Exploring relationships between alcohol consumption, inflammation, and brain structure in a heavy drinking sample.

BACKGROUND: Chronic alcohol consumption is associated with structural brain changes and increased inflammatory signaling throughout the brain and body. Increased inflammation in the brain has been associated with structural damage. Recent studies have also shown that neurofilament light polypeptide (NfL) is released into the systemic circulation following neuronal damage. Although NfL has thus been proposed as a biomarker for neurodegenerative diseases, its connection to alcohol use disorder has not been explored. For this secondary data analysis, we proposed a conceptual model linking alcohol consumption, the pro-inflammatory cytokine IL-6, brain structure, and NfL in heavy drinking participants. METHODS: Of the 182 individuals enrolled in this study, 81 participants had usable data on gray matter (GM) thickness and 80 had usable data on white matter (WM) diffusivity. A subset of participants had NfL (n = 78) and IL-6 (n = 117) data. An estimate of GM thickness was extracted from middle frontal brain regions using FreeSurfer. Estimated mean WM diffusivity values were extracted from Tract Based Spatial Statistics. NfL and IL-6 were measured in blood. Regression models were used to test individual linkages in the conceptual model. Based on significant regression results, we created a simplified conceptual model, which we tested using path analysis. RESULTS: In regressions, negative relationships emerged between GM and both drinks per drinking day (DPDD) (p = 0.018) and NfL (p = 0.004). A positive relationship emerged between WM diffusivity and DPDD (p = 0.033). IL-6 was not significantly associated with alcohol use, GM or WM. The final path model demonstrated adequate fit to the data and showed significant, negative associations between DPDD and middle frontal gyrus (MFG) thickness, and between MFG thickness and NfL, but the association between DPDD and NfL was not significant. CONCLUSIONS: This is the first study to show that heavy drinking is associated with lower GM thickness and higher WM diffusivity and that lower GM thickness is associated with higher circulating NfL. The analyses also show that the effects of drinking do not involve the pro-inflammatory cytokine IL-6.

Magnitude and correlates of alcohol use disorder in south Gondar zone, northwest Ethiopia: A community based cross-sectional study.

BACKGROUND: Alcohol use disorder is the major public health problem in low- and middle-income countries that account for up to 70% of alcohol related premature mortality in the region. Therefore, the aim of this study was to assess the magnitude of alcohol use disorder and its associated factors among adult residents in south Gondar zone, Northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted among 848 adult residents of the south Gondar zone from January 13 to February 13, 2020. A multistage sampling technique was used to recruit study participants. We assessed alcohol use disorder (AUD) using the alcohol use disorder identification test (AUDIT). A binary logistic regression model was employed to identify factors associated with AUD. RESULTS: The prevalence of alcohol use disorder over the last 12-months was found to be 23.7% (95% CI: 20.9, 26.7). Being male (AOR = 4.34, 95 CI; 2.800, 6.743), poor social support (AOR = 1.95, 95 CI: 1.098, 3.495), social phobia (AOR = 1.69, 95 CI; 1.117, 2.582), perceived high level of stress (AOR = 2.85, 95 CI; 1.829, 34.469), current cigarette smoking (AOR = 3.06, 95 CI; 1.764, 5.307) and comorbid depression (AOR = 1.81, 95 CI; 1.184, 2.778) were significantly associated with alcohol use disorder. CONCLUSION: The prevalence of alcohol use disorder is high among adult residents of the south Gondar zone and associated with many factors. So, it needs public health attention to decrease the magnitude of alcohol use disorder in Ethiopia.

Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems: A Randomized Clinical Trial.

Importance: To date, few multisite investigations have evaluated early interventions for injured patients with posttraumatic stress disorder (PTSD) symptoms. Objective: To simultaneously assess the effectiveness and implementation of a brief stepped collaborative care intervention targeting PTSD and comorbidity. Design, Setting, and Participants: A stepped-wedge cluster randomized clinical trial was conducted at 25 US level I trauma centers. Participants included hospitalized survivors of physical injury who underwent a 2-step evaluation for PTSD symptoms. Patients reporting high levels of distress on the PTSD Checklist (PCL-C) were randomized (N = 635) per the stepped-wedge protocol to enhanced usual care control (n = 370) or intervention (n = 265) conditions. The study was conducted from January 4, 2016, through November 2018. Data analysis was performed from November 4, 2019, to December 8, 2020. Interventions: The Trauma Survivors Outcomes and Support collaborative care intervention included proactive injury case management that assisted patients transitioning from hospital inpatient to outpatient and community settings. The intervention also integrated evidence-based pharmacotherapy and psychotherapeutic elements targeting PTSD symptoms and comorbidity. Main Outcomes and Measures: The primary study outcome was PTSD symptoms assessed with the PCL-C at baseline in the surgical ward and at 3, 6, and 12 months postinjury. Secondary outcomes included depressive symptoms, alcohol use, and physical function. Subgroup analyses examined the effect of baseline risk factors for enduring PTSD and quality of protocol implementation on study outcomes. Primary statistical analyses were conducted using the intent-to-treat sample. Results: A total of 327 men (51.5%) were included in analysis; mean (SD) age was 39.0 (14.2) years. The investigation attained follow-up of 75% to 80% of the participants at 3 to 12 months. The intervention lasted a mean (SD) of 122 (132) minutes. Mixed model regression analyses revealed statistically significant changes in PCL-C scores for intervention patients compared with control patients at 6 months (difference, -2.57; 95% CI, -5.12 to -0.03; effect size, 0.18; P < .05) but not 12 months (difference, -1.27; 95% CI, -4.26 to 1.73; effect size, 0.08; P = .35). Subgroup analyses revealed larger PTSD treatment effects for patients with 3 or more baseline risk factors for enduring PTSD and for patients, including firearm injury survivors, treated at trauma centers with good or excellent protocol implementation. Intervention effects for secondary outcomes did not attain statistical significance. Conclusions and Relevance: A brief stepped collaborative care intervention was associated with significant 6-month but not 12-month PTSD symptom reductions. Greater baseline PTSD risk and good or excellent trauma center protocol implementation were associated with larger PTSD treatment effects. Orchestrated efforts targeting policy and funding should systematically incorporate the study findings into national trauma center requirements and verification criteria. Trial Registration: ClinicalTrials.gov Identifier: NCT02655354.

Childhood and Adolescent Bullying Perpetration and Later Substance Use: A Meta-analysis.

CONTEXT: Previous meta-analyses substantially contributed to our understanding of increased drug use risk in bullies but only included research up to 2014 and did not report on other types of substances. OBJECTIVE: To review and meta-analyze existing evidence regarding the prospective association between peer bullying perpetration in childhood and adolescence and later substance use. DATA SOURCES: Electronic databases were searched on March 14, 2019. STUDY SELECTION: We selected peer-reviewed articles and dissertations in English reporting original empirical studies on associations between bullying perpetration in childhood or adolescence and later use of drugs, alcohol, or tobacco. Records were assessed for eligibility independently by 2 authors. DATA EXTRACTION: Data extraction and quality assessment was performed by one author and checked by another author. RESULTS: In total, 215 effects were included from 28 publications, reporting on 22 samples, comprising 28 477 participants. Bullying perpetration was associated positively with all types of substance use (drugs, alcohol, tobacco, and general). The results for combined bullying-victimization were more mixed, with generally weaker effects. LIMITATIONS: Effects were based on a large variability in operationalizations and measures of bullying and substance use, impeding the interpretation of the pooled effect sizes. Although bullying appears to be a risk factor for substance use, no inferences can be made about so-called causal risk factors that can provide the basis for preventive interventions. CONCLUSIONS: There is evidence that adolescents and particularly children who bully their peers have a higher risk of substance use later in life than their nonbullying peers.

Practice facilitation to promote evidence-based screening and management of unhealthy alcohol use in primary care: a practice-level randomized controlled trial.

BACKGROUND: Unhealthy alcohol use is the third leading cause of preventable death in the United States. Evidence demonstrates that screening for unhealthy alcohol use and providing persons engaged in risky drinking with brief behavioral and counseling interventions improves health outcomes, collectively termed screening and brief interventions. Medication assisted therapy (MAT) is another effective method for treatment of moderate or severe alcohol use disorder. Yet, primary care clinicians are not regularly screening for or treating unhealthy alcohol use. METHODS AND ANALYSIS: We are initiating a clinic-level randomized controlled trial aimed to evaluate how primary care clinicians can impact unhealthy alcohol use through screening, counseling, and MAT. One hundred and 25 primary care practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) will be engaged; each will receive practice facilitation to promote screening, counseling, and MAT either at the beginning of the trial or at a 6-month control period start date. For each practice, the intervention includes provision of a practice facilitator, learning collaboratives with three practice champions, and clinic-wide information sessions. Clinics will be enrolled for 6-12 months. After completion of the intervention, we will conduct a mixed methods analysis to identify changes in screening rates, increase in provision of brief counseling and interventions as well as MAT, and the reduction of alcohol intake for patients after practices receive practice facilitation. DISCUSSION: This study offers a systematic process for dissemination and implementation of the evidence-based practice of screening, counseling, and treatment for unhealthy alcohol use. Practices will be asked to implement a process for screening, counseling, and treatment based on their practice characteristics, patient population, and workflow. We propose practice facilitation as a robust and feasible intervention to assist in making changes within the practice. We believe that the process can be replicated and used in a broad range of clinical settings; we anticipate this will be supported by our evaluation of this approach. TRIAL REGISTRATION: ClinicalTrials.gov, ClinicalTrials.gov Identifier: NCT04248023, Registered 5 February 2020.

Pain Severity and Alcohol Use Among Daily Tobacco Cigarette Smokers.

BACKGROUND AND OBJECTIVES: Pain is associated with hazardous alcohol use. Drinkers have reported using alcohol for pain-coping, and negative affect may be a key mechanism in pain-induced motivation to drink. However, no previous study has examined pain severity in relation to alcohol consumption, dependence, and alcohol-related consequences. Moreover, no studies have examined pain-alcohol interrelations among tobacco cigarette smokers. These secondary analyses tested the hypotheses that greater past 4-week pain severity would be positively associated with indices of hazardous drinking (ie, quantity/frequency, harmful use, and dependence), and that the current pain intensity would be positively/indirectly associated with the urge to drink via negative affect. METHODS: Participants included 225 daily smokers (43% female; MCPD = 22) who completed the baseline session for a larger experimental study. RESULTS: Every one-point increase in pain severity was associated with a 47% increased likelihood of hazardous drinking, and pain severity was positively associated with quantity/frequency of alcohol consumption, harmful patterns of drinking, and alcohol dependence level (Ps < .05). Pain intensity was indirectly associated with urge to drink via negative affect (P < .05). CONCLUSIONS: These findings provide initial evidence that smokers with greater pain severity may also report hazardous patterns of alcohol use. SCIENTIFIC SIGNIFICANCE: This is the first study to demonstrate that past 4-week pain severity may be one factor that maintains three conceptually distinct patterns of hazardous drinking among smokers. The current results also provide the first evidence that greater pain intensity may be associated with an increased urge to drink alcohol, via negative affect. (Am J Addict 2020;29:134-140).

Craniofacial Trauma Is Associated With Significant Psychosocial Morbidity 1 Year Post-Injury.

PURPOSE: The face and head play critical roles in one's sense of self and body image; as such, facial, head, and scalp injuries and potential associated disfigurement can lead to particular difficulties in coping. This study examined the psychosocial outcomes of patients with craniofacial (CF) trauma 1 year after injury and compared these outcomes with those of other traumatically injured patients who did not sustain such injuries. It was hypothesized that participants in the CF injury group would have worse outcomes than those without CF trauma. MATERIALS AND METHODS: This prospective longitudinal study included patients at least 18 years of age admitted to the trauma service of a level I trauma center for at least 24 hours. Demographic and injury-related variables were collected. CF injury was determined by International Classification of Diseases, Ninth Revision codes. Outcomes were measured at baseline and at 12 months and included depression, post-traumatic stress disorder (PTSD), alcohol use, and pain severity. Paired t tests and logistic regression were used for analysis. RESULTS: Fifteen percent (n = 35) of the study sample (N = 230) had CF injuries. Those with CF injuries had lower income, higher injury severity, and higher intensive care unit admission rates. The CF and non-CF trauma groups did not differ in rates of depression or PTSD at either time point. However, participants with CF trauma had higher odds of risky alcohol use than those without CF trauma at baseline and lower odds of a higher pain severity score at baseline and 12 months. CONCLUSIONS: The groups did not differ in depression and PTSD. However, rates of depression, PTSD, alcohol use, and physical pain were higher than expected for