Phone-delivered brief motivational interventions for mandated college students delivered during the summer months

Objective

Across the United States, tens of thousands of college students are mandated to receive an alcohol intervention following an alcohol policy violation. Telephone interventions may be an efficient method to provide mandated students with an intervention, especially when they are away from campus during summer vacation. However, little is known about the utility of telephone-delivered brief motivational interventions.

Method

Participants in the study (N = 57) were college students mandated to attend an alcohol program following a campus-based alcohol citation. Participants were randomized to a brief motivational phone intervention (pBMI) (n = 36) or assessment only (n = 21). Ten participants (27.8%) randomized to the pBMI did not complete the intervention. Follow-up assessments were conducted 3, 6, and 9 months post-intervention.

Results

Results indicated the pBMI significantly reduced the number of alcohol-related problems compared to the assessment-only group. Participants who did not complete the pBMI appeared to be lighter drinkers at baseline and randomization, suggesting the presence of alternate influences on alcohol-related problems.

Conclusion

Phone BMIs may be an efficient and cost-effective method to reduce harms associated with alcohol use by heavy-drinking mandated students during the summer months.     

Daily ratings measures of alcohol craving during an inpatient stay define subtypes of alcohol addiction that predict subsequent risk for resumption of drinking

Background

Both depressive symptoms and alcohol craving have been postulated as important predictors of relapse in patients with addictive disorders. The purpose of this study was to examine the course of affective symptoms and cravings for alcohol use during the initial 25 days of residential treatment for middle aged and older adults addicted to alcohol and the relationship between these symptoms and recovery outcomes.

Methods

95 alcohol-dependent subjects were enrolled in this observational study. Participants completed a daily diary of alcohol craving, positive affect, and negative affect during residential treatment. Participants were interviewed 1 and 6 months after discharge to assess clinical symptoms of relapse and functioning.

Results

Latent class analysis identified three groups of individuals for each of the three daily measures. For alcohol craving, 17 subjects reported elevated cravings during the entire treatment stay, 37 subjects reported initially elevated but then a slight improvement in craving, and 41 subjects reported relatively low craving from the time of admission to the end of residential treatment. Alcohol craving class was associated with negative affect but not positive affect. Alcohol craving class but not affective class was predictive of time to relapse to any drinking in the 6 months after residential treatment (p < 0.05).

Conclusion

Results suggest that non-cue induced alcohol craving may define a subtype of alcohol dependence that is less responsive to treatment and may explain heterogeneity in treatment outcomes. These results also may suggest a role for differential treatment programming to address high states of craving for alcohol.     

Evidence of deficits in behavioural inhibition and performance monitoring in young female heavy drinkers

Background

New models of the development and maintenance of substance abuse give increasing importance to the role of deficits in inhibitory function. Much of the evidence to support this claim comes from male participants, despite some researchers showing greater disinhibition in females. Clearly, more research on female heavy drinkers is warranted. In this study, we examine behavioural and psychophysiological measures of inhibitory function in female young adults who do and do not regularly drink heavily.

Methods

Participants were thirty female young adults (aged 18–21) who drink heavily (four or more standard drinks per occasion) at least once a month (n = 13) or who drink heavily less often than this (n = 17); none regularly used any other drugs, including tobacco. They underwent interviews assessing prior use of alcohol, before completing a stop-signal task while brain electrical activity was recorded.

Results

Regular heavy drinkers displayed a longer stop-signal reaction time (the time required to stop an inappropriate response), and a larger P3 increase for successful compared to failed inhibition trials. Heavy drinkers also displayed a smaller error-related negativity (ERN) amplitude, indexing a deficit in performance monitoring.

Conclusion

These results indicate that large deficits in inhibitory processing and performance monitoring occur in young female heavy drinkers, and that heavy drinkers may have to work harder in order to successfully inhibit a response. Future research may determine whether these deficits pre-date or are caused by alcohol abuse.     

