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Background Phosphatidylethanol (PEth) is a specific marker of alcohol intake, used both as a screening method for hazardous use and as an outcome measure in the treatment of alcohol use disorder (AUD). However, what cut-off values to apply for hazardous use in a treatment setting is still unclear. We aimed to investigate the correlation between PEth and self-reported drinking and identify the optimal cut-off for hazardous use, for patients with AUD and a stated goal of controlled drinking. Methods We used data from a randomized controlled trial of two different psychological treatments aiming for controlled drinking, conducted within specialized addiction care in Stockholm, Sweden. A total of 181 patients left samples that could be included in the current analysis. Outcomes were measured at five different time points over 2 years of follow-up. PEth 16:0/18:1 values were correlated with subjective reports of recent drinking based on the Timeline Follow-Back Method. Results The correlation between PEth and self-reported alcohol intake increased significantly over time, with the weakest correlation found at baseline (Spearman's ρ = 0.42) and the strongest at the 104-week follow-up (ρ = 0.69). When used to indicate hazardous drinking according to Swedish guidelines (≥10 units per week), receiver operating characteristic analysis revealed PEth ≥ 0.22 μmol/l to be the optimal cut-off. Conclusions PEth is a useful outcome measure that can be used to validate subjective reports of current drinking. In a treatment setting aimed at controlled drinking, the accuracy of patients' self-report measures seems to improve over time. In this context, a PEth value of ≥0.22 μmol/l is a sensitive and specific indicator of hazardous drinking. [ABSTRACT FROM AUTHOR]

Background: Research is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). The aim of the study was to investigate one-year outcomes of an RCT, investigating Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) and predictors of positive outcome for weekly alcohol consumption, CD and symptom reduction in AUD. Methods: This study is based on secondary analyses from a randomized controlled trial including 250 individuals with AUD (52% men) recruited from three specialized addiction clinics in Stockholm, Sweden. Linear and logistic mixed regression models were used for outcomes at 52 weeks, and linear and logistic regression models for the predictor analyses. Results: BSCT was superior to MET for the change between baseline to 52 weeks for the outcome of CD, defined as low-risk drinking below ten standard drinks per week for both genders (p = 0.048). A total of 57% of individuals in BSCT attained a level of CD, as opposed to 43% in MET. Females were significantly better in attaining low-risk drinking levels compared to men. The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption. Conclusions: BSCT was superior to MET in obtaining CD levels, and women were superior to men for the same outcome. The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. The study contributes with important knowledge on key treatment targets, and knowledge to support and advice patients in planning for treatment with a goal of controlled drinking. Trial registration: The original study was registered retrospectively at isrtcn.com (14539251). [ABSTRACT FROM AUTHOR]

Background: Abstinence has historically been considered the preferred goal of alcohol use disorder (AUD) treatment. However, most individuals with AUD do not want to abstain and many are able to reduce their drinking successfully. Craving is often a target of pharmacological and behavioral interventions for AUD, and reductions in craving may signal recovery. Whether reductions in drinking during AUD treatment are associated with reductions in craving has not been well examined. Methods: We conducted secondary analyses of data from three AUD clinical trials (N's= 1327, 346, and 200). Drinking reductions from baseline to the end of treatment were measured as changes in World Health Organization (WHO) risk drinking levels; alcohol craving was measured using validated self‐report measures. Regression analyses tested whether drinking reductions were associated with end‐of‐treatment craving reductions; moderation analyses tested whether associations between drinking reduction and end‐of‐treatment craving differed across AUD severity. Results: Reductions of at least 1 or at least 2 WHO risk drinking levels were associated with lower craving (all p's < 0.05). Results were substantively similar after removing abstainers at the end‐of‐treatment. Associations between drinking reductions and craving were generally not moderated by AUD severity. Conclusions: Individuals with WHO risk drinking level reductions reported significantly lower craving, as compared to those who did not achieve meaningful reductions in drinking. The results demonstrate the utility of WHO risk drinking levels as AUD clinical trial endpoints and provide evidence that drinking reductions mitigate craving. [ABSTRACT FROM AUTHOR]

Background and aims: Controlled drinking (CD) is an attractive treatment goal for a large proportion of individuals with alcohol use disorder (AUD), but the availability of treatment methods supporting a goal of CD is scarce. We tested if behavioural self‐control training (BSCT) was superior to motivational enhancement therapy (MET) for individuals with AUD with a treatment goal of CD. Design: Randomized controlled two‐group trial. Follow‐ups were conducted at 12 and 26 weeks (primary end‐point) after inclusion. Setting: Three specialized dependency care clinics in Stockholm, Sweden. Participants: Two hundred and fifty self‐referred adults (52% men) fulfilling criteria of AUD (DSM‐5) and a stated treatment goal of CD. Intervention and comparator: BSCT (n = 125), a five‐session treatment based on cognitive behavioural therapy versus the active comparator, MET (n = 125), containing four sessions based on Motivational Interviewing. Measurements Primary outcome measure was mean weekly alcohol consumption at the 26‐week follow‐up, adjusted for baseline consumption. Conclusions: A randomized controlled trial found no evidence of a difference between behavioural self‐control training and motivational enhancement therapy in reducing weekly alcohol consumption. Both groups substantially reduced consumption and behavioural self‐control training was superior in reducing hazardous drinking. [ABSTRACT FROM AUTHOR]

Background: ETHER ("Education THEérapeutique pour la Réduction des dommages en alcoologie" or Therapeutic education for alcohol-related harm reduction) is a multicentre community-based mixed-methods study, which aims to evaluate the effectiveness of the innovative therapeutic patient education (TPE) programme 'Choizitaconso' in a sample of French people with alcohol use disorder (people with AUD). Choizitaconso teaches people with AUD psychosocial skills to help them (re)establish controlled drinking and reduce alcohol-related harms. Recruitment started in October 2019. We present here the protocol of the ETHER study. Methods: ETHER's quantitative component involves a 6-month controlled intervention study which evaluates Choizitaconso's effectiveness by comparing 30 people with AUD following the programme with a control group of 60 people with AUD not enrolled in it, using a questionnaire co-constructed by the research team and members of the people with AUD community. Thirty-four alcohol-related harms are assessed and summed to provide an individual measure of the 'harm burden' from consuming alcohol (primary outcome). Secondary outcomes are anticipated and internalized stigma, alcohol consumption measures, craving for alcohol, coping strategies, health-related quality of life, self-confidence to control or abstain from drinking, treatment self-regulation, anxiety and depressive symptoms, alcohol-related neuropsychological impairments, and capabilities (a measure of wellbeing in adults). Data will be collected in face-to-face and phone-based interviews at enrolment and 6 months later. Linear regression models will be used to assess the impact of the TPE programme on changes in the primary and secondary outcomes, while adjusting for other correlates and confounders. The study's qualitative component comprises semi-structured interviews with 16 people with AUD who have already completed the TPE programme at least 6 months before the interview. Qualitative interviews will be analysed using thematic analysis. Results and conclusions: ETHER is the first evaluation study of an innovative TPE programme specifically designed to reduce alcohol-related harms and reach controlled drinking in France. The involvement of the people with AUD community in selecting which experienced and perceived alcohol-related harms to measure ensures that ETHER will provide healthcare staff and researchers with a relevant set of harm reduction criteria for use in future research. Finally, ETHER will provide scientific justification for implementing novel alcohol-related harm reduction approaches and champion controlled drinking as a therapeutic goal. Trial registration ClinicalTrials.gov, NCT03954054. Registered 17 May 2019—Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03954054?cond=alcohol&cntry=FR&city=Marseille&draw=1&rank=1. [ABSTRACT FROM AUTHOR]

