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Katie Witkiewitz, Kimber Saville, Kacie HamreusDepartment of Psychology, Washington State University Vancouver, Vancouver, WA, USAAbstract: Acamprosate, or N-acetyl homotaurine, is an N-methyl-D-aspartate receptor modulator approved by the Food and Drug Administration (FDA) as a pharmacological treatment for alcohol dependence. The exact mechanism of action of acamprosate is still under investigation, but the drug appears to work by promoting a balance between the excitatory and inhibitory neurotransmitters, glutamate and gamma-aminobutyric acid, respectively, and it may help individuals with alcohol dependence by reducing withdrawal-associated distress. Acamprosate has low bioavailability, but also has an excellent tolerability and safety profile. In comparison with naltrexone and disulfiram, which are the other FDA-approved treatments for alcohol dependence, acamprosate is unique in that it is not metabolized by the liver and is also not impacted by alcohol use, so can be administered to patients with hepatitis or liver disease (a common comorbid condition among individuals with alcohol dependence) and to patients who continue drinking alcohol. Acamprosate has demonstrated its efficacy in more than 25 placebo-controlled, double-blind trials for individuals with alcohol dependence, and has generally been found to be more efficacious than placebo in significantly reducing the risk of returning to any drinking and increasing the cumulative duration of abstinence. However, acamprosate appears to be no more efficacious than placebo in reducing heavy drinking days. Numerous trials have found that acamprosate is not significantly more efficacious than naltrexone or disulfiram, and the efficacy of acamprosate does not appear to be improved by combining acamprosate with other active medications (eg, naltrexone) or with psychosocial treatment (eg, cognitive-behavioral therapy). In this review, we present the data on acamprosate, including its pharmacology, efficacy, safety, and tolerability in the treatment of alcohol dependence.Keywords: alcohol abuse, acamprosate, N-methyl-D-aspartate receptor, gamma- aminobutyric acid

In the treatment of addictions, engaging in any substance use following treatment is often viewed as a treatment failure. This paper provides theoretical and empirical support for a harm reduction approach to the evaluation of treatment outcomes. Such an approach focuses on consequences associated with the post-treatment drinking, without using rigid definitions of 'success' or 'failure.' Harm reduction approaches to alcohol treatment are introduced and recommendations for future research and social work practice are provided. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the alcohol literature, most cognition research has focused on alcohol expectancies. Overall scores on alcohol expectancy questionnaires predict longitudinal changes in drinking behavior. However, the association between expectancy subscale scores and drinking behavior is inconsistent and modest. Attitudinal information may vary in accessibility (i.e., the ease or speed with which attitudinal information is evaluated), and more accessible (i.e., faster) attitudinal evaluations may predict heavier alcohol consumption. An alternative hypothesis arising from response competition theory is that heavy drinkers will show slow attitudinal evaluations, given that heavy drinkers frequently show mixed, inconsistent, or opposing alcohol-related beliefs. In this study we examined the degree to which speed of processing of alcohol-related evaluative judgments longitudinally predicted alcohol consumption in university students. METHODS: Response latencies for alcohol- and non-alcohol-related attitudinal inquiries and measures of alcohol use were administered at two intervals 4 months apart. RESULTS: The key findings were that response times for tension reduction and cognitive impairment items at time 1 positively predicted alcohol consumption at time 2. These results held after we accounted for autocorrelation in drinking and individual variability in reactivity. CONCLUSION: For items relating to tension reduction, response times fit a response competition hypothesis better than the attitude accessibility hypothesis. [ABSTRACT FROM AUTHOR]

The cumulative percentage frequencies are presented for differences among reliable component analysis (RCA) scores for the verbal comprehension, perceptual organization, freedom from distractibility, and processing speed constructs assessed by the Wechsler Intelligence Scale for Children--Third edition (WISC-III) for the standardization sample and a learning disabled sample. Using RCA scores to form differences has several advantages over traditional equally weighted scores for the WISC-III. J. C. Caruso and N. Cliff (2000) presented tables to assess the statistical significance of differences among the RCA scores for the WISC-III. It is important, however, to use a dual approach in interpreting difference scores; both the statistical significance of a difference and the frequency with which it occurred in a relevant comparison group should be determined. This article contains the information necessary for practitioners to use the recommended dual approach to interpreting RCA difference scores for the WISC-III. [ABSTRACT FROM AUTHOR]