Genetic influences on craving for alcohol

Introduction

Craving is being considered for inclusion in the Diagnostic and Statistical Manual (DSM) DSM-5. However, little is known of its genetic underpinnings — specifically, whether genetic influences on craving are distinct from those influencing DSM-IV alcohol dependence.

Method

Analyses were conducted in a sample of unrelated adults ascertained for alcohol dependence (N = 3976). Factor analysis was performed to examine how alcohol craving loaded with the existing DSM-IV alcohol dependence criteria. For genetic analyses, we first examined whether genes in the dopamine pathway, including dopamine receptor genes (DRD1, DRD2, DRD3, DRD4) and the dopamine transporter gene (SLC6A3), which have been implicated in neurobiological studies of craving, as well as alpha-synuclein (SNCA), which has been previously found to be associated with craving, were associated with alcohol craving in this sample. Second, in an effort to identify novel genetic variants associated with craving, we conducted a genomewide association study (GWAS). For variants that were implicated in the primary analysis of craving, we conducted additional comparisons — to determine if these variants were uniquely associated with alcohol craving as compared with alcohol dependence. We contrasted our results to those obtained for DSM-IV alcohol dependence, and also compared alcohol dependent individuals without craving to non-dependent individuals who also did not crave alcohol.

Results

Twenty-one percent of the full sample reported craving alcohol. Of those reporting craving, 97.3% met criteria for DSM-IV alcohol dependence with 48% endorsing all 7 dependence criteria. Factor analysis found a high factor loading (0.89) for alcohol craving. When examining genes in the dopamine pathway, single nucleotide polymorphisms (SNPs) in DRD3 and SNCA were associated with craving (p < 0.05). There was evidence for association of these SNPs with DSM-IV alcohol dependence (p < 0.05) but less evidence for dependence without craving (p > 0.05), suggesting that the association was due in part to craving. In the GWAS, the greatest evidence of association with craving was for a SNP in the integrin alpha D (ITGAD) gene on chromosome 7 (rs2454908; p = 1.8 × 10^− 6). The corresponding p-value for this SNP with DSM-IV alcohol dependence was similar (p = 4.0 × 10^− 5) but was far less with dependence without craving (p = 0.02), again suggesting the association was due to alcohol craving. Adjusting for dependence severity (number of endorsed criteria) attenuated p-values but did not eliminate association.

Conclusions

Craving is frequently reported by those who report multiple other alcohol dependence symptoms. We found that genes providing evidence of association with craving were also associated with alcohol dependence; however, these same SNPs were not associated with alcohol dependence in the absence of alcohol craving. These results suggest that there may be unique genetic factors affecting craving among those with alcohol dependence.     

Testing the effects of e-mailed personalized feedback on risky alcohol use among college students

Objective

Although research utilizing the Internet to intervene with college student drinkers is growing, this study is the first to investigate the use of a theoretically-based and empirically supported personalized feedback form delivered via a single e-mail to college students.

Method

Students (n = 191) completed measures of their alcohol use, related consequences, and peer perceptions at baseline and 6 weeks after the intervention. Students were randomly assigned to receive either e-mailed personalized feedback or e-mailed generic feedback.

Results

Students who received e-mailed personalized feedback reported consuming significantly fewer drinks in a given week, as well as a fewer number of days being drunk in the previous 30 days. They also exhibited a significant reduction in the number of days they perceived their peers to have drunk alcohol and in the amount of alcohol they perceived their peers to consume per drinking occasion.

Conclusion

e-Mailed personalized feedback appears to help students become more aware of normative drinking behavior and reduce the quantity of alcohol they consume. Furthermore, e-mailed personalized feedback may be a cost-effective manner in which to intervene with college student drinkers.     

Variations by age and sex in alcohol-related problematic behaviour per drinking volume and heavier drinking occasion

Aims

This study aims to assess the relationships between age, sex, drinking behaviour and self-reported alcohol-related problem behaviour.

Design

Cross-sectional population survey.

Setting and participants

Interviews were undertaken in 2004, with a representative sample of Australian residents aged 12 and over (N = 29,445).

Measurements

Alcohol use was measured using graduated frequency questions and, using these questions, estimates of total annual intake and frequency of heavy drinking occasions were derived. Alcohol-related problems were measured using a 10-item scale, relating to behaviour in the 12 months prior to the survey.

Findings

Alcohol-related problem behaviours clustered into two groups: hazardous behaviour and delinquent behaviour. Rates of problem behaviours and drinking followed similar patterns for males and females, with peaks in early adulthood and a subsequent decline with age. Males drank at higher levels than females and behaved more problematically. Once alcohol consumption and drinking pattern were controlled for, male and female rates of problem behaviours were not markedly different. However, there were substantial differences by age, with young people behaving significantly more problematically than older people with the drinking variables controlled for.

Conclusions

The results of this study provide strong evidence that young drinkers behave more problematically than older drinkers with drinking behaviour controlled for. The study also provides further evidence that women and men do not report substantially different rates of alcohol-related problems for similar amounts or patterns of drinking. The study has implications for public health messages that focus on the risk of harm from drinking, clearly demonstrating that young drinkers are more likely to report problems for a given amount of drinking.     

Alcohol dependent inpatients who receive general hospital care vs. detoxification in psychiatric care and alcohol problem 1 year later

Aim

The aims were to investigate differences between alcohol dependent inpatients who seek alcohol treatment and those who do not seek alcohol specific but general hospital treatment, and to investigate problem drinking 12 months after hospitalization.

Methods

Two samples of alcohol dependent inpatients were recruited: N = 571 at general hospitals and N = 473 at psychiatric alcohol detoxification units, and were followed-up 12 months later.

Results

Multivariate logistic regression analyses revealed that higher age, living alone, being employed, previous help-seeking, increased severity of dependence, increased adverse consequences from drinking and increased motivation were significant predictors of receiving alcohol detoxification vs. general hospital treatment. A composite assessment of motivation to change and to seek help was the strongest predictor of positive outcome 12 months later.

Conclusions

Alcohol dependent individuals who receive detoxification in psychiatric care have a more severe alcohol problem and fewer social resources than those treated in general hospitals. Interventions targeting at enhancing motivation to change and to seek help should be part of routine general hospital care and of detoxification treatment in psychiatric care.     

Effects of caffeinated vs. non-caffeinated alcoholic beverage on next-day hangover incidence and severity,perceived sleep quality,and alertness

Aims

Beliefs about the effects of mixing caffeine and alcohol on hangover or sleep may play a role in motivation to consume these mixtures; therefore, information is needed about actual effects. We investigated whether intoxication with caffeinated vs. non-caffeinated beer differentially affected perceived sleep quality, sleepiness, and hangover incidence and severity the next morning.

Methods

University students (89%) and recent graduate drinkers were randomized to receive: (1) beer with the equivalent of 69 mg caffeine/12 oz glass of regular beer (n = 28) or (2) beer without caffeine (n = 36), in sufficient quantity to attain a BrAC of 0.12 g%. After an 8-h supervised sleep period, participants completed measures of hangover, sleep quality, sleep latency and time asleep, and sleepiness.

Results

While caffeinated beer improved perceived sleep quality, effect sizes were greater for morning alertness than for quality while sleeping, with no effect on sleep latency or total sleep time. No effects were seen on hangover incidence or severity.

Conclusions

Mixing caffeine and alcohol does not significantly impair amount of sleep or sleep latency, hangover, or sleepiness the morning after drinking to intoxication in this population.     

Moderate/heavy alcohol use and HCV infection among injection drug users in two Russian cities

Background

In Russia, injection drug use and transmission of blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are inextricably linked, however the burden of alcohol use remains unexplored among injection drug users (IDUs).

Methods

Individuals who were 18 years of age and older and had injected drugs in the previous 30 days were recruited in the cities of Novosibirsk and Ivanovo by respondent driven sampling. Consenting individuals were administered a quantitative survey instrument and provided blood samples for serological testing.

Results

In Novosibirsk and Ivanovo, 29% and 35% of respondents were categorized as moderate/heavy drinkers, respectively. Individuals reported problems related to alcohol use that affected their physical health (23%), family (55%), and induced financial hardships (43%). In the multivariate analysis, we found that methamphetamine injection in the past 12 months was a strong and significant correlate of moderate/heavy drinking in Novosibirsk (aOR = 5.63 95% CI: [1.01–31.47]) and Ivanovo (aOR = 3.81 95% CI: [2.20–6.62]). There was poor agreement between self-reported HCV status and HCV test results (κ = −0.05 and 0.26 in Novosibirsk and Ivanovo, respectively). IDUs who correctly knew their HCV seropositive status in Novosibirsk and IDUs who correctly knew their HCV seronegative status in Ivanovo were significantly more likely to be moderate/heavy drinkers.

Conclusion

Alcohol use is problematic among IDUs who are at high risk for HCV. Future interventions should target IDUs who are moderate/heavy drinkers in order to prevent liver complications resulting from HCV infection.     

Social desirability biases in self-reported alcohol consumption and harms

Aims

Self-reports remain the most common means of assessing alcohol consumption despite concern for their validity. The objective of this research is to assess the extent to which social desirability biases relate to self-reported consumption, hazardous use, and harms.

Methods

In each of two studies presented, undergraduate students (N = 391 and N = 177) who reported that they had consumed alcohol in the past year completed online confidential surveys.

Results

Both studies show consistent associations between impression management bias and self-reported consumption such that high impression managers report 20 to 33% less consumption and are about 50% less likely to report risky drinking. No significant correlations involving consumption were found for self-deception bias. Study 2 also indicated that high impression managers report 30–50% fewer acute harms following a drinking episode, and that these effects are maintained after controlling statistically for trait impulsivity/constraint.

Conclusions

Impression management bias represents a significant threat to the validity of self-reported alcohol use and harms. Such bias may lead to misspecification of models and under-estimates of harmful or hazardous use.     

Understanding the role of cessation fatigue in the smoking cessation process

Background

To understand the dynamic process of cessation fatigue (i.e., the tiredness of trying to quit smoking) with respect to its average trend, effect on relapse, time-varying relations with craving and negative affect, and differences among genders and treatment groups.

Method

Randomized placebo-controlled clinical trial. Participants received either placebo, monotherapy (bupropion SR, nicotine patch, nicotine lozenge), or combined pharmacotherapy (bupropion SR + nicotine lozenge, nicotine patch + nicotine lozenge). Data were collected from 1504 daily smokers who were motivated to quit smoking. The participants completed baseline assessments and ecological momentary assessments for 2 weeks post-quit.

Results

Cessation fatigue reduced the likelihood of 6-month post-quit abstinence (OR = 0.97, 95% CI (0.95, 0.99)), and was positively associated with craving and negative affect. After controlling for these two factors, average cessation fatigue increased over time. Compared to men, women experienced greater fatigue (t = −10.69, p < 0.0001) and a stronger relation between fatigue and craving (t = −8.80, p < 0.0001). The relationship between fatigue and negative affect was significantly stronger in men (t = 5.73, p < 0.0001). Cessation fatigue was significantly reduced by combined pharmacotherapy (t = −13.4, p < 0.0001), as well as monotherapy (t = −6.2, p < 0.0001).

Conclusions

Cessation fatigue was closely related to craving, negative affect, and cessation outcomes. Women reported greater cessation fatigue than men. Current treatments appeared to reduce fatigue and weaken its relations with craving and negative affect.     

Topiramate treatment for alcoholic outpatients recently receiving residential treatment programs: A 12-week,randomized, placebo-controlled trial

Background

Initiation of a relapse prevention medication is crucial at the end of alcohol detoxification. This study aimed to examine the efficacy and safety of topiramate for alcoholism in patients receiving a residential treatment program of alcohol detoxification and post-acute treatment.

Methods

This was a 12-week, randomized, double-blind, placebo-controlled trial of topiramate for alcoholism in patients receiving a residential treatment program. Individuals with DSM-IV alcohol dependence with minimal withdrawal were enrolled. Participants were randomly assigned to receive either 100–300 mg/day of topiramate or placebo. Primary outcomes were given as percentages of heavy drinking days and time to first day of heavy drinking. Other drinking outcomes, craving, and health-related quality of life were evaluated.

Results

A total of 106 participants were randomized to receive topiramate (n = 53) or placebo (n = 53). Twenty-eight participants of the topiramate group (52.8%) and 25 participants of the placebo group (47.2%) completed the study. Averaged over the trial period, there was no significant difference between groups on the mean percentages of heavy drinking days [1.96 (−1.62 to 5.54), p = .28]. Log rank survival analysis found no difference of time to first day of heavy drinking between topiramate and placebo groups (61.8 vs. 57.5 days, respectively; χ² = 0.61, d.f. = 1, p = .81). Other secondary outcomes were not significantly different between groups.

Conclusions

By using a conservative model for data analysis, we could not detect the effectiveness of topiramate in this particular population. As the sensitivity analysis showed a trend of its benefit, further studies in larger sample sizes are still warranted.     

Low frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex transiently increases cue-induced craving for methamphetamine: A preliminary study

Background

Repetitive transcranial magnetic stimulation (rTMS) can temporarily interrupt or facilitate activity in a focal brain region. Several lines of evidence suggest that rTMS of the dorsolateral prefrontal cortex (DLPFC) can affect processes involved in drug addiction. We hypothesized that a single session of low-frequency rTMS of the left DLPFC would modulate cue-induced craving for methamphetamine (MA) when compared to a sham rTMS session.

Methods

In this single-blind, sham-controlled crossover study, 10 non-treatment seeking MA-dependent users and 8 healthy controls were randomized to receive 15 min of sham and real (1 Hz) DLPFC rTMS in two experimental sessions separated by 1 h. During each rTMS session, participants were exposed to blocks of neutral cues and MA-associated cues. Participants rated their craving after each cue block.

Results

In MA users, real rTMS over the left DLPFC increased self-reported craving as compared to sham stimulation (17.86 ± 1.46 vs. 24.85 ± 1.57, p = 0.001). rTMS had no effect on craving in healthy controls. One Hertz rTMS of the left DLPFC was safe and tolerable for all participants.

Conclusions

Low frequency rTMS of the left DLPFC transiently increased cue-induced craving in MA participants. These preliminary results suggest that 1 Hz rTMS of the left DLPFC may increase craving by inhibiting the prefrontal cortex or indirectly activating subcortical regions involved in craving.     

Smoke-free policies in drinking venues predict transitions in alcohol use disorders in a longitudinal U.S. sample

Background

Smoke-free legislation prohibiting smoking in indoor public venues, including bars and restaurants, is an effective means of reducing tobacco use and tobacco-related disease. Given the high comorbidity between heavy drinking and smoking, it is possible that the public health benefits of smoke-free policies extend to drinking behaviors. However, no prior study has examined whether tobacco legislation impacts the likelihood of alcohol use disorders (AUDs) over time. The current study addresses this gap in the literature using a large, prospective U.S. sample.

Method

Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we utilized logistic regression to examine whether the implementation of state-wide smoke-free legislation in bars and restaurants between Waves I (2001–2002) and II (2004–2005) predicted changes in DSM-IV AUD status (remission, onset, recurrence) in current drinkers at Wave I (n = 19,763) and participants who drank in public ≥once per month (n = 5913).

Results

Individuals in states that implemented smoke-free legislation in drinking venues had a higher likelihood of AUD remission compared to participants in states without such legislation. Among public drinkers, smoke-free legislation was associated with a greater likelihood of AUD remission and a lower likelihood of AUD onset. These findings were especially pronounced among smokers, men, and younger age groups.

Discussion

These results demonstrated the protective effects of smoke-free bar and restaurant policies on the likelihood of AUDs; furthermore, these findings call attention to an innovative legislative approach to decrease the morbidity and mortality associated with AUDs.     

Evidence for greater cue reactivity among low-dependent vs. high-dependent smokers

Introduction

Cue reactivity paradigms are well-established laboratory procedures used to examine subjective craving in response to substance-related cues. For smokers, the relationship between nicotine dependence and cue reactivity has not been clearly established. The main aim of the present study was to further examine this relationship.

Methods

Participants (N = 90) were between the ages 18–40 and smoked ≥10 cigarettes per day. Average nicotine dependence (Fagerström Test for Nicotine Dependence; FTND) at baseline was 4.9 (SD = 2.1). Participants completed four cue reactivity sessions consisting of two in vivo cues (smoking and neutral) and two affective imagery cues (stressful and relaxed), all counterbalanced. Craving in response to cues was assessed following each cue exposure using the Questionnaire of Smoking Urges-Brief (QSU-B). Differential cue reactivity was operationally defined as the difference in QSU scores between the smoking and neutral cues, and between the stressful and relaxed cues.

Results

Nicotine dependence was significantly and negatively associated with differential cue reactivity scores in regard to hedonic craving (QSU factor 1) for both in vivo and imagery cues, such that those who had low FTND scores demonstrated greater differential cue reactivity than those with higher FTND scores (β = −.082; p = .037; β = −.101; p = .023, respectively). Similar trends were found for the Total QSU and for negative reinforcement craving (QSU factor 2), but did not reach statistical significance.

Discussion

Under partially sated conditions, less dependent smokers may be more differentially cue reactive to smoking cues as compared to heavily dependent smokers. These findings offer methodological and interpretative implications for cue reactivity studies.     

Biological markers of problem drinking in homeless patients

Objective

In the search for optimal biomarkers of excessive drinking, a central limitation has been the lack of sensitivity of measures. Many patients have apparently normal values of liver markers despite a considerable alcohol intake. This study aimed to test a novel combined indicator of alcohol drinking.

Material and methods

Concentrations of carbohydrate-deficient transferrin (%CDT), γ glutamyl transferase (γGT), aspartate aminotransferase (ASAT), and mean corpuscular volume (MCV), together with a combined index of the %CDT and γGT, the Antilla Index (AI), were studied in 104 homeless patients with (n = 87) or without (n = 24) problem drinking according to the Fast Alcohol Screening Test.

Results

Concentrations of all markers were significantly higher in the alcoholic patients than in other homeless patients. The best agreement between liver markers and self-reported status was found between the combined %CDT and γGT index (kappa = 0.61, p < 0.001, sensitivity = 63%, specificity = 94%).

Conclusions

The combined AI is a relatively efficient measure of current drinking in homeless populations.     

Results from a pilot clinical trial of varenicline for the treatment of alcohol dependence

Background

Alcohol use, abuse and dependence remain a pressing public health problem. Based on its mechanism of action, varenicline seemed to be a likely candidate for treating alcohol dependence.

Methods

Alcohol dependent subjects (n = 40) were enrolled in a 13-week double-blind placebo controlled clinical trial. Subject visits were once per week. At each visit, subjects were tested for breath alcohol levels, provided self-report data on alcohol and nicotine use, and on mood and craving. In addition, subjects received once a week medical management (MM).

Results

There was no difference between varenicline and placebo treated groups on any of the drinking outcomes. Compared to placebo-treated subjects, varenicline treated subjects had decreased rates of alcohol craving and cigarette smoking, as well as greater mood improvements during the later part of the study (weeks 6–13). In addition, among subjects who were cigarette smokers, those treated with varenicline were significantly less likely to report heavy drinking during the trial.

Conclusions

Although varenicline was not significantly more effective than placebo at reducing drinking during the trial, its effects on alcohol craving and mood suggest that future investigation of the mechanism of action of varenicline, as well as additional clinical studies may be warranted. In particular, the findings regarding the influence of smoking status on heavy drinking among varenicline-treated subjects should be investigated in future studies.     

Television-supported self-help for problem drinkers: A randomized pragmatic trial

Objectives

To test the effectiveness of a television-supported self-help intervention for problem drinking.

Methods

Dutch television viewers (N = 181) drinking in excess of the guidelines for low-risk alcohol use were randomly assigned either to the Drinking Less TV self-help course (consisting of five televised sessions supplemented by a self-help manual and a self-help website) or to a waitlisted control group. To ensure trial integrity, intervention delivery was mimicked beforehand by sending intervention participants weekly DVDs in advance of the actual telecasts in 2006. Pre-post assessments were carried out on both groups, as well as a 3-month follow-up assessment on the intervention group to study effect maintenance. The primary outcome measure was low-risk drinking.

Results

The intervention group was more successful than the waitlist group in achieving low-risk drinking at post-intervention (OR = 9.4); the effects were maintained in the intervention group at 3-month follow-up.

Conclusions

The low-threshold television-based course Drinking Less appears effective in reducing problem drinking.     

Cognitive behavioral smoking cessation during alcohol detoxification treatment: A randomized,controlled trial

Background

Among alcohol-dependent subjects tobacco smoking is very common and causes a variety of health risks. Therefore, it is necessary to reach this high-risk population early with appropriate smoking interventions.

Methods

Smokers in alcohol detoxification treatment were offered to participate in a smoking cessation study. A total of 103 patients was enrolled and randomly assigned to either the experimental group (EG) receiving a cognitive behavioral smoking cessation treatment (CBT) or the control group (CG) receiving autogenic training. Smoking outcomes were measured by self-report and carbon monoxide levels, directly after intervention and 6 months later, where additionally alcohol outcomes were recorded.

Results

There were no differences in smoking quit rates directly after intervention. However, patients in the EG were significantly more likely to reduce their daily cigarette use compared to CG (p = .046). Sub-group analyses revealed that heavy smokers (FTND score ≥ 7) seemed to profit most in the EG regarding cigarette reduction. After 6 months, these positive effects had leveled out. No evidence was found that smoking cessation might jeopardize alcohol outcomes.

Conclusions

Results suggest that alcohol-dependent smokers are interested in smoking interventions even during alcohol detoxification. CBT is promising in short-term smoking outcomes and in the approach of harm reduction, however, long-term effects are desirable. These findings underline the feasibility and the importance to provide smoking cessation interventions to patients in alcohol detoxification treatments.     

Naltrexone with or without guanfacine for preventing relapse to opiate addiction in St.-Petersburg,Russia

Background

Stress is a key precipitant to discontinuing naltrexone and relapsing to opiate abuse. Alpha-2 adrenergic agonists like guanfacine may reduce stress induced craving and have reduced opiate relapse in small clinical trials.

Methods

This randomized, double blind double dummy placebo-controlled 6-month trial tested oral naltrexone with or without guanfacine for reducing stress and preventing opiate relapse. We randomized 301 patients to: naltrexone 50 mg/day + guanfacine 1 mg/day (n = 75) (N/G), naltrexone + guanfacine placebo (N/P) (n = 76), naltrexone placebo + guanfacine (n = 75) (P/G), and double placebo (n = 75) (P/P).

Results

Among the 75 patients in each group the percentage still retained on naltrexone treatment at six months was: N/G 26.7%, N/P 19.7% (p = 0.258 to N/G), P/G 6.7% (p < 0.05 to both N groups), and P/P 10.7% (p = 0.013 to N + G). Guanfacine reduced the severity of stress particularly at weeks 10 and 18. Adverse events (AE) were infrequent (4.7%) without group differences, with most common AEs: headache, poor appetite, insomnia, and dizziness.

Conclusions

Adding guanfacine to naltrexone did not improve treatment retention or opiate free urines, but it reduced both stress and craving at later time points in treatment, which may be related to stress-induced craving and the animal model of incubation of reinstatement. During treatment, HIV risk, anxiety, and depression reduced among all patients in treatment, regardless of group.