Introduction: The Alcohol Dependence Scale (ADS) is used to identify the overuse and dependence on alcohol taking into account the assessment of the severity of currently existing alcohol problems. So far, there has been no cultural adaptation of the ADS scale carried out in Poland. The ADS scale can be a useful tool in the social rehabilitation process and in modifying drinking patterns in general. Objective: The objective of the study was to culturally adapt the ADS and elaborate its norms. Method: The study was conducted in a group of 708 persons (F: 49%). The average age of the respondents was 35.5 years (SD = 13.72, <18.81>). The tool was translated according to the norms of the International Society for Pharmacoeconomics and Outcomes Research Quality of Life Special Interest group. Criterion validity and reliability were assessed and norms were established. Results: The validity was assessed by correlating ADS results with AUDIT (r = 0.86, p < 0.01). The total Cronbach's alpha value was 0.94. The ROC analysis demonstrated sensitivity and specificity ranging from 0.79 for Psychoperceptual and Psychophysiological Withdrawal Symptoms to 0.81 for aggregate results. Specificity ranged from 0.55 for Psychoperceptual and Psychophysiological Withdrawal Symptoms to 0.64 for Compulsive Drinking and the whole. Due to gender differences, standards for women and men were developed for the total and individual areas. Conclusions: High validity and reliability of the questionnaire was obtained. ADS is a tool that may be used in clinical practice in Polish conditions. High sensitivity and satisfactory specificity allows for using the questionnaire to select the optimal goals of the treatment. [ABSTRACT FROM AUTHOR]

Background: While accumulating evidence suggests a relation between the severity of alcohol dependence and the risk of its recurrence, the impact of dependence severity on the course of the disorder has not been carefully evaluated. The present study examined the impact of several severity indices of alcohol dependence on the drinking course after inpatient treatment. Methods: This prospective study was conducted over a 12‐month period following alcohol treatment at a specialized hospital. A total of 712 consecutively admitted alcohol‐dependent patients were targeted for enrollment at the time of their hospitalization, with 637 patients registered and followed. The characteristics and severity of the subjects were assessed using multiple methods at admission, with their course after discharge followed continuously using mailed questionnaires that queried them regarding their drinking behavior. Results: Greater severity of dependence, assessed using the number of ICD‐10 diagnostic criteria met, was associated with a lower rate of abstinence during the study period (p = 0.035). The rate of abstinence also decreased significantly as the baseline blood gamma‐glutamyl transferase value and Alcohol Dependence Scale (ADS) score increased (p = 0.031 and p = 0.0002, respectively). In multivariate Cox proportional hazards analyses, the group with the most severe ADS scores had a significantly greater risk of relapse to drinking than the group with the least severe scores (HR = 2.67, p = 0.001). Dependence severity also associated with the drinking pattern; participants in both the controlled drinking group and the abstinence group had lower ADS scores at admission and a later age at first drinking (p = 0.001 and p < 0.001, respectively) than those with poorer drinking outcomes. Conclusions: The present study showed that more severe alcohol dependence predicts a poorer course after alcohol treatment, as reflected by findings on multiple measures. These results suggest that assessing the dependence severity at the outset of treatment could be useful both in predicting treatment outcome and targeting interventions to alcohol‐dependent individuals who need additional support in their recovery. [ABSTRACT FROM AUTHOR]

Background and Aims: The proportion of untreated patients with alcohol use disorder (AUD) exceeds that of any other mental health disorder, and treatment alternatives are needed. A widely discussed strategy is to depart from the abstinence paradigm as part of controlled drinking approaches. This first systematic review with meta‐analysis aims to assess the efficacy of non‐abstinent treatment strategies compared with abstinence‐based strategies. Methods: CENTRAL, PubMed, PsycINFO and Embase databases were searched until February 2019 for controlled (randomized and non‐randomized) clinical trials (RCTs and non‐RCTs) among adult AUD populations, including an intervention group aiming at controlled drinking and a control group aiming for abstinence. Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) and Cochrane Collaboration guidelines, literature search, data collection and risk of bias assessment were carried out independently by two reviewers [International Prospective Register of Systematic Reviews (PROSPERO), registration no. CRD42019128716]. The primary outcome was the proportion of participants consuming alcohol at or below the recommended threshold. Secondary outcomes were social functioning, drinking reductions, abstinence rates and dropouts. Using random‐effects models, RCTs and non‐RCTs were analyzed separately. Sensitivity and subgroup analyses accounted for methodological rigor, inclusion of goal‐specific treatment, length of follow‐up and AUD severity. Results: Twenty‐two studies (including five RCTs) with 4204 patients were selected. There was no statistically significant difference between both treatment paradigms in RCTs [odds ratio (OR) = 1.32, 95% confidence interval (CI) = 0.51–3.39]. Non‐randomized studies of free goal choice favored abstinence‐orientation (OR = 0.60, 95% CI = 0.40–0.90), unless goal‐specific treatment was provided (OR = 0.79, 95% CI = 0.40–1.56), or in studies of low risk of bias (OR = 0.73, 95% CI = 0.49–1.09) or with long follow‐up (OR = 1.49, 95% CI = 0.78–2.85). Effect sizes were not clearly dependent upon AUD severity. Abstinence‐ and controlled drinking interventions did not clearly differ in their effect on social functioning and drinking reductions. Conclusions: Available evidence does not support abstinence as the only approach in the treatment of alcohol use disorder. Controlled drinking, particularly if supported by specific psychotherapy, appears to be a viable option where an abstinence‐oriented approach is not applicable. [ABSTRACT FROM AUTHOR]

Rationale: Alcohol use disorder is a common and devastating mental illness for which satisfactory treatments are still lacking. Nalmefene, as an opioid receptor modulator, could pharmacologically support the reduction of drinking by reducing the (anticipated) rewarding effects of alcohol and expanding the range of treatment options. It has been hypothesized that nalmefene acts via an indirect modulation of the mesolimbic reward system. So far, only a few imaging findings on the neuronal response to nalmefene are available. Objectives: We tested the effect of a single dose of 18 mg nalmefene on neuronal cue-reactivity in the ventral and dorsal striatum and subjective craving. Methods: Eighteen non-treatment-seeking participants with alcohol use disorder (67% male, M = 50.3 ± 13.9 years) with a current high-risk drinking level (M = 76.9 ± 52 g of pure alcohol per day) were investigated using a cue-reactivity task during functional magnetic resonance imaging (fMRI) in a double-blind, placebo-controlled, cross-over study/design. In addition, self-reported craving was assessed before and after exposure to alcohol cues. Results: An a priori defined region of interest (ROI) analysis of fMRI data from 15 participants revealed that nalmefene reduced alcohol cue-reactivity in the ventral, but not the dorsal striatum. Additionally, the subjective craving was significantly reduced after the cue-reactivity task under nalmefene compared to placebo. Conclusion: In the present study, reduced craving and cue-reactivity to alcohol stimuli in the ventral striatum by nalmefene indicates a potential anti-craving effect of this drug via attenuation of neural alcohol cue-reactivity. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present the theoretical foundation and practical approach of "open-target addiction treatment" (OTAT). Traditional treatment programmes are usually-oriented towards fixed predefined goals (abstinence, reduced consumption and harm reduction) and often focus on one substance only (e.g. alcohol). However, as a rule, people who use drugs consume several substances and sometimes additionally exhibit behavioural addictions. For many of these addictions, there is more or less motivation for change, but commonly it is not abstinence as a consistent goal. The paradigm of OTAT systematically considers multi-substance use, expects high readiness to change and is aware that commonly clients lack the willingness to abstain permanently. Design/methodology/approach: The theory and practice of OTAT involve three components, namely, first, to create a systematic inventory of all psychoactive substances consumed and addictive behaviours performed, second, to clarify, which substance-related change goals clients pursue and third, to choose adequate treatment options matching the substance-specific goals of the clients. Furthermore, OTAT includes didactic tools to support working along with these three steps (e.g. a set of cards to gain an overview over the psychoactive substances used and addictive behaviours performed). Findings: The systematic implementation of OTAT requires fundamentally different concepts about addiction and its treatment, specific competencies of the staff and a corresponding portfolio of interventions within the treatment facilities. Research limitations/implications: Future research should focus more on patients' goal preferences and their impact on their willingness to take up treatment and its outcomes. Practical implications: To implement OTAT treatment, institutions have to undergo a systematic process of team and organizational development. Social implications: OTAT has the potential to reduce the treatment gap and to serve severely addicted individuals in a more comprehensive way. Originality/value: The OTAT approach has not been described in the addiction treatment literature so far. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to give an overview of the scientific evidence for reduced drinking in alcohol use disorders. While the aim of alcohol use disorders (AUD) treatment usually focuses on abstinence, only a minority of individuals with AUD enter treatment. Lack of alternative treatment goals, including reduced drinking instead of abstinence, have been identified as a potential barrier for treatment entry. Epidemiological and treatment outcome studies reveal that a large proportion of individuals with AUD are able to substantially reduce their alcohol intake for a prolonged duration of time. Design/methodology/approach: A narrative review of the literature on prevalence rates and health effects as well as evidence-based approaches fostering reduced drinking in individuals with AUD is presented. Findings: Reduced drinking is associated with improvements in both morbidity and mortality. Research has identified evidence-based psychosocial and pharmacological treatment approaches; however, implementation is still scarce. Originality/value: Target groups for interventions fostering drinking reduction instead of abstinence are defined and desiderata for further research are outlined. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate how clients – five years after completing treatment interventions endorsing abstinence – view abstinence and the role of Alcoholics Anonymous (AA) in their recovery process. Design/methodology/approach: Interviews with 40 clients were conducted shortly after them finishing treatment and five years later. All the interviewees had attended treatment programmes based on the 12-step philosophy, and they all described abstinence as crucial to their recovery process in an initial interview. Findings: At follow-up, the majority remained abstinent. For many, attending AA meetings was still important – some described attending as a routine, whereas others stressed that the meetings were crucial for remaining abstinent. For those who reported controlled drinking (CD), this was described either as a natural step in their recovery process or as associated with worries and self-doubts. Research limitations/implications: The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit from support in this process, both from peers and professionals. Originality/value: There are heterogeneous views on the possibilities of CD after recovery from substance use disorder both in research and in treatment systems. This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion. [ABSTRACT FROM AUTHOR]

Alcohol use disorders (AUD) is a major public health concern. General practitioners (GP) must play a key role in identifying this disorder and offering appropriate interventions. The authors conducted a survey among French GP in the Provence - Alpes - Côte-d'Azur (PACA) region to better understand their practices regarding AUD. Random sampling was used to enrol 101 GP in a 15-minute survey. A Computer-Assisted Telephone Interview exploring demographic and professional characteristics was conducted using a questionnaire. One third (31.7%) of the participants systematically addressed alcohol use with their patients whereas six (5.9%) never addressed it. Logistic regression analyses showed that after adjustment for the number of AUD patients followed up (odds ratio [OR] = 1.92; 95% confidence interval [CI] [1.19, 3.08]) and GP interest in addiction medicine (5.41 [2.17, 13.40]), GP who systematically screened patients for AUD were more likely to accept controlled drinking as a therapeutic goal (5.41 [2.17, 13.33]), and to perceive patient denial of AUD as a major barrier to care (1.39 [0.60, 3.22]). GP providing care for AUD were more likely to monitor tobacco cessation (9.08 [2.60, 31.64]) and to prescribe opioid maintenance treatment (7.35 [2.52, 21.41]). Alcohol screening is insufficient in general practice in France. Providing updated guidelines is essential to foster experience in this field among GP. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders (AUDs) is an emerging concept. Our objective was to explore the comparative effectiveness of drugs used in this indication. Design: Systematic review with direct and network meta‐analysis of double‐blind randomized controlled trials (RCTs) assessing the efficacy of nalmefene, naltrexone, acamprosate, baclofen or topiramate in non‐abstinent adults diagnosed with alcohol dependence or AUDs. Two independent reviewers selected published and unpublished studies on Medline, the Cochrane Library, Embase, ClinicalTrials.gov, contacted pharmaceutical companies, the European Medicines Agency and the Food and Drug Administration, and extracted data. Setting: Thirty‐two RCTs. Participants: A total of 6036 patients. Measurements: The primary outcome was total alcohol consumption (TAC). Other consumption outcomes and health outcomes were considered as secondary outcomes. Findings: No study provided direct comparisons between drugs. A risk of incomplete outcome data was identified in 26 studies (81%) and risk of selective outcome reporting in 17 (53%). Nalmefene [standardized mean difference (SMD) = −0.19, 95% confidence interval (CI) = −0.29, –0.10; I2 = 0%], baclofen (SMD = −1.00, 95% CI = −1.80, −0.19; one study) and topiramate (SMD = −0.77, 95% CI = −1.12, –0.42; I2 = 0%) showed superiority over placebo on TAC. No efficacy was observed for naltrexone or acamprosate. Similar results were observed for other consumption outcomes, except for baclofen (the favourable outcome on TAC was not reproduced). The number of withdrawals for safety reasons increased under nalmefene and naltrexone. No treatment demonstrated any harm reduction (no study was powered to explore health outcomes). Indirect comparisons suggested that topiramate was superior to nalmefene, naltrexone and acamprosate on consumption outcomes, but its safety profile is known to be poor. Conclusions: There is currently no high‐grade evidence for pharmacological treatment to control drinking using nalmefene, naltrexone, acamprosate, baclofen or topiramate in patients with alcohol dependence or alcohol use disorder. Some treatments show low to medium efficacy in reducing drinking across a range of studies with a high risk of bias. None demonstrates any benefit on health outcomes. [ABSTRACT FROM AUTHOR]