Objective: Community characteristics (e.g., alcohol access, poverty) are associated with alcohol use disorder (AUD) at the population level, and person-level AUD severity indicators (e.g., drinking practices, problems) predict heterogeneity in individual AUD risk profiles and recovery outcomes. Guided by behavioral economic theory, this study investigated whether residing in relatively enriched communities with substance-free reward sources, greater health/behavioral health care access, lower alcohol access, and less poverty were associated with less risky individual AUD risk profiles., Method: This secondary analysis combined an integrated data set of individual natural recovery attempts with zip code community characteristics obtained from public data sources. Four AUD latent risk profiles, previously derived from individual problem severity indicators that predicted 1-year recovery outcomes, were predicted by zip code-level substance-free reward sources, alcohol access, health/behavioral health care access, and poverty surrounding AUD recovery ( N = 528)., Results: As hypothesized, multinomial regression analyses indicated that greater community access to substance-free reward sources (educational services, religious organizations, sports/fitness/recreation programs, fresh food) and lower community poverty were associated with lower AUD risk profiles compared with higher AUD risk profiles. This pattern was most pronounced in comparisons between a global lower risk profile and a higher risk profile characterized by high alcohol dependence and alcohol-related psychosocial problems. Alcohol access and health care access did not differentiate profile membership., Conclusions: Results suggest that community characteristics contribute to heterogeneity in individual drinking problem development, and community enrichment may offer a promising approach to AUD prevention and promotion of positive recovery outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Chronic pain and opioid use disorder (OUD) are public health crises and their co-occurrence has led to further complications and public health impacts. Provision of treatments for comorbid chronic pain and OUD is paramount to address these public health crises. Medications for OUD (MOUD) are gold standard treatments for OUD that have also demonstrated benefit in pain management. However, clinics that provide MOUD for chronic pain or OUD often lack behavioral treatments to address the challenges experienced by individuals with both conditions. Developing and implementing a behavioral treatment that complements MOUD may better equip clinics to provide comprehensive care to the growing proportion of clients who present with comorbid chronic pain and OUD. In the Healing Opioid misuse and Pain through Engagement (HOPE) Trial, we are using an effectiveness-implementation hybrid design to examine the benefits of an integrated behavioral treatment and to determine the feasibility of implementing the integrated treatment into clinics that provide MOUD. The treatment integrated 2 evidence-based treatments-Acceptance and Commitment Therapy and Mindfulness-Based Relapse Prevention-to target the emotional, behavioral, and physiological sequelae of OUD and chronic pain. Implementation feasibility will include assessing changes in implementation readiness and identifying facilitators and barriers to implementing the integrated treatment among all personnel employed in clinics that provide MOUD. This commentary offers an overview of the study and design and details adaptations we made to our study protocol, based largely on clinic personnel time constraints and variable clinic procedures during the COVID-19 pandemic., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background/objectives: There is a great unmet need for accessible adjunctive interventions to promote long-term recovery from substance use disorder (SUD). This study aimed to iteratively develop and test the initial feasibility and acceptability of Mindful Journey, a novel digital mindfulness-based intervention for promoting recovery among individuals with SUD., Patients/materials: Ten adults receiving outpatient treatment for SUD., Methods: Phase 1 ( n  = 5) involved developing and testing a single introductory digital lesson. Phase 2 included a separate sample ( n  = 5) and involved testing all 15 digital lessons (each 30- to 45-minutes) over a 6-week period, while also receiving weekly brief phone coaching for motivational/technical support., Results: Across both phases, quantitative ratings (rated on a 5-point scale) were all at or above a 4 (corresponding with 'agree') for key acceptability dimensions, such as usability, understandability, appeal of visual content, how engaging the content was, and helpfulness for recovery. Additionally, in both phases, qualitative feedback indicated that participants particularly appreciated the BOAT (Breath, Observe, Accept, Take a Moment) tool for breaking down mindfulness into steps. Qualitative feedback was used to iteratively refine the intervention. For example, based on feedback, we added a second core mindfulness tool, the SOAK (Stop, Observe, Appreciate, Keep Curious), and we added more example clients and group therapy videos. In Phase 2, 4 out of 5 participants completed all 15 lessons, providing initial evidence of feasibility. Participants reported that the phone coaching motivated them to use the app. The final version of Mindful Journey was a smartphone app with additional features, including brief on-the-go audio exercises and a library of mindfulness practices. Although, participants used these additional features infrequently., Conclusions: Based on promising initial findings, future acceptability and feasibility testing in a larger sample is warranted. Future versions might include push notifications to facilitate engagement in the additional app features.

