electronic address: cindye@scripps.edu.
• Drug Alcohol Depend. 2016 Apr 1;161:222-9. doi: 10.1016/j.drugalcdep.2016.02.006. Epub 2016 Feb 8. 

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Social-Context Factors, Refusal Self-Efficacy, and Alcohol Use among Female Sex Workers in China

Excessive alcohol use is considered as a health risk behavior that may produce negative health outcomes. Examining predictors of alcohol use in a social or individual context can advance understanding of why people indulge in alcohol use. 

Our research on female sex workers (FSWs) examined associations among several social-context factors (alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence), refusal self-efficacy, and alcohol use. 

Seven hundred FSWs were recruited from two cities in Southern China. Structural equation modeling (SEM) was used to analyze the direct effects of alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence on FSWs’ alcohol use. In addition, the mediation effects of refusal self-efficacy were also examined in the SEM model. 

Results showed that alcohol use by family members and alcohol use by peers significantly predicted FSWs’ alcohol use; the prediction effect of alcohol use by peers on FSWs’ alcohol use was stronger than that of alcohol use by family members; client-perpetrated pressure or violence directly predicted FSWs’ alcohol use and indirectly influenced FSWs’ alcohol use through refusal self-efficacy; refusal self-efficacy directly predicted FSWs’ alcohol use. Administrators of effective intervention programs focused on alcohol use in China should adopt a multilevel approach to reduce negative social influences, particularly the influence from peer, and sex work establishments on FSWs’ alcohol use. 

Meanwhile, training to improve refusal self-efficacy should also be included in intervention programs to reduce FSWs’ alcohol use.

Below:  Associations among social-context factors, refusal self-efficacy and alcohol use of FSWs (N=688)

Full article at: http://goo.gl/kwYF36

By:  Shaobing Su,1 Xiaoming Li,2,* Danhua Lin,3 Chen Zhang,4 Shan Qiao,2 and Yeujiao Zhou5

¹ Eliot-Pearson Department of Child and Human Development, Tufts University, Medford, MA 02155, USA.

² Carman and Ann Adams Department of Pediatrics Prevention Research Center, Wayne State University School of Medicine, Detroit, MI 48201, USA

³ Institute of Developmental Psychology, Beijing Normal University, Beijing, 100875, China

⁴ Division of Epidemiology, Vanderbilt Institute of Global Health, Nashville, TN, USA

⁵ Center for Disease Control and Prevention, Guangxi, China.

Psychol Health Med. 2015; 20(8): 889–895.

Published online 2014 Oct 15. doi:  10.1080/13548506.2014.966727

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Comparisons of Cocaine-Only, Opioid-Only, and Users of Both Substances in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND:

Cocaine and opioid co-use is a notable public health concern, but little is known about correlates of this behavior. Most prior findings come from treatment samples and concern cocaine and heroin. Findings from a nationally representative sample involving primarily prescription opioid misuse would expand knowledge.

METHODS:

Past-12-month cocaine and/or opioid users in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) formed the sample (N = 839). Cocaine-only, opioid-only, and cocaine/opioid co-users were compared regarding sociodemographics, other substance involvement, psychiatric, and medical conditions/events.

RESULTS:

Opioid-only users were the largest group (n = 622), followed by cocaine-only (n = 144) and co-users (n = 73). The vast majority of opioid misuse was of prescription opioids (1.4% with past-12-month use of heroin). Notably, co-users did not differ from single drug users in frequency of use of either drug. Co-users did not have significantly greater incidence of any psychiatric conditions, medial conditions, or events. In preliminary analyses, co-users were more likely than either single use group to report several classes of other drug use. However, for most comparisons, opioid use did not add substantial risk beyond cocaine use. Differences on multiple sociodemographic variables suggested opioid-only users were at lowest risk of negative outcomes. These results may relate to a finding that opioid-only users were less likely to have sought treatment. 

CONCLUSIONS: 
This sample of past-12-month cocaine and/or opioid users had greater involvement with other substances, more psychiatric and medical conditions compared to the general population. Co-users had greater involvement with other substances than opioid-only users in particular.

