Substance familiarity in middle childhood and adolescent substance use.

BACKGROUND: Childhood familiarity with (knowledge of) substances is a potentially important, currently understudied adolescent substance use risk factor. We aimed to describe changes in childhood familiarity with substances and to test whether baseline familiarity predicts early adolescent substance use. METHODS: Utilizing the Substance Use Module of the longitudinal cohort study, Adolescent Brain Cognitive Development (ABCD; US youth aged 9-10 years followed for 10 years) through Data Release 4 (n=7896; individuals who completed all six assessments in the first three years), we conducted longitudinal mixed models and survival analyses to describe changes in familiarity and to determine the adjusted odds of substance use by age 13 based on number of familiar substances at baseline. RESULTS: The sample consisted of 3754 females and 4142 males, aged 9-10 at baseline, with majority White individuals (68.9%). Unconditional time models indicated age significantly predicted familiarity (B=0.08, p<0.001; R2=0.288) with ~3.59 familiar substances at 9 years increasing to ~7.43 substances at 13 years. Family history, home use, peer use, and neighborhood availability predicted familiarity, accounting for 1% of additional variance (R2=0.299; ∆R2=0.011). For each additional familiar substance at baseline, adjusted odds of future use increased 1.28 times (95% CI 1.22, 1.34). CONCLUSIONS: This is the first study to characterize substance familiarity in this age range as a predictor of future substance use. Familiarity increases with age (age being the most predictive indicator). Familiarity at age 9-10 predicts early adolescent substance use. As such, childhood familiarity may represent an easily implemented screening tool for at-risk youth.

Women's use of alcohol: Neurobiobehavioral concomitants and consequences.

In this narrative review, we draw from historical and contemporary literature to explore the impact of alcohol consumption on brain and behavior among women. We examine three domains: 1) the impact of alcohol use disorder (AUD) on neurobiobehavioral outcomes, 2) its impact on social cognition/emotion processing, and 3) alcohol's acute effects in older women. There is compelling evidence of alcohol-related compromise in neuropsychological function, neural activation, and brain structure. Investigations of social cognition and alcohol effects in older women represent emerging areas of study. Initial analyses suggest that women with AUD show significant deficits in emotion processing, a finding also observed in older women who have consumed a moderate dose of alcohol. Critically, despite the long-recognized need for programmatic interrogation of alcohol's effect in women, studies with sufficient numbers of women for meaningful analysis represent a small proportion of the literature, constraining interpretation and generalization.

Age as a potential modulator of alcohol-related deficits.

Although their individual significance is well-documented, the interaction effects of age, sex, and alcohol use disorder (AUD) have undergone little systematic investigation. Here, we extend prior work interrogating sex and group (AUD vs. community comparison [CC]) by probing the main and interaction effects of age on emotion processes as well as two conventional neuropsychological tests. Main effects for age and group were anticipated; however, interaction effects comprise our primary focus. While sex differences in AUD prevalence are commonly reported, sex differences within AUD samples are inconsistently found. Therefore, we pose our inquiry regarding sex as exploratory. In this study, 54 CC (n = 30 women) and 55 AUD (n = 14 women) subjects completed a battery that included an emotional face discrimination task, the Trail-Making Test-B (TMT-B), and the Digit Symbol Substitution Test (DSST). The initial/full models included the main and interaction effects of age (as a continuous variable; 25-59 years of age), sex, and group (AUD, CC). In analysis of the emotional face discrimination task, performance on a non-affective face discrimination task was entered as a covariate. Analysis of emotion identification revealed group and age main (p = .02; d = .53 & .003; d = .50, respectively) and interaction effects (p = .05; d = .41). The latter suggested that age and emotion processing performance were positively correlated in the AUD group, but unrelated in the CC group. Notably, neither sex, main, nor interaction effects achieved significance. Using the full model, analysis of the TMT-B and DSST failed to show sex effects or reveal expected performance decrement in the AUD group. To clarify the latter, simple models including only group as well as correlations between age and performance by group for each task were conducted. These analyses demonstrated the expected AUD-related deficits and suggested differential relationships between age and neurocognitive performance as a function of both group and task. Outcomes across tasks emphasize the need to reframe aging effects, particularly in the context of AUD.

A pilot randomized controlled trial of group-based indoor gardening and art activities demonstrates therapeutic benefits to healthy women.

BACKGROUND: There is mounting anecdotal and empirical evidence that gardening and art-making afford therapeutic benefits. OBJECTIVES: This randomly controlled pilot study tested the hypothesis that participation in group-based indoor gardening or art-making activities for one hour twice a week for four weeks would provide quantifiably different therapeutic benefits to a population of healthy women ages 26-49. METHODS: A population of 42 volunteers was randomly assigned to parallel gardening or art-making treatment groups. A total of 36 participants initiated the treatment protocol and 32 (Gardening n = 15 and Art n = 17) received the interventions and completed all assessments. Treatments included eight one-hour group-based gardening or art intervention sessions. Self-report psychometric assessments were conducted for anxiety, depression symptomatology, mood disturbance, stress, satisfaction with discretionary social activities, and quality of life measures. Cardiac physiological data were also collected. Outcomes were measured at baseline, during, and post-intervention. RESULTS: Engaging in both gardening and art-making activities resulted in apparent therapeutic improvements for self-reported total mood disturbance, depression symptomatology, and perceived stress with different effect sizes following eight one-hour treatment sessions. Gardening also resulted in improvements for indications of trait anxiety. Based on time-course evidence, dosage responses were observed for total mood disturbance, perceived stress, and depression symptomatology for both gardening and art-making. However, gardening or art-making did not have an apparent influence on heart rate or blood pressure or result in marked improvement for satisfaction with discretionary leisure activities. CONCLUSION: The data did not support the hypothesis of differential therapeutic benefits of gardening and art-making for healthy women. When taken together, group-based gardening or art-making can provide quantitatively measurable improvements in healthy women's psychosocial health status that imply potentially important public health benefits. TRIAL REGISTRATION: ClinicalTrials.gov NCT03266120.

Age-related changes and longitudinal stability of individual differences in ABCD Neurocognition measures.

Temporal stability of individual differences is an important prerequisite for accurate tracking of prospective relationships between neurocognition and real-world behavioral outcomes such as substance abuse and psychopathology. Here we report age-related changes and longitudinal test-retest stability (TRS) for the Neurocognition battery of the Adolescent Brain and Cognitive Development (ABCD) study, which included the NIH Toolbox (TB) Cognitive Domain and additional memory and visuospatial processing tests administered at baseline (ages 9-11) and two-year follow-up. As expected, performance improved significantly with age, but the effect size varied broadly, with Pattern Comparison and the Crystallized Cognition Composite showing the largest age-related gain (Cohen's d:.99 and.97, respectively). TRS ranged from fair (Flanker test: r = 0.44) to excellent (Crystallized Cognition Composite: r = 0.82). A comparison of longitudinal changes and cross-sectional age-related differences within baseline and follow-up assessments suggested that, for some measures, longitudinal changes may be confounded by practice effects and differences in task stimuli or procedure between baseline and follow-up. In conclusion, a subset of measures showed good stability of individual differences despite significant age-related changes, warranting their use as prospective predictors. However, caution is needed in the interpretation of observed longitudinal changes as indicators of neurocognitive development.

Cognitive training in recently-abstinent individuals with alcohol use disorder improves emotional stroop performance: Evidence from a randomized pilot trial.