Previous work examining the extent to which individuals seek alcohol to enhance positive experiences (reward drinking) or relieve aversive states (relief drinking) has shown that reward/relief drinking predicts response to naltrexone and acamprosate treatment for alcohol use disorder. Yet, various measures of reward/relief drinking have been used in prior research, and the comparative psychometric properties of these measures are unknown. Evaluating and comparing the psychometric properties of these reward/relief drinking measures could identify measures with the most promise for translating precision medicine findings to clinical practice. In a community sample of 65 individuals with heavy/hazardous alcohol use on the Alcohol Use Disorder Identification Test, we showed good internal consistency reliability, test-retest reliability, and concurrent validity for theoretically aligned measures (e.g., reward drinking and reward responsiveness, relief drinking and depression/anxiety symptoms) of the reward and relief subscales across the six measures. We then used ecological momentary assessment to determine whether reward and relief drinking subscales predicted within-person associations between contextual factors of interest (e.g., negative affect, positive affect, distress intolerance, physical pain, hangover symptoms, social drinking situations, alcohol cues) and same-moment alcohol craving. All six measures demonstrated limited predictive validity for alcohol craving contexts in daily life as assessed via ecological momentary assessment. Despite these findings, reward and relief drinking measures show good reliability and concurrent validity and previously demonstrated clinical utility for predicting response to alcohol use disorder treatments, including naltrexone. Future research should aim to elucidate the mechanisms underlying the association between responses to reward/relief drinking measures and pharmacotherapy outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Personalized normative feedback interventions show efficacy in reducing health risk behaviors (e.g., alcohol use, sexual aggression). However, complex personalized normative feedback interventions may require manual methods of inputting participant data into graphics, which introduces error, and automated approaches require substantial technical costs and funding and may limit the types of feedback that can be provided., Method: To make personalized normative feedback more accessible, we outline a method of using easily accessible software programs including IBM Statistical Package for the Social Sciences (SPSS), Microsoft Excel, and Microsoft PowerPoint, to create and display complex personalized normative feedback graphics. We also describe methods through which personalized normative feedback graphics can be created within a larger preventive intervention for alcohol and sexual assault in college men., Results: We first provide step-by-step instructions for collecting data and then creating semi-automated syntax files within SPSS and Excel to merge participant data into complex personalized normative feedback graphics in Excel. To do so, we append annotated syntax in text and in supplemental material. Next, we outline the process of creating risk feedback graphics, whereby individual items or exact wording of items are displayed back to the participant. Finally, we provide guidance regarding the process of translating graphics from Excel for viewing via PowerPoint without having to manually update PowerPoint slides for each presentation., Conclusions: Via the described syntax and graphic generation, researchers are then able to create semi-automated personalized normative feedback and risk feedback graphics. This tutorial may help in increasing the dissemination of complex personalized normative feedback interventions.

Harmful alcohol use and alcohol use disorder (AUD) are common worldwide, and rates of alcohol-associated liver disease (ALD) are also increasing. AUD is a disease that is treatable and can be diagnosed and managed, and recovery from AUD through abstinence or reductions in drinking is possible. Management of AUD among individuals with ALD is increasingly being addressed via integrated medical and psychosocial treatment teams that can support reductions in drinking and prevent progression of liver disease. Early diagnosis of AUD and ALD can improve lives and reduce mortality., Competing Interests: Disclosure K. Witkiewitz has received travel and speaker fees in the past 5 years from the Alcohol Clinical Trials Initiative (ACTIVE) Workgroup which has been supported previously, but not in the past 36 months, by Abbott/Abbvie, Amygdala Neurosciences, Arbor Pharmaceuticals, GSK, Janssen, Lilly, Mitsubishi, Pfizer, and Schering Plow, but in the past 36 months its activities were supported by Alkermes, Dicerna, Ethypharm, Indivior, Kinnov Therapeutics, Lundbeck, Otsuka, and Pear Therapeutics. J.L. Mellinger has consulted for GlaxoSmithKline. This research was supported by R01AA022328 (PI WItkiewitz) from the National Institute on Alcohol Abuse and Alcoholism., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Cognitive impairments are common in alcohol use disorder (AUD), but only a few studies have investigated the accuracy of the Montreal Cognitive Assessment (MoCA) in this population. We examined the accuracy and precision of the MoCA in detecting cognitive impairment in a sample of patients with AUD. In addition, we investigated whether the MoCA predicts premature discontinuation from treatment., Method: A sample of 126 persons with AUD undergoing treatment in specialist health services were administered the MoCA and a battery of 12 neuropsychological tests. Five cognitive domains were derived from the reference tests. A composite total score from these tests was used as a reference criterion for determining correct and incorrect classifications for the MoCA. We analyzed the optimal cut-off score for the MoCA and the accuracy and agreement of classification between the MoCA and the reference tests., Results: Receiver operating characteristic (ROC) curve analyzes yielded an area under the curve (AUC) of 0.77 (95% CI [0.67, 0.87]). Applying 25 as the cut-off, MoCA sensitivity was 0.77 and specificity 0.62. The PPV was 0.53. The NPV was 0.84. Using a cut-off score of 24 yielded a lower sensitivity 0.60, but specificity was significantly better i.e., 0.79. PPV was 0.68. The NPV was 0.82. Kappa agreement between MoCA and the reference tests was fair to moderate, 0.38 for the cut-off of 25, and 0.44 for the cut-off of 24. MoCA did not predict discontinuation from treatment., Conclusions: Our findings indicate limitations in the classification accuracy of the MoCA in predicting cognitive impairment in AUD. Achieving the right balance between accurately identifying impaired cases without including too many false positives can be challenging. Further, MoCA does not predict discontinuation from treatment. Overall, the results do not support MoCA as a time-efficient screening instrument., (© 2024 The Author(s). Alcohol, Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.)

Introduction: Substance use disorder (SUD) recovery is heterogeneous. Yet, over the last 50 years, substance use treatment providers and researchers have often defined success as sustained abstinence from substance use. An often overlooked but equally valid pathway to recovery for persons with SUD is non-abstinent recovery. However, most of the literature on non-abstinent recovery exists for individuals with alcohol use disorder (AUD) with few studies of non-abstinent recovery for other types of SUD. Literature exploring the mechanisms that lead to non-abstinent recovery is also lacking. As such, the current study aimed to examine recovery profiles for individuals (N = 454) recruited in two randomized clinical trials comparing mindfulness-based relapse prevention with cognitive-behavioral relapse prevention and/or treatment as usual., Methods: Latent profile analysis empirically derived profiles of recovery following outpatient aftercare SUD treatment. Multinomial logistic regression examined associations between treatment assignment and recovery profile, including potential psychological mediators (e.g., mindfulness) and contextual moderators (e.g., annual household income)., Results: Analyses supported four recovery profiles: (1) low-functioning frequent substance use; (2) low-functioning infrequent substance use; (3) high-functioning frequent substance use; (4) high-functioning infrequent substance use. There were no significant interaction effects of race or ethnicity by treatment type, or household income by treatment type, in predicting recovery profiles. Trait mindfulness, craving, and psychological flexibility failed to mediate the association between treatment assignment and recovery profile; however, there were statistically significant differences in trait mindfulness with individuals expected to be classified in the low-functioning infrequent substance use profile showing significantly lower levels of trait mindfulness compared to individuals in the two high-functioning profiles., Conclusions: Findings suggest that recovery from SUD is heterogeneous, and profiles of recovery based on dimensions of substance use and functioning can be identified across a variety of SUD, including among people with co-occurring SUD. Additionally, trait mindfulness appears to be a differentiating factor across recovery profiles. Further research is needed to explore how psychological and social factors may moderate and influence both abstinent and non-abstinent forms of recovery., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Personalized medicine promises the ability to improve patient outcomes by tailoring treatment recommendations to the likelihood that any given patient will respond well to a given treatment. It is important that predictions of treatment response be validated and replicated in independent data to support their use in clinical practice. In this paper, we propose and test an approach for validating predictions of individual treatment effects with continuous outcomes across samples that uses matching in a test (validation) sample to match individuals in the treatment and control arms based on their predicted treatment response and their predicted response under control. To examine the proposed validation approach, we conducted simulations where test data is generated from either an identical, similar, or unrelated process to the training data. We also examined the impact of nuisance variables. To demonstrate the use of this validation procedure in the context of predicting individual treatment effects in the treatment of alcohol use disorder, we apply our validation procedure using data from a clinical trial of combined behavioral and pharmacotherapy treatments. We find that the validation algorithm accurately confirms validation and lack of validation, and also provides insights into cases where test data were generated under similar, but not identical conditions. We also show that the presence of nuisance variables detrimentally impacts algorithm performance, which can be partially reduced though the use of variable selection methods. An advantage of the approach is that it can be widely applied to different predictive methods., (© 2024 John Wiley & Sons Ltd.)

Background: The US Department of Veterans Affairs, Department of Defense (VA/DoD) clinical guidelines recommend extended-release naltrexone (XR-NTX) as a treatment option for moderate-to-severe alcohol use disorder (AUD); however, contemporary real-world outcomes related to this guideline are lacking. This retrospective, observational, descriptive study examined treatment patterns and healthcare resource use (HCRU) among veterans with an AUD diagnosis who initiated XR-NTX., Methods: Veterans with incident AUD who initiated XR-NTX between 8/2014 and 11/2018 were identified. Treatment patterns and HCRU were assessed during the 1-year baseline period before and following XR-NTX initiation (the index date)., Results: Of the 3665 VA patients (mean [SD] age: 46 [12.5] years; male: 89.7%; White: 76.9%) included in the study, time from AUD diagnosis to XR-NTX initiation was highly variable (mean [range]: 13.6 [0-50.5 months]). Patients received a mean [SD] of 6.8 [6.1] XR-NTX administrations; 44.4% received ⩾6. Mean [SD] time to XR-NTX discontinuation was 93.4 [75.7] days, and 31.3% of discontinuing patients resumed XR-NTX therapy. Of those who received other subsequent medications for AUD, 38.6% (acamprosate) to 47.8% (disulfiram) re-initiated XR-NTX. The proportion of patients with ⩾1 inpatient admissions decreased during follow-up compared with baseline (all-cause: 61.5% to 37.8%; AUD-related: 58.0%-35.4%); with a smaller decrease observed in emergency department (ED) visits. In contrast, more patients had ⩾1 outpatient visits during follow-up (all-cause: 97.5%-99.7%; AUD-related: 84.4%-92.7%). Compared with baseline, mean number of inpatient admissions and ED visits decreased during follow-up, while the number of outpatient visits increased for both all-cause and AUD-related care., Conclusions: Among VA patients with AUD who initiated XR-NTX, we observed reductions in all-cause and AUD-related acute care, and increases in outpatient care. This finding demonstrates a possible transition from acute, inpatient treatment to long-term, outpatient care that may reflect a reduction in disease severity. Additional research is warranted., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RG is an employee of Alkermes, Inc. JL, AKO and MAS and were employees of Alkermes, Inc., during the conduct of the study and may own stock in the company. SS, ES and AL are employees of Analysis Group, Inc., a consulting firm that received funding from the study’s sponsor to conduct this study. KW serves on the Scientific Advisory Board for Pear Therapeutics and is a member of the Alcohol Clinical Trials Initiative (ACTIVE) Workgroup, which has been supported previously, but not in the past 36 months, by Abbott/AbbVie, Amygdala Neurosciences, Arbor Pharmaceuticals, GSK, Indivior, Janssen, Lilly, Pfizer, and Schering Plough; but in the past 36 months, its activities were supported by Alkermes, Inc., Dicerna, Ethypharm, Lundbeck, Mitsubishi, and Otsuka. SL, LS and KD have no financial conflicts of interest to disclose., (© The Author(s) 2024.)