Potential interactions between psychotropic drugs and alcohol and tobacco dependence

Abstract The aim of this study was to identify and analyze the potential interactions between psychotropic drugs and alcohol and tobacco addiction. A cross-sectional study was carried out on secondary data collection in a Center for Psychosocial Care in Alcohol and Other Drugs. Subjects aged 18 years old and over, with alcohol and tobacco dependence, who were taking psychotherapies were included. Medical records with the most recent prescriptions were reviewed. Potential interactions between psychotropic drugs and alcohol and tobacco were analyzed using the Micromedex database and stratified according to clinical risks and mechanisms of action. The Pearson's Chi-square test was used to find significant associations between the variables of interest. The significance level was set at 5%. Between the 2010-2018 period, 2,322 subjects were treated at the care center. Of these, 1,020 fulfilled the inclusion criteria, out of whom 515 (50.5%) were dependent on alcohol and 310 (30.4%) were dependent on tobacco. We found 1,099 potential interactions between psychotropic drugs and alcohol and 160 potential interactions between psychotropic drugs and tobacco. In relation to alcohol dependence, psychotropic drugs interacted largely with moderate clinical risk, and pharmacokinetic mechanisms of action. In relation to tobacco dependence, high clinical risk interactions and pharmacodynamic mechanisms of action predominated.

A systematic review of self-report measures used in epidemiological studies to assess alcohol consumption among older adults.

BACKGROUND: There is a lack of standardization regarding how to assess and categorize alcohol intake in older adults. The aim of this study was to systematically review methods used in epidemiological studies to define drinking patterns and measure alcohol consumption among older adults. METHODS: A systematic search was conducted in the MEDLINE, PubMed, PsycINFO, EMBASE, and CINAHL databases for studies published from January 2009 to April 2021. Studies were included if they were observational studies with a quantitative design; the mean age of the participants was ≥ 65 years; questionnaires, screening tools, or diagnostic tools were used to define alcohol consumption; and alcohol consumption was self-reported. RESULTS: Of 492 studies considered, 105 were included. Among the 105 studies, we detected 19 different drinking patterns, and each drinking pattern had a wide range of definitions. The drinking patterns abstaining from alcohol, current drinking, and risk drinking had seven, 12 and 21 diverse definitions, respectively. The most used questionnaire and screening tools were the quantity-frequency questionnaire, with a recall period of 12 months, and the full and short versions of the Alcohol Use Disorders Identification Test, respectively. CONCLUSION: No consensus was found regarding methods used to assess, define, and measure alcohol consumption in older adults. Identical assessments and definitions must be developed to make valid comparisons of alcohol consumption in older adults. We recommend that alcohol surveys for older adults define the following drinking patterns: lifetime abstainers, former drinkers, current drinkers, risk drinking, and heavy episodic drinking. Standardized and valid definitions of risk drinking, and heavy episodic drinking should be developed. The expanded quantity-frequency questionnaire including three questions focused on drinking frequency, drinking volume, and heavy episodic drinking, with a recall period of 12 months, could be used.

Does the Fast Alcohol Screening Test Accurately Distinguish Between Harmful and Severely Dependent Tiers of Alcohol Misuse?

AIMS: Primary aim: to determine the efficacy of FAST (the Fast Alcohol Screening Test) for detecting harmful and dependent levels of alcohol use. Secondary aim: to compare the performance of the FAST to two short forms of the Alcohol Use Disorder Identification Test (AUDIT): the AUDIT-C and AUDIT-3. METHODS: Data from 3336 individuals in South Wales, compiled from full AUDIT datasets, were examined. AUROC analysis, alongside measures of sensitivity and specificity of the FAST, AUDIT-C and AUDIT-3 were utilized for the identification of harmful and dependent alcohol use. RESULTS: The FAST demonstrated efficacy in the identification of harmful and dependent levels of alcohol use, with superior performance to both the AUDIT-C and AUDIT-3. CONCLUSION: The present paper demonstrates the potential of the FAST as a cost- and time-effective method for appropriate screening and signposting in the stepped care model utilized by many health care and treatment services. Further studies are needed to ensure validity, both within the general population and for specific services and populations.

Heterogeneity in DSM-5 Symptom Criteria: Phenotypes of Alcohol Use Disorder in a Sample Seeking Alcohol Treatment.

AIMS: This study sought to identify phenotypic variations among individuals with alcohol use disorder (AUD) that may, in part, help improve the effectiveness of existing AUD interventions. METHODS: Latent class analysis was conducted to examine the potential heterogeneity of AUD in a sample (N = 220; Mage = 51.19 years, standard deviation = 9.94; 37.7% female) of treatment-seeking participants diagnosed with AUD using DSM-5 criteria. RESULTS AND CONCLUSIONS: Three distinct patterns of responses to the 11 DSM-5 AUD symptoms emerged: Class 1 (n = 114, 51.8%), Class 2 (n = 78, 35.5%) and Class 3 (n = 28, 12.7%). The identified profiles were further differentiated by demographics, alcohol-related constructs, individual difference characteristics and diagnostic and treatment variables. The findings have implications for refining AUD assessment as well as optimizing personalized treatment.

Habitual versus affective motivations in obsessive-compulsive disorder and alcohol use disorder.

OBJECTIVE: To (1) confirm whether the Habit, Reward, and Fear Scale is able to generate a 3-factor solution in a population of obsessive-compulsive disorder and alcohol use disorder (AUD) patients; (2) compare these clinical groups in their habit, reward, and fear motivations; and (3) investigate whether homogenous subgroups can be identified to resolve heterogeneity within and across disorders based on the motivations driving ritualistic and drinking behaviors. METHODS: One hundred and thirty-four obsessive-compulsive disorder (n = 76) or AUD (n = 58) patients were assessed with a battery of scales including the Habit, Reward, and Fear Scale, the Yale-Brown Obsessive-Compulsive Scale, the Alcohol Dependence Scale, the Behavioral Inhibition/Activation System Scale, and the Urgency, (lack of ) Premeditation, (lack of ) Perseverance, Sensation Seeking, and Positive Urgency Impulsive Behavior Scale. RESULTS: A 3-factor solution reflecting habit, reward, and fear subscores explained 56.6% of the total variance of the Habit, Reward, and Fear Scale. Although the habit and fear subscores were significantly higher in obsessive-compulsive disorder (OCD) and the reward subscores were significantly greater in AUD patients, a cluster analysis identified that the 3 clusters were each characterized by differing proportions of OCD and AUD patients. CONCLUSIONS: While affective (reward- and fear-driven) and nonaffective (habitual) motivations for repetitive behaviors seem dissociable from each other, it is possible to identify subgroups in a transdiagnostic manner based on motivations that do not match perfectly motivations that usually described in OCD and AUD patients.

Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia.

Importance: Evidence on alcohol consumption as a risk factor for dementia usually relates to overall consumption. The role of alcohol-induced loss of consciousness is uncertain. Objective: To examine the risk of future dementia associated with overall alcohol consumption and alcohol-induced loss of consciousness in a population of current drinkers. Design, Setting, and Participants: Seven cohort studies from the UK, France, Sweden, and Finland (IPD-Work consortium) including 131 415 participants were examined. At baseline (1986-2012), participants were aged 18 to 77 years, reported alcohol consumption, and were free of diagnosed dementia. Dementia was examined during a mean follow-up of 14.4 years (range, 12.3-30.1). Data analysis was conducted from November 17, 2019, to May 23, 2020. Exposures: Self-reported overall consumption and loss of consciousness due to alcohol consumption were assessed at baseline. Two thresholds were used to define heavy overall consumption: greater than 14 units (U) (UK definition) and greater than 21 U (US definition) per week. Main Outcomes and Measures: Dementia and alcohol-related disorders to 2016 were ascertained from linked electronic health records. Results: Of the 131 415 participants (mean [SD] age, 43.0 [10.4] years; 80 344 [61.1%] women), 1081 individuals (0.8%) developed dementia. After adjustment for potential confounders, the hazard ratio (HR) was 1.16 (95% CI, 0.98-1.37) for consuming greater than 14 vs 1 to 14 U of alcohol per week and 1.22 (95% CI, 1.01-1.48) for greater than 21 vs 1 to 21 U/wk. Of the 96 591 participants with data on loss of consciousness, 10 004 individuals (10.4%) reported having lost consciousness due to alcohol consumption in the past 12 months. The association between loss of consciousness and dementia was observed in men (HR, 2.86; 95% CI, 1.77-4.63) and women (HR, 2.09; 95% CI, 1.34-3.25) during the first 10 years of follow-up (HR, 2.72; 95% CI, 1.78-4.15), after excluding the first 10 years of follow-up (HR, 1.86; 95% CI, 1.16-2.99), and for early-onset (<65 y: HR, 2.21; 95% CI, 1.46-3.34) and late-onset (≥65 y: HR, 2.25; 95% CI, 1.38-3.66) dementia, Alzheimer disease (HR, 1.98; 95% CI, 1.28-3.07), and dementia with features of atherosclerotic cardiovascular disease (HR, 4.18; 95% CI, 1.86-9.37). The association with dementia was not explained by 14 other alcohol-related conditions. With moderate drinkers (1-14 U/wk) who had not lost consciousness as the reference group, the HR for dementia was twice as high in participants who reported having lost consciousness, whether their mean weekly consumption was moderate (HR, 2.19; 95% CI, 1.42-3.37) or heavy (HR, 2.36; 95% CI, 1.57-3.54). Conclusions and Relevance: The findings of this study suggest that alcohol-induced loss of consciousness, irrespective of overall alcohol consumption, is associated with a subsequent increase in the risk of dementia.

Subtypes of Alcohol Dependence and 36-Year Mortality.

BACKGROUND: Chronic, heavy alcohol use is associated with multiple health problems, including premature death. Further, the clinical presentation of alcohol dependence may differentially affect and predict the long-term health consequences of affected individuals. Subtypes of alcohol dependence based upon treatment intake information can help identify homogenous groups of patients for treatment purposes, but have not been used to predict long-term outcomes. The current study examined mortality in a 36-year posttreatment interval among 4 subtypes of alcohol-dependent patients based upon their initial intake data. METHODS: Extensive baseline data were collected from n = 316 male and female patients receiving inpatient treatment for alcohol dependence between 1980 and 1982. Four alcohol dependent subtypes (Del Boca & Hesselbrock, Alcohol Health Res World, 20:56, 1996) derived from the baseline data were used to examine the 1-year posttreatment drinking status and the risk of death 36 years postdischarge. Public records were used to determine patient deaths in the 36 years since discharge. RESULTS: At the 36-year follow-up interval since discharge, 68.4% of the sample had died. The 4 subtypes were found to be associated with different rates of resumption of regular drinking in the first year posttreatment and a differential risk of mortality. An increased risk for returning to regular drinking (once a week or more) and early death were associated with subtypes defined, in part, by conduct problems and externalizing disorders. Regardless of subtype membership, women had the highest risk of death following treatment. CONCLUSIONS: This study demonstrates the clinical usefulness of subtypes of alcohol dependence for examining different alcohol use outcomes, including predicting mortality. The increased risks for returning to regular drinking once a week or more and early death posttreatment among subtypes associated with conduct problems and externalizing disorders suggest the need for continued monitoring and possible additional intervention postdischarge.

The impact of DSM classification changes on the prevalence of alcohol use disorder and 'diagnostic orphans' in Lebanese college youth: Implications for epidemiological research, health practice, and policy.

BACKGROUND: Studies comparing prevalence of alcohol use disorder (AUD) using DSM-IV and DSM-5 diagnostic criteria in college students are limited. This study examines changes in AUD prevalence estimates using DSM-IV versus DSM-5 and characterizes the profile of DSM-5 "diagnostic orphans." METHODS AND FINDINGS: A college student sample (n = 1,155; mean age: 21 ±1.97) selected conveniently from six large private and public universities in Greater Beirut, Lebanon completed an anonymous survey in May 2016. The study response rate was 83.1%. Data on DSM-IV and DSM-5 AUD criteria were gathered from 582 past-year drinkers, of which 377 (65%) were screened to have DSM-IV abuse/dependence, and 203 (35%) to have any DSM-5 AUD (58% mild, 21% moderate, and 21% severe). Overall percent agreement between measures was 68% (kappa = 0.41). One hundred and ninety-one students met one DSM-5 AUD criterion only (i.e. "diagnostic orphans," herein DOs), of which the majority (82%) endorsed "hazardous use." Compared to past-year drinkers with zero-endorsed DSM-5 criteria, DOs were more likely to be aged 21 or above [OR = 1.57(1.21-2.03)], less likely to perceive their socioeconomic status (SES) as poorer vs. same as others [OR = 0.17(0.07-0.43)], more likely to drink 1-2 times/week vs. ≤3 times per month [OR = 2.24(1.44-3.49)], and more likely to report past-year cigarette smoking [OR = 2.16(1.10-4.24)]. When compared to past-year drinkers with DSM-5 AUD, DOs were more likely to be pursuing a graduate or medical degree (vs. undergraduate degree) [2.06 (1.09-3.89)], and to be living with parents most of the time vs. not [OR = 2.68(1.14-6.31)]. DOs (versus drinkers with AUD) were less likely to drink at a high frequency (3-4 times /week or more vs.≤3 times per month) [OR = 0.15(0.05-0.48)], and to report past-year waterpipe smoking [OR = 0.54(0.34-0.85)], but more likely to report past-year marijuana use [1.89(1.10-3.23)]. The findings are subject to recall bias and under-reporting and the study could not infer causality because temporality of associations cannot be established in a cross-sectional study design. CONCLUSIONS: DSM-IV abuse/dependence prevalence rate was higher than DSM-5 AUD prevalence mainly due to the high percentage of students who engaged in "hazardous use". The DO screen might capture a young person in transition between non-drinking/occasional drinking to drinking frequently/developing an AUD. The prevention, identification, and management of DOs may be critical components of a national alcohol harm-reduction policy.

[Substance use disorder in the elderly and specified DSM-5 criteria]. / Tous les critères DSM-5 du trouble lié à l'usage de substance se valent-ils chez les sujets âgés ?

BACKGROUND: Substance use disorder (SUD) is commonly thought to be less frequent among the elderly than among younger adults. However, this disorder could be insufficiently screened in this population. And the diagnosis could be difficult to make especially because of specificities of this population. The diagnosis is based on the criteria of the DSM-5. Nevertheless, DSM-5 criteria were elaborated for younger adults and some of them could be inappropriate for older adults. METHODS: We studied the frequency of the DSM-5 criteria in a population of 59 patients aged around of 80 years, non-dependent and exposed to alcohol or benzodiazepines. We collected data relative to age, gender, type of residence (self-home or retirement house), medical past history, current treatment. Patient were also asked about their alcohol consumption, time of exposition, quantity of alcohol ingested or dose of benzodiazepines ingested and frequency of consumption. Alcohol consumption was reported as alcohol unit per day (one unit containing 10-gram alcohol). Frequency consisted in number of days with consumption in a week. Concerning benzodiazepine with evaluated the quantity by converting dose in equivalent diazepam per day. We determine the frequency of each criterion and the association with SUD diagnosis. RESULTS: We found that 45% of patients presented a diagnosis of SUD. DSM criteria 1, 2, 4, 9, 10 and 11 were found significantly more frequently in patients with addiction than in those without addiction. On the regression analysis criteria 1, 4, 6, 9, 10 and 11 as well as the number of units of alcohol consumed per day were associated with the diagnosis of addiction. The other socio-demographic factors were not associated with the diagnosis. CONCLUSION: This pilot study highlights that certain DSM-5 addiction criteria seem to be more relevant to seek in the elderly.

Examining the Relationship Between Self-Reported Drinking and In-Laboratory Drinking and Craving: Is There Concordance?

BACKGROUND: In-laboratory drinking sessions that allow direct assessment of drinking and craving are an emerging method for testing novel pharmacotherapy compounds and behavioral interventions for alcohol use disorders. Despite wide implementation, limited evidence supports the concordance between drinking in the laboratory and in a natural setting. This study examined the relationship between self-reports of drinking prior to and drinking and craving during an alcohol drinking paradigm (ADP). METHODS: Participants were adult heavy drinkers (N = 64) who participated in a pharmacotherapy study. Participants completed self-report alcohol assessments and a baseline ADP session prior to any medication administration. Alcohol craving was assessed during priming and ad lib ADP phases. Outcomes were the associations of total drinks consumed in-laboratory and summary drinking measures for the 30 days prior to the ADP and reports of maximum drinks (past year and lifetime). Additional outcomes were the association of self-reported drinking and alcohol craving during the ADP and the concordance between self-report and ADP World Health Organization (WHO) drinking classifications. RESULTS: Number of drinking days, average drinks per drinking occasion, and lifetime and past-year maximum drinks were all related to drinking in the laboratory. Heavy drinking days were not related to drinking in the laboratory but were associated with ADP craving. Alcohol craving was also associated with other measures of self-reported drinking. There was also a significant association between WHO drinking risk classification and in-laboratory drinking. CONCLUSIONS: The observed relationships between self-reported drinking and drinking in-laboratory across drinking indices suggest that in-laboratory alcohol consumption may reflect participants' real-world alcohol consumption, supporting the value of laboratory-based drinking paradigms. The demonstrated relationship with self-reported drinking and ADP alcohol craving further supports the value of such paradigms to model key drinking predictors. These results provide support for the validity of laboratory-based paradigms to accurately reflect participants' recent drinking levels.

A multimodal neuroimaging classifier for alcohol dependence.

With progress in magnetic resonance imaging technology and a broader dissemination of state-of-the-art imaging facilities, the acquisition of multiple neuroimaging modalities is becoming increasingly feasible. One particular hope associated with multimodal neuroimaging is the development of reliable data-driven diagnostic classifiers for psychiatric disorders, yet previous studies have often failed to find a benefit of combining multiple modalities. As a psychiatric disorder with established neurobiological effects at several levels of description, alcohol dependence is particularly well-suited for multimodal classification. To this aim, we developed a multimodal classification scheme and applied it to a rich neuroimaging battery (structural, functional task-based and functional resting-state data) collected in a matched sample of alcohol-dependent patients (N = 119) and controls (N = 97). We found that our classification scheme yielded 79.3% diagnostic accuracy, which outperformed the strongest individual modality - grey-matter density - by 2.7%. We found that this moderate benefit of multimodal classification depended on a number of critical design choices: a procedure to select optimal modality-specific classifiers, a fine-grained ensemble prediction based on cross-modal weight matrices and continuous classifier decision values. We conclude that the combination of multiple neuroimaging modalities is able to moderately improve the accuracy of machine-learning-based diagnostic classification in alcohol dependence.

Multidisciplinary team actions of a Brazilian Psychosocial Care Center for Alcohol and Drugs / Acciones del equipo multiprofesional del Centro de Atención Psicosocial Alcohol y Drogas / Ações da equipe multiprofissional do Centro de Atenção Psicossocial Álcool e Drogas

ABSTRACT Objective: to investigate the criteria used by health professionals to identify the phase of consumption of alcohol and drug users, and actions directed to their care. Method: a qualitative study developed with 14 professionals from a Brazilian Psychosocial Care Center for Alcohol and Drugs (Centro de Atenção Psicossocial Álcool e Drogas) based in the south of the country. Data were collected in June 2017 through semi-structured interviews and then submitted to thematic analysis. Results: the criteria used by the professionals were: periodicity of use; amount and type of drug used; repercussions of misuse; and place that the drug occupies in the person's life. The actions developed were orientation and referral to support groups, therapeutic workshops and individual care. Final considerations: the chronic nature of alcohol/drug use/dependence requires specific care in each phase, and objective criteria to identify and intervene in early phases, aiming at the prevention of chemical dependence.

RESUMEN Objetivo: investigar los criterios utilizados por los profesionales de la salud para identificar la fase del consumo en que se encuentran los usuarios de alcohol y drogas y las acciones que realizan para el cuidado de los mismos. Método: estudio cualitativo, desarrollado con 14 profesionales de un Centro de Atención Psicosocial Alcohol y Drogas, ubicado en el sur del país. Los datos fueron recolectados en junio/2017, a través de entrevistas semiestructuradas y sometidos al análisis temático. Resultados: los criterios utilizados por los profesionales fueron: periodicidad del uso; cantidad y tipo de droga ingerida; repercusiones del uso indebido; y lugar que la droga ocupa en la vida de la persona. Las acciones desarrolladas fueron orientación y encaminamiento para grupos de apoyo, talleres terapéuticos y atendimientos individuales. Consideraciones finales: la naturaleza crónica del uso/dependencia de alcohol y drogas requiere cuidados específicos en cada fase, y criterios objetivos para identificar e intervenir en las fases iniciales, buscando la prevención de la dependencia química.

RESUMO Objetivo: investigar os critérios utilizados pelos profissionais da saúde para identificar a fase do consumo em que se encontram os usuários de álcool e drogas, e as ações que realizam para o cuidado dos mesmos. Método: estudo qualitativo, desenvolvido com 14 profissionais de um Centro de Atenção Psicossocial Álcool e Drogas, localizado no sul do país. Os dados foram coletados em junho/2017, através de entrevistas semiestruturadas e submetidos à análise temática. Resultados: os critérios utilizados pelos profissionais foram: periodicidade do uso; quantidade e tipo de droga ingerida; repercussões do uso indevido; e lugar que a droga ocupa na vida da pessoa. As ações desenvolvidas foram orientação e encaminhamento para grupos de apoio, oficinas terapêuticas e atendimentos individuais. Considerações finais: a natureza crônica do uso/dependência de álcool e drogas requer cuidados específicos em cada fase, e critérios objetivos para identificar e intervir nas fases iniciais, visando à prevenção da dependência química.

Multidisciplinary team actions of a Brazilian Psychosocial Care Center for Alcohol and Drugs.

OBJECTIVE: to investigate the criteria used by health professionals to identify the phase of consumption of alcohol and drug users, and actions directed to their care. METHOD: a qualitative study developed with 14 professionals from a Brazilian Psychosocial Care Center for Alcohol and Drugs (Centro de Atenção Psicossocial Álcool e Drogas) based in the south of the country. Data were collected in June 2017 through semi-structured interviews and then submitted to thematic analysis. RESULTS: the criteria used by the professionals were: periodicity of use; amount and type of drug used; repercussions of misuse; and place that the drug occupies in the person's life. The actions developed were orientation and referral to support groups, therapeutic workshops and individual care. FINAL CONSIDERATIONS: the chronic nature of alcohol/drug use/dependence requires specific care in each phase, and objective criteria to identify and intervene in early phases, aiming at the prevention of chemical dependence.

Different Characteristics and Heritabilities of Alcohol Use Disorder Classes: A Population-Based Swedish Study.

AIMS: The aims of the present study are to identify alcohol use disorder (AUD) classes among a population-based Swedish sample, determine if these classes differ by variables known to be associated with AUD and determine whether some AUD classes have stronger genetic influences than others. METHODS: A latent class analysis (LCA), based on types of registrations, was conducted on Swedish individuals with an AUD registration born between 1960 and 1990 (N = 184,770). These classes were then validated using demographics; patterns of comorbidity with drug abuse, psychiatric disorders and criminal behavior; and neighborhood-level factors, i.e. peer AUD and neighborhood deprivation. The degree of genetic and environmental influence was also investigated. RESULTS: The best-fit LCA had four classes: (a) outpatient/prescription, characterized by a mix of outpatient medical and prescription registrations, (b) low-frequency inpatient, characterized entirely by inpatient medical registrations, with the majority of individuals having one AUD registration, (c) high-frequency mixed, characterized by a mix of all four registration types, with the majority having four or more registrations and (d) crime, characterized almost entirely by criminal registrations. The highest heritability for both males and females was found for Class 3 (61% and 65%, respectively) and the lowest for Class 1 (20% for both), with shared environmental influences accounting for 10% or less of the variance in all Classes. CONCLUSIONS: Using comprehensive, nationwide registry data, we showed evidence for four distinct, meaningful classes of AUD with varying degrees of heritability.

Reward, Relief and Habit Drinking: Initial Validation of a Brief Assessment Tool.

AIMS: Alcohol use disorder is highly heterogeneous. One approach to understanding this heterogeneity is the identification of drinker subtypes. A candidate classification consists of reward and relief subtypes. The current study examines a novel self-report measure of reward, relief, and habit drinking for its clinical correlates and subjective response (SR) to alcohol administration. METHODS: Non-treatment-seeking heavy drinkers (n = 140) completed the brief reward, relief, habit drinking scale (RRHDS). A subset of this sample (n = 67) completed an intravenous alcohol administration. Individuals were classified into drinker subtypes. A crowdsourced sample of heavy drinkers (n = 187) completed the RRHDS and a validated reward relief drinking scale to compare drinking classification results. RESULTS: The majority of the sample was classified as reward drinkers (n = 100), with fewer classified as relief (n = 19) and habit (n = 21) drinkers. Relief and habit drinkers reported greater tonic alcohol craving compared to reward drinkers. Reward drinkers endorsed drinking for enhancement, while relief drinkers endorsed drinking for coping. Regarding the alcohol administration, the groups differed in negative mood, such that relief/habit drinkers reported a decrease in negative mood during alcohol administration, compared to reward drinkers. The follow-up crowdsourcing study found a 62% agreement in reward drinker classification between measures and replicated the tonic craving findings. CONCLUSIONS: Our findings suggest that reward drinkers are dissociable from relief/habit drinkers using the brief measure. However, relief and habit drinkers were not successfully differentiated, which suggests that these constructs may overlap phenotypically. Notably, measures of dysphoric mood were better at detecting group differences than measures capturing alcohol's rewarding effects.

An Empirically Based Typology of Alcohol Users in a Community Sample Using Latent Class Analysis.

BACKGROUND: Different classification models have been proposed to explain the heterogeneity of alcohol-related problems in general populations. Such models suggest quantitatively or qualitatively different symptom endorsement characteristics between subgroups of alcohol drinkers. OBJECTIVES: The present study aimed to identify homogenous subgroups of drinkers in a general population sample in addition to examining the relationship between the subgroups and psychopathological symptoms. METHOD: Data of past-year alcohol users (n = 1,520) were analyzed from the nationally representative sample of the National Survey on Addiction Problems in Hungary 2015. Latent class analysis (LCA) was conducted to identify subgroups of drinkers based on the dichotomous indicator items of the Alcohol Use Disorders Identification Test questionnaire. Multinomial logistic regression and multiple comparisons were performed to explore the relationship between latent classes and socio-demographical variables and psychopathological symptoms. RESULTS: LCA suggested a 3-class model: "Light alcohol drinkers" (71.6%), "Alcohol drinkers with low risk of dependence" (19.3%), and "Alcohol drinkers with severe dependence symptoms" (9.1%). More severe subgroups showed significantly higher level of anxiety, depression, hostility, obsessive-compulsivity, interpersonal sensitivity, and psychiatric or alcohol use disorder-related treatment involvement. Male gender, younger age, lower level of educational achievement, and earlier onset of the first alcoholic drink were associated with membership of more severe subgroups. CONCLUSIONS: The present results indicated that severity-based subgroups of drinkers can be discriminated. Approximately 9% of the alcohol users showed severe symptoms of alcohol dependence. The present data also supported the association between more severe forms of alcohol consumption, and internalizing and externalizing characteristics. Although the 2 at-risk classes of alcohol drinkers did not differ in terms of alcohol consumption-related measures, they were distinguished by the level of harmful consequences due to alcohol use, psychopathological symptoms and psychiatric treatment history.

The influence of sample selection on the structure of psychopathology symptom networks: An example with alcohol use disorder.

Increasingly, the structure of mental disorders has been studied in the form of a network, characterizing how symptoms or criteria interact with and influence each other. Many studies of psychiatric symptoms and diagnostic criteria employ community or population-based surveys using co-occurrence of the symptoms/criteria to form the networks. However, given the overall low prevalence rates of mental disorders and their symptoms in the general population, most of those surveyed may not exhibit or endorse any symptoms and yet are often included in network analyses. Consequently, because network models are built on associations between symptoms/criteria, much of the observed variability is driven by individuals who are asymptomatic. Using data from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) Wave 2 and NESARC-III, we explore the effect of these "asymptomatic" observations on the estimated relations among diagnostic criteria of alcohol use disorder to determine the effects of such observations on estimated networks. We do so using the eLasso tool, as well as with traditional measures of correlation between binary variables (the Φ coefficient and odds ratio). We find that when the proportion of asymptomatic individuals are systematically culled from the sample, the estimated pairwise relations are often significantly affected, even changing signs in some cases. Our findings indicate that researchers should carefully consider the population(s) included in their sample and the implications it has on their interpretations of pairwise similarity estimates and resulting generalizability and reproducibility of estimates of network structures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys.

BACKGROUND AND AIMS: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. DESIGN: Cross-sectional household surveys. SETTING: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. PARTICIPANTS: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. MEASUREMENTS: Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). FINDINGS: Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. CONCLUSIONS: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable.