Methadone patients and alcohol abuse

A literature review was conducted on the excess use of alcohol by methadone patients. Although the rate of alcohol abuse among methadone patients was found to be high (compared to general population estimates), the rate was comparable to individuals who engaged in risk-taking behaviors and individuals under stress, such as college students and emergency room patients. Comparisons of rates for different samples was difficult because of the varying criteria used to define alcohol abuse and the absence of operational criteria applicable across different populations. Another source of difficulty was that some studies evaluated motivational variables (why the person drank) and found them to be more important predictors than sociodemographic variables (for example, history of drinking and social class). Contrary to the expectation that methadone patients who consumed excessive amounts of alcohol would require higher dosages of methadone, it was found that nonalcohol-abusing methadone patients requested the higher dosage levels. This finding, however, was subject to methodological confounds. The issue of whether the methadone patient who abused alcohol has a negative treatment outcome was a multifaceted question. The definition of treatment outcome for alcohol-abusing methadone patients determined whether the investigator concluded that there was a negative impact versus minimal impact.     

Backtracking booze with Bayes--the retrospective interpretation of blood alcohol data.

1. A Bayesian method is described which allows the explicit estimation of errors produced in estimating drug concentrations at times for which samples are not available for analysis. 2. This method was applied to the problem of 'backtracking' alcohol concentrations for medico-legal purposes. 3. Computer simulation allowed the effect of continuing alcohol absorption on the position and range of estimates of alcohol concentrations to be studied.     

Statistical considerations in the interpretation of negative carcinogenicity data

The regulation of toxic substances present in the environment requires that carcinogens be distinguished from noncarcinogens on the strength of the available toxicological and epidemiological evidence for carcinogenicity. In this article, we consider the difficulties associated with establishing strong evidence against carcinogenicity. In particular, the ability of both animal and human studies to detect small increases in tumor occurrence rates is evaluated in statistical terms. Consideration is also given to resolving apparent conflicts between the toxicological and the epidemiological sources of data.     

Comorbidity of personality disorders with alcohol abuse

There is high comorbidity of alcohol dependence with mood, anxiety, substance abuse and personality disorders. Personality disorders, in particular, are considered to be an important contributing and/or predisposing factor in the pathogenesis, clinical course and treatment outcome of alcohol dependence. According to clinical and epidemiological studies, the prevalence of personality disorders in alcoholism ranges from as low as 22-40% to as high as 58-78%. The literature has focused primarily on antisocial and borderline personality disorders; however, almost the whole spectrum of personality disorders can be encountered in alcohol dependence, such as the dependent, avoidant, paranoid and others. A number of factors, such as sampling methods, diagnostic criteria used or assessment procedures applied, may explain this wide variation. The quest of a distinct 'alcoholic personality' dates from the first half of the 20th century but failed to reveal consistent and strong substantiation. However, renewed efforts provided evidence for the importance of impulsivity/ disinhibition and neuroticism/negative affectivity in the development of alcohol dependence; the role of other personality traits such as extraversion/sociability is still unclear. These findings led to a number of typologies, some of the most popular and influential being those of Cloninger, Babor, and Lesch.     

Trends in alcoholism and narcotics abuse from medical examiner data

To determine trends in alcoholism and narcotics abuse, New Jersey State Medical Examiner cases from Essex County of those age 12 or older during three consecutive 12-month periods from October 1981 to September 1984 (years 1, 2 and 3) were analyzed. Cases were classified as alcoholics or narcotics abusers according to the following criteria: any case record report of drinking problems or narcotics abuse, alcoholism or narcotics abuse indicated in the manner or cause of death or autopsy findings of liver change or pancreatitis due to alcoholism, or toxicology findings of narcotics (unless medically prescribed). The age-eligible cases decreased from 710 in year 1 to 691 in year 2 and 643 in year 3. Decedents classified as alcoholics rose from 18% in year 1 to 25% in years 2 and 3. The proportions classified as narcotic abusers and those with both conditions were relatively constant, averaging 7 and 5%, respectively, over the 3 years. Substance abuse itself was the manner of death for alcoholics and most of those with both conditions; 38% of the narcotics abusers were homicide victims. There were no appreciable demographic changes among substance abusers during this period.     

Factors associated with alcohol consumption among medical cannabis patients with chronic pain

IntroductionChronic pain is the most common reason for medical cannabis certification. Data regarding alcohol use and risky drinking among medical cannabis patients with pain is largely unknown. Therefore, we examined the prevalence and correlates of alcohol use and risky drinking in this population.MethodsParticipants completed surveys regarding demographics, pain-related variables, anxiety, cannabis use, and past six-month alcohol consumption. Alcohol use groups were defined using the AUDIT-C [i.e., non-drinkers, low-risk drinkers, and high-risk drinkers (≥ 4 for men and ≥ 3 for women)] and compared on demographic characteristics, pain measures, anxiety, and cannabis use.ResultsOverall, 42% (n = 330/780) were non-drinkers, 32% (n = 251/780) were low-risk drinkers, and 26% (n = 199/780) were high-risk drinkers. Compared to non-drinkers, low- and high-risk drinkers were significantly younger whereas a larger proportion of low-risk drinkers reported being African-American compared to non- or high-risk drinkers. High-risk drinkers reported significantly lower pain severity/interference compared to the other groups; high-risk drinkers were also less likely to be on disability compared to other groups. A multinomial logistic regression showed that patients reporting lower pain severity and less disability had greater odds of being classified a high-risk drinker.ConclusionsHigh-risk drinking appears common among medical cannabis patients. Future research should examine whether such use is concurrent or consecutive, and the relationship of such co-use patterns to consequences. Nevertheless, individuals treating patients reporting medical cannabis use for pain should consider alcohol consumption, with data needed regarding the efficacy of brief alcohol interventions among medical cannabis patients.     

Neurobiology of alcohol abuse.

Excessive consumption of beverage alcohol (ethanol) is a major health concern worldwide. Understanding the mechanisms by which ethanol affects neural functioning, after both acute and chronic exposure, has become a major goal in the study of alcoholism. With such an understanding, we should be able to institute more effective treatments and preventative measures for alcohol abuse problems. Recent studies have found, contrary to earlier assumptions, that ethanol has selective, dose-dependent effects on various neurotransmitter systems within the CNS. These effects are observed at all levels of analysis, from molecular to behavioral. This review by Herman Samson and Adron Harris covers these recent findings, with the intent of generating questions that will focus further research efforts.     

Attitudes of Nigerian medical students towards use and abuse of tobacco, alcohol and drugs

The questionnaire devised by WHO as a standardized instrument for use across cultures, and modified to suit an African culture, was completed by 104 clinical medical students (male and female) selected at random. After statistical analysis, the results were discussed regarding attitudes (approval/disapproval); perceived availability; social connotation; perceived harmfulness; perceived problems; perceived parental norms; religion; and exposure to use. A significant finding was that 78% of the medical students disapprove of people using all the listed drugs, 11% disapprove slightly and only 11% do not disapprove.     

Towards the prevention of alcohol abuse

Mortality resulting from alcohol abuse in young French people is too high in spite of prevention campaigns for road safety in particular. There are problems in identifying alcohol abuse in young people in preventive medicine or alcohol care services. This study was carried out in alcohol centres; data from patients under 25 are analysed and compared to a same-age group of young adults who are consulting in preventive medicine centres. In comparison with older people, these two groups of young adults presented similar characteristics, a lower educational grade, a precocity of psychotropic substance consumption, a preference for beers and spirits consumed episodically or during weekends, more frequent use of tobacco and cannabis, and, finally, greater frequency of drunkenness. The consequent risks of accidents are higher, on road use particularly. Therefore, early identification of alcohol abuse and training for professionals who work in socioeducational settings should be developed to improve the response to these new behaviours. The preventive medicine centres are appropriate for the detection of risk behaviours associated with alcohol or with polysubstance use. Local programs should be set up not only to delay the age of the first intake but to decrease the consumption peak.     

Towards the prevention of alcohol abuse

Mortality resulting from alcohol abuse in young French people is too high in spite of prevention campaigns for road safety in particular. There are problems in identifying alcohol abuse in young people in preventive medicine or alcohol care services. This study was carried out in alcohol centres; data from patients under 25 are analysed and compared to a same-age group of young adults who are consulting in preventive medicine centres. In comparison with older people, these two groups of young adults presented similar characteristics, a lower educational grade, a precocity of psychotropic substance consumption, a preference for beers and spirits consumed episodically or during weekends, more frequent use of tobacco and cannabis, and, finally, greater frequency of drunkenness. The consequent risks of accidents are higher, on road use particularly. Therefore, early identification of alcohol abuse and training for professionals who work in socioeducational settings should be developed to improve the response to these new behaviours. The preventive medicine centres are appropriate for the detection of risk behaviours associated with alcohol or with polysubstance use. Local programs should be set up not only to delay the age of the first intake but to decrease the consumption peak.     

DSM-III: alcohol abuse and alcohol dependence--inter-rater diagnostic reliability

In the DSM-III field trials, measures of inter-rater diagnostic agreement were obtained only for major diagnostic categories. Two diagnoses subsumed under the major diagnostic category of Substance Use Disorders are Alcohol Abuse and Alcohol Dependence. The purpose of the present study was to obtain inter-rater reliability estimates among raters given identical clinical information for the two diagnoses, for the separate criteria for each diagnosis and for the definitional components of each criterion. Intra-class correlation coefficients were obtained with results ranging from 0.07 to 0.85. The need for further statistical studies examining the specificity of definitions for the diagnostic criteria within DSM III is addressed.     

A typology of families with parental alcohol or drug abuse

Objectives To estimate the prevalence of parental alcohol abuse (PAA) or parental drug abuse (PDA), to compare families with PAA/PDA to non-PAA/PDA families, and to identify different types of families with PAA/PDA in terms of mental disorders in parents, family separation, financial difficulties and educational level. Methods Register-based data from a complete birth cohort of children born in 1991 in Finland (N?=?62,751), and their biological parents. Data were derived from Finnish administrative registers from 1991 to 2009. Latent class analysis was used to construct typology of families with PAA/PDA. Results 10.5% of families were affected by PAA or PDA before the children’s 18th birthday. Of these families, five family types were identified. The most common type was characterised by father’s alcohol abuse but had no other detectable problems besides parental separation. The second type was a family where the father had a drinking or drug problem, had financial difficulties and had moved away from the family’s home. The two less common family types were characterised by the mother’s drinking or drug abuse and mental disorders. The mothers of these family types were rather commonly living with their children. In the fifth family type, child typically did not live with either of the parents, both parents had alcohol/drug abuse and accumulated problems. Conclusions Early prevention and treatment are needed to avoid the accumulation of parental problems in PAA/PDA families. As both biological parents rather rarely were substance abusers, the parental role of the non-substance abusing parent should be supported and strengthened.     

Past year treatment status and alcohol abuse symptoms among US adults with alcohol dependence

Objective

We tested whether the number and type of alcohol abuse symptoms were associated with an increased likelihood of treatment seeking among respondents with alcohol dependence.

Methods

Data from 4027 adult respondents from 2006 and 2007 National Survey on Drug Use and Health (NSDUH) who met DSM-IV criteria for the past year alcohol dependence were used. Respondents were classified according to the number of past year alcohol abuse symptoms endorsed, as well as type of abuse symptom. Associations were estimated using weighted multivariate logistic regressions that controlled for severity of alcohol dependence, other drug use disorders and other characteristics.

Results

Twenty-eight percent of individuals with alcohol dependence had one alcohol abuse symptom, 20% had two and 19% had three or four. Individuals with more alcohol abuse symptoms differed from those without alcohol abuse symptoms in a number of sociodemographic characteristics and severity of alcohol and drug dependence. Even after adjusting for these factors, individuals with three or four alcohol abuse symptoms had 2.67 times increased odds of treatment seeking, as compared to those without alcohol abuse symptoms [95% CI = 1.65–4.30]. However, individuals with one or two alcohol abuse symptoms were no more likely to seek treatment than those without alcohol abuse symptoms. Majority of those with one or two alcohol abuse symptoms endorsed the hazardous abuse symptom.

Conclusion

Alcohol abuse symptoms are important factors for treatment seeking in individuals with alcohol dependence, but only among certain subset of individuals with three or four alcohol abuse symptoms. Examining structural and psychosocial differences across these subgroups may help inform and reduce barriers to treatment seeking among this population.     

The relationship between prenatal care,personal alcohol abuse and alcohol abuse in the home environment

Aims: Nearly one-fourth of African-American women receive no prenatal care during the first trimester of pregnancy. The aim of the current study is to identify factors that underlie inadequate prenatal care among African-American women. Maternal alcohol abuse has been examined as one risk factor for inadequate prenatal care, but findings have been inconsistent, perhaps because (a) alcohol use during pregnancy is substantially under-reported and (b) studies have not considered the wider social network in which maternal alcohol use takes place. The current study attempts to clarify relationships between personal alcohol use, alcohol use in the home environment, and prenatal care in a sample of post-partum women.

Methods: Participants were 107 low-income, primarily African-American women. All participants completed a computer-based screening which assessed personal and environmental alcohol use, prenatal care and mental health.

Findings: Environmental alcohol use was related to delayed prenatal care while personal alcohol use was not. More specifically, after controlling for demographic variables, the presence of more than three person-episodes of binge drinking in a woman's home environment increased the odds of seriously compromized prenatal care by a factor of seven.

Conclusions: Findings suggest the need to further assess environmental alcohol use and to examine the reliability of personal alcohol use measures.     

5-HT and alcohol abuse.

Recent experimental data, both in animals and the clinic, suggest that drugs selectively interacting with the 5-HT system may reduce alcohol intake. Although the precise mechanisms underlying these drug effects are unknown, it seems that there are at least two pharmacological strategies available, described in this review by Edward Sellers and colleagues. The first is enhancement of 5-HT neuronal activity using compounds that will release 5-HT, block 5-HT reuptake, or act as selective 5-HT receptor agonists. A second approach involves selective 5-HT3 receptor antagonists. If the initial research findings with these drugs are confirmed and extended, they may present useful therapies for the treatment of alcohol abuse, especially if used in conjunction with psychosocial therapy.     

Factors associated with untreated remissions from alcohol abuse or dependence

This paper describes an epidemiologic-based sample of individuals who remitted from alcohol abuse or alcohol dependence, both with and without treatment, to abstinence or moderate drinking. Inspection of the severity, onset, and duration of alcohol problems experienced by these individuals suggests that there may be two primary categories of drinkers with distinct pathways to remission. The first is a population of individuals who experience significant problems for an extended period of time who then resolve to abstinence through the use of treatment services. The second is a population of individuals who drink heavily at some point in their lives, experience some problems, and then "mature out" of this stage in their life as they age and take on other life roles.     

Anomie, alcohol abuse and alcohol consumption: a prospective-analysis

Cross-sectional and 36-month prospective analyses of the relationships among anomie and both alcohol abuse and alcohol consumption patterns provided little support that anomie was directly associated with ethanol ingestion patterns in a sample of 302 male air traffic controllers. This lack of association was observed for self-reported alcohol consumption, interview-established alcohol abuse and biochemical markers of alcohol intake. In addition, anomie was not predictive of change in alcohol use/abuse over 36 months, controlling for baseline levels of alcohol use and abuse and for relevant demographic factors. Measurement of anomie and alcohol use/abuse, the relative importance of anomie in various socioeconomic groups and issues related to prospective research on this topic are discussed.