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By:  Leeman RF1, Sun Q2, Bogart D3, Beseler CL4, Sofuoglu M1.

• 1 Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.
• 2 Ecology and Evolutionary Biology, Yale University , New Haven , Connecticut , USA.
• 3 Psychology, Yale University , New Haven , Connecticut , USA.
• 4 Psychology, Colorado State University , Fort Collins , Colorado , USA.
• Subst Use Misuse. 2016 Mar 22:1-12. 

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Brief Motivational Intervention to Reduce Alcohol and HIV/Sexual Risk Behavior in Emergency Department Patients

OBJECTIVE:

Given the prevalence of co-occurring risky sexual behavior and drinking among emergency department (ED) patients, we developed a motivational intervention (MI) to address both behaviors. This study tested efficacy of a single-session MI compared to brief advice (BA) for reducing heavy drinking and condomless sex in adult ED patients screening positive for both.

METHOD:

We randomized 372 patients to MI (n = 184) or BA (n = 188). Alcohol and sex risk outcomes were assessed over 9 months.

RESULTS:

Generalized estimating equations models analyzing 327 patients with follow-up data provided strong support for efficacy of this integrated alcohol and sex-risk MI. Compared to BA, and after controlling for baseline covariates, those in MI reported significantly fewer heavy drinking days, drinks per week, and were less likely to engage in excessive drinking over follow-up (all ps < .05). MI was also favored over BA for reducing sex risk. Compared to BA, those in MI reported significantly fewer days on which they engaged in condomless sex with casual partners, had lower odds of reporting any condomless sex with a casual partner, and reported fewer days of sex under the influence of alcohol/other drugs (all ps < .05).

CONCLUSION:

This innovative MI was acceptable, feasible, and successfully delivered in 2 community hospitals and thus shows great promise for scalability and dissemination into complex health settings where newly insured at-risk individuals are likely to seek care. 

Purchase full article at:   http://goo.gl/ai3Yxk

By:  Monti PM, Mastroleo NR, Barnett NP, Colby SM, Kahler CW, Operario D.

J Consult Clin Psychol. 2016 Mar 17.

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Poorly Controlled HIV Infection: An Independent Risk Factor for Liver Fibrosis

BACKGROUND:

Liver disease is a major cause of mortality among HIV-infected persons. There is limited information about the extent to which HIV disease severity impacts liver disease progression.

METHODS:

We determined the incidence and predictors of advanced hepatic fibrosis measured by the FIB-4 index (≥3.25) in a large diverse population of HIV-infected patients without significant liver disease at baseline (FIB-4<1.45) in care between January 2000 and March 2014. We used Cox proportional hazards analysis to examine factors associated with progression to FIB-4 ≥3.25.

RESULTS:

Among 14,198 HIV-infected patients, HCV coinfection (adjusted hazard ratio [aHR] 1.9, 95% CI 1.6-2.1), HBV coinfection (aHR 1.5, 95% CI 1.2-1.8), alcohol use disorder (aHR 1.4, 95% CI 1.2-1.6) and diabetes (aHR 1.9, 95% CI 1.6-2.3) were associated with progression to advanced fibrosis in multivariable analysis. In addition, patients at each lower level of time-varying CD4 count had a significantly greater risk of progression, with a nearly 7-fold higher risk in those with CD4 <100 cells/mm (aHR 6.9, 95% CI 5.8-8.3) compared with CD4 ≥500 cells/mm. An increasing gradient of risk was also observed among patients with higher time-varying HIV viral load (VL), with the greatest risk noted with VL ≥100,000 copies/ml (aHR 2.6, 95% CI 2.2-3.1) compared with VL <500 copies/ml.

CONCLUSION:

Lower CD4 count and higher HIV VL were significantly associated with progression to advanced hepatic fibrosis in a dose-dependent manner, independent of the risk associated with traditional factors: HCV or HBV coinfection, alcohol, and diabetes. Our findings suggest that early treatment of HIV infection could mitigate liver disease.