BACKGROUND: Cognitive training interventions appear capable of improving alcohol-associated neurobehavioral deficits in recently detoxified individuals. However, efficacy remains incompletely characterized in alcohol use disorder (AUD) and available data address only non-affective cognitive outcomes; enhancement of social cognition remains uninvestigated. We utilized a training paradigm in which successfully ignoring emotionally-valent stimuli benefitted task performance. We hypothesized trained individuals would display improvements in an affective inhibitory control task, and that individuals trained with high valence (relative to neutral) stimuli would evince greater improvement. METHODS: 42 recently detoxified inpatients with AUD were assigned to one of three groups (Emotional Training, Neutral Training, or Treatment as Usual [TAU]). Training consisted of two computerized working memory tasks (dual-modality n-back task; attend/ignore task) which included task-irrelevant stimuli (emotional vs. neutral). Post-training performance efficiency (indexing speed-accuracy tradeoffs) in an emotional Stroop task was the outcome of interest. RESULTS: Significant group by time interactions were detected for emotional Stroop performance, supporting our hypothesis that trained groups would exhibit greater improvement than TAU controls (F[2,39]=8.61, p < .01). Additionally, the emotional training condition appeared to result in greater improvement relative to neutral training (F[1,26]=4.98, p < .01). CONCLUSION: Results are consistent with current literature suggesting the potential of training to enhance cognitive recovery in early abstinence. Findings inform the development of training protocols, suggesting integration of task-irrelevant distractor stimuli in training may enhance cognitive control outcomes. Further, they expand the relevant domains for application of training approaches, providing novel evidence that among individuals with AUD, training-associated benefits may extend to social cognitive domains.

A combined laboratory and field test of a smartphone breath alcohol device and blood alcohol concentration estimator to facilitate moderate drinking among young adults.

OBJECTIVE: Innovative strategies are needed to reduce young adult drinking. Real-time feedback via mobile health (mHealth) technology (e.g., smartphone devices/apps) may facilitate moderate drinking, yet requires evidence of feasibility, acceptability, and usability. METHOD: Young adults reporting frequent heavy drinking (N = 99, Mage = 23, 51% male) participated in a manualized, brief, motivational interview on recent typical and peak blood alcohol concentration (BAC), then were randomized to use 1 of the 3 forms of technology: (a) smartphone breathalyzer device/app; (b) app that estimates BAC based on factors including sex, weight, number/types of drinks over time; or (c) self-text messaging after each drink. Technologies were tested initially in small-group laboratory alcohol self-administration sessions. Participants then completed a 2-week field test wherein they had free access to all three technologies. Participants reported on usability and acceptability. RESULTS: Laboratory alcohol self-administration did not differ significantly by technology condition. The smartphone breathalyzer and BAC estimator app had favorable acceptability and usability. Participants used at least one form of technology on 67% of drinking days in the field period. In exploratory analyses, alcohol use during the field period was significantly lower than the baseline including a decrease of nearly one drink per drinking day. CONCLUSIONS: These findings support the feasibility of research combining lab and field methods to test moderate drinking technologies in young adults. Findings further support the acceptability and usability of these technologies, along with young adults' openness to using them. Exploratory results suggest potential efficacy of combined mobile technology intervention to be tested in subsequent controlled studies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Racially invariant stimuli may bias outcomes in assessment of emotion processing.

OBJECTIVE: Difficulties identifying emotional facial expressions are commonly observed in alcohol use disorder (AUD). Critically, this work utilizes single-race stimulus sets, although study samples are not similarly constrained. This is particularly concerning given evidence among community samples showing the impact of racial incongruity, giving rise to interpretative caveats. METHOD: Community controls (n = 55, 12 Black) and individuals with AUD (n = 46, 9 Black) completed a two-choice emotion judgment task. A similar nonaffective sex judgment task was employed as a covariate. Repeated measures mixed-model analyses were conducted with race, AUD status (AUD vs. control), and their interaction as fixed effects. Accuracy and reaction time (RT) were primary dependent measures. A post hoc analysis was conducted on efficiency (accuracy/RT). RESULTS: In addition to lower accuracy by individuals with AUD (p = .02), Black participants were less accurate than White participants (p = .0001) overall. Significant interactions between race and AUD were also detected for accuracy (p = .002), RT (p = .05), and efficiency (p = .01), wherein Black participants with AUD identified emotional expressions most poorly. This latter finding suggests that AUD-associated differences may be biased under racial incongruity. CONCLUSION: Taken together, these preliminary findings do not reflect a deficit among Black respondents. Instead, our results reflect the need for greater attention to stimulus diversity and sensitivity to respondent demographics in emotion-processing examinations. Given the purported role of emotion processing in alcohol-related problems and the increase in racial minority representation in the U.S., elucidating these differences remains critical. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Neural vulnerability and hurricane-related media are associated with post-traumatic stress in youth.

