Implementation and Outcomes of a Pilot Collaborative Surgical Hydrocele Training in Côte d'Ivoire.

Lymphatic filariasis (LF) is a neglected tropical disease that can cause hydrocele and its associated stigma, loss of economic productivity, and depression. Hydrocele surgery is an essential part of LF morbidity management but can be difficult for national programs to implement. To improve access to hydrocele surgeries in Côte d'Ivoire, we provided a WHO-certified surgical training for six surgical teams from five health districts in Côte d'Ivoire. We then evaluated the surgical outcomes and assessed the impact of hydrocele surgery on quality of life of hydrocelectomy patients. Preoperative and operative records were reviewed to describe baseline hydrocele characteristics and operative details. Postoperative interviews were conducted 4 to 6 months after surgical correction using a standardized questionnaire. Seventeen men underwent surgery during the training and were available for an interview at the 6-month visit. At the time of 6-month follow-up, 11/17 (64.7%) reported improvement in activities of daily living and reduction in difficulties with work, 8/17 (47.1%) reported an improved economic situation, 15/17 (88.2%) reported improved social interactions, and 15/16 (93.8%) reported improved sex life after surgical correction. Three patients (17.6%) had minor postoperative complications, but none required hospitalization. All 17 patients who were available for an interview were satisfied with their surgery. Surgical hydrocelectomy training in Côte d'Ivoire was well received and provided life-altering health improvements for participating patients across multiple domains of life. Support to scale up surgical capacity for this neglected problem is needed.

A Mixed-Methods Examination of Language Used by College Students to Describe Alcohol Recovery.

Given that approximately 5% of the U.S. population is currently attending college, research is needed to better understand the language that college students use to describe alcohol recovery regardless of their current drinking behavior. College student perceptions of alcohol recovery are important, given that students may experience an alcohol use disorder themselves or may encounter others with an alcohol use disorder. Research on college student perceptions of alcohol recovery in the literature is scarce but is needed to better understand the alcohol recovery process. The current mixed-methods study examines language that college students use to describe alcohol recovery based on findings from two focus group interviews. The focus groups were conducted with college students who reported using alcohol at least once in their lifetime. All participants (N = 18) were asked questions regarding language perceived to be associated with alcohol recovery. Data were examined within a thematic analysis framework. The three central themes related to alcohol recovery that emerged in the study were harm reduction-based recovery, abstinence-based recovery, and social correlates of recovery. College students rated the terms "recovered," "drinking reduction," and "sobriety" as being highly representative of being in recovery, whereas the terms "bars" and "light drinker" were identified as not being representative of recovery. A better understanding of these themes will help the field understand the language that college students use to describe alcohol recovery.

Mental Health Risk Profiles and Related Substance Use During Coronavirus Pandemic Among College Students Who Use Substances.

College students have shown elevated mental distress during the coronavirus disease of 2019 (COVID-19). The extent and persistence of mental distress as COVID-19 restrictions have continued is unclear. This study used latent profile analysis to identify student mental health risk subgroups and to evaluate subgroups in relation with substance use. A four-profile solution was supported with a sample of 930 college students (69.6% female, 58.1% White) from 11 US-based institutions. Students were characterized by slight mental health symptoms, mild mental health symptoms, moderate-to-severe mental health symptoms with mild psychosis/substance use, and severe mental health symptoms. The severe profile comprised more ethnoracial or sexual minorities and students impacted from COVID-19. Whereas the severe profile had more alcohol-related consequences, the slight profile had fewer cannabis-related consequences. COVID-19 has exacerbated college student risks for psychiatric disorders. Students of diverse backgrounds and more impacted by COVID-19 show disproportionately more mental distress and related substance use.

Risk factors for mortality and multidrug resistance in pulmonary tuberculosis in Guatemala: A retrospective analysis of mandatory reporting.

BACKGROUND: Risk factors for mortality and MDR-TB in Guatemala are poorly understood. We aimed to identify risk factors to assist in targeting public health interventions. METHODS: We performed a retrospective study of adults with pulmonary TB reported to the Guatemalan TB Program between January 1, 2016 and December 31, 2017. The primary objective was to determine risk factors for mortality in pulmonary TB. The secondary objective was to determine risk factors associated with MDR-TB. RESULTS: Among 3,945 patients with pulmonary TB, median age was 39 years (IQR 25-54), 59% were male, 25% of indigenous ethnicity, 1.1% had MDR-TB and 3.9% died. On multivariable analysis, previous TB treatment (odds ratio [OR] 3.57, CI 2.24-5.68 [p < 0.001]), living with HIV (OR 3.98, CI 2.4-6.17 [p < 0.001]), unknown HIV diagnosis (OR 2.65, CI 1.68-4.18 [p < 0.001]), indigenous ethnicity (OR 1.79, CI 1.18-2.7 [p = 0.005]), malnutrition (OR 7.33, CI 3.24-16.59 [p < 0.001]), and lower educational attainment (OR 2.86, CI 1.43-5.88 [p = 0.003]) were associated with mortality. Prior treatment (OR 53.76, CI 25.04-115.43 [p < 0.001]), diabetes (OR 4.13, CI 2.04-8.35 [p < 0.001]), and indigenous ethnicity (OR 11.83, CI 1.46-95.73 [p = 0.02]) were associated with MDR-TB. CONCLUSIONS: In Guatemala, both previous TB treatment and indigenous ethnicity were associated with higher TB mortality and MDR-TB risk among patients with pulmonary TB.

Diagnostic Accuracy of Health Care Administrative Diagnosis Codes to Identify Nontuberculous Mycobacteria Disease: A Systematic Review.

BACKGROUND: Health care administrative database research frequently uses standard medical codes to identify diagnoses or procedures. The aim of this review was to establish the diagnostic accuracy of codes used in administrative data research to identify nontuberculous mycobacterial (NTM) disease, including lung disease (NTMLD). METHODS: We searched Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to April 2019. We included studies assessing the diagnostic accuracy of International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) diagnosis codes to identify NTM disease and NTMLD. Studies were independently assessed by 2 researchers, and the Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess bias and quality. RESULTS: We identified 5549 unique citations. Of the 96 full-text articles reviewed, 7 eligible studies of moderate quality (3730 participants) were included in our review. The diagnostic accuracy of ICD-9-CM diagnosis codes to identify NTM disease varied widely across studies, with positive predictive values ranging from 38.2% to 100% and sensitivity ranging from 21% to 93%. For NTMLD, 4 studies reported diagnostic accuracy, with positive predictive values ranging from 57% to 64.6% and sensitivity ranging from 21% to 26.9%. CONCLUSIONS: Diagnostic accuracy measures of codes used in health care administrative data to identify patients with NTM varied across studies. Overall the positive predictive value of ICD-9-CM diagnosis codes alone is good, but the sensitivity is low; this method is likely to underestimate case numbers, reflecting the current limitations of coding systems to capture NTM diagnoses.

I am what I am: A meta-analysis of the association between substance user identities and substance use-related outcomes.

OBJECTIVE: Research indicates that a substance user identity (i.e., drinking, smoking, and marijuana identity) is positively correlated with substance use-related outcomes (e.g., frequency, quantity, consequences, and disorder symptoms). The current study aimed to meta-analytically derive single, weighted effect size estimates of the identity-outcome association as well as to examine moderators (e.g., substance use type, explicit/implicit assessment, demographic characteristics, and research design) of this association. METHOD: Random effects meta-analysis was conducted on 70 unique samples that assessed substance user identity and at least one substance use-related outcome (frequency, quantity, consequences, and/or disorder symptoms), and provided the necessary information for effect size calculations. RESULTS: Substance user identity was found to be a statistically significant moderate-to-large correlate of all substance use-related outcomes examined in the current study (r w = .365, p < .001, rw² = .133). The strongest associations were observed between identity and disorder symptoms (alcohol) and frequency of substance use (tobacco or marijuana). In terms of moderators of the identity-outcome association, the link between explicit drinking identity and alcohol use-related outcomes appeared to be stronger in magnitude than the relationship between implicit drinking identity and alcohol use-related outcomes; however, this difference appears to be largely due to the finding that implicit measures have lower reliability. The strongest identity-outcome association was observed among younger individuals. CONCLUSIONS: Substance user identity is clearly an important correlate of substance use-related outcomes and this association is stronger among younger individuals. Additional theoretical, empirical, and intervention research is needed to utilize knowledge gleaned from the current study on the identity-outcome association. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Interleukin-6 Trajectory and Secondary Infections in Mechanically Ventilated Patients With Coronavirus Disease 2019 Acute Respiratory Distress Syndrome Treated With Interleukin-6 Receptor Blocker.

To describe the infectious complications and interleukin-6 trajectories in mechanically ventilated patients with coronavirus disease 2019. DESIGN: Retrospective cohort study. SETTING: ICUs at Washington University-Barnes Jewish Hospital in St. Louis, MO. PARTICIPANTS: All consecutive patients admitted to the medical ICU and requiring mechanical ventilation from March 12, 2020, to April 21, 2020, were included. INTERVENTIONS: Tocilizumab, an interleukin-6 receptor blocker, was prescribed at the discretion of the treating physicians to patients with a clinical picture compatible with cytokine release syndrome. MEASUREMENTS: All the patients were followed to death or hospital discharge. Demographic and laboratory data were collected retrospectively from the electronic medical record. Interleukin-6 levels were measured at days 0, 3, 7, 14, and 21. Infections were divided into culture positive and culture negative (clinically suspected and treated). The main outcomes were infectious complications and interleukin-6 levels at different points in time. RESULTS: Forty-three patients with respiratory failure secondary to coronavirus disease 2019 were on mechanical ventilation during the study period. Twenty-seven (68%) were male, and 31 (72.1%) were African-American. Median Charlson score was 2 (interquartile range, 0-4). Median Pao2/Fio2 was 171.5 (122-221) on the day of mechanical ventilation initiation, and 13 patients (30.2%) required vasopressors. C-reactive protein was 142.7 (97.7-213.7), d-dimer 1,621 (559-13,434), and Acute Physiology and Chronic Health Evaluation-II 11 (9-15). Interleukin-6 levels at admission were 61 pg/mL (interquartile range, 28.6-439 pg/mL). Patients treated with tocilizumab had higher levels of interleukin-6 at each measurement (days 0, 3, 7, 14, and 21) compared with patients receiving standard of care. Both groups reached peak interleukin-6 levels at day 7. Administration of tocilizumab was associated with a trend toward increased risk of infection. CONCLUSIONS: Interleukin-6 levels peak at day 7 in patients with severe coronavirus disease 2019 pneumonia requiring mechanical ventilation and follows a similar trajectory in patients with coronavirus disease 2019 pneumonia requiring mechanical ventilation irrespective of treatment with interleukin-6R blockers. Interleukin-6 levels continued to rise in nonsurvivors, in comparison with survivors, where the rise in interleukin-6 levels was followed by a decline.

A novel approach to assess descriptive and injunctive norms for college student marijuana use.

Descriptive and injunctive norms are traditionally assessed using different metrics. Following an innovation in the alcohol field, we examined a novel measure of perceived descriptive and injunctive marijuana norms (i.e., Marijuana Norms Grid, MNG) to characterize how these normative perceptions relate to one's own use of marijuana. The present study addressed three research questions: (1) Do college students overestimate descriptive/injunctive marijuana norms of typical college students and close friends? (2) Are descriptive/injunctive norms uniquely related to marijuana frequency and quantity? (3) Are injunctive norms related to marijuana frequency and quantity above and beyond how injunctive norms are traditionally assessed? College students (n = 7000) were recruited from 9 universities throughout the US, including 2077 past month marijuana users. Participants completed an online, cross-sectional survey that included measures assessing marijuana use, marijuana consequences, and descriptive and injunctive marijuana norms using traditional and novel assessments, among other assessments. The results revealed robust self-other discrepancies using the MNG such that participants overestimated how often and how much college students use marijuana. We also found that both descriptive and injunctive norms related uniquely to one's own marijuana use. The MNG injunctive norms explained about 19% of additional variability in marijuana outcomes beyond injunctive norms assessed using the traditional method. The findings of the present study support the utility of the novel assessment of injunctive marijuana norms. Implications for norms-based interventions are discussed.

Can Individuals With Alcohol Use Disorder Sustain Non-abstinent Recovery? Non-abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment.

OBJECTIVE: Four decades ago, the "controlled drinking" controversy roiled the alcohol field. Data have subsequently accumulated indicating that nonabstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether nonabstinent recovery at 3 years after AUD treatment is associated with better functioning at 10 years after treatment. METHODS: Data were from the 10-year follow-up of Project MATCH (New Mexico site only, n  = 146; 30.1% female, 58.6% non-White). Recovery was defined by latent profile analyses based on psychosocial functioning and alcohol consumption 3 years after treatment. Drinking practices and consequences, depression, purpose in life, and anger were assessed 10 years after treatment. Distal outcome analyses examined differences in drinking and functional outcomes at 10 years as a function of the 3-year latent profiles. Analyses were preregistered at https://osf.io/3hbxr. RESULTS: Four latent profiles identified at 3 years after treatment (ie, low functioning frequent heavy drinkers, low functioning infrequent heavy drinkers, high functioning heavy drinkers, and high functioning infrequent nonheavy drinkers) were significantly associated with outcomes 10 years after treatment. The 2 high functioning profiles at 3 years had the highest level of psychological functioning at 10 years posttreatment, regardless of alcohol consumption level. Abstinence at 3 years did not predict better psychological functioning at 10 years. CONCLUSIONS: Nonabstinent AUD recovery is possible and is sustainable for up to 10 years after treatment. The current findings align with recent proposals to move beyond relying on alcohol consumption as a central defining feature of AUD recovery.

Alcohol and marijuana protective behavioral strategies mediate the relationship between substance use identity and use-related outcomes: A multi-sample examination.

Substance use identity has been consistently associated with problematic substance use. Limited attention has considered mechanisms of this association. This research examined whether greater identification as a drinker or marijuana user would be associated with the use of fewer alcohol/marijuana protective behavioral strategies (PBS; e.g., avoiding drinking games/avoiding using marijuana in public places). Further, PBS have been associated with lower levels of negative alcohol/marijuana-related outcomes (i.e., frequency, quantity, consequences). In the current multi-sample study, PBS were examined as a mediator of the relationship between drinking/marijuana identity and alcohol/marijuana-related outcomes across three studies. Study 1 was an intervention study with heavy drinking college students (N = 605), Study 2 was a multisite study of marijuana outcomes among college students (N = 2,077), and Study 3 was a study of substance use in a community sample (n = 369alcohol; n = 146marijuana). Cross-sectional and/or longitudinal data were collected across studies. Substance use identity, PBS, and use-related outcomes were measured across the three studies. Indirect effects were evaluated by Monte Carlo confidence intervals. Manner of Drinking PBS were found to be the only statistically significant mediator of the relationship between drinking identity and alcohol-related outcomes (i.e., quantity and consequences) cross-sectionally. These significant cross-sectional mediation effects for alcohol were replicated in one of three longitudinal models. Marijuana PBS were also found to mediate the relationship between marijuana identity and all marijuana-related outcomes examined in the current study. Study findings may help to inform the development of identity-based and PBS-based interventions that aim to reduce negative alcohol/marijuana-related outcomes.

What Is Recovery?

Alcohol use disorder (AUD) is among the most prevalent psychiatric disorders and is associated with enormous public health costs. Although AUD and other addictive behaviors have been described as chronic relapsing conditions, most individuals who develop AUD will eventually recover. This narrative review provides an overview of definitions of recovery, with a focus on recovery from AUD. The definitions reviewed include those developed by key stakeholder groups, as well as definitions derived from recent quantitative and qualitative studies of individuals who meet criteria for AUD and attempt to resolve their problems with or without treatment or who self-identify as pursuing or achieving recovery. The literature reviewed supports a definition of recovery as an ongoing dynamic process of behavior change characterized by relatively stable improvements in biopsychosocial functioning and purpose in life. The review concludes that definitions of recovery that rely solely on abstinence from alcohol and the absence of AUD symptoms fail to capture the multidimensional and heterogeneous pathways to recovery that are evident among individuals in general population and clinical samples.

Does Gambling Identity Predict Unique Variance in Negative Gambling-Related Outcomes: An Examination of Direct and Interactive Associations.

Research from other addiction-related domains have reported identity-related constructs to be positively associated with substance use-related outcomes (e.g., frequency, quantity, and/or problems). Moreover, substance use identity has also been found to be predictive of unique variance in substance use-related outcomes. Given the similarities between substance use and behavioral addictions, it may also be the case that gambling identity is predictive of unique variance in negative gambling-related outcomes (e.g., frequency, expenditure, and gambling problem severity). The current study was conducted to examine whether gambling identity was predictive of negative gambling-related outcomes above and beyond the variance explained by other known risk factors of problem gambling (e.g., motives, social norms, and protective behavioral strategy [PBS] use). Moreover, gambling identity was examined as a moderator of the relationship between known risk factors of problem gambling and negative gambling-related outcomes. The current online study consisted of 270 U.S. participants who were predominantly male (90%), White (82%) and 33 years of age. The results from the negative binomial regression analyses indicated that gambling identity was predictive of unique variance in all of the negative gambling-related outcomes assessed. Moreover, gambling identity was found to moderate the relationship between motives, social norms, and PBS use in the prediction of negative gambling-related outcomes. Taken together, the results from the current study replicate and extend the extant body of gambling research and are used to highlight the importance of assessing gambling identity in future studies.

Is marijuana identity associated with marijuana use and consequences? An examination of direct and interactive associations.

BACKGROUND: There is relatively little research examining the relationship between identity and marijuana-related outcomes (e.g., marijuana use and consequences). Identity may both directly help shape marijuana use behaviors and moderate the influence of other risk factors on marijuana outcomes. OBJECTIVES: The current study examines the relationship between marijuana identity and marijuana-related outcomes among emerging adults and explores whether identity moderates the relationships between nonidentity correlates (e.g., perceived norms and negative affect) of marijuana-related outcomes. METHODS: College students who reported marijuana use in the past 12 months completed measures of marijuana identity, perceived norms, negative affect, frequency of marijuana use, and marijuana consequences. Conclusions/Importance: The results indicated that marijuana identity is associated with marijuana use frequency and moderates the relationship between perceived norms and marijuana consequences. The findings have implications for both identity-based and social norms-based interventions targeting problematic marijuana use among emerging adults.

Corrected white blood cell count, cell index, and validation of a clinical model for the diagnosis of health care-associated ventriculitis and meningitis in adults with intracranial hemorrhage.

OBJECTIVES: To evaluate the utility of the corrected CSF white blood cell (WBC) count, cell index, CSF lactate, CSF glucose and a newly developed diagnostic model for the diagnosis of healthcare-associated ventriculitis or meningitis (HCAVM) in the setting of intracranial hemorrhage (ICH). PATIENTS AND METHODS: A case-control study of 111 adult patients with ICH with HCAVM (cases) or without HCAVM (controls) matched 1:2 by age, Glasgow Coma Scale (GCS), and Acute Physiology and Chronic Health Evaluation II (APACHE II) score enrolled in a large tertiary care center from 2003 to 2016. RESULTS: Subjects were appropriately matched by age, GCS, and APACHE II score (P > 0.2). Cases had significantly higher CSF WBC count (uncorrected and corrected), cell index, and CSF lactate, but lower CSF glucose levels than controls (P < 0.05). There were no differences between CSF protein, CSF neutrophilic pleocytosis, and serum C-reactive protein between cases and controls (P > 0.1). The diagnostic accuracy as analyzed by the area under the receiver operating characteristic curve (AUC of ROC) was found to be good for the cell index (0.825), fair for the corrected CSF WBC count (0.770), and poor for the diagnostic model and uncorrected CSF WBC count (0.652 and 0.653, respectively). CONCLUSION: The diagnosis of HCAVM in patients with ICH remains challenging and although no single parameter is sufficient for diagnosis the cell index proved to be an important indicator of infection in our study.

Use of Alcohol Protective Behavioral Strategies as a Moderator of the Alcohol Use-Consequences Relationship: Evidence from Multiple Replications.

BACKGROUND: The use of protective behavioral strategies (PBS) has been found to attenuate the relationship between alcohol use and related consequences. OBJECTIVES: The current study examined PBS use as a moderator of the association between alcohol use and consequences in multiple samples (N = 9) of college students with different sample sizes (e.g., ns 125-736). We also examined sex as a moderator of the PBS moderation analyses. Across all samples, we predicted that the use of more PBS would attenuate the use-consequences relation. METHODS: In total, 3,524 college students completed online measures of alcohol use, consequences, and PBS use (i.e., PBSS) across two sites. Conclusions/importance: In the analyses, 3 two-way interactions were consistent with the literature (i.e., use-consequences relation weakest among those with high PBS use), 6 were opposite of what was reported in the literature (i.e., use-consequences relation strongest among those with high PBS use), and 39 were not statistically significant. These results corroborate, contradict, and extend the current body of knowledge in the extant alcohol PBS literature. In the examination of three-way interactions in the combined sample, serious harm reduction (SHR) PBS was found to moderate the use-consequences relation among female, but not among male students. Specifically, the use-consequences relation was weakest among female students who used more SHR PBS indicating that SHR PBS may be an important intervention target for female college students. Additional experimental and longitudinal studies are needed to examine the effects of PBS use on the use-consequences relation.

Alcohol, tobacco, and marijuana expectancies as predictors of substance use initiation in adolescence: A longitudinal examination.

Outcome expectancies have been found to be predictive of substance use. While development of expectancies may be dynamic during adolescence, it is unknown whether the rate of change (slope) in substance use expectancies is a risk factor for use onset across multiple substance use domains. The present study tested the hypothesis that the slope of positive and negative alcohol, tobacco, and marijuana use expectancies during mid-adolescence (9th-10th grade) would predict use onset of each respective substance during late adolescence (11th-12th grade). Data from 3,396 ethnically diverse high school students were collected across eight waves of assessment and analyzed within a latent growth modeling framework. Results revealed that the slopes of positive substance use expectancies among never-users of each respective substance predicted increased odds of onset (Alcohol: ORB = 7.73, p < .001; Tobacco: ORB = 5.58, p < .001; Marijuana: ORB = 2.49, p = .001). Only the slope of negative marijuana expectancies predicted increased odds of onset (Marijuana: ORB = .44, p = .04). Baseline level of positive and negative substance use outcome expectancies were also generally found to be associated with onset. For three common drugs used by adolescents, change in substance use expectancies during the first two years of high school may be a marker of risk propensity for substance use onset. Change in expectancies may be an important target in substance use prevention, with research indicating that expectancy challenge and life skills interventions being potentially efficacious. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Profiles of recovery from alcohol use disorder at three years following treatment: can the definition of recovery be extended to include high functioning heavy drinkers?

BACKGROUND AND AIMS: Recovery from alcohol use disorder (AUD) is often narrowly defined by abstinence from alcohol and improvements in functioning (e.g. mental health, social functioning, employment). This study used latent profile analysis to examine variability in recovery outcomes, defined by alcohol use, alcohol-related problems and psychosocial functioning at 3 years following treatment. Secondary analysis investigated pre-treatment, post-treatment and 1- and 3-year post-treatment covariate predictors of the latent profiles. DESIGN: Secondary analysis of data from a randomized clinical trial. SETTING: United States. PARTICIPANTS: We used data from the out-patient arm of Project MATCH (n = 806; 29.7% female, 22.2% non-white). MEASUREMENTS: Recovery was defined by latent profile analyses including measures of psychosocial functioning and life satisfaction (Psychosocial Functioning Inventory), unemployment and mental health (Addiction Severity Index), alcohol and other drug use (Form 90) and alcohol-related consequences (Drinker Inventory of Consequences) 3 years following treatment. Mixture modeling was used to examine correlates of profiles. FINDINGS: We identified four profiles at 3 years following treatment: (1) poor functioning frequent heavy drinkers, (2) poor functioning infrequent heavy drinkers, (3) high functioning occasional heavy drinkers and (4) high-functioning infrequent non-heavy drinkers. There were relatively few differences on indicators of functioning and treatment-related variables between the high functioning infrequent non-heavy drinkers and the high-functioning occasional heavy drinkers, other than high-functioning occasional heavy drinkers having lower alcohol dependence severity [odds ratio (OR) = 0.94, 95% confidence interval (CI) = 0.90, 0.98], fewer post-treatment coping skills (OR = 0.54, 95% CI = 0.32, 0.90) and lower 3-year post-treatment abstinence self-efficacy (OR = 0.37, 95% CI = 0.28, 0.49) and Alcoholics Anonymous (AA) involvement (OR = 0.87, 95% CI = 0.85, 0.99). The two high-functioning profiles showed the greatest improvements in functioning from baseline through the 3-year follow-up, whereas the low-functioning profiles showed the least amount of improvement. High-functioning occasional heavy drinkers had higher purpose in life than the poor-functioning profiles. CONCLUSIONS: Some individuals who engage in heavy drinking following treatment for alcohol use disorder may function as well as those who are mostly abstinent with respect to psychosocial functioning, employment, life satisfaction and mental health.

Abstinence and low risk drinking during treatment: Association with psychosocial functioning, alcohol use, and alcohol problems 3 years following treatment.

Abstinence from alcohol is often considered a critical element of recovery from alcohol use disorder. Yet, low risk drinking may be more desirable for some patients. There is mixed literature on whether low risk drinking is achievable and stable. Low risk drinking outcomes during treatment and outcomes 3 years after treatment were examined using data from the outpatient arm in Project MATCH (n = 877). Drinking outcomes were defined by repeated measures latent class analysis of weekly abstinence, low risk drinking days (<4/5 drinks for women/men), and heavy drinking days (≥4/5 drinks for women/men) during 12 weeks of treatment. Functioning outcome measures included psychosocial functioning, alcohol use, and alcohol-related consequences. Mixture modeling was used to examine the association between drinking classes and functioning outcomes. We identified 7 classes based on drinking during treatment: persistent heavy drinking, abstinence to heavy drinking, abstinence and heavy drinking, heavy drinking to mostly abstinent, low risk and heavy drinking, abstinence and low risk drinking, and abstinence. As compared with heavier drinkers, individuals who achieved mostly abstinence or low risk drinking, even with some heavy drinking episodes during treatment, had significant improvements in alcohol use, alcohol-related consequences, and psychosocial functioning 3 years after treatment. Those who were mostly abstinent or engaged in low risk drinking during treatment did not differ on any outcomes at 3 years after treatment. Findings indicate that low risk drinking is achievable for some individuals during treatment and that improvement in functioning among low risk drinkers can be observed at 3 years after treatment. (PsycINFO Database Record

Hazardous drinking has unique relationships with implicit and explicit drinking identity.

Measures of drinking identity are predictive of hazardous drinking. The extent to which hazardous drinking is differentially related to implicit compared to explicit drinking identity is not well understood. Neurocognitive models of addiction indicate that chronic alcohol use is associated with deficits in self-awareness which could limit the growth or recognition of drinking identity for individuals engaging in hazardous drinking. This might be particularly true for more reflective explicit measures of identity because their assessment and underlying cognitive processes rely more on self-awareness and conscious introspection. We predicted there would be different patterns of relationships between hazardous drinking and implicit/explicit drinking identity measures. A linear model was predicted to better fit the hazardous drinking and implicit identity relationship whereas a non-linear model was predicted to better fit the hazardous drinking and explicit identity relationship due to decreased ability to reflect on changes in identity at high levels of hazardous drinking. The present study is a re-analysis of a large secondary dataset (Project Implicit Mental Health; N = 11,320) which included measures of hazardous drinking (e.g., Alcohol Use Disorder Identification Test) and implicit/explicit identity. Results were consistent with predictions. The relationship between hazardous drinking and implicit drinking identity was best modeled by a linear function whereas the relationship between hazardous drinking and explicit drinking identity was best modeled by a non-linear cubit spline function. These findings are consistent not only with neurocognitive models but also with dual process formulations that implicit and explicit drinking identity are somewhat related but also quite distinct.