Posttreatment Low-Risk Drinking as a Predictor of Future Drinking and Problem Outcomes Among Individuals With Alcohol Use Disorders.

Posttreatment low-risk drinking as a predictor of future drinking and problem outcomes among individuals with alcohol use disorders.

Filed under: Addiction Rehab

Alcohol Clin Exp Res. 2013 Jan; 37 Suppl 1: E373-80
Kline-Simon AH, Falk DE, Litten RZ, Mertens JR, Fertig J, Ryan M, Weisner CM

Treatment for alcohol disorders has traditionally been abstinence-oriented, but evaluating the merits of a low-risk drinking outcome as part of a primary treatment endpoint is a timely issue given new pertinent regulatory guidelines. This study explores a posttreatment low-risk drinking outcome as a predictor of future drinking and problem severity outcomes among individuals with alcohol use disorders in a large private, not for profit, integrated care health plan.Study participants include adults with alcohol use disorders at 6 months (N = 995) from 2 large randomized studies. Logistic regression models were used to explore the relationship between past 30-day drinker status at 6 months posttreatment (abstinent [66%], low-risk drinking [14%] defined as nonabstinence and no days of 5+ drinking, and heavy drinking [20%] defined as 1 or more days of 5+ drinking) and 12-month outcomes, including drinking status and Addiction Severity Index measures of medical, psychiatric, family/social, and employment severity, controlling for baseline covariates.Compared to heavy drinkers, abstinent individuals and low-risk drinkers at 6 months were more likely to be abstinent or low-risk drinkers at 12 months (adj. ORs = 16.7 and 3.4, respectively; p < 0.0001); though, the benefit of abstinence was much greater than that of low-risk drinking. Compared to heavy drinkers, abstinent and low-risk drinkers were similarly associated with lower 12-month psychiatric severity (adj. ORs = 1.8 and 2.2, respectively, p < 0.01) and family/social problem severity (adj. OR = 2.2; p < 0.01). While abstinent individuals had lower 12-month employment severity than heavy drinkers (adj. OR = 1.9; p < 0.01), low-risk drinkers did not differ from heavy drinkers. The drinking groups did not differ on 12-month medical problem severity.Compared to heavy drinkers, low-risk drinkers did as well as abstinent individuals for many of the outcomes important to health and addiction policy. Thus, an endpoint that allows low-risk drinking may be tenable for individuals undergoing alcohol specialty treatment. HubMed – addiction


Effects of l-Cysteine on Reinstatement of Ethanol-Seeking Behavior and on Reinstatement-Elicited Extracellular Signal-Regulated Kinase Phosphorylation in the Rat Nucleus Accumbens Shell.

Filed under: Addiction Rehab

Alcohol Clin Exp Res. 2013 Jan; 37 Suppl 1: E329-37
Peana AT, Giugliano V, Rosas M, Sabariego M, Acquas E

Alcoholism is a neuroadaptive disorder, and the understanding of the mechanisms of the high rates of relapse, which characterize it, represents one of the most demanding challenges in alcoholism and addiction research. The extracellular signal-regulated kinase (ERK) is an intracellular kinase, critical for neuroplasticity in the adult brain that is suggested to play a fundamental role in the molecular mechanisms underlying drug addiction and relapse. We previously observed that a nonessential amino acid, l-cysteine, significantly decreases oral ethanol (EtOH) self-administration, reinstatement of EtOH-drinking behavior, and EtOH self-administration break point.Here, we tested whether l-cysteine can affect the ability of EtOH priming to induce reinstatement of EtOH-seeking behavior. In addition, we determined the ability of EtOH priming to induce ERK phosphorylation as well as the ability of l-cysteine to affect reinstatement-elicited ERK activation. To these purposes, Wistar rats were trained to nose-poke for a 10% v/v EtOH solution. After stable drug-taking behavior was obtained, nose-poking for EtOH was extinguished, and reinstatement of drug seeking, as well as reinstatement-elicited pERK, was determined after an oral, noncontingent, priming of EtOH (0.08 g/kg). Rats were pretreated with either saline or l-cysteine (80 to 120 mg/kg) 30 minutes before testing for reinstatement.The findings of this study confirm that the noncontingent delivery of a nonpharmacologically active dose of EtOH to rats, whose previous self-administration behavior had been extinguished, results in significant reinstatement into EtOH-seeking behavior. In addition, the results indicate that reinstatement selectively activates ERK phosphorylation in the shell of the nucleus accumbens (Acb) and that pretreatment with l-cysteine reduces either reinstatement of EtOH seeking and reinstatement-elicited pERK in the AcbSh.Altogether, these results indicate that l-cysteine could be an effective pharmacological agent for the prevention of behavioral and molecular correlates of EtOH-primed reinstatement of EtOH seeking and that the shell of the Acb represents a critical neural substrate for priming-elicited reinstatement mechanisms involving ERK phosphorylation.
HubMed – addiction


Perceived access to reinforcers as a function of alcohol consumption among one first nation group.

Filed under: Addiction Rehab

Alcohol Clin Exp Res. 2013 Jan; 37 Suppl 1: E314-21
Spillane NS, Smith GT, Kahler CW

Spillane and Smith (2007, Psychol Bull 133:395-418) postulated that high levels of problem drinking in some First Nation (FN) communities resulted in part from the perception that there is low access to alternative reinforcers (e.g., jobs, friendships, family relationships, and financial security), that many alternative reinforcers are less contingent on sobriety, and that others are available regardless of drinking status for reserve-dwelling FN members.This study examined perceptions of access to alternative reinforcers and the extent to which access varied as a function of drinking in 211 FN members living on 1 reserve in Canada, 138 middle socioeconomic status Caucasians (MCCs), and 98 low socioeconomic status Caucasians (LCCs).The FN group expected less access to employment, quality family and friend relationships, and financial security compared with the MCC group. After controlling for perceived access in general, gender, and age, the FN group reported that drinking would not cause a decrease in access to employment, family relationships, friendships, and finances as compared to the MCC group. The FN group did not differ from the LCC group in the degree to which they expected drinking to cost access to family relationships or finances, but the LCC group expected drinking to have less of an impact on access to jobs and friendships as compared to the FN group.The results provide initial support for the Spillane and Smith theory of problem drinking among this 1 FN group. The results suggest that increasing access to these reinforcers may reduce problematic drinking in this FN group.
HubMed – addiction


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