The human toll of disasters extends beyond death, injury and loss. Post-traumatic stress (PTS) can be common among directly exposed individuals, and children are particularly vulnerable. Even children far removed from harm's way report PTS, and media-based exposure may partially account for this phenomenon. In this study, we examine this issue using data from nearly 400 9- to 11-year-old children collected before and after Hurricane Irma, evaluating whether pre-existing neural patterns moderate associations between hurricane experiences and later PTS. The 'dose' of both self-reported objective exposure and media exposure predicted PTS, the latter even among children far from the hurricane. Furthermore, neural responses in brain regions associated with anxiety and stress conferred particular vulnerability. For example, heightened amygdala reactivity to fearful stimuli moderated the association between self-reported media exposure and PTS. Collectively, these findings show that for some youth with measurable vulnerability, consuming extensive disaster-related media may offer an alternative pathway to disaster exposure that transcends geography and objective risk.

Substance use patterns in 9-10 year olds: Baseline findings from the adolescent brain cognitive development (ABCD) study.

BACKGROUND: The Adolescent Brain Cognitive Development ™ Study (ABCD Study®) is an open-science, multi-site, prospective, longitudinal study following over 11,800 9- and 10-year-old youth into early adulthood. The ABCD Study aims to prospectively examine the impact of substance use (SU) on neurocognitive and health outcomes. Although SU initiation typically occurs during teen years, relatively little is known about patterns of SU in children younger than 12. METHODS: This study aims to report the detailed ABCD Study® SU patterns at baseline (n = 11,875) in order to inform the greater scientific community about cohort's early SU. Along with a detailed description of SU, we ran mixed effects regression models to examine the association between early caffeine and alcohol sipping with demographic factors, externalizing symptoms and parental history of alcohol and substance use disorders (AUD/SUD). PRIMARY RESULTS: At baseline, the majority of youth had used caffeine (67.6 %) and 22.5 % reported sipping alcohol (22.5 %). There was little to no reported use of other drug categories (0.2 % full alcohol drink, 0.7 % used nicotine, <0.1 % used any other drug of abuse). Analyses revealed that total caffeine use and early alcohol sipping were associated with demographic variables (p's<.05), externalizing symptoms (caffeine p = 0002; sipping p = .0003), and parental history of AUD (sipping p = .03). CONCLUSIONS: ABCD Study participants aged 9-10 years old reported caffeine use and alcohol sipping experimentation, but very rare other SU. Variables linked with early childhood alcohol sipping and caffeine use should be examined as contributing factors in future longitudinal analyses examining escalating trajectories of SU in the ABCD Study cohort.

Retrospective Hair Cortisol Concentrations from Pretreatment to Early Recovery in Alcohol Use Disorder.

Cortisol profiles are known to vary across phases of alcohol use disorder (AUD; e.g. chronic use, withdrawal and early/sustained recovery). These patterns have largely been established through between-subjects contrasts. Using a segmental hair cortisol concentrations (HCC) approach, retrospective longitudinal analyses are feasible. Here, we examine monthly cortisol secretion in treatment-seekers with AUD from alcohol use to abstinence. At ~6 weeks of recovery we collected hair samples from individuals with moderate-to-severe AUD. We examined HCC from three consecutive segments; proximal to the scalp representing the most recent month (sustained abstinence from alcohol), the midsegment representing the previous month in which abstinence was attained, and the distal segment representing 2 months prior during active drinking. Analyses examined main and interactive effects of segment and sex, controlling for monthly alcohol consumption. Best fit by a quadratic shape, within-subject change was significant (F1,15 = 5.27, P = 0.04, ηpartial2 = 0.26). The distal and midsegments did not differ from one another (P = 0.51). The proximal segment was significantly lower than both the distal (M∆ = 0.200, P = 0.004) and mid (M∆ = 0.175, P < 0.001) segments. An effect of sex approached significance suggesting women had modestly higher HCC than men (MWOMEN = 1.37 vs. MMEN = 1.02, P = 0.10). Consistent with previous cross-sectional reports, these data confirm nonlinear patterns of cortisol accumulation with elevations apparent during periods of alcohol consumption and a decrease in abstinence. Capturing these within-subject patterns via HCC trajectories may serve as a valuable resource in identifying profiles associated with increased risk and post-treatment outcomes.

The impact of emotional face stimuli on working memory performance among men and women with alcohol use disorder.

BACKGROUND: Individuals with alcohol use disorder (AUD) often display compromise in emotional processing and non-affective neurocognitive functions. However, relatively little empirical work explores their intersection. In this study, we examined working memory performance when attending to and ignoring facial stimuli among adults with and without AUD. We anticipated poorer performance in the AUD group, particularly when task demands involved ignoring facial stimuli. Whether this relationship was moderated by facial emotion or participant sex were explored as empirical questions. METHODS: Fifty-six controls (30 women) and 56 treatment-seekers with AUD (14 women) completed task conditions in which performance was advantaged by either attending to or ignoring facial stimuli, including happy, neutral, or fearful faces. Group, sex, and their interaction were independent factors in all models. Efficiency (accuracy/response time) was the primary outcome of interest. RESULTS: An interaction between group and condition (F1,107 = 6.03, p < .02) was detected. Individual comparisons suggested this interaction was driven by AUD-associated performance deficits when ignoring faces, whereas performance was equivalent between groups when faces were attended. Secondary analyses suggested little influence of specific facial emotions on these effects. CONCLUSIONS: These data provide partial support for initial hypotheses, with the AUD group demonstrating poorer working memory performance conditioned on the inability to ignore irrelevant emotional face stimuli. The absence of group differences when scenes were to be ignored (faces remembered) suggests the AUD-associated inability to ignore irrelevance is influenced by specific stimulus qualities.

Brain Structure and Function in Recovery.

Alcohol use disorder (AUD) commonly is associated with compromise in neurobiological and/or neurobehavioral processes. The severity of this compromise varies across individuals and outcomes, as does the degree to which recovery of function is achieved. This narrative review first summarizes neurobehavioral, neurophysiological, structural, and neurochemical aberrations/deficits that are frequently observed in people with AUD after detoxification. Subsequent sections review improvements across these domains during recovery, taking into account modulators of recovery to the extent permitted. Where appropriate, the discussion includes work integrating outcomes across domains, leveraging the strengths of diverse experimental methods. Interventions to ameliorate neurobiological or neurobehavioral deficits do not constitute a primary objective of this review. However, their consideration is a logical inclusion. Therefore, a limited introduction to existing methods is also presented.

Effects of Age and Acute Moderate Alcohol Consumption on Electrophysiological Indices of Attention.

OBJECTIVE: Despite increased attention to risks and benefits associated with moderate drinking lifestyles among aging adults, relatively few empirical studies focus on acute alcohol effects in older drinkers. Using electroencephalographic indices of early attention modulation (P1 and N1) and later stimulus processing (P3), we investigated whether acute alcohol consumption at socially relevant doses differentially influences neurocognitive performance in older, relative to younger, moderate drinkers. METHOD: Younger (25-35 years; n = 97) and older (55-70 years; n = 87) healthy drinkers were randomly assigned to receive one of three alcohol doses (placebo, .04 g/dl, or .065 g/dl target breath alcohol concentrations). Repeated-measures analysis of variance examined the effects of age, alcohol dose concentration, and their potential interaction on P1/P3 amplitudes and N1 latency during completion of a directed attend/ignore task. RESULTS: Age-specific effects on P1 amplitudes varied by instruction set, with alcohol-associated decreases in amplitude among older drinkers in response to task-relevant stimuli and increases to irrelevant stimuli, F(2, 141) = 2.70, p = .07, ηp2 = .04. In contrast, N1 analyses demonstrated alcohol-related latency reductions among older, relative to younger, adults, F(2, 83) = 3.42, p = .04. Although no Age × Alcohol interactions were detected for P3, main effects indicated dose-dependent amplitude reductions for relevant stimuli, F(2, 144) = 5.73, p < .01, ηp2 = .08. CONCLUSIONS: Our results underscore the impact of acute moderate alcohol consumption on attentional functioning, highlighting age-dependent sensitivity in electrophysiological indices of early attentional processing. Given the import of attentional functioning to quality of life and increases in drinking among a rapidly expanding aging population, these findings have broad public health relevance.

Acute Alcohol Intake Produces Widespread Decreases in Cortical Resting Signal Variability in Healthy Social Drinkers.

BACKGROUND: Acute alcohol intoxication has wide-ranging neurobehavioral effects on psychomotor, attentional, inhibitory, and memory-related cognitive processes. These effects are mirrored in disruption of neural metabolism, functional activation, and functional network coherence. Metrics of intraregional neural dynamics such as regional signal variability (RSV) and brain entropy (BEN) may capture unique aspects of neural functional capacity in healthy and clinical populations; however, alcohol's influence on these metrics is unclear. The present study aimed to elucidate the influence of acute alcohol intoxication on RSV and to clarify these effects with subsequent BEN analyses. METHODS: 26 healthy adults between 25 and 45 years of age (65.4% women) participated in 2 counterbalanced sessions. In one, participants consumed a beverage containing alcohol sufficient to produce a breath alcohol concentration of 0.08 g/dl. In the other, they consumed a placebo beverage. Approximately 35 minutes after beverage consumption, participants completed a 9-minute resting-state fMRI scan. Whole-brain, voxel-wise standard deviation was used to assess RSV, which was compared between sessions. Within clusters displaying alterations in RSV, sample entropy was calculated to assess BEN. RESULTS: Compared to the placebo, alcohol intake resulted in widespread reductions in RSV in the bilateral middle frontal, right inferior frontal, right superior frontal, bilateral posterior cingulate, bilateral middle temporal, right supramarginal gyri, and bilateral inferior parietal lobule. Within these clusters, significant reductions in BEN were found in the bilateral middle frontal and right superior frontal gyri. No effects were noted in subcortical or cerebellar areas. CONCLUSIONS: Findings indicate that alcohol intake produces diffuse reductions in RSV among structures associated with attentional processes. Within these structures, signal complexity was also reduced in a subset of frontal regions. Neurobehavioral effects of acute alcohol consumption may be partially driven by disruption of intraregional neural dynamics among regions involved in higher-order cognitive and attentional processes.

Impact of polysubstance use on social and non-affective cognitive performance among treatment-seeking individuals with alcohol use disorders.

BACKGROUND: Individuals with alcohol use disorder (AUD) display deficits across a range of cognitive processes. Decrements in social cognition may be particularly important for interpersonal functioning and post-treatment adaptation. Although social cognitive deficits are associated with chronic use of numerous substances, the role of polysubstance use in AUD-associated deficits remains largely unaddressed. METHODS: Community volunteers (n = 49; 22 men) and inpatient treatment-seekers with AUD were administered neurocognitive tasks indexing emotion processing and non-affective cognitive functioning. Tasks included an emotion discrimination task, a working memory task with affective stimuli, a general face processing (control) task, two measures of executive function, and two measures of visual spatial function. AUD subgroups included individuals with no recent (6-month) polysubstance use (AUD-Only; n = 22; 15 men), and those with at least weekly use (Poly-SU; n = 22; 18 men). RESULTS: Poly-SU individuals evinced disadvantaged performance relative to other groups on the emotion discrimination task [ps ≤ 0.001], affective working memory task [ps ≤ 0.050], and two executive function measures [ps ≤ 0.051]. No differences were observed for visual spatial functioning [ps ≥ 0.498] or general face processing [ps ≥ 0.190]. No performance differences between AUD-Only and community volunteers were noted. CONCLUSIONS: Results extend the emerging literature exploring emotion processing in AUD and add to the established literature regarding cognitive deficits in this population. The data suggest that among individuals with AUD, those with polysubstance use may be particularly vulnerable to deficits in decoding emotional face content. The current work highlights the need to incorporate more nuanced and careful considerations of polysubstance use in the design and analysis for future investigations of alcohol-associated deficits in emotion processing.

Randomized trial to assess safety/feasibility of memantine administration during residential treatment for alcohol use disorder: a pilot study.

The N-methyl-D-aspartate receptor (NMDAr) system is critically involved in the pathogenesis and neurobehavioral sequelae of alcohol use disorder (AUD), and constitutes a potential pharmacotherapeutic target. Memantine (Namenda) is an FDA-approved NMDAr antagonist with suggested utility in AUD, however its safety and tolerability during long-term administration among recently-detoxified patients remains uncharacterized. This pilot study assessed safety, feasibility, and several secondary measures of interest, during a 4-week period of residential AUD treatment. Participants (N = 18) met diagnostic criteria for AUD. A double-blind, placebo-controlled, escalating-dose design was utilized. Assessments of medication side-effects were conducted weekly. At intake, week 2, and study completion, participants completed a battery assessing affective symptomatology, craving, and neurocognitive function. Medication groups reported equivalent side effects and severity. Medication compliance was high, and did not differ by group. No memantine effects were observed in secondary outcome measures. Memantine maintains a profile of high tolerability and low side-effects during post-detoxification AUD treatment. These data suggest a more aggressive dosing/escalation schedule may be used safely in future trials designed to ascertain improvements in neurocognitive function, affect, and/or craving as primary measures.

Clarifying the neurobehavioral sequelae of moderate drinking lifestyles and acute alcohol effects with aging.

Epidemiological estimates indicate not only an increase in the proportion of older adults, but also an increase in those who continue moderate alcohol consumption. Substantial literatures have attempted to characterize health benefits/risks of moderate drinking lifestyles. Not uncommonly, reports address outcomes in a single outcome, such as cardiovascular function or cognitive decline, rather than providing a broader overview of systems. In this narrative review, retaining focus on neurobiological considerations, we summarize key findings regarding moderate drinking and three health domains, cardiovascular health, Type 2 diabetes (T2D), and cognition. Interestingly, few investigators have studied bouts of low/moderate doses of alcohol consumption, a pattern consistent with moderate drinking lifestyles. Here, we address both moderate drinking as a lifestyle and as an acute event. Review of health-related correlates illustrates continuing inconsistencies. Although substantive reductions in risk for cardiovascular and T2D events are reported, robust conclusions remain elusive. Similarly, whereas moderate drinking is often associated with enhanced cognition and lower dementia risk, few benefits are noted in rates of decline or alterations in brain structure. The effect of sex/gender varies across health domains and by consumption levels. For example, women appear to differentially benefit from alcohol use in terms of T2D, but experience greater risk when considering aspects of cardiovascular function. Finally, we observe that socially relevant alcohol doses do not consistently impair performance in older adults. Rather, older drinkers demonstrate divergent, but not necessarily detrimental, patterns in neural activation and some behavioral measures relative to younger drinkers. Taken together, the epidemiological and laboratory studies reinforce the need for greater attention to key individual differences and for the conduct of systematic studies sensitive to age-related shifts in neurobiological systems.

Cognitive training as a component of treatment of alcohol use disorder: A review.

OBJECTIVE: Cognitive training is an effective means of improving performance in a range of populations. Whether it may serve to facilitate cognitive recovery and longer-term outcomes in persons with alcohol use disorders (AUDs) is unclear. Here, we review historical and current literature and offer perspectives for model development and potential implementation. METHOD: We considered a large literature regarding the nature of alcohol-related compromise, early efforts to clarify the nature of recovery and current models and methods underlying cognitive training paradigms. We then constructed a narrative review demonstrating evolving frameworks and empirical data informing the critical review of cognitive training methods as a means of mitigating compromise and facilitating functional outcomes. RESULTS: Cognitive improvement with abstinence is generally noted, but training protocols may enhance performance and generalize benefit to untrained, but highly similar, tasks. Transfer of training to dissimilar tasks and functional outcomes is uncommonly reported. It is noteworthy that some work suggests that clinician ratings for participants are improved. Inconsistency in sample characteristics, training protocols, and outcome measures constrain general conclusions while suggesting opportunities for study and development. CONCLUSIONS: Cognitive training protocols have shown benefit in a variety of populations but have been examined infrequently in persons with AUDs. This overview indicates significant opportunity for cognitive improvement and recovery and thus a strong potential role for training protocols. However, supportive data are not robustly obtained. We suggest that one step in bridging this gap is the implementation of a conceptual framework incorporating contextual, behavioral, and neurobiological variables. (PsycINFO Database Record (c) 2019 APA, all rights reserved).