Complications of low‐dose,echo‐guided alcohol septal ablation

Background : Alcohol septal ablation (ASA) is a catheter‐based intervention that has been used as an alternative to surgical myectomy in highly symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods : This retrospective study was designed to evaluate the incidence of major complications in the mid‐term follow‐up of low‐dose (1–2.5 ml of ethanol), echo‐guided alcohol septal ablation. Results : A total of 101 consecutive patients (56 ± 15 years) with highly symptomatic HOCM were enrolled. At 6 months, there was a significant decrease in resting outflow gradient accompanied by reduction in basal septal diameter and improvement in symptoms (P < 0.01). Two patients (2%) experienced procedural ventricular tachycardias terminated by electrical cardioversion. A total of 87 patients (86%) underwent an uneventful postprocedural hospital stay. The postprocedural complete heart block occurred in 10 patients (10%), and subsequent permanent pacemaker was implanted in four cases (4%). Sustained ventricular arrhythmias requiring electrical cardioversion occurred in four patients (4%) within postprocedural hospital stay. Subsequently, ICD was not implanted in any of these cases. The patients were repeatedly examined by Holter ECG monitoring, and in the mid‐term follow‐up (6–50 months), they stayed asymptomatic and without any ventricular arrhythmias. Conclusion : This study demonstrates the same early incidence of complete heart block requiring permanent pacemaker implantation (4%) and sustained ventricular arrhythmias following low‐dose, echo‐guided ASA. © 2009 Wiley‐Liss, Inc.     

Predictors of injury‐related and non‐injury‐related mortality among veterans with alcohol use disorders

Aims To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all‐cause, injury‐related and non‐injury‐related mortality among those diagnosed with an AUD. Setting Department of Veterans Affairs, Veterans Health Administration (VHA). Participants A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 (n = 3 944 778), followed from the beginning of FY02 through the end of FY06. Measurements Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index. Findings Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury‐related (HR = 3.29) and by non‐injury‐related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury‐related than non‐injury‐related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non‐injury related compared to injury‐related mortality. Conclusions In users of a large health‐care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non‐injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non‐injury‐related death.     

The dimensionality of alcohol use disorders and alcohol consumption in a cross‐national perspective

Aims To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. Design Cross‐sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM‐IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. Setting Participants were 5195 injured and non‐injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995–2001). Findings Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear‐cut distinction between the criteria for dependence and abuse in all sites. Results from item response theory analyses showed that the current DSM‐IV criteria tap people in the middle–upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM‐IV diagnostic criteria to help tap the middle–lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. Conclusions DSM‐IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples.     

Computer‐delivered interventions for alcohol and tobacco use: a meta‐analysis

Aims To quantify the overall effectiveness of computer‐delivered interventions for alcohol and tobacco use. Methods Meta‐analysis of 42 effect sizes from randomized controlled trials, based on the responses of 10 632 individuals. Results The weighted average effect size (d) was 0.20, P < 0.001. While lower effect sizes were associated with studies addressing tobacco use (d = 0.14) this may well reflect differences in the types of outcome measure used. Effect sizes did not vary significantly as a function of treatment location, inclusion of entertaining elements, provision of normative feedback, availability of a discussion feature, number of treatment sessions, emphasis on relapse prevention, level of therapist involvement or follow‐up period. Conclusion Findings of the meta‐analysis suggest that minimal contact computer‐delivered treatments that can be accessed via the internet may represent a cost‐effective means of treating uncomplicated substance use and related problems.     

Behavioral economic analysis of cue‐elicited craving for alcohol

Aims Craving as a motivational determinant of drug use remains controversial because of ambiguous empirical findings. A behavioral economic approach may clarify the nature of craving, theorizing that subjective craving functionally reflects an acute increase in a drug's value. The current study tested this hypothesis via a multidimensional assessment of alcohol demand over the course of an alcohol cue reactivity procedure. Design One‐way within‐subjects design. Setting Human laboratory environment. Participants Heavy drinkers (n = 92) underwent exposures to neutral (water) cues followed by personalized alcohol cues. Assessments Participants were assessed for craving, alcohol demand, affect, and salivation following each exposure. Findings Alcohol versus neutral cues significantly increased craving and multiple behavioral economic measures of the relative value of alcohol, including alcohol consumption under conditions of zero cost (intensity), maximum expenditure on alcohol (O_max), persistence in drinking to higher prices (breakpoint) and proportionate price insensitivity (normalized P_max). Craving was significantly correlated with demand measures at levels ranging from 0.21–0.43. Conclusions These findings support the potential utility of a behavioral economic approach to understanding the role of environmental stimuli in alcohol‐related decision making. Specifically, they suggest that the behavioral economic indices of demand may provide complementary motivational information that is related to though not entirely redundant with measures of subjective craving.     

A randomized,placebo‐controlled proof‐of‐concept trial of adjunctive topiramate for alcohol use disorders in bipolar disorder

Background and Objectives

Topiramate is effective for alcohol use disorders (AUDs) among non‐psychiatric patients. We examined topiramate for treating comorbid AUDs in bipolar disorder (BD).

Methods

Twelve participants were randomized to topiramate or placebo for 12 weeks.

Results

The topiramate group, with two out of five participants (40%) completing treatment, experienced less improvement in drinking patterns than the placebo group, with five out of seven participants (71%) completing treatment.

Discussion and Conclusions

Topiramate did not improve drinking behavior and was not well‐tolerated. This study failed to recruit adequately. Problems surrounding high attrition, a small study sample, and missing data preclude interpretation of study findings.

Scientific Significance

This is the first randomized, placebo‐controlled trial of topiramate for AUDs in BD. (Am J Addict 2016;25:94–98)