Using population data to examine the prevalence and correlates of neonatal abstinence syndrome

The objective of this study was to determine the population prevalence and correlates of neonatal abstinence syndrome among neonates born to women on methadone, using a cross-sectional analysis of linked population health data. A total of 2941 live births to women actively on methadone at delivery were analysed over an 11-year period (1992 - 2002). Of these births, 796 neonates (27%) were diagnosed with an International Classification of Diseases - 9CM (ICD-9CM) or International Classification of Diseases ICD - 10AM (ICD-10AM) diagnosis related to neonatal withdrawal from exposure to opiates in utero (NAS). There were significant differences found between mothers whose neonates did and did not receive an International Classification of Diseases NAS-related diagnosis. Mothers of neonates with a NAS-related diagnosis had a higher number of previous pregnancies, were more likely to be indigenous, to smoke more heavily and were more likely to present for delivery unbooked. Neonates diagnosed with NAS were admitted to Special Care Nursery more often. NAS is diagnosed less frequently using International Classification of Diseases (ICD) codes than when using clinical scales measuring opiate-related neonatal withdrawal. This suggests that NAS may be under-represented in hospital morbidity databases that use ICD codes to quantify patient throughput and in some circumstances this may result from under-detection of the condition. Future research should therefore seek to determine the validity of NAS recording in hospital morbidity databases reliant on the use ICD codes.     

Personality and motivational correlates of alcohol consumption and alcohol-related problems among excessive drinking university students

ObjectivesThe study had three objectives: (1) to assess relationships between personality characteristics and alcohol consumption and alcohol-related problems among university students who drink alcohol excessively; (2) to assess relationships between motivational structure and alcohol consumption and problems among students who consume excessive amounts of alcohol; and (3) to assess how personality characteristics and motivational structure are related to each other and how the two are jointly related to alcohol consumption and problems.DesignPersonality, motivational structure, alcohol use, and alcohol-related problems were assessed among 111 undergraduate students.FindingsMediation analyses showed that both maladaptive motivational structure and novelty seeking predicted participants' alcohol-related problems beyond that predicted by alcohol consumption.ConclusionFuture research should aim to reduce alcohol-related negative consequences by targeting students with a maladaptive motivational structure, while taking into account the role of personality characteristics. Screening and intervention programmes would benefit from addressing novelty seeking and maladaptive motivation.     

Acamprosate supports abstinence, naltrexone prevents excessive drinking: evidence from a meta-analysis with unreported outcomes

Two pharmacological agents have repeatedly been shown to be efficacious for relapse prevention in alcohol dependence: The putative glutamate-antagonist acamprosate and the opioid-antagonist naltrexone. Clinical evidence for both drugs is based on various outcome criteria. Whereas for acamprosate primarily abstinence maintenance has been demonstrated, studies with naltrexone have mostly emphasised the prevention of heavy drinking. The remaining effects of both drugs are not always reported; accordingly the corresponding database is fragmentary. Thus, the primary objective of the present meta-analysis was to complete the efficacy profiles for acamprosate and naltrexone and to compare them with each other. Unreported results, requested from the study investigators and the drug manufacturers, were integrated in the computation of effect sizes. For the meta-analysis, emphasis was placed on the conceptual distinction between having a first drink and returning to heavy drinking. Naltrexone was found to have a significant effect on the maintenance of abstinence as well as the prevention of heavy drinking. Acamprosate was shown only to support abstinence; it did not influence alcohol consumption after the first drink. When the efficacy profiles of the two drugs were compared, acamprosate was found to be more effective in preventing a lapse, whereas naltrexone was better in preventing a lapse from becoming a relapse. The superiority of either one drug or over the other one cannot be determined as a general rule, it rather depends on the therapeutic target. Benefits in the treatment of alcohol dependence might be optimized by matching the efficacy profiles of specific antidipsotropics with the motivational status of alcohol-dependent patients.     

Sociodemographic characteristics and drinking locations of convicted drunken drivers

The present study utilizes multiple regression analysis to identify relationships between 13 sociodemographic characteristics and the frequency of drinking in seven different types of drinking places among convicted drunken drivers (N = 6,183). The results indicate that different sociodemographic subgroups of drinking drivers tend to drink in different types of places. Younger respondents were more likely than older respondents to report frequent drinking in away-from-home locations such as friends' homes, bars, parties, cars, and parking lots. The males were more likely than the females to report frequent drinking in cars and parking lots, and unmarried respondents drink at parties and in bars more frequently than married respondents. Education, race, and the frequency of worship service attendance are also found to be important predictors of drinking locations.     

Narcotic abstinence in dependent rats: EEG and behavioral correlates

The purpose of the study was to assess and compare EEG and behavioral correlates of abstinence from morphine, methadone, LAAM, NLAAM, and DNLAAM in dependent rats. Rats were initially trained to lever press for self-injections on a FR-20 schedule of reinforce. Following substitution of saline for each of the narcotic agonists, REM sleep was significantly suppressed during morphine, methadone, and NLAAM abstinence, but not during LAAM and DNLAAM abstinence. Significant increases in lever pressing for saline during abstinence from morphine, methadone, and NLAAM emerged earlier than with LAAM and DNLAAM. Significant increases in head-shake behavior occurred during morphine, methadore, NLAAM, and DNLAAM abstinence, but not during LAAM abstinence. These results demonstrated further pharmacodynamic differences between the five narcotics studied. Our findings suggested that in dependent rats abstinence from LAAM was the least severe when compared with abstinence from any of the other four narcotics studied.     

Predictors of abstinence and nonproblem drinking after 12-step treatment in Sweden

OBJECTIVE: The aims of this study were to identify individual predictors of 12 months continuous abstinence and nonproblem drinking after Swedish inpatient Minnesota Model treatment and to evaluate the outcome variance explained by pretreatment, within-treatment, and posttreatment factors for each outcome, separately and in conjunction. METHOD: One-hundred and twenty-nine men and 47 women were interviewed on admission to Swedish Minnesota Model treatment and after 12 months. Two interviewers who were not involved in treatment delivery performed structured interviews. Statistical analyses included bivariate and multivariate logistic regression models applied to pair-wise contrasts of three types of treatment outcome. RESULTS: The final multivariate models for the three pair-wise contrasts explained 71% (abstinence vs problem drinking), 44% (nonproblem drinking vs problem drinking), and 25% (abstinence vs. nonproblem drinking) of outcome variance. Abstention and nonproblem drinking were both differentiated from problem drinking by the completion of aftercare, satisfaction with treatment, and number of public addiction care contacts. When contrasted with nonproblem drinking, abstention was predicted by the endorsement of a baseline goal to stop drinking and a higher degree of posttreatment affiliation with mutual-help groups. CONCLUSIONS: Results from this study support the fact that treatment is only one of many factors that contributes to an outcome and suggests issues that may need consideration in similar treatment settings.     

Sociodemographic differentials of adult death in a rural population

Mortality rates in this country are very high, but most of the deaths occur unattended by a health worker and hence pass unrecorded. As a result, there is a critical lack of information to make sound judgement on what kind of interventions are needed to reduce the high toll of death. This case-control study was conducted in the Meskan and Mareko District, in the ten kebeles that are under continuous demographic surveillance by the Butajira Rural Health Program (BRHP). Included in the study were 515 cases, of which 49.3% were females and 50.7% were males, and 785 controls, of which 52.1% were females and 47.9% males. The most important sociodemographic factors that were found to influence adult death were single marital status (OR 1.63; 95% CI: 1.13, 2.35), having no educated person in the family (OR 1.91; 95% CI 1.11, 3.29), not having gainful occupation (OR 1.40; 95% CI 1.01, 1.82), and perceived poor and very poor economic status (OR 1.97; 95% CI 1.31, 2.94 and OR 2.98, 95% CI 1.73, 5.13, respectively). The male sex (OR 1.46; 95% CI 1.09, 1.95) and living in the rural lowlands (OR 1.54; 95% CI 1.03, 2.31) are also significantly associated with adult mortality. This study revealed that many of the factors associated with adult mortality are related to poor socio-economic conditions and to the prevailing under development of the rural areas.     

Heavy drinking and its correlates in young men

This study examined the drinking behavior of a sample of 98 college men and the relationship to drinking of a variety of subject variables. The subjects reported drinking an average of nearly eight days a month, about five drinks each time, and were intoxicated more than three times monthly. Nearly half reported having experienced two or more drinking-related adverse consequences within the past year and over a third were intoxicated four or more times monthly. Forty percent of the subjects could be described as problem drinkers. Illicit drug use and the disinhibition factor of the sensation seeking scale were the most consistent correlates of drinking behavior and its adverse consequences, although belonging to a fraternity, consuming alcohol/drugs before age 15, the Macandrew Alcoholism Scale score, and a family member having received alcoholism treatment were also found to be consistently associated with drinking in the subjects. Sociodemographic characteristics, physical health, mental health treatment, childhood behavior problems, adolescent antisocial behavior, and familial alcoholism were by and large not found to be related to drinking behavior. A stepwise multiple regression analysis revealed that five variables accounted for 51% of the total variance in drinking behavior. The significant predictors included a heavy drug use factor, a smoking factor, fraternity membership, drug/alcohol use before age 15, and having a family member who had received alcoholism treatment. Thus, four of the five significant predictor variables were reflective of drug use in the subject or his family. The findings underline the need for further prospective longitudinal research to understand the origins of problem drinking and its relationship to alcoholism.     

Hazardous drinking and drinking patterns among the reindeer-herding Sami population in Sweden

The objective of this study was to investigate hazardous drinking among reindeer-herding Sami in Sweden. A cross-sectional questionnaire study was conducted in 2007, which included the Alcohol Use Disorder Identification Test. A total of 319 reindeer-herding Sami were compared with urban and rural reference populations of 1,393 persons. Data were analyzed with regard to population, gender, age group, education, anxiety, depression, and work-related stress. The Sami population did not report a higher prevalence of hazardous drinking compared with the reference groups; however, subgroups of Sami men with symptoms of depression were revealed as at risk, in contrast to Sami women who were not found to be at risk at all. Limitations of the study are discussed.     

alpha-Synuclein expression in the brain and blood during abstinence from chronic alcohol drinking in mice

alpha-Synuclein is a presynaptic protein proposed to serve as a negative regulator of dopaminergic neurotransmission. Recent research has implicated alpha-synuclein in chronic neuroadaptations produced by psychostimulant and opiate use, as well as in genetically determined susceptibility to alcoholism in humans. The aim of our study was to characterize the changes in alpha-synuclein expression after short-term abstinence from chronic alcohol drinking in mice. Male C57BL/6J mice were allowed to drink increasing concentrations of alcohol in the two-bottle choice procedure. Then the mice were given constant access to an 8% alcohol solution and water for 32 days, and were sacrificed 2 h, 24 h or 48 h after alcohol withdrawal. RT-PCR, in situ hybridization and Western blotting techniques were used to measure alpha-synuclein mRNA and protein levels in the brain and blood. alpha-Synuclein protein levels were elevated by up to 80% in the amygdala of mice withdrawn from alcohol for 24 h or 48 h. No changes in alpha-synuclein levels were found in the mesencephalon or striatum/accumbens. The levels of alpha-synuclein mRNA remained unchanged in all brain regions examined (the striatum, nucleus accumbens, amygdala, substantia nigra, ventral tegmental area). alpha-Synuclein mRNA was up-regulated in the whole blood 48 h after alcohol withdrawal. The accumulation of alpha-synuclein in the amygdala, observed in this study, seems to be a common feature of alcohol and opiate abstinence. This finding suggests a role of alpha-synuclein in common neuroadaptations produced by long-term alcohol and drug use. Although alpha-synuclein expression in the blood seems unrelated to that in the brain, it may serve as a peripheral biomarker of chronic alcohol consumption.     

A discriminant-function analysis of screening tests for excessive drinking and alcoholism

Because a previous study among 385 psychiatric admissions had shown each of three rapid interviews to be far superior to each of nine laboratory tests in screening for excessive drinking and alcoholism, the separation of patients with these drinking patterns from normal drinkers was reexamined by the more sophisticated technique of discriminant analysis. It was thus possible to determine where there was overlap in the information provided by some tests in contrast to "new information" provided by others and whether the arbitrary cut-off points of the normal ranges of the laboratory tests were contributing to their poor sensitivity. Discriminant analysis again confirmed the good performance of the rapid interviews, particularly the Brief Michigan Alcoholism Screening Test and the Reich interview, but it also identified glutamate dehydrogenase (GDH) as the best of the laboratory tests and of comparable efficacy to the rapid interview for the group of excessive drinkers. By comparison, gamma-glutamyl transpeptidase and mean corpuscular volume performed poorly. Using the whole range of results rather than a single cut-off point for discriminant analysis did not alter the relative performance of the screening tests. The optimum combination of tests was that of the Reich interview and the GDH, achieving 100% sensitivity for excessive drinking and alcoholism without any decline in the specificity or predictive value of a positive test result.     

Self-efficacy for cocaine abstinence: pretreatment correlates and relationship to outcomes

Little research has been conducted on the relationship of self-efficacy at treatment entry to individual differences or to treatment outcome for patients with cocaine dependence. Those relationships were examined in 163 cocaine-dependent patients in a residential treatment program using two measures of self-efficacy administered in the first week of treatment: beliefs about success in quitting in general and confidence about not using in 11 cocaine-specific high-risk situations. The most robust correlates of self-efficacy were greater desire to stop using and lower urge to use in high-risk situations. Age, depressive symptoms, cognitive functioning, recent substance use, and past success with quitting also correlated with self-efficacy. Both measures of self-efficacy predicted quantity and frequency of cocaine use and abstinence at 3 but not 6 months after treatment after controlling pretreatment cocaine use. Results suggest that treatments should target self-efficacy in cocaine-dependent patients.     

Random assignment to abstinence or controlled drinking in a cognitive-behavioral program: Short-term effects on drinking behavior

The effects on drinking behavior of random assignment to an abstinence or a controlled drinking goal were assessed. Subjects were 70 socially stable problem drinkers who received a cognitive-behavioral outpatient treatment once per week. Drinking was monitored during the first 3 weeks of treatment, when both groups were expected to be abstinent. The subjects assigned to the abstinence group drank significantly more frequently and consumed significantly more per occasion than did subjects in the controlled drinking group. Controlled drinking was found to be a significantly more acceptable treatment goal than abstinence.     

The effects of moderate drinking and abstinence on serum and urinary beta-hexosaminidase levels

The effects of moderate alcohol intake on serum (SHEX)- and urinary beta-hexosaminidase (UHEX) were studied in ten healthy volunteers, who ingested 60 g of 100% ethanol daily for 10 days. The drinking period was preceded and followed by an abstinence period. Moderate drinking and abstinence were rapidly and significantly reflected on SHEX, while UHEX levels did not change significantly during the study. Gramma-glutamyl transpeptidase (GGT), aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) decreased during the first abstinence period (P less than 0.05), but stayed thereafter at a constant level. It is concluded that SHEX may better reflect recent alcohol consumption than UHEX, GGT, ASAT or ALAT.     

Cognitive and psychological correlates of smoking abstinence, and predictors of successful cessation

The neural circuitry implicated in addictive drug use, which appears to be down-regulated in early abstinence, corresponds closely with brain reward pathways. A literature review suggests that responses to incentive stimuli and the ability to inhibit reflexive responses, both of which have been associated with normal functioning in these pathways, might be weakened during acute abstinence from chronic drug use. In an ongoing study, 82 smokers, abstinent overnight before two separate testing occasions, have been assessed after administration of nicotine and placebo lozenges (order of sessions counterbalanced). Nicotine administration is associated with a significant reduction in anhedonia, a near-significant increase in response to financial incentive, enhanced ability to inhibit reflexive eye movements, and increased attentional bias to words with appetitive significance. Fifty-nine participants then initiated a quit attempt and 19 reported relapsing within 7 days. Comparing their performance in the two prequit lozenge assessment sessions, relapsers showed a stronger effect of nicotine on enhancing their ability to inhibit reflexive eye movements and a near-significant trend towards greater nicotine-induced increases in attentional bias toward appetitive words.     

Schedule-induced drinking in humans: a potential factor in excessive alcohol use

The timed delivery of monetary reinforcement by a computer-controlled slot machine altered the amount of fluid drunk adjunctively by human subjects. In separate experiments, subjects were allowed access to one of three fluids, water, non-alcoholic beer, or alcoholic beer, while receiving monetary reinforcement from the slot machine on one of two Fixed-Interval schedules (FI30 s or FI90 s). The largest difference in intake between the two schedule conditions occurred when water was the fluid available, but a similar trend in consumption was observed in the other studies. Greater consumption occurred when reinforcement was presented on the FI90-s schedule, which was predicted from previous studies using animals. The possible interaction of schedule-induced drinking with other variables known to influence human alcohol consumption is discussed.     

Gender differences in the correlates of hazardous drinking among Iraq and Afghanistan veterans

BackgroundDespite increasing numbers of women veterans from the Iraq and Afghanistan conflicts, few studies have examined hazardous drinking in this group. The present study examined the prevalence of and risk and protective factors for hazardous drinking in a community-based sample of men and women veterans of Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND).MethodsVeterans completed a structured survey that assessed hazardous drinking using the Alcohol Use Disorders Identification Test (AUDIT), and a broad range of demographic, life history, and psychopathology variables. Correlations and multivariate logistic regression analyses were conducted to examine risk and protective factors associated with hazardous drinking.ResultsA total 30.2% of male veterans and 16.3% of female veterans screened positive for hazardous drinking. In a multivariate analysis in male veterans, younger age, lifetime exposure to assaultive trauma, and conflict in interpersonal relationships were independently associated with hazardous drinking (p < .05). Among women veterans, younger age and posttraumatic stress disorder (PTSD) symptoms were independently associated with hazardous drinking in a multivariate analysis (p < .05). Secondary analyses of PTSD symptom clusters revealed that emotional numbing symptoms were independently related to hazardous drinking in women veterans (p < .05).ConclusionsResults of this study suggest that hazardous drinking is prevalent in both men and women OEF/OIF/OND veterans and is more likely to occur at younger ages. In addition, results indicate gender differences in the association between hazardous drinking and lifetime trauma history, PTSD symptoms, and interpersonal conflict, which may have important implications for the treatment of alcohol problems in men and women veterans.     

Effect of naltrexone on alcohol consumption during chronic alcohol drinking and after a period of imposed abstinence in free-choice drinking rhesus monkeys

Relapse into problematic alcohol drinking is a serious problem in the treatment of alcoholism. Free-choice drinking rhesus monkeys show relapse-like behaviour after imposed abstinence of alcohol, by immediately reinitiating ethanol intake at an increased level. The relapse-like behaviour of the monkeys seems not induced by physical withdrawal, but rather argues for a resistance to extinction of ethanol-reinforced behaviour. It has been suggested that endogenous opioids play a role in the positive reinforcing effect of ethanol. In this study, the effect of the opiate antagonist naltrexone was investigated in eight adult male rhesus monkeys(Macaca mulatta) who had about 1 year experience with alcohol drinking, under two conditions: 1) (expt 1) during continuous and concurrent supply of drinking water and two ethanol/water solutions (16% and 32% (v/v)), and 2) (expt 2) after 2 days of alcohol abstinence. In both experiments, each monkey received six doses of naltrexone (0.02, 0.06, 0.17, 0.5, 1.0, 1.5 mg · kg^–1); each dose was paired with a placebo injection (im) in a cross-over design. Consumption was measured from 16.00 hours in the afternoon (30 min after injection) to 9.00 hours the next morning. In experiment 1 naltrexone reduced total net ethanol intake in a graded dose-dependent manner. The effect of naltrexone was apparent shortly after injection, and lasted until the following day. Consumption of drinking water was reduced only shortly after injection. In expt 2, reduction of net ethanol intake was largely restricted to the first few hours of reinitiation of alcohol drinking, i.e. the period in which the abstinence-induced increase was manifest. Consumption of drinking water was not affected by naltrexone. Naltrexone hardly influenced consumption of the non-preferred ethanol solution of 32%. It is postulated that the opioid modulation specifically interacted with positively reinforced behaviour. In expt 2 naltrexone reduced ethanol intake at a lower dose (0.17 mg · kg^–1) compared to expt 1 (0.50 mg · kg^–1), but net ethanol intakes however remained higher. It might be that alcohol abstinence resulted in altered opioid activity, leading to increased ethanol-seeking behaviour. The renewed presentation of ethanol solutions (also) might have stimulated reinitiation of alcohol drinking, representing conditioned incentive stimuli. The reported monkey model of relapse in alcohol drinking could be a useful tool to evaluate new hypotheses and experimental treatments with respect to human alcoholism.     

Frequency distribution of dextromethorphan O-demethylation in a Greek population

OBJECTIVE: To determine the CYP2D6 phenotype in a Greek population by using dextromethorphan (DM) as a probe drug. METHODS: DM (30 mg) was given orally to 102 unrelated Greek subjects and 8-hour urine samples were collected. Concentrations of DM and its metabolite dextrorphan (DX) were determined using a validated HPLC assay. Metabolic molar ratio (MR) of DM to free DX in log form was used as an in vivo index of metabolic status. RESULTS: The frequency distribution histogram of MR was bimodal. An antimode of 0.25 for the mean log MR was determined using probit analysis. Seven of 102 subjects (6.9%) were poor metabolizers (PMs). CONCLUSION: The PM frequency of CYP2D6 in Greek subjects was similar to other Caucasian populations.