AUDIT-C as a brief screen for alcohol misuse in primary care

BACKGROUND: The Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questions have been previously validated as a 3-item screen for alcohol misuse and implemented nationwide in Veterans Affairs (VA) outpatient clinics. However, the AUDIT-C's validity and optimal screening threshold(s) in other clinical populations are unknown. METHODS: This cross-sectional validation study compared screening questionnaires with standardized interviews in 392 male and 927 female adult outpatients at an academic family practice clinic from 1993 to 1994. The AUDIT-C, full AUDIT, self-reported risky drinking, AUDIT question #3, and an augmented CAGE questionnaire were compared with an interview primary reference standard of alcohol misuse, defined as a Diagnostic and Statistical Manual, 4th ed. alcohol use disorder and/or drinking above recommended limits in the past year. RESULTS: Based on interviews with 92% of eligible patients, 128 (33%) men and 177 (19%) women met the criteria for alcohol misuse. Areas under the receiver operating characteristic curves (AUROCs) for the AUDIT-C were 0.94 (0.91, 0.96) and 0.90 (0.87, 0.93) in men and women, respectively (p=0.04). Based on AUROC curves, the AUDIT-C performed as well as the full AUDIT and significantly better than self-reported risky drinking, AUDIT question #3, or the augmented CAGE questionnaire (p-values <0.001). The AUDIT-C screening thresholds that simultaneously maximized sensitivity and specificity were > or =4 in men (sensitivity 0.86, specificity 0.89) and > or =3 in women (sensitivity 0.73, specificity 0.91). CONCLUSIONS: The AUDIT-C was an effective screening test for alcohol misuse in this primary care sample. Optimal screening thresholds for alcohol misuse among men (> or =4) and women (> or =3) were the same as in previously published VA studies.     

Long-term effects of brief substance use interventions for mandated college students: sleeper effects of an in-person personal feedback intervention

BACKGROUND: It is known that brief interventions for mandated college students decrease alcohol use and/or related problems in the short term. However, none of the existing studies has followed students' past 6 months. Therefore, we compared the long-term efficacy of 2 brief substance use feedback interventions for mandated college students. METHODS: We followed up mandated students (N=348) who were randomly assigned to either a brief motivational interview (BMI; n=180) or a written feedback-only (WF; n=168) intervention at 4 months and 15 months postintervention. RESULTS: Long-term follow-up data revealed that students, at the aggregate level, decreased their peak blood alcohol concentration (BAC) levels, number of drinks per week, and number of alcohol-related problems at 15 months postintervention compared with their baseline levels. With the exception of peak BAC, the observed long-term reduction was mainly due to the positive change among students who received the BMI intervention. Students in the BMI intervention showed significantly lower levels of alcohol-related problems at 15 months than those in the WF intervention. The BMI intervention more effectively reduced within-individual alcohol-related problems during the initial 4 months, and more successfully curbed the subsequent increase in alcohol use frequency and number of drinks per week during the 11 months between the 2 follow-up assessments. CONCLUSIONS: The results suggest that brief substance use interventions reduce the riskiest type of alcohol use (e.g., peak BAC) among mandated college students over the long term, and that sleeper effects of in-person personal feedback interventions (PFIs) exist. In-person PFIs in the context of a motivational interview may be more efficacious in the long term than written feedback-only interventions for mandated students. Future studies comparing interventions for college students should extend follow-up for longer periods of time.     

Alcohol drinking in MCH receptor-1-deficient mice

Background: Recently, we demonstrated that exogenous melanin‐concentrating hormone (MCH) increases alcohol drinking in rats when administered into the brain. However, because the physiological relevance of this finding is unclear, we tested the hypothesis that endogenous MCH signaling enhances alcohol consumption. Methods: Alcohol intake was assessed in male and female wildtype (WT), heterozygous (HET), and homozygous MCH receptor‐1‐deficient (KO) mice. Mice were given 24‐hour access to a series of alcohol‐containing solutions. Following this, the mice were given limited (1‐hour) access to 10% alcohol. Finally, mice were allowed 24‐hour access to sucrose/quinine as a caloric control and a means to assess taste preference. A naïve cohort of male WT and KO mice was tested for alcohol clearance following intraperitoneal administration of 3 g/kg alcohol. Another naïve cohort of female mice was utilized to confirm that intracerebroventricular administration of MCH (5 μg) would augment alcohol drinking in mice. Results: Exogenous MCH enhanced 10% alcohol consumption in mice (saline=0.45±0.08 g/kg, 5 μg MCH=0.94±0.20 g/kg). Male KO mice consumed more 10% alcohol (11.50±1.31 g/kg) than WT (6.26±1.23 g/kg) and HET mice (6.49±1.23 g/kg) during ad libitum access. However, alcohol intake was similar among genotypes during 1 hour daily access. Male KO mice tended to consume less 17.75% sucrose+1.3 mM quinine than controls (WT=10.5±3.6, HET=7.5±1.7, KO=4.4±0.9 g/kg). Alcohol metabolism was similar between WT and KO mice. Conclusions: The finding that male KO consume more alcohol than WT and HET mice, are reminiscent of the counterintuitive reports that KO mice are hyperphagic and yet eat more when administered exogenous MCH. Changes in taste preference or alcohol metabolism do not appear to be important for the increased alcohol drinking in KO mice.     

Role of stress in acquisition of alcohol-conditioned place preference in adolescent and adult mice

Background:  Both clinical evidence and findings from animal models demonstrate that there are differences between adolescents and adults in alcohol dependence. As stress plays a critical role in processes of alcohol addiction, we tested whether stress is involved in alcohol vulnerability differently during adolescence and adulthood in mice.
Methods:  To determine whether age differences exist in the acquisition of alcohol-conditioned place preference (CPP) in mice, adolescent and adult mice were trained for CPP with different doses of alcohol (0, 0.5, 1, and 2 g/kg, i.p.). To explore the effects of stress (footshock) on acquisition of alcohol CPP in mice of different ages, adolescent and adult mice underwent acute (1 day) or chronic (1 week) stress before CPP training. Acquisition of CPP was examined after the CPP training.
Results:  Under nonstress conditions, adult mice acquired alcohol CPP when trained with 2 g/kg alcohol, while adolescent mice did not acquire alcohol CPP. After chronic but not acute stress exposure, adolescent mice acquired significant CPP trained with 2 g/kg alcohol that did not produce CPP under nonstress conditions. However, stress did not have significant effect on acquisition of CPP in adult mice trained CPP with 1 g/kg alcohol.
Conclusions:  These results indicate that there is an age difference in acquiring alcohol CPP and adolescent mice are more sensitive than adults to stress.     

Treatments for patients with dual diagnosis: a review

BACKGROUND: Comorbid substance use and mental illness is prevalent and often results in serious consequences. However, little is known about the efficacy of treatments for patients with dual diagnosis. METHODS: This paper reviews both the psychosocial and medication treatments for those diagnosed with a substance-related disorder and one of the following disorders: (a) depression, (b) anxiety disorder, (c) schizophrenia, (d) bipolar disorder, (e) severe mental illness, and (f) nonspecific mental illness. We made no restriction of study design to include all published studies, due to the dearth of studies on treatments of patients with dual diagnosis. RESULTS: Fifty-nine studies were identified (36 randomized-controlled trials; RCT). Limited number of studies, especially RCTs, have been conducted within each comorbid category. This review did not find treatments that had been replicated and consistently showed clear advantages over comparison condition for both substance-related and other psychiatric outcomes. CONCLUSIONS: Although no treatment was identified as efficacious for both psychiatric disorders and substance-related disorder, this review finds: (1) existing efficacious treatments for reducing psychiatric symptoms also tend to work in dual-diagnosis patients, (2) existing efficacious treatments for reducing substance use also decrease substance use in dually diagnosed patients, and (3) the efficacy of integrated treatment is still unclear. This review provides a critique of the current state of the literature, identifies the directions for future research on treatment of dual-diagnosis individuals, and calls for urgent attention by researchers and funding agencies to conduct more and more methodologically rigorous research in this area.     

Identification of candidate genes for alcohol preference by expression profiling of congenic rat strains

Background: A highly significant quantitative trait locus (QTL) on chromosome 4 that influenced alcohol preference was identified by analyzing crosses between the iP and iNP rats. Congenic strains in which the iP chromosome 4 QTL interval was transferred to the iNP (NP.P) exhibited the expected increase in alcohol consumption compared with the iNP background strain. This study was undertaken to identify genes in the chromosome 4 QTL interval that might contribute to the differences in alcohol consumption between the alcohol‐naïve congenic and background strains. Methods: RNA from 5 brain regions from each of 6 NP.P and 6 iNP rats was labeled and analyzed separately on an Affymetrix Rat Genome 230 2.0 microarray to look for both cis‐regulated and trans‐regulated genes. Expression levels were normalized using robust multi‐chip average (RMA). Differential gene expression was validated using quantitative real‐time polymerase chain reaction. Five individual brain regions (nucleus accumbens, frontal cortex, amygdala, hippocampus, and striatum) were analyzed to detect differential expression of genes within the introgressed QTL interval, as well as genes outside that region. To increase the power to detect differentially expressed genes, combined analyses (averaging data from the 5 discrete brain regions of each animal) were also carried out. Results: Analyses within individual brain regions that focused on genes within the QTL interval detected differential expression in all 5 brain regions; a total of 35 genes were detected in at least 1 region, ranging from 6 genes in the nucleus accumbens to 22 in the frontal cortex. Analysis of the whole genome detected very few differentially expressed genes outside the QTL. Combined analysis across brain regions was more powerful. Analysis focused on the genes within the QTL interval confirmed 19 of the genes detected in individual regions and detected 15 additional genes. Whole genome analysis detected 1 differentially expressed gene outside the interval. Conclusions: Cis‐regulated candidate genes for alcohol consumption were identified using microarray profiling of gene expression differences in congenic animals carrying a QTL for alcohol preference.     

The alcohol use disorders identification test: an update of research findings

BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) has been extensively researched to determine its capability to accurately and practically screen for alcohol problems. METHODS: During the 5 years since our previous review of the literature, a large number of additional studies have been published on the AUDIT, abbreviated versions of it, its psychometric properties, and the applicability of the AUDIT for a diverse array of populations. The current article summarizes new findings and integrates them with results of previous research. It also suggests some issues that we believe are particularly in need of further study. RESULTS: A growing body of research evidence supports the criterion validity of English version of the AUDIT as a screen for alcohol dependence as well as for less severe alcohol problems. Nevertheless, the cut-points for effective detection of hazardous drinking as well as identification of alcohol dependence or harmful use in women need to be lowered from the originally recommended value of 8 points. The AUDIT-C, the most popular short version of the AUDIT consisting solely of its 3 consumption items, is approximately equal in accuracy to the full AUDIT. Psychometric properties of the AUDIT, such as test-retest reliability and internal consistency, are quite favorable. Continued research is urged to establish the psychometric properties of non-English versions of the AUDIT, use of the AUDIT with adolescents and with older adults, and selective inclusion of alcohol biomarkers with the AUDIT in some instances. CONCLUSIONS: Research continues to support use of the AUDIT as a means of screening for the spectrum of alcohol use disorders in various settings and with diverse populations.     

Alcohol selectively reduces brain activity during the affective processing of negative information

BACKGROUND: Although it has frequently been suggested that alcohol influences emotions such as anxiety and fear through the modulation of affective information processing, few studies addressed this topic using objective measures. OBJECTIVES: The acute effects of alcohol on affective processing of pictorial stimuli were investigated using electrophysiological measures. METHODS: Event-related brain potentials (ERP) resulting from watching pleasant, unpleasant, and neutral pictures were investigated in a group of participants receiving a beverage containing a moderate dose of alcohol (n=26) and a group of participants receiving a nonalcoholic placebo beverage (n=24). Both early [early posterior negativity (EPN)] and late [late positive potential (LPP)] ERP components were employed as index of emotional processing. RESULTS: The results show that alcohol reduced brain activity during watching unpleasant information in a late stage (700-1000 ms). This suggests that alcohol selectively influences the processing of unpleasant information. CONCLUSIONS: The findings are in concordance with theories linking alcohol administration to decreased processing of affective information. The results are discussed in the context of the role of the effect of alcohol on affective information processing, and its relevance to alcoholism.     

Chylous Ascites Secondary to Pancreatitis: Management of an Uncommon Entity Using Parenteral Nutrition and Octreotide

Malignancy, surgical trauma, cirrhosis and tuberculosis account for more than 95% of causes for chylous ascites. We report a case of persistent chylous ascites following acute pancreatitis that responded to parenteral nutrition and octreotide. A 50 year-old male was diagnosed with acute alcoholic pancreatitis after presenting with typical abdominal pain, and elevated amylase and lipase. The acute symptoms resolved within one week. Four weeks later he started developing increased abdominal girth. Examination revealed the presence of shifting dullness and paracentesis confirmed diagnosis of chylous ascites. Investigations for the common causes of chylous ascites were negative. Laparoscopy confirmed the presence of fat necrosis within mesenteric lymph nodes linking the chylous ascites to the episode of pancreatitis. The Chylous ascites was resistant to the usual medical therapy, but responded only to the combination of octreotide and total parenteral nutrition with complete resolution of ascites in 8 weeks. This case of chylous ascites secondary to pancreatitis represents an uncommon presentation with effective management resulting in a dramatic response.