Social cognitive theory suggests when individuals select their own goals, they work harder to achieve them and experience increases in self-efficacy. Research in adults with alcohol use disorder supports the utility of treatment goal choice in predicting longitudinal outcomes; a total abstinence (TA) goal choice has been associated with better clinical outcomes versus a controlled use goal choice. Research on goal choice in adolescent substance users has not been reported. Data from 110 adolescents were collected upon admission to outpatient substance use disorder treatment. Hierarchical linear regressions tested baseline goal choice as a predictor of drinking outcomes at 6-, 12-, and 24-month follow-ups. Goal choice significantly predicted drinking outcomes at 12-month follow-up, but not at 6- or 24-month time points; TA was associated with better clinical outcomes. These findings suggest that goal choice may have clinical utility as a predictor of alcohol use disorder clinical course in adolescents. [ABSTRACT FROM PUBLISHER]

Background and aims There is evidence that low-risk drinking is possible during the course of alcohol treatment and can be maintained following treatment. Our aim was to identify characteristics associated with low-risk drinking during treatment in a large sample of individuals as they received treatment for alcohol dependence. Design Integrated analysis of data from the Combined Pharmacotherapies and Behavioral Intervention (COMBINE) study, Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) and the United Kingdom Alcohol Treatment Trial (UKATT) using repeated-measures latent class analysis to identify patterns of drinking and predictors of low-risk drinking patterns during treatment. Setting United States and United Kingdom. Participants Patients ( n = 3589) with alcohol dependence receiving treatment in an alcohol clinical trial were primarily male (73.0%), white (82.0%) and non-married (41.7%), with an average age of 42.0 (standard deviation = 10.7). Measurements Self-reported weekly alcohol consumption during treatment was assessed using the Form-90 and validated with biological verification or collateral informants. Findings Seven patterns of drinking during treatment were identified: persistent heavy drinking (18.7% of the sample), increasing heavy drinking (9.6%), heavy and low-risk drinking (6.7%), heavy drinking alternating with abstinence (7.9%), low-risk drinking (6.8%), increasing low-risk drinking (10.5%) and abstinence (39.8%). Lower alcohol dependence severity and fewer drinks per day at baseline significantly predicted low-risk drinking patterns [e.g. each additional drink prior to baseline predicted a 27% increase in the odds of expected classification in heavy drinking versus low-risk drinking patterns; odds ratio = 1.27 (95% confidence interval (CI) = 1.10, 1.47, P = 0.002]. Greater negative mood and more heavy drinkers in the social network were significant predictors of expected membership in heavier drinking patterns. Conclusions Low-risk drinking is achievable for some individuals as they undergo treatment for alcohol dependence. Individuals with lower dependence severity, less baseline drinking, fewer negative mood symptoms and fewer heavy drinkers in their social networks have a higher probability of achieving low-risk drinking during treatment. [ABSTRACT FROM AUTHOR]

Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept "intermediate harm reduction" (European Medicines Agency) or "low-risk drinking limits" (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD. [ABSTRACT FROM AUTHOR]

Background:The study presented here sheds light on factors promoting or impeding change in the Polish treatment system, by focusing on the specific case of reduced risk drinking (RRD) as treatment objective and modality. More specifically, treatment providers’ perceptions of implementation, barriers and potential chances of adoption of RRD in practice were explored. Method:The 26 alcohol addiction professionals working in 13 outpatient facilities in different parts of Poland took part in four focus group interviews conducted from June to August 2015. The computer assisted qualitative data analysis followed an inductive–deductive procedure. Initially, the transcripts were inductively coded ‘sentence by sentence’ in order to capture the meaning of data. Afterwards, the codes were linked with the deductive, theoretical categories. Results:In their assessment addiction therapists drew upon their individual experience and organizational context, but also stressed system and societal aspects. Five types of barriers to the adoption of RRD programs emerged from the qualitative data analysis: (a) Potential conflicts between RRD and abstinence-oriented programs; (b) Professional routines and paradigms; (c) Information deficits and knowledge requirements; (d) Feasibility and implementation problems and (e) Evaluation issues. Conclusions:The typology of barriers to reduced risk drinking identified among treatment providers will inform policy efforts to plan changes and to anticipate dynamics within the addiction treatment systems more successfully and reduce the treatment gap. [ABSTRACT FROM PUBLISHER]

INTRODUCTION - Parents are often warned about the negative consequences of drinking alcohol in the presence of their children, while surveys indicate that children fairly often see their parents drink and also being drunk. We applied a mixed method approach to explore attitudes towards parents' drinking in the presence of their children, using (1) survey and (2) focus group data. In the analysis of the focus group data, we also addressed which consequences of parents' drinking the participants emphasised, and how they reasoned for their opinions. The results were merged in order to compare, contrast and synthesise the findings from both data sets. METHODS - The data stem from a web survey among 18-69-year-old Norwegians (Study 1, N=2171) and from focus group interviews with 15-16-year-olds and parents of teenagers (Study 2, 8 groups, N=42). RESULTS - In both data sets, drinking moderately in the presence of children was mostly accepted, but attitudes became more restrictive with an increased drinking frequency and with visible signs of intoxication. The results from Study 2 showed also that definitions of moderation varied and that the participants used contextual factors such as atmosphere and occasion to define when drinking was acceptable and when it was not. In reflections on the importance of moderation, they emphasised parental responsibility for the family as a unit and parents' immoderate drinking as posing a risk to children's safety. The participants also underlined the importance of parental drinking in the alcohol socialisation process. CONCLUSION - Parents' drinking in the presence of children was generally accepted as long as the drinking was moderate. The focus group data showed that definitions of moderation varied, and that social context also was used to define moderation. [ABSTRACT FROM AUTHOR]

This report describes a mild, aqueous-phase strategy that enables stereoretentive C-H activation at sp3 C-H sites bearing amine or alcohol groups. The transformation utilizes D2O to replace the hydrogen with deuterium while retaining stereochemistry. Electroactivated ruthenium particles, which are supported by an activated carbon cloth (Ru/ACC), catalyze this reaction on a timescale of minutes to hours. This yields optimal results at low current density and mild temperature. [ABSTRACT FROM AUTHOR]

This paper offers some reflections on Griffith Edwards' continuing legacy with particular reference to his and Milton Gross's formulation of alcohol dependence as a 'provisional' clinical syndrome. The ideas and language from this seminal paper have heavily influenced international diagnostic classification systems. However, it is observed that there has also been significant (and increasing) divergence-in particular around the original proposal that dependence and negative alcohol-related consequences are independent, if inevitably inter-related dimensions. This is most apparent in the conflation of alcohol-related problems and dependence phenomena implicit in DSM-V. It is also argued that the alcohol dependence syndrome (ADS) has substantial continuing influence and relevance to current clinical practice. The hypothesis that degree of alcohol dependence is a useful indicator of the possibility of a return to controlled drinking continues to receive support, and underpins the widespread implementation of brief interventions for 'early stage' problem drinkers. It is suggested that the kind of careful clinical observations that underpinned the original concept of alcohol dependence have continuing relevance to the formulation of improved understanding, measurement instruments, diagnostic systems and clinical responses. [ABSTRACT FROM AUTHOR]

AIM-This article explores the multiplicity of former heavy drinkers' narratives. The focus lies on turning points from heavy drinking among people who have recovered through self-change and among those who recovered by participating in Alcoholics Anonymous (AA) meetings. DESIGN-We conducted 42 qualitative interviews with media-recruited informants in 2009-2013. The interviews allowed the respondents to narrate their life histories of drinking and quitting drinking, including accounts of causality and order of events. RESULTS-These narratives are enactments shaped in the practice and context in which they were experienced. It is argued that the multiplicity of drinking narratives results not only from the fact that people have different experiences while drinking nor only from different people having different ways of recovering from a problematic consumption. The multiplicity is also the result of the very enactment of recovering and the lives lived after the recovery. The multiplicity is created in practice and is revealed in the narratives. CONCLUSIONS-The narratives and the enactment of the narratives of one's past, present and future that occur when making momentous changes in one's life-such as stopping drinking-are all essential for the process of quitting alcohol and the life to be lived hereafter. We should therefore pay more attention to the multiplicity that is created in the enactment of narratives in the process of recovery. [ABSTRACT FROM AUTHOR]

Social marketing by Western governments that use fear tactics and threatening information to promote anti-drinking messages has polarized 'binge drinking' and 'moderate drinking' through a continuum that implies benefits and harms for both individuals and society. With the goal of extending insights into social marketing approaches that promote safer drinking cultures in Australia, we discuss findings from a study that examines alcohol consumers' moderate-drinking intentions. By applying the theory of planned behaviour and emotions theory, we discuss survey results from a sample of alcohol consumers, which demonstrate that positively framed value propositions that evoke happiness and love are more influential in the processing of an alcohol moderation message for alcohol consumers. The key limitations of this study are the cross-sectional nature of the data and the focal-dependent variable being behavioural intentions rather than behaviours. Research insight into the stronger influence of positive emotions on processing an alcohol moderation message establishes an important avenue for future social marketing communications that moves beyond negative, avoidance appeals to promote behaviour change in drinkers. These research findings will benefit professionals involved in developing social change campaigns that promote and reinforce consumers' positive intentions, with messages about the benefits of controlled, moderate drinking. [ABSTRACT FROM AUTHOR]

Background: Although there is evident association between alcohol-related hospitalization and alcohol use, the relationship has not been well examined. This study analyzed the extent of alcohol abstinence, non-hazardous use and hazardous use among people who had experienced alcohol-related hospitalization during the preceding decade. Method: Registry data concerning alcohol-related hospitalizations between 1996 and 2007 were linked to two representative surveys, in 2006 and 2007, of residents of Stockholm County. Relevant contrasts were modeled, using logistic regression, in the pooled sample (n = 54 955). Ages were 23-84 years at follow-up. Results: Among persons previously hospitalized (n = 576), half reported non-hazardous use. Non-hazardous use was less prevalent than in the general population - and the extent of non-hazardous use did not change over time following hospitalization. There were no significant age differences, but non-hazardous use was less frequent among people with repeated episodes of care. One in six was abstinent. Abstinence was more common among the old, while hazardous use (exceeding 14 drinks per week for men, and 9 drinks per week for women) decreased with age. Abstinence also increased over time; among persons hospitalized ten years ago, the abstinence rate was twice that of the general population. Associations with hazardous use over time were less conclusive. Hazardous use among those previously hospitalized decreased over time in one sample but not in the other. After pooling the data, there were indications of a decrease over time following hospitalization, but more prevalent hazardous use than in the general population. Conclusions: Following alcohol-related hospitalization, abstinence increased, and there was no evidence of regression towards the mean, i.e., towards non-hazardous use. Abstinence was also more widespread among previously hospitalized persons of older ages. With advancing age, changing hazardous alcohol habits among previously hospitalized appears to yield a trend towards promotion of abstinence. [ABSTRACT FROM AUTHOR]

Aims This study explores the early development of brief interventions for alcohol using a history of ideas approach with a particular focus on intervention content. Methods The source publications of the key primary studies published from approximately 1962 to 1992 were examined, followed by a brief review of the earliest reviews in this field. These studies were placed in the context of developments in alcohol research and in public health. Results After early pioneering work on brief interventions, further advances were not made until thinking about alcohol problems and their treatment, most notably on controlled drinking, along with wider changes in public health, created new conditions for progress. There was then a golden era of rapid advance in the late 1980s and early 1990s, when preventing the development of problem drinking became important for public health reasons, in addition to helping already problematic drinkers. Many research challenges identified at that time remain to be met. The content of brief interventions changed over the period of study, although not in ways well informed by research advances, and there were also obvious continuities, with a renewed emphasis on the facilitation of self-change being one important consequence of the development of internet applications. Conclusions Ideas about brief interventions have changed in important ways. Brief interventions have been studied with different populations of drinkers, with aims embracing both individual and population-level perspectives, and without well-specified contents. The brief intervention field is an appropriate target for further historical investigations, which may help thinking about addressing alcohol and other problems. [ABSTRACT FROM AUTHOR]

BACKGROUND: Alcohol consumption and its interaction with disease, medication use, and functional status may result in serious health problems, but little information exists about the national prevalence of alcohol-related health risk in older adults. OBJECTIVE: To estimate the prevalence of harmful and hazardous alcohol use and the prevalence of consumption in excess of National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommendations, in people aged 65 and older, and by sex and race/ethnicity sub-group. DESIGN: Cross-sectional, using data from the 2005-2008 National Health and Nutrition Examination Survey of the non-institutionalized U.S. population. PARTICIPANTS: One thousand and eighty-three respondents aged 65 and older who consume alcohol. MAIN MEASURES: Participants' alcohol consumption was classified as Harmful, Hazardous, or Healthwise, in the context of their specific health status, using the Alcohol-Related Problems Survey classification algorithm. KEY RESULTS: Overall, 14.5 % of older drinkers (95 % CI: 12.1 %, 16.8 %) consumed alcohol above the NIAAA's recommended limits. However, when health status was taken into account, 37.4 % of older drinkers (95 % CI: 34.9 %, 40.0 %) had Harmful consumption and 53.3 % (95 % CI: 50.1 %, 56.6 %) had either Hazardous or Harmful consumption. Among light/moderate drinkers, the proportions were 17.7 % (95 % CI: 14.7 %, 20.7 %) and 28.0 % (95 % CI: 24.8 %, 31.1 %), respectively. Male drinkers had significantly greater odds of Hazardous/Harmful consumption than female drinkers (OR = 2.14 [95 % CI: 1.77, 2.6]). Black drinkers had worse health status and significantly greater odds of Hazardous/Harmful consumption than white drinkers (OR = 1.49; 95 % CI: 1.02, 2.17), despite having no greater prevalence of drinking in excess of NIAAA-recommended limits. CONCLUSION: Most older Americans who drink are light/moderate drinkers, yet substantial proportions of such drinkers drink in a manner that is either harmful or hazardous to their health. Older adults with risky alcohol consumption are unlikely to be identified by health care providers if clinicians rely solely on whether patient consumption exceeds the NIAAA-recommended limits. [ABSTRACT FROM AUTHOR]

Copyright of Physis: Revista de Saúde Coletiva is the property of CEPESC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on a study which examines a person's capacity for making reasoned decisions. It assesses the concepts, terminologies, and dilemmas in connection with alcoholism, insight, lack of insight, denial, judgement, will, decisional capacity, and competence in patients. An overview of the assessments of patients suffering from alcoholism an other dyscontrol problems is provided.

This review describes and discusses studies related to reduced-risk drinking as an additional treatment option for patients with problematic alcohol use and alcohol dependence. The review provides some empirical support for the following statements: (a) reduced-risk drinking is a viable option for at least some problem and dependent drinkers; (b) abstinence and non-abstinence-based treatments appear to be equally effective; (c) allowing patients to choose their treatment goal increases the success rate. The relatively short follow-up period (1–2 years) of the studies hampers a proper evaluation of the added value of the reduced-risk drinking approach. [ABSTRACT FROM PUBLISHER]

Background A large subset of patients who enter treatment for alcohol dependence report nonabstinent drinking goals (e.g., reduction in drinking) rather than abstinence, and this pretreatment goal choice may be associated with drinking outcomes and alcohol-related problems. Methods An analysis of the 16-week Combined Pharmacotherapies and Behavioral Interventions ( COMBINE) study was conducted to determine the association between self-reported pretreatment drinking goal and drinking outcomes and alcohol-related problems. Participants who reported a nonabstinent drinking goal ( n = 340) were matched with participants who reported an abstinent drinking goal ( n = 340) on 3 variables believed to contribute to treatment outcomes: COMBINE experimental group, gender, and number of prebaseline heavy drinking days. Results Analyses revealed no interaction between the COMBINE experimental group and drinking goal on outcome measures, so results were collapsed and examined as a function of drinking goal group. Participants who chose an abstinent drinking goal had significantly more weeks with no drinking or no heavy drinking, reported fewer heavy drinking days, reported fewer days with >1 drink, and were more likely to have a ≥50% decrease in drinks per day between baseline and week 16 of the intervention. However, both groups reported reductions over time in percent drinking days, mean drinks per day, number of heavy drinking days, and number of drinking days per week, and participants in both groups experienced significant reductions in alcohol-related problems and improvements in psychosocial functioning. Conclusions Results replicate and expand upon previous studies examining the association between drinking goal and treatment outcome. These data also provide support for the standard inclusion of drinking treatment goal as a stratification variable in study interventions or as a covariate in outcome analyses and highlight several areas that warrant additional research regarding patients who enter alcohol treatment with a nonabstinent drinking goal. [ABSTRACT FROM AUTHOR]

Spirituality and forgiveness have been shown to be associated with psychological well-being, while guilt has been associated with poor health. Little is known, however, about the relationship between forgiveness, spirituality, guilt, posttraumatic stress (PTSD) and psychological co-morbidity among people in recovery from addiction. Eighty-one people (F = 36, M = 45) in recovery from drug and alcohol addiction were recruited from two residential units and two drop-in centres in a city in the United Kingdom. They completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28), the Spiritual Involvement and Beliefs Scale (SIBS), the Heartland Forgiveness Scale (HFS), the Traumatic Guilt Inventory (TGI), the Michigan Alcoholism Screening Test (MAST-22) and the Drug Abuse Screening Test (DAST-20). The control group comprised of 83 (F = 34, M = 49) individuals who confirmed that they did not have addiction and completed the PDS & GHQ-28. 54 % of the addiction group met the criteria for full PTSD and reported anxiety, somatic problems and depression. They described themselves as spiritual, had strong feelings of guilt associated with their addiction, and had difficulty in forgiving themselves. Controlling for demographics, number of events and medication management, regression analyses showed that spirituality predicted psychological co-morbidity, whilst feelings of guilt predicted PTSD symptoms and psychological co-morbidity. Unexpectedly, forgiveness did not predict outcomes. This study supports existing literature, which shows that people with drug and alcohol addiction tend to have experienced significant past trauma and PTSD symptoms. Their posttraumatic stress reactions and associated psychological difficulties can be better understood in the light of guilt and spirituality. Meanwhile, their ability to forgive themselves or others did not seem to influence health outcomes. [ABSTRACT FROM AUTHOR]

From plate tectonics theory to psychoneuroimmunology, to medical uses of marijuana, and controlled drinking by alcoholics, there has been a consistent failure by scientists and medical researchers to consider radically new ideas and theories. A review and analysis of these cases and other examples identified numerous reasons or barriers for this failure. Learning from these episodes of failure requires attention to and reflection on these barriers, an understanding of how the scientific process progresses and scientific knowledge evolves, and a willingness to test and evaluate these new ideas and theories before passing final judgment on them. [ABSTRACT FROM AUTHOR]

Introduction and Aims This article studies the various ways of regulating drinking used by Finns and how these vary between men and women, and in different groups of age, educational attainment and alcohol consumption. Design and Methods The data consist of a cross-section of survey data collected in Finland in 2005. The response rate was 53%. The analysis was restricted to respondents who had used alcohol in the last 12 months and were between 15 and 71 years of age ( n = 1013). A factor analysis was performed to discover underlying dimensions in the ways of regulation. In order to study the relationship between the ways of regulation and drinking habits, correlations and regression analyses were used. Results The ways of regulating one's drinking extracted to three factors which were named self-control, social control and external control. Self-control was the most common way of regulation. Stronger reliance on external control of drinking increased the probability of heavy alcohol use. Discussion and conclusions These survey results indicate that external control of drinking, for example the restriction of availability of alcohol, could have a greater impact on heavy drinking than on moderate drinking. [ABSTRACT FROM AUTHOR]

Chronic alcohol consumption is a major reason for several human diseases, and alcoholism has been associated with a variety of societal problems. Changes in fatty acid metabolism in alcoholics and its effects leading to membrane damage are largely unknown. Therefore, we aimed to investigate the fatty acid composition of erythrocyte membrane phospholipids in relation with plasma lipid profile and other plasma metabolites in chronic alcoholics in comparison with controls. We systematically measured the levels of glucose, lactate and pyruvate in the blood and free amino acids, free fatty acids, mucoproteins and glycolipids, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein (VLDL) cholesterol and triglycerides (TG) in plasma of chronic alcoholics and controls. Furthermore, we measured fatty acid composition by gas chromatographic analysis. The fatty acid composition clearly revealed certain changes in chronic alcoholic erythrocyte membrane, chiefly increments in C16:0 and a decrease in C22:4 and C22:6 fatty acids besides the presence of unidentified fatty acids, probably C-24 or C-26 fatty acids. In addition, a significant increase in blood lactate, decrease in blood pyruvate and increased levels of free amino acids and free fatty acids, mucoproteins, VLDL cholesterol, TG and HDL-C in chronic alcoholics were observed with no significant change in plasma TC, LDL-C and glycolipids when compared with controls. Alcohol-induced alterations in plasma and erythrocyte membranes of chronic alcoholics in the present study might be an adaptive response to counteract the deleterious effects of alcohol. The implications of our findings warrant further investigation and needs further in-depth study to explore the mechanisms of alcohol-induced membrane changes. [ABSTRACT FROM PUBLISHER]

Setting: Treatment default is a serious problem in tuberculosis control because it implies persistence of infection source, increased mortality, increased relapse rates and facilitates the development of resistant strains. Objective: This study analyzed tuberculosis treatment default determinants in the Amazonas State to contribute in planning appropriate control interventions. Design: Observational study with a retrospective cohort using Brazilian Disease Notification System data from 2005 to 2010. A nested case control study design was used. Patients defaulting from treatment were considered as 'cases' and those completing treatment as 'controls'. In the analysis, 11,312 tuberculosis patients were included, 1,584 cases and 9,728 controls. Results: Treatment default was observed to be associated to previous default (aOR 3.20; p<0.001), HIV positivity (aOR 1.62; p<0.001), alcoholism (aOR 1.51; p<0.001), low education level (aOR 1.35; p<0.001) and other co-morbidities (aOR 1.31; p = 0.05). Older patients (aOR 0.98; p = 0.001) and DOT (aOR 0,72; p<0.01) were considered as protective factor for default. Conclusions: Associated factors should be considered in addressing care and policy actions to tuberculosis control. Information on disease and treatment should be intensified and appropriate to the level of education of the population, in order to promote adherence to treatment and counter the spread of multidrug resistance to anti-TB drugs. [ABSTRACT FROM AUTHOR]

Genetic factors, externalizing personality traits such as impulsivity, and brain processing of salient stimuli all can affect individual risk for alcoholism. One of very few confirmed genetic association findings differentiating alcoholics from non-alcoholics is with variants in the inhibitory γ-amino butyric acid α2 receptor subunit (GABRA2) gene. Here we report the association of two of these GABRA2 variants with measures of alcohol symptoms, impulsivity and with insula cortex activation during anticipation of reward or loss using functional magnetic resonance imaging (fMRI). In a sample of 173 families (449 subjects), 129 of whom had at least one member diagnosed with alcohol dependence or abuse, carriers for the G allele in two single-nucleotide polymorphisms (SNPs) and haplotypes were more likely to have alcohol dependence symptoms (rs279858, P=0.01; rs279826, P=0.05; haplotype, P=0.02) and higher NEO Personality Inventory-Revised (NEO-PI-R) Impulsiveness scores (rs279858, P=0.016; rs279826, P=0.012; haplotype, P=0.032) with a stronger effect in women (rs279858, P=0.011; rs279826, P=0.002; haplotype, P=0.006), all P-values are corrected for family history and age. A subset of offspring from these families (n=44, 20 females), genotyped for GABRA2, participated in an fMRI study using a monetary incentive delay task. Increased insula activation during reward (r2=0.4; P=0.026) and loss (r2=0.38; P=0.039) anticipation was correlated with NEO-PI-R Impulsiveness and further associated with the GG genotype for both SNPs (P's<0.04). Our results suggest that GABRA2 genetic variation is associated with Impulsiveness through variation of insula activity responses, here evidenced during anticipatory responses. [ABSTRACT FROM AUTHOR]

Moderation Management (MM) is a mutual-help organization for problem drinkers who are not alcohol-dependent. MM members pursue a goal of moderate drinking as defined by specific guidelines for frequency and quantity of alcohol consumption. MM's program for change is based primarily on cognitive restructuring and behavioral self-control enhancement and has no inherent spiritual component. MM's definition of the “nondependent” problem drinker is based on the individual's ability to adhere to MM guidelines, which include an initial 30-day abstinence period followed by limits on daily consumption. MM's members, on average, are less alcohol-dependent and have higher social capital than individuals who participate in Alcoholics Anonymous or seek inpatient alcohol treatment. Although no longitudinal studies to date have examined the efficacy of MM, there are positive outcome data for similar cognitive and brief behavioral interventions delivered by health care professionals. Critics of MM claim the organization feeds denial among dependent drinkers and thereby delays abstinence-oriented treatment, but its defenders point out that MM may prevent some problem drinkers from progressing to a more deteriorated state such that abstinence would be necessary. Randomized trials examining whether MM is more effective than no treatment, or if it is comparable to existing evidence-based ambulatory treatments, are needed to resolve this debate. That many MM members have never sought help before suggests the organization has some public health value by widening the range of attractive options available to people with alcohol use disorders. [ABSTRACT FROM PUBLISHER]

This study assessed the effects of a contingency management (CM) intervention for alcohol consumption in 10 alcohol-dependent participants. An ABCA design was used. Vouchers were provided contingent on results of ethyl glucuronide (EtG) urine tests (an alcohol biomarker with a 2-day detection period) and alcohol breath tests during the C phase. The percentage of negative urines was 35% during the first baseline phase, 69% during the C phase, and 20% during the return-to-baseline phase. Results suggest that EtG urine tests may be a feasible method to deliver CM to promote alcohol abstinence. [ABSTRACT FROM AUTHOR]

The wars in Iraq and Afghanistan are associated with high rates of post-traumatic stress disorder (PTSD) and comorbid alcohol use disorders. The pharmacotherapy of these comorbid conditions has received relatively little study. The current study compared the serotonin uptake inhibitor, paroxetine, to the norepinephrine uptake inhibitor, desipramine. It also evaluated the adjunctive efficacy of the Food and Drug Administration (FDA)-approved alcoholism pharmacotherapy, naltrexone, relative to placebo. Four groups of predominately male veterans (n=88) meeting current diagnostic criteria for both alcohol dependence (AD) and PTSD were randomly assigned under double-blind conditions to one of four groups: paroxetine+naltrexone; paroxetine+placebo; desipramine+naltrexone; desipramine+placebo. Main outcome measures included standardized scales that assessed symptoms of PTSD and alcohol consumption. Paroxetine did not show statistical superiority to desipramine for the treatment of PTSD symptoms. However, desipramine was superior to paroxetine with respect to study retention and alcohol use outcomes. Naltrexone reduced alcohol craving relative to placebo, but it conferred no advantage on drinking use outcomes. Although the serotonin uptake inhibitors are the only FDA-approved medications for the treatment of PTSD, the current study suggests that norepinephrine uptake inhibitors may present clinical advantages when treating male veterans with PTSD and AD. However, naltrexone did not show evidence of efficacy in this population. This study was registered with ClinicalTrials.gov, registration number NCT00338962 and URL: http://clinicaltrials.gov/ct2/show/NCT00338962?term=desipramine+AND+alcohol+dependence+AND+depression&recr=Closed&rank=1. [ABSTRACT FROM AUTHOR]

There is a lack of outcome evidence for alcohol interventions for offenders whose crime is alcohol related. In this study, the authors report the intermediate outcomes of a feasibility study for a randomized controlled trial of an alcohol-related violence intervention. Control of Violence for Angry Impulsive Drinkers (COVAID) was tested with sentenced prisoners in the United Kingdom. Participants were 115 adult men who were randomly allocated to COVAID or treatment as usual. Measures were the Alcohol-Related Aggression Questionnaire (ARAQ), the State-Trait Anger Expression Inventory (STAXI-2), the Eysenck Impulsivity, Venturesome, and Empathy Scale (IVE), and the Controlled Drinking Self-Efficacy Scale (CDSES). After the intervention, participants allocated to COVAID reported significantly greater improvement on the ARAQ Alcohol-Aggression subscale and all CDSES subscales. No significant differences were obtained for the STAXI-2 or the IVE. COVAID may have the potential to fill a gap in treatment provision for offenders whose crimes of violence are alcohol related. [ABSTRACT FROM AUTHOR]

Copyright of Substance Use & Misuse is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents the topics discussed in the 2011 issues. The early diagnosis of acute kidney injury remains as an issue with great importance, with an objective to establish early preventive measures in patients who are critically ill. Three epidemiologic studies have examined the results of postsurgical patients, revealed the presence of pre-existing morbidities including cirrhosis, respiratory or cardiac failure, and alcoholism.

Across the face of modern Europe and the United States of America an enourmous amount of overdrinking among all classes of society was a norm of style of life. Traditionally, drinking had been a basic part of men s working lives . It concluded occasions as formal as the signing of a contract and accompanied such informal activities as card games. Drink was a staple offering at political speeches, rallies, and elections. In the old artisanal workshops, drinking had been a customary pastime. Much of the drinking was well within the bounds of sociability, but the widespread use (more than seven gallons hard drink per capita) in the beginning of the 19th century must have encouraged drunkenness. The vast majority of Europeans and Americans considered alcohol an essential stimulant to exertion as well as a symbol of hospitality and fellowship. Drinking was unquestionably the favorite leisure time activity of working people and the norm of lifestyle of upper classes men. The English squire, for example, who loved to ride with his hounds, loved drink with a similar passion. Women rarely drank in public, but women drank as well as men, but usually much less heavily. They were more likely to make themselves „tipsy“ with alcohol containing patent medicines than to become inebriated with gin, rum or whiskey. Drinking was deadly serious business. City men came to their neighborhood taverns, puns, gin -- houses, gin --shops, gin -- palaces etc. daily. Children also enjoyed drinking and it was allowed. Generally, however, heavy problem drinking declined by the late nineteenth century as it became less and less socially acceptable. The new middle class, preoccupied with respectability and morality, found the old easygoing drinking ways unacceptable. Drinking were denounced as vice, but hard work, self -- discipline, and personal achievement were celebrated as virtues. As work pattern changed, employers banned alcohol at work and increasingly considered drinking men not only unreliably, but immoral. Temperance became a social and political issue. There were many reasons to support temperance. Heavy drinking men hurt their families economically by spending their wages on drink. Excessive drinking also led to violance and crime within and in the larger society. Campaigns against alcohol was more frequent and successful. Concern over drinking would remain constant throughout the nineteenth century. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine the relationship between neuropsychological impairment in severe alcohol dependence and relapse. This was assessed following inpatient detoxification over a period of three months. Participants were tested on measures of neuropsychological functioning at the end of a seven to ten day stay in an inpatient alcohol detoxification unit. Participants were followed up three months later by telephone to ascertain the number of days in which alcohol was consumed during this period using the Timeline Follow Back procedure (TLFB). A correlation and regression design was used to analyse results. An inpatient alcohol detoxification unit. Thirty-four residents in an inpatient alcohol detoxification unit. Executive dysfunction during detoxification was found to predict number of days drinking in the three months following discharge. Neuropsychological impairment, and specifically executive dysfunction, appears to be a significant barrier to ability to remain abstinent from alcohol following a period of detoxification. Given the high rates of relapse found within the current study it suggests that the cognitive domains that executive functioning describe are particularly relevant in facilitating abstinence in alcohol dependence. [ABSTRACT FROM AUTHOR]

This study evaluated the effectiveness of s web-based personalized normative feedback program, elettronic Check-Up to Go (e-CHUG), in detreasing heavy drinking among 1st-year university students. Results indicated high-risk students reteiving the e-CHUG program during 1st-year orientation activities reported significantly greater reductions in heavy drinking and alcohol-related consequences than did students in an assessment-only control group at a 3-month follow-up. Recommendations for integrating e-CHUG into orientation activities are discussed. [ABSTRACT FROM AUTHOR]

The authors studied longitudinally four healthy young adults to explore if habitual evening intake of a 'moderate' amount of wine alters parameters, including period (τ) of circadian rhythms. Subjects, synchronized by diurnal activity from 07.30 h ± 60 min to 23.00 h ± 90 min and nocturnal rest, were studied during a continuous 22-day span: 11 days without alcohol (control) and 11 days with a glass (200 mL) of wine nightly at supper (alcohol). The amount of alcohol ingested with dinner ranged from 0.28 to 0.42 g/kg/24 h/participant and the estimated evening blood alcohol level ranged from 0.02 to 0.10 g/L/participant. Single reaction time (SRT; yellow light signal), three-choice reaction time (CRT) (red, green, and yellow signals) of both hands, related cumulated errors (c-errors), as well as oral temperature (OT) and grip strength (GS) were measured four to seven times/24 h. Time series were analyzed individually to quantify 24-h means (M), circadian τ (power spectra), and cosinor, and correlation, χ2, and t tests were performed. The sleep-wake τ (actography) was 24 h in every subject for both conditions. With alcohol, all subjects showed an OT circadian τ shorter than the control one. The SRT circadian M was longer (poorer performance) with wine versus control in three subjects, while CRT was longer with wine versus control in only one subject. Correlation analyses also showed the detrimental effect of alcohol on the same variables. Number of days with <2 c-errors was predominant in control and decreased with alcohol, especially for SRT. The desynchronization of the 10 different documented rhythms was greater with alcohol with reference to control in two of the four studied subjects. This work shows that habitual "moderate" wine drinking at supper reduces the performance of subjects, increases the level of c-errors/24 h, especially for SRT, suggesting a 'moderate' amount of alcohol has the potential to increase accident risk, and it can also desynchronize circadian time organization. (Author correspondence: ) [ABSTRACT FROM AUTHOR]