Purchase full article at:   http://goo.gl/HVfMN5

By:  Kim HN1, Nance R, Van Rompaey S, Delaney JC, Crane HM, Cachay ER, Geng E, Boswell SL, Rodriguez B, Eron J, Saag M, Moore RD, Kitahata MM.

• 1Department of Medicine, University of Washington 
• 2 Department of Epidemiology, University of Washington 
• 3 Department of Medicine, University of California San Diego 
• 4 Department of Medicine, University of California San Francisco 
• 5 Fenway Health, Boston MA 
• 6 Department of Medicine, Case Western University 
• 7 Department of Medicine, University of North Carolina Chapel Hill 
• 8 Department of Medicine, University of Alabama, Birmingham 
• 9 Department of Medicine, Johns Hopkins University.
• J Acquir Immune Defic Syndr. 2016 Mar 16. 

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Number of Drinks to "Feel a Buzz" by HIV Status and Viral Load in Men

The impact of HIV and its treatment on the effects of alcohol remain unclear. Blood alcohol concentrations have been noted to be higher in HIV infected individuals prior to antiretroviral initiation. 

Our goal was to compare number of drinks to "feel a buzz or high" among HIV infected and uninfected men, stratified by viral load (VL) suppression. Data includes 1478 HIV infected and 1170 uninfected men in the veterans aging cohort study who endorsed current drinking. 

Mean (SD) number of drinks to feel a buzz was 3.1 (1.7) overall. In multivariable analyses, HIV infected men reported a lower mean number of drinks to feel a buzz compared to uninfected men (coef = -14 for VL < 500; -34 for VL ≥ 500; p ≤ .05). Men with HIV, especially those with a detectable VL, reported fewer drinks to feel a buzz. 

Future research on the relationship between alcohol and HIV should consider the role of VL suppression.

Below:  Number of Drinks to Feel a Buzz by HIV, Viral Load, and Alcohol Use

Below: Number of Drinks to Feel a Buzz by HIV, Viral Load, and Age

Full article at:   http://goo.gl/rYu8ah

By:  Kathleen A. McGinnis,1,2 David A. Fiellin, MD,2,3,4 Janet P. Tate,2,3,4 Robert L Cook,5 R. Scott Braithwaite,6 Kendall J. Bryant,7 E. Jennifer Edelman,2,3,4 Adam J. Gordon,1,8 Kevin L. Kraemer, MD,8 Stephen Maisto,9 Amy C. Justice,2,3,4and For the Veterans Aging Cohort Study

• 1Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. kathleen.mcginnis3@va.gov.
• 2Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA. kathleen.mcginnis3@va.gov.
• 3Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
• 4Division of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
• 5Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, USA.
• 6Departments of Epidemiology and Medicine, University of Florida, Gainesville, FL, USA.
• 7Department of Population Health, New York University School of Medicine, New York, USA.
• 8National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
• 9Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
• 10Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
• 11Department of Psychology, Syracuse University, Syracuse, NY, USA.
• AIDS Behav. 2016 Mar;20(3):504-11. doi: 10.1007/s10461-015-1053-7.

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Is Treatment for Alcohol Use Disorder Associated with Reductions in Criminal Offending? A National Data Linkage Cohort Study in England

BACKGROUND:

This is the first English national study of change in criminal offending following treatment for alcohol use disorder (AUD).

METHODS:

All adults treated for AUD by all publicly funded treatment services during April 2008-March 2009 (n=53,017), with data linked to the Police National Computer (April 2006-November 2011). Pre-treatment offender sub-populations were identified by Latent Profile Analysis. The outcome measure was the count of recordable criminal offences during two-year follow-up after admission. A mixed-effects, Poisson regression modelled outcome, adjusting for demographics and clinical information, the latent classes, and treatment exposure covariates.

RESULTS:

Twenty-two percent of the cohort committed one or more offences in the two years pre-treatment (n=11,742; crude rate, 221.5 offenders per 1000). During follow-up, the number of offenders and offences fell by 23.5% and 24.0%, respectively (crude rate, 69.4 offenders per 1000). During follow-up, a lower number of offences was associated with: completing treatment (adjusted incident rate ratio [IRR] 0.82; 95% confidence interval [CI] 0.79-0.85); receiving inpatient detoxification (IRR 0.84; CI 0.80-0.89); or community pharmacological therapy (IRR 0.89; CI 0.84-0.96). Reconviction was reduced in the sub-population characterised by driving offences (n=1,140; 11.7%), but was relatively high amongst acquisitive (n=768; 58.3% reconvicted) and violent offending sub-populations (n=602; 77.6% reconvicted).

CONCLUSIONS:

Reduced offending was associated with successful completion of AUD treatment and receiving inpatient and pharmacological therapy, but not enrolment in psychological and residential interventions. Treatment services (particularly those providing psychological therapy and residential care) should be alert to offending, especially violent and acquisitive crime, and enhance crime reduction interventions.

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By:  Willey H1, Eastwood B2, Gee IL3, Marsden J4.

• 1Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom.
• 2Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London,United Kingdom.
• 3Centre for Public Health, Liverpool John Moores University, United Kingdom.
• 4Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London,United Kingdom. Electronic address: john.marsden@kcl.ac.uk. 
• Drug Alcohol Depend. 2016 Jan 29. pii: S0376-8716(16)00048-X. doi: 10.1016/j.drugalcdep.2016.01.020. 

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Understanding HIV Risk Behavior among Tuberculosis Patients with Alcohol Use Disorders in Tomsk, Russian Federation

Russian Federation’s (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. 

This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. 

Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history, age under 41, drug addiction, history of a sexually transmitted disease (STD), low social capital and heavier alcohol use were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41, incarceration history and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. 

Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed.

Below:  Substance use and HIV risk characteristics of study participants, by sex

Full article at:   http://goo.gl/B9iCmD

By:  

Ann C. Miller, Sonya S. Shin

Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America

A. Katrina Nelson, Sidney Atwood, Charmaine S. Lastimoso, Sonya S. Shin

Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America

Viktoria Livchits

Partners In Health Representative Office in Russian Federation, Moscow, Russia

Shelly F. Greenfield, Hilary S. Connery

Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA United States of America

Shelly F. Greenfield, Hilary S. Connery

Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America

Shelly F. Greenfield

Division of Women's Mental Health, McLean Hospital, Belmont, MA, United States of America

Galina Yanova, Sergei Yanov

Tomsk Oblast Tuberculosis Hospital, Tomsk, Russian Federation

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mHealth Tool for Alcohol Use Disorders among Latinos in Emergency Department

Latino drinkers experience a disparate number of negative health and social consequences. Emergency Department Alcohol Screening Brief Intervention and Referral to Treatment (ED-SBIRT) is viable and effective at reducing harmful and hazardous drinking. However, barriers (e.g. readily available language translators, provider time burden, resources) to broad implementation remain and account for a major lag in adherence to national guidelines. We describe our approach to the design of a patient-centered bilingual Web-based mobile health ED-SBIRT App that could be integrated into a clinically complex ED environment and used regularly to provide ED-SBIRT for Spanish speaking patients.

Below:  AB-CASI Language Selection Screen

Below:  AB-CASI Frequency of Drinks Screen

Below:  Architecture of ED-SBIRT Mobile App Bilingual Text-to-Speech Generation

Below:  AB-CASI Ruler Screen

Full article at:   http://goo.gl/3r2GIa

By:  Fuad Abujarad and Federico E. Vaca

Department of Emergency Medicine Yale University, School of Medicine New Haven, Connecticut

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Nalmefene for the Treatment of Alcohol Use Disorders: Recent Data & Clinical Potential

Few pharmacotherapies are available for alcoholism. Numerous studies indicate the involvement of the opioid-endorphin system in mediating the reinforcing effects of alcohol via dopaminergic neurons. The opioid antagonist naltrexone was found to be effective in alcohol treatment and the European Medicines Agency has now approved the mu-opioid antagonist und partial kappa agonist nalmefene. Areas covered: 

This article presents background information on the chemistry of nalmefene and pre-clinical and clinical findings. The three relevant Phase III studies, all of which followed a harm-reduction, "as needed" approach and found reduced alcohol consumption with nalmefene 18 (20) mg, are discussed in detail. 

Expert opinion: The integration of the "as needed" approach into conventional psychosocial alcohol therapies may be challenging but offers the opportunity to reach otherwise not treated patients. Nalmefene is the first medication to be approved specifically in this indication and seems to be most suitable for patients with alcohol misuse or a rather low physical dependence on alcohol who do not require immediate detoxification or inpatient treatment. 

Although a categorical distinction between patients who want to stop heavy drinking or drinking at all over time may be somewhat hypothetical, nalmefene offers new treatment options to patients with alcohol use disorder.

Purchase full article at:   http://goo.gl/f9ej1w

By:  Soyka M1,2.

• 1 Department of Psychiatry and Psychotherapy , Ludwig Maximilian University , Munich , Germany.
• 2 Privatklinik Meiringen , Meiringen , Switzerland.
• Expert Opin Pharmacother. 2016 Jan 25.

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Declining & Rebounding Unhealthy Alcohol Consumption During the First Year of HIV Care in Rural Uganda, Using Phosphatidylethanol to Augment Self-Report

AIMS:

We examined whether unhealthy alcohol consumption, which negatively impacts HIV outcomes, changes after HIV care entry overall and by several factors. We also compared using phosphatidylethanol (PEth, an alcohol biomarker) to augment self-report to using self-report alone.

DESIGN:

A prospective 1-year observational cohort study with quarterly visits.

SETTING:

Large rural HIV clinic in Mbarara, Uganda.

PARTICIPANTS:

A total of 208 adults (89 women and 119 men) entering HIV care, reporting any prior year alcohol consumption.

MEASUREMENTS:

Unhealthy drinking was PEth+ (≥ 50 ng/ml) or Alcohol Use Disorders Identification Test-Consumption+ (AUDIT-C+, over 3 months, women ≥ 3; men ≥ 4). We calculated adjusted odds ratios (AOR) for unhealthy drinking per month since baseline, and interactions of month since baseline with perceived health, number of HIV symptoms, antiretroviral therapy (ART), gender and self-reported prior unhealthy alcohol use.

FINDINGS:

The majority of participants (64%) were unhealthy drinkers (PEth+ or AUDIT-C+) at baseline. There was no significant trend in unhealthy drinking overall [per-month AOR: 1.01; 95% confidence interval (CI) = 0.94-1.07], while the per-month AORs were 0.91 (95% CI = 0.83-1.00) and 1.11 (95% CI = 1.01-1.22) when participants were not yet on ART and on ART, respectively (interaction P-value < 0.01). In contrast, 44% were AUDIT-C+; the per-month AORs for being AUDIT-C+ were 0.89 (95% CI = 0.85-0.95) overall, and 0.84 (95% CI = 0.78-0.91) and 0.97 (95% CI = 0.89-1.05) when participants were not on and were on ART, respectively.

CONCLUSIONS:

Unhealthy alcohol use among Ugandan adults entering HIV care declines prior to the start of anti-retroviral therapy but rebounds with time. Augmenting self-reported alcohol use with biomarkers increases the ability of current alcohol use measurements to detect unhealthy alcohol use.

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By:  Hahn JA1,2, Emenyonu NI1, Fatch R1, Muyindike WR3, Kekiibina A3, Carrico AW4, Woolf-King S1, Shiboski S2.

• 1University of California, Department of Medicine, San Francisco, CA, USA.
• 2University of California, Department of Epidemiology and Biostatistics, San Francisco, CA, USA.
• 3Mbarara University of Sciences and Technology, Faculty of Medicine, Mbarara, Uganda.
• 4University of California, Department of Community Health Systems, San Francisco, CA, USA.
• Addiction. 2016 Feb;111(2):272-9. doi: 10.1111/add.13173. Epub 2015 Nov 5. 

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