Prescription procedures in medication for relapse prevention after inpatient treatment for alcohol use disorders in Switzerland. Risk factors for treatment failure in smokers: relationship to alcohol use and to lifetime history of an alcohol use disorder. Perception of patients with alcohol use disorder and comorbid depression about the usefulness of supportive text messages. Antidepressant effectiveness of deep Transcranial Magnetic Stimulation (dTMS) in patients with Major Depressive Disorder (MDD) with or without Alcohol Use Disorders (AUDs): a 6-month, open label, follow-up study. The role of mental disorders in the risk and speed of transition to alcohol use disorders among community youth. Multiple Sessions of Transcranial Direct Current Stimulation (tDCS) Reduced Craving and Relapses for Alcohol Use: A Randomized Placebo-Controlled Trial in Alcohol Use Disorder Early adolescent psychopathology as a predictor of alcohol use disorders by young adulthood. Anxiety disorders and risk for alcohol use disorders: the moderating effect of parental support. Comparison of opiate-primary treatment seekers with and without alcohol use disorder. Randomized controlled trial of cognitive behaviour therapy for comorbid post-traumatic stress disorder and alcohol use disorders. A Pilot Study of a Brief Motivational Intervention for Incarcerated Drinkers. Feasibility and safety of extended‐release naltrexone treatment of opioid and alcohol use disorder in HIV clinics: a pilot/feasibility randomized trial Effectiveness of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia. Dissociable brain signatures of choice conflict and immediate reward preferences in alcohol use disorders New Strategies to Detect Alcohol Use Disorders in the Preoperative Assessment Clinic of a German University Hospital A randomized trial of individual and couple behavioral alcohol treatment for women. Impulsivity in rodents with a genetic predisposition for excessive alcohol consumption is associated with a lack of a prospective strategy Adolescent Predictors of a Typology of DSM-5 Alcohol Use Disorder Symptoms in Young Adults Derived by Latent Class Analysis Using Data From an Australian Cohort Study. Context‐Specific Inhibition is Related to Craving in Alcohol Use Disorders: A Dangerous Imbalance Naltrexone augmentation of neuroleptic treatment in alcohol abusing patients with schizophrenia A Randomized Controlled Trial of Brief Intervention by Interactive Voice Response Combining seeking safety with sertraline for PTSD and alcohol use disorders: A randomized controlled trial. Cessation and reduction in alcohol consumption and misuse after psychedelic use
AIMS In r and omized controlled trials with high internal validity , pharmacotherapy using acamprosate , naltrexone , and , to a somewhat lesser extent , disulfiram has proved effective in preventing relapse in patients with alcohol use disorders ( AUD ) . There remains , however , a paucity of studies with sufficient external validity in which the effectiveness of pharmacotherapy in clinical practice is investigated . This study aim ed to make a contribution to close this gap in research . METHODS In this naturalistic , prospect i ve study , a comparison on indices of substance use , psychiatric symptoms , and treatment service utilization was carried out using sample s of 92 patients who received pharmacotherapy and 323 patients who did not receive pharmacotherapy following discharge from 12 residential AUD programmes ( index stay ) . RESULTS Patients that received pharmacotherapy were more likely to use alcohol during the index stay and at the 1-year follow-up . Moreover , this patient group more readily utilized treatment services during a 2-year period prior to and a 1-year period following index stay than patients who were not given pharmacotherapy . Nevertheless , when pharmacotherapy was prescribed before first post-treatment alcohol use , it was associated with delay of alcohol use , fewer relapses , and a reduced need for inpatient treatment . In many cases , however , medication was not prescribed until alcohol use and relapse had occurred . The length of time to first alcohol use was longer , and the cumulative abstinence rate higher , for disulfiram than for acamprosate , the latter being generally prescribed for more severely alcohol-dependent patients . CONCLUSIONS There is a need for further studies to probe the reasons why medication for relapse prevention is not prescribed upon discharge from residential treatment and for less severely alcohol-dependent patients Little is known about the impact of alcohol involvement on  smoking cessation relapse  or possible mechanisms for these associations . We addressed these issues using data from a r and omized clinical trial of two types of framed messages ( gain vs. loss ) in conjunction with open label sustained-release ( SR ) bupropion ( Toll et al. , 2007 ) ( N = 249 ) . Participants were categorized according to whether or not they were diagnosed with a lifetime alcohol use disorder ( AUD ; i.e. , current or past alcohol abuse or past alcohol dependence ) and according to three levels of alcohol use : abstinence , moderate , or hazardous use . Alcohol use categories were established for drinking at baseline , during the 6-week treatment period and through 12 weeks post-quit . There were few significant differences by baseline alcohol use level or AUD history for a series of predictors of smoking cessation failure ( e.g. , depressive symptoms ) . During treatment and follow-up , the probability of any smoking on heavy drinking days was significantly higher than the probability of smoking on moderate drinking or abstinent days . AUD history did not predict smoking cessation relapse in any analysis , nor were any alcohol usexAUD history interactions significant . Moderate alcohol users and , to a lesser extent , abstainers from alcohol at baseline were less likely than hazardous drinkers to have relapsed at 12 weeks post-quit . Based on these findings , it appears that risk of any smoking and of relapse was associated primarily with heavy drinking days and a hazardous pattern of use respectively , rather than with moderate drinking BACKGROUND Very little is known about the perception of patients with alcohol use disorder ( AUD ) and comorbid depression about the usefulness of supportive text messages . OBJECTIVE To examine the perception of patients with AUD and comorbid depression about the usefulness of supportive text messages . METHODS Participants ( n=26 ) with a DSM IV diagnosis of AUD and depression and completing an in-patient dual diagnosis treatment programme had twice daily supportive text messages delivered to their mobile phones for three months as part of a r and omised trial . Participants were contacted at the end of the third month to obtain their views regarding the usefulness of the supportive text messages using a semi-structured question naire . RESULTS Overall , 24 out of 26 patients were contactable for feedback ( 92 % response rate ) . Eighteen ( 75 % ) patients reported that the text messages always or often reminded them to remain abstinent from alcohol . Again , 20 ( 83 % ) patients reported that the intervention had played a useful role in helping to improve their mental health , in particular , in serving as a motivation for recovery and in preventing relapse . CONCLUSIONS Patients with AUD and depression perceive that supportive text messages help them to remain abstinent from alcohol and also improve upon their mental wellbeing INTRODUCTION Co-occurrence of Major Depressive ( MDD ) and Alcohol Use Disorders ( AUDs ) is frequent , causing more burden than each disorder separately . Since the dorsolateral prefrontal cortex ( DLPFC ) is critically involved in both mood and reward and dysfunctional in both conditions , we aim ed to evaluate the effects of dTMS stimulation of bilateral DLPFC with left prevalence in patients with MDD with or without concomitant AUD . METHODS Twelve MDD patients and 11 with concomitant MDD and AUD ( MDD+AUD ) received 20 dTMS sessions . Clinical status was assessed through the Hamilton Depression Rating Scale ( HDRS ) and the Clinical Global Impressions severity scale ( CGIs ) , craving through the Obsessive Compulsive Drinking Scale ( OCDS ) in MDD+AUD , and functioning with the Global Assessment of Functioning ( GAF ) . RESULTS There were no significant differences between the two groups in sociodemographic ( age , sex , years of education and duration of illness ) and baseline clinical characteristics , including scores on assessment scales . Per cent drops on HDRS and CGIs scores at the end of the sessions were respectively 62.6 % and 78.2 % for MDD+AUD , and 55.2 % and 67.1 % for MDD ( p<0.001 ) . HDRS , CGIs and GAF scores remained significantly improved after the 6-month follow-up . HDRS scores dropped significantly earlier in MDD+AUD than in MDD LIMITATIONS : The small sample size and factors inherent to site and background treatment may have affected results . CONCLUSIONS High frequency bilateral DLPFC dTMS with left preference was well tolerated and effective in patients with MDD , with or without AUD . The antidepressant effect of dTMS is not affected by alcohol abuse in patients with depressive episodes . The potential use of dTMS for mood modulation as an adjunct to treatment in patients with a depressive episode , with or without alcohol abuse , deserves further investigation BACKGROUND Among adolescents and young adults with DSM-IV alcohol use disorders ( AUDs ) , there are inter-individual differences in the speed of transition from initial alcohol use ( AU ) to AUD . AUDs are highly co-morbid with other mental disorders . The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear . Given this background we examined ( 1 ) whether prior anxiety , mood , externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse ( AA ) and alcohol dependence ( AD ) and ( 2 ) whether early age of onset of prior mental disorders ( PMDs ) is a promoter of rapid transition . METHOD A total of 3021 community subjects ( 97.7 % lifetime AU ) aged 14 - 24 years at baseline were followed up prospect ively for up to 10 years . AU and mental disorders were assessed with the DSM-IV/M-CIDI . RESULTS Among subjects with lifetime AU , several PMDs , such as specific phobia , bipolar disorder and nicotine dependence , were associated with an increased risk of AUD independent of externalizing disorders . Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent . Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs . Earlier age of onset of PMD was not associated with rapid transition . CONCLUSIONS Mental disorders are associated with the risk of AUD . With the possible exception of social phobia and externalizing disorders , they do not promote rapid transition , even if they occur particularly early . Future research needs to identify factors relevant to rapid transition to AUD Background : Transcranial direct current stimulation ( tDCS ) , a non-invasive brain stimulation technique , has been studied as an adjunctive therapeutic agent for alcohol dependence . In a previous study , we showed that five consecutive sessions of tDCS applied bilaterally over the dorsolateral prefrontal cortex ( dlPFC ) reduced relapse to the use of alcohol in alcohol use disorder ( AUD ) out patients . However , no changes on craving scores were observed . In the present study , we investigated if an extended number of sessions of the same intervention would reduce craving and relapses for alcohol use in AUD in patients . Methods : Thus , a r and omized , double-blind , sham-controlled , clinical trial with parallel arms was conducted ( https:// clinical trials.gov/ct2/show/NCT02091284 ) . AUD patients from two private and one public clinics for treatment of drug dependence were r and omly allocated to two groups : real tDCS ( 5 × 7 cm2 , 2 mA , for 20 min , cathodal over the left dlPFC , and anodal over the right dlPFC ) and sham-tDCS . Real or sham-tDCS was applied once a day , every other day , in a total of 10 sessions . Craving was monitored by a 5-item obsessive compulsive drinking scale once a week ( one time before , three times during and once after brain stimulation ) over about 5 weeks . Results : Craving scores progressively decreased over five measurements in both groups but were significantly reduced only in the real tDCS group after treatment . Corrected Hedges ' within-group ( initial and final ) effect sizes of craving scores were of 0.3 for the sham-tDCS and of 1.1 for the real tDCS group . Effect size was 3-fold larger in the real tDCS group . In addition , the between-group analysis on craving score difference was nearly significant , and the effect size was 0.58 , in favor for a larger effect in the real tDCS group when compared to sham-tDCS . Furthermore , in a 3-months follow-up after intervention , 72.2 % of sham-tDCS group relapsed to the alcohol use whereas 72.7 % of tDCS group were abstinent . Conclusions : Multiple sessions of bilateral prefrontal tDCS were well tolerated with no significant adverse events . Thus , extended repetitive bilateral tDCS over the dlPFC is a promising adjunctive clinical tool that could be used to reduce alcohol craving and relapses and facilitate alcoholism cessation Few prospect i ve studies have examined the relation between early adolescent conduct disorder ( CD ) symptoms and the development of alcohol use disorders ( AUD ) by young adulthood . The relative contribution of other forms of adolescent psychopathology ( i.e. , attention-deficit hyperactivity disorder , depression , anxiety/withdrawal ) to the development of AUD also remains poorly understood . There is some suggestion that the co-occurrence of conduct disorder symptoms with other forms of psychopathology may interact synergistically in predicting later alcohol use problems . The current study explores these issues using data on 506 boys from the oldest sample of the Pittsburgh Youth Study ( PYS ) . Consistent with prior research , early conduct disorder symptoms emerged as a consistent predictor of increased AUD symptoms and an alcohol dependence diagnosis by young adulthood . In contrast , adolescent boys with high levels of anxiety/withdrawal had lower levels of AUD symptoms and were less likely to develop alcohol dependence by young adulthood . Increased depression in early adolescence was associated with higher AUD symptoms and alcohol abuse and dependence diagnoses by young adulthood , but only for boys with high levels of conduct disorder symptoms . No evidence was found for a relation between attention-deficit hyperactivity disorder symptoms and AUD symptoms or diagnoses after controlling for co-occurring psychopathology BACKGROUND There have been mixed findings on the temporal relation between anxiety disorders and alcohol use disorders ( AUDs ) , suggesting that the pathway to AUDs may differ among individuals . The aim of the current study was to test whether parental support moderated the association between anxiety disorders and the development of AUDs . We also tested whether our effects differed as a function of age of AUD onset . METHODS 817 individuals were assessed for lifetime diagnoses of psychopathology during 4-waves between adolescence ( mean age=16 ) and adulthood ( mean age=30 ) . RESULTS Proportional hazards model analyses indicated that baseline anxiety disorders interacted with baseline perceived maternal support  to prospect ively predict onset of AUDs . At high levels of maternal support , anxiety disorders were associated with a reduced risk for AUD onset ( HR=0.74 , 95 % CI=0.55 - 1.00 ) . However , this effect was more robust for AUDs that developed prior to age 20 . At low levels of maternal support , anxiety disorders were associated with an increased risk for AUD onset ( HR=1.65 , 95 % CI=1.21 - 2.26 ) . This effect was present for AUDs that developed across adolescence and adulthood . Paternal support was not associated with AUDs and did not interact with anxiety disorders . CONCLUSIONS Prevention and intervention efforts targeted at maternal support in adolescents with anxiety disorders may be valuable , as this may represent a factor that has a significant impact on the developmental course of AUDs Many persons seeking opiate treatment  present with complex clinical challenges , which may be exacerbated by alcohol misuse . This report details secondary data analyses aggregating treatment-seeking sample s across 10 National Institute on Drug Abuse ( NIDA ) Clinical Trials Network treatment trials to examine alcohol-related characteristics of  opiate- primary ( OP ) clients and compare broad pretreatment characteristics of those with and without an alcohol use disorder ( AUD ) . Analysis of this aggregate OP client sample ( n = 1,396 ) indicated that 38 % had comorbid AUD and that a history of alcohol treatment episodes and recent alcohol problems were common . Further , comparisons of OP clients with and without AUD revealed the former were more likely to have had a history of pervasive difficulties in psychosocial functioning . Findings suggest the need for detection of and intervention for alcohol misuse at the outset of opiate treatment and support for the practice of availing medical , psychological , case management , and other support services Aims This study aim ed to test the efficacy of integrated cognitive behaviour therapy ( CBT ) for coexisting post traumatic stress disorder ( PTSD ) and alcohol use disorders ( AUD ) . Setting Clinics across Sydney , Australia . Design R and omized controlled trial of 12 once-weekly individual sessions of either integrated CBT for PTSD and AUD(integrated therapy , IT ; n = 33 ) or CBT for AUD plus supportive counselling ( alcohol-support , AS ; n = 29 ) . Blind assessment s were conducted at baseline and post-treatment and at 5 [ st and ard deviation ( SD ) = 2.25 ] and 9.16(SD = 3.45 ) months post-treatment . Participants Sixty-two adults with concurrent PTSD and AUD . Measurements Outcomes included changes in alcohol consumption ( time-line follow-back ) , PTSD severity [ clinician-administered PTSD scale ( CAPS ) ] , alcohol dependence and problems , and depression and anxiety . Findings Reductions in PTSD severity were evident in both groups . IT participants who had received one or more sessions of exposure therapy exhibited a twofold greater rate of clinical ly significant change in CAPS severity at follow-up than AS participants [ IT60 % , AS 39 % , odds ratio ( OR ) : 2.31 , 95 % confidence interval ( CI ) : 1.06 , 5.01 ] . AS participants exhibited larger reductions than IT participants in alcohol consumption , dependence and problems within the context of greater treatment from other services during follow-up . Results lend support to a mutually maintaining effect between AUD and PTSD . Conclusions Individuals with severe and complex presentations of coexisting post-traumatic stress disorder(PTSD ) and alcohol use disorders ( AUD ) can derive substantial benefit from cognitive behaviour therapy targeting AUD , with greater benefits associated with exposure for PTSD . Among individuals with dual disorders , these therapies can generate significant , well-maintained treatment effects on PTSD , AUD and psychopathology Almost half of convicted jail inmates have an alcohol use disorder and many are released to environments that put them in contact with network members and cues that make them more likely to relapse on alcohol or drugs . Given the high-risk period immediately following release , the purpose of this study was to examine the efficacy of a brief motivational intervention administered just prior to release to increase substance use treatment entry and attendance , decrease alcohol and drug use , and change social networks for inmates with alcohol use disorders . Forty adult male inmates with AUDs were consented into the study and r and omized to a motivational intervention or the control condition ( an educational intervention ) , and then were contacted to do a 1-month follow-up interview ( 62.5 % completed this interview ) . Results indicated that conducting these interventions was feasible and considered extremely helpful by participants . Although there were no significant group differences , medium to large effect sizes suggest possible benefits from the motivational intervention in decreasing days of alcohol and drug use and increasing abstinence , and reducing the proportion of heavy drug users or users of any kind in the social network . Future studies should replicate these findings in larger sample sizes and over longer follow-up time periods . Results may have implication s for the use of brief intervention strategies at jails for inmates with AUDs BACKGROUND AND AIMS HIV-infected people with substance use disorders are least likely to benefit from advances in HIV treatment . Integration of extended-release naltrexone ( XR-NTX ) into HIV clinics may increase engagement in the HIV care continuum by decreasing substance use . We aim ed to compare ( 1 ) XR-NTX treatment initiation , ( 2 ) retention and ( 3 ) safety of XR-NTX versus treatment as usual ( TAU ) for treating opioid use disorder ( OUD ) and /or alcohol use disorder ( AUD ) in HIV clinics . DESIGN Non-blinded r and omized trial of XR-NTX versus pharmacotherapy TAU . SETTING HIV primary care clinics in Vancouver , BC , Canada and Chicago , IL , USA . PARTICIPANTS Fifty-one HIV-infected patients seeking treatment for OUD ( n = 16 ) , AUD ( n = 27 ) or both OUD and AUD ( n = 8) . MEASUREMENTS Primary outcomes were  XR-NTX initiation ( receipt of first injection within 4 weeks of r and omization ) and retention at 16 weeks . Secondary outcomes generated point estimates for change in substance use , HIV viral suppression [ HIV RNA polymerase chain reaction ( pcr ) < 200 copies/ml ] and safety . FINDINGS Two-thirds ( 68 % ) of participants assigned to XR-NTX initiated treatment , and 88 % of these were retained on XR-NTX at 16 weeks . In comparison , 96 % of TAU participants initiated treatment , but only 50 % were retained on medication at 16 weeks . Mean days of opioid use in past 30 days decreased from 17.3 to 4.1 for TAU and from 20.3 to 7.7 for XR-NTX . Mean heavy drinking days decreased from 15.6 to 5.7 for TAU and 12.5 to 2.8 for XR-NTX . Among those with OUD , HIV suppression improved from 67 to 80 % for XR-NTX and 58 to 75 % for TAU . XR-NTX was well tolerated , with no precipitated withdrawals and one serious injection-site reaction . CONCLUSIONS Extended-release naltrexone ( XR-NTX ) is feasible and safe for treatment of opioid use disorder and alcohol use disorder in HIV clinics . Treatment initiation appears to be lower and retention greater for XR-NTX compared with treatment as usual ( clinical trials.gov NCT01908062 ) AIMS To test the feasibility and effectiveness of brief counseling intervention ( BCI ) and naltrexone integrated into tuberculosis ( TB ) care in Tomsk , Russia . DESIGN Using a factorial r and omized controlled trial design , patients were r and omized into : naltrexone ( NTX ) , brief behavioral compliance enhancement therapy ( BBCET ) , treatment as usual ( TAU ) and BCI . SETTING AND PARTICIPANTS In the Tomsk Oblast , hospitalized TB patients diagnosed with alcohol use disorders ( AUDs ) by the DSM-IV were referred at the start of TB treatment . Of the 196 participants , the mean age was 41 years and 82 % were male . Severe TB ( 84.7 % had cavitary disease ) and smoking ( 92.9 % ) were common . The majority had a diagnosis of an AUD ( 63.0 % ) ; 27.6 % reported nearly daily drinking and consumed a median of 16 st and ard drinks per day . MEASUREMENTS Primary outcomes were ' favorable ' TB outcome ( cured , completed treatment ) and change in mean number of abstinent days in the last month of study compared with baseline . Change in mean number of heavy drinking days , defined as four drinks per day and five drinks per day for women and men , respectively , and TB adherence , measured as percentage of doses taken as prescribed under direct observation , were secondary outcomes . Analysis based on ' intention-to-treat ' was performed for multivariable analysis . FINDINGS Primary TB and alcohol end-points between naltrexone and no-naltrexone or BCI and no-BCI groups did not differ significantly . TB treatment adherence and change in number of heavy drinking days also did not differ significantly among treatment arms . Among individuals with a prior quitting attempt ( n = 111 ) , naltrexone use was associated with an increased likelihood of favorable TB outcomes ( 92.3 % versus 75.9 % , P = 0.02 ) . CONCLUSIONS In Tomsk Oblast , Russia , tuberculosis patients with severe alcohol use disorders who were not seeking alcohol treatment did not respond to naltrexone or behavioral counselling integrated into tuberculosis care ; however , those patients with past attempts to quit drinking had improved tuberculosis outcomes Impulsive delayed reward discounting ( DRD ) is an important behavioral process in alcohol use disorders ( AUDs ) , reflecting incapacity to delay gratification . Recent work in neuroeconomics has begun to unravel the neural mechanisms supporting DRD , but applications of neuroeconomics in relation to AUDs have been limited . This study examined the neural mechanisms of DRD preferences in AUDs , with emphasis on dissociating activation patterns based on DRD choice type and level of cognitive conflict . Heavy drinking adult men with ( n = 13 ) and without ( n = 12 ) a diagnosis of an AUD completed a monetary DRD task during a functional magnetic resonance imaging scan . Participant responses were coded based on choice type ( impulsive versus restrained ) and level of cognitive conflict ( easy versus hard ) . AUD+ participants exhibited significantly more impulsive DRD decision‐making . Significant activation during DRD was found in several decision‐making regions , including dorsolateral prefrontal cortex ( DLPFC ) , insula , posterior parietal cortex ( PPC ) , and posterior cingulate . An axis of cognitive conflict was also observed , with hard choices associated with anterior cingulate cortex and easy choices associated with activation in supplementary motor area . AUD+ individuals exhibited significant hyperactivity in regions associated with cognitive control ( DLPFC ) and prospect i ve thought ( PPC ) and exhibited less task‐related deactivation of areas associated with the brain 's default network during DRD decisions . This study provides further clarification of the brain systems supporting DRD in general and in relation to AUDs Background : Although alcohol use disorders ( AUDs ) have enormous public health consequences , the rate of diagnosis of AUDs remains unsatisfactorily low . The primary aim of this study was to compare the detection of AUDs by anesthesiologists in a large preoperative assessment clinic to that by computerized self- assessment of the Alcohol Use Disorder Identification Test . Secondary outcome measures were to compare the actions taken by anesthesiologists upon a finding of an AUD . Methods : One thous and five hundred fifty-six patients were included . Before preoperative assessment , patients were asked to complete the  Alcohol Use Disorder Identification Test  ( positive scores : men ≥ 8 , women ≥ 5 ) using a computer . The authors performed a retrospective chart analysis of the anesthesiologists ’ actions upon a finding of an AUD . The anesthesiologists were blinded to the results of the computer-based assessment and to the subsequent chart analysis . Results : The prevalence rate of AUDs determined by the anesthesiologists was 6.9 % ( 107 of 1,556 ) , whereas the proportion of patients positive for an AUD using the computerised Alcohol Use Disorder Identification Test was 18.1 % ( 282 of 1,556 ) ( P < 0.001 ) . The detection rate by the anesthesiologists of AUDs among men was significantly higher than among women ( P < 0.001 ) as well as in the elderly compared with younger patients ( P < 0.001 ) . Action taken by anesthesiologists was mainly based on evaluating quantity of alcohol consumption . Conclusion : The computer-based self- assessment  increases detection rates of AUDs in busy setting s such as a preoperative assessment clinic . Prevalence rates of AUDs are underestimated . Best- practice guidelines for detection of AUDs are not implemented in the daily clinical routine . Barrier analysis is urgently required Although alcohol use disorders ( AUDs ) adversely affect women , research on efficacious treatments for women is limited . In this r and omized efficacy trial of 102 heterosexual women with AUDs , the authors compared alcohol behavioral couple therapy ( ABCT ) and alcohol behavioral individual therapy ( ABIT ) on percentage of days abstinent ( PDA ) and percentage of days of heavy drinking ( PDH ) over 6 months of treatment and 12 months of posttreatment follow-up . Baseline relationship functioning and comorbid disorders were tested as moderators of outcome . Piecewise linear growth models were used to model outcomes . During treatment , women increased their PDA and decreased their PDH , with significantly greater improvements in ABCT  than in  ABIT  ( d = 0.59 for PDA ; d = 0.79 for PDH ) . Differences favoring  ABCT  were maintained during follow-up . Women with poorer baseline relationship functioning improved more on PDA during treatment with ABCT  than with ABIT  . For PDH , results during treatment and follow-up favored  ABCT  for women with better baseline relationship functioning . ABCT  result ed in better outcomes than  ABIT  for women with Axis I disorders at the end of follow-up ( PDA ) , and for women with Axis II disorders at the end of treatment ( PDA ) and at the end of follow-up ( PDH ) Increasing evidence supports the hypothesis that impulsive decision-making is a heritable risk factor for an alcohol use disorder ( AUD ) . Clearly identifying a link between impulsivity and AUD risk , however , is complicated by the fact that both AUDs and impulsivity are heterogeneous constructs . Underst and ing the link between the two requires identifying the underlying cognitive factors that lead to impulsive choices . Rodent models have established that a family history of excessive drinking can lead to the expression of a transgenerational impulsive phenotype , suggesting heritable alterations in the decision-making process . In the present study , we explored the cognitive processes underlying impulsive choice in a vali date d , selectively bred rodent model of excessive drinking — the alcohol-preferring ( “ P ” ) rat .  Impulsivity was measured via delay discounting ( DD ) , and P rats exhibited an impulsive phenotype as compared to their outbred foundation strain — Wistar rats .  Steeper discounting in P rats was associated with a lack of a prospect i ve behavioral strategy , which was observed in Wistar rats and was directly related to DD . To further explore the underlying cognitive factors mediating these observations , a drift diffusion model of DD was constructed . These simulations supported the hypothesis that prospect i ve memory of the delayed reward guided choice decisions , slowed discounting , and optimized the fit of the model to the experimental data . Collectively , these data suggest that a deficit in forming or maintaining a prospect i ve behavioral plan is a critical intermediary to delaying reward , and by extension , may underlie the inability to delay reward in those with increased AUD risk OBJECTIVE There is little research examining alcohol use disorder ( AUD ) symptoms ( based on criteria from the Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition [ DSM-5 ] ) in young adulthood . We assessed symptom structure at 24 years using latent class analysis ( LCA ) , examining relationships between class membership and ( a ) concurrent alcohol use and DSM-5 AUD severity and ( b ) adolescent risk factors . METHOD A stratified , r and om sample of 1,943 adolescents ages 14 - 15 years was recruited from 44 secondary schools in Victoria , Australia , and interviewed during adolescence and young adulthood . We report findings on drinkers who completed the AUD module ( N = 1,268 ; 51 % male ) . RESULTS Data clearly fit a three-class , dimensional model , comprising " mild symptoms " ( 63.2 % ) , " moderate symptoms " ( 32.2 % ) , and " severe symptoms " ( 4.6 % ) classes . Class membership was vali date d by concurrent drinking patterns and in reasonable agreement with DSM-5 AUD severity categories . Relative to mild symptoms class membership , moderate symptoms class membership increased odds of adolescent alcohol problems ( odds ratio [ OR ] = 2.0 , 95 % CI [ 1.2 , 3.5 ] ) and persisting anxiety/depression symptoms ( OR = 1.9 , 95 % CI [ 1.2 , 3.1 ] ) . Daily smoking ( OR = 2.6 , 95 % CI [ 1.1 , 5.9 ] ) , persisting anxiety/ depression symptoms ( OR = 2.5 , 95 % CI [ 1.3 , 5.0 ] ) , and antisocial behavior ( OR = 3.2 , 95 % CI [ 1.5 , 6.8 ] ) increased odds of severe symptoms class membership . Adolescent daily smoking ( OR = 0.3 , 95 % CI [ 0.11 , 0.81 ] ) and antisocial behavior ( OR = 0.3 , 95 % CI [ 0.14 , 0.64 ] ) were less likely among members of the moderate symptoms class , relative to the severe symptoms class . CONCLUSIONS We found support for a dimensional AUD typology like that in DSM-5 . Young adults with more severe AUD symptoms had a different adolescent risk profile than those in the low and moderate classes . These findings provide a focus for preventive intervention in adolescence to limit the severity of AUDs in young adulthood BACKGROUND Most contemporary neuroscientific models of alcohol use disorders ( AUD ) incorporate an imbalance between enhanced cue reactivity , which results in a strong urge to consume , and the impaired inhibitory control of that urge . While these phenomena have been frequently investigated separately , studies involving both aspects and thus precisely investigating the postulated imbalance are rare . In this study , inhibition was investigated in an addiction-specific context and individual craving levels were also examined . METHODS This study compared inhibition in alcohol-related and neutral context s in patients with AUD and healthy controls , while also taking into account the individual amount of craving . All subjects performed a Go/NoGo task involving neutral and alcohol-related NoGo trials , while their brain activity was recorded using multichannel electroencephalography . The map strength and topography of the N2 and P3 components of the NoGo event-related potentials were compared between groups and context s using whole-scalp r and omization-based methods . The effects of interest were further investigated with sLORETA source analysis . RESULTS For the N2 component , the context by craving interaction was strong for map strength and map topography . The source analysis indicated that in subjects with high craving , alcohol-related context led to enhanced and prolonged activation in the posterior cingulate and premotor cortical areas . This interaction was specific for craving , but not for diagnostic classification . The amplitude of the P3 component was reduced in subjects with AUD , which replicated previous findings . CONCLUSIONS In subjects with strong craving , the conflict reflected in the NoGo-N2 was enhanced in the alcohol-related context . Such enhanced conflict probably makes the successful inhibition of the urge to drink in high-risk situations even more difficult for this subgroup of patients and should therefore be addressed in individualized treatment planning Objective Alcohol abuse in patients with schizophrenia is associated with psychiatric and social complications . While two medications have been approved by the Federal Drug Administration ( FDA ) for the treatment of alcoholism : disulfiram and naltrexone , no medications have been approved for individuals with alcohol dependence and comorbid schizophrenia . The purpose of this study was to evaluate the efficacy of naltrexone in alcohol-abusing schizophrenic patients . Method Thirty-one patients with schizophrenia and comorbid alcohol abuse or dependence were treated for 12 weeks in an outpatient study using naltrexone or placebo in a r and omized , double-blind fashion in addition to their neuroleptic medication . Patients also participated in a weekly therapy using cognitive-behavioral drug relapse prevention strategies combined with skills training . Outcomes included drinking measured by the time line follow-back method , craving using the Tiffany Craving Question naire , psychotic symptoms using the Positive and Negative Symptoms Scale ( PANSS ) , side effects and a measures of abnormal involuntary movements . Results There were no significant differences in treatment exposure or medication compliance between groups . Naltrexone treated patients had significantly fewer drinking days , heavy drinking days ( > 5 drinks ) and reported less craving compared to the placebo treated patients . Naltrexone did not affect symptoms of schizophrenia , such as psychosis . The medication was well tolerated and there were no group differences in side effects . Conclusions These data suggest that naltrexone may be an effective medication for individuals with comorbid alcohol dependence and schizophrenia . Given the widespread problems associated with alcohol misuse in this population , and the lack of effective pharmacotherapies , these findings represent an exciting clinical development Aims To determine the effect of an Interactive Voice Response ( IVR ) brief intervention ( BI ) to reduce alcohol consumption  among adults seeking primary care . Methods Patients ( N = 1855 ) with unhealthy drinking were recruited from eight academic internal medicine and family medicine clinics and r and omized to IVR-BI ( n = 938 ) versus No IVR-BI control ( n = 917 ) .  Daily alcohol consumption was assessed at baseline , 3- and 6-months using the Timeline Followback . Results The IVR-BI was completed by 95 % of the 938 patients r and omized to that condition , and 62 % of them indicated a willingness to consider a change in their drinking . Participants in both conditions significantly reduced consumption over time , but changes were not different between groups . Regardless of condition , participants with alcohol use disorder ( AUD ) showed significant decreases in drinking outcomes . No significant changes were observed in patients without AUD , regardless of condition . Conclusion Although the IVR intervention was well accepted by patients , there was no evidence that IVR-BI was superior to No IVR-BI for reducing drinking in the subsequent 6 months . Because both the design and the intervention tested were novel , we can not say definitively why this particular eHealth treatment lacked efficacy . It could be useful to evaluate the effect of the pre-r and omization assessment alone on change in drinking . The high treatment engagement rate and successful implementation protocol are strengths , and can be adopted for future trials . Short summary We examined the efficacy of a novel BI for patient self-administration by automated telephone . Alcohol consumption decreased over time but there were no between-group changes in consumption . Regardless of treatment condition , participants with alcohol use disorder ( AUD ) showed significant reduction in drinking but participants without AUD showed no change OBJECTIVE The current study marks the first r and omized controlled trial to test the benefit of combining Seeking Safety ( SS ) , a present-focused cognitive-behavioral therapy for co-occurring posttraumatic stress disorder ( PTSD ) and alcohol use disorder ( AUD ) , with sertraline , a front-line medication for PTSD shown to also impact drinking outcomes . METHOD Sixty-nine participants ( 81 % female ; 59 % African American ) with primarily childhood sexual ( 46 % ) and physical ( 39 % ) trauma exposure , and drug dependence in addition to AUD were r and omized to receive a partial-dose ( 12 sessions ) of SS with either sertraline ( n = 32 ; M = 7 sessions ) or placebo ( n = 37 ; M = 6 sessions ) . Assessment s conducted at baseline , end-of-treatment , 6- and 12-months posttreatment measured PTSD and AUD symptom severity . RESULTS Both groups demonstrated significant improvement in PTSD symptoms . The SS plus sertraline group exhibited a significantly greater reduction in PTSD symptoms than the SS plus placebo group at end-of-treatment ( M difference = -16.15 , p = .04 , d = 0.83 ) , which was sustained at 6- and 12-month follow-up ( M difference = -13.81 , p = .04 , d = 0.71 , and M difference = -12.72 , p = .05 , d = 0.65 , respectively ) . Both SS groups improved significantly on AUD severity at all posttreatment time points with no significant differences between SS plus sertraline and SS plus placebo . CONCLUSION Results support the combining of a cognitive-behavioral therapy and sertraline for PTSD/AUD . Clinical ly significant reductions in both PTSD and AUD severity were achieved and sustained through 12-months follow-up , Moreover , greater mean improvement in PTSD symptoms was observed across all follow-up assessment s in the SS plus sertraline group . ( PsycINFO Data base Background : Meta- analysis of r and omized studies using lysergic acid diethylamide ( LSD ) for alcohol use disorder ( AUD ) showed large , significant effects for LSD efficacy compared to control conditions . Clinical studies suggest potential anti-addiction effects of LSD and mechanistically-related classic psychedelics for alcohol and other substance use disorders . Aims : To supplement clinical studies , reports of psychedelic use in naturalistic setting s can provide further data regarding potential effects of psychedelics on alcohol use . Methods : An anonymous online survey of individuals with prior AUD reporting cessation or reduction in alcohol use following psychedelic use in non- clinical setting s. Results : 343 respondents , mostly White ( 89 % ) , males ( 78 % ) , in the USA ( 60 % ) completed the survey . Participants reported seven years of problematic alcohol use on average before the psychedelic experience to which they attributed reduced alcohol consumption , with 72 % meeting retrospective criteria for severe AUD . Most reported taking a moderate or high dose of LSD ( 38 % ) or psilocybin ( 36 % ) , followed by significant reduction in alcohol consumption . After the psychedelic experience 83 % no longer met AUD criteria . Participants rated their psychedelic experience as highly meaningful and insightful , with 28 % endorsing psychedelic-associated changes in life priorities or values as facilitating reduced alcohol misuse . Greater psychedelic dose , insight , mystical-type effects , and personal meaning of experiences were associated with a greater reduction in alcohol consumption , controlling for prior alcohol consumption and related distress . Conclusions : Although results can not demonstrate causality , they suggest that naturalistic psychedelic use may lead to cessation or reduction in problematic alcohol use , supporting further investigation of psychedelic-assisted treatment for AUD
The only study available on disulfiram showed reduced REM sleep .
Acamprosate showed no/little effect on self-reported sleep but improved sleep continuity and architecture measured by polysomnography .
The two opioidergic drugs naltrexone and nalmefene had mainly detrimental effect on sleep , giving increased insomnia and /or somnolence compared with placebo , although not always significant .
The meta- analysis confirmed significantly increased somnolence and insomnia in the naltrexone group , compared with the placebo .
Overall , the currently available evidence s show more sleep problems with the opioidergic drugs ( especially naltrexone ) , while acamprosate seems to be well tolerated or even beneficial .
Acamprosate might be a more suitable choice when patients with AUD report sleep problems .
Background : Sleep disorders are commonly associated with acute and chronic use of alcohol and with abstinence .
To date , there are four approved drugs to treat alcohol use disorder ( AUD ) : disulfiram , acamprosate , naltrexone , and nalmefene .
These AUD therapies reduce the craving and risk of relapse into heavy drinking , but little is known about their effect on sleep .
As recent evidence s indicate a crucial role of sleep disorders in AUD , cl aim ing that sleep problems may trigger alcohol abuse and relapses , it is fundamental to clarify the impact of those drugs on the sleep quality of AUD patients .
This systematic review aims to answer the question : how does the pharmacotherapy for AUD affect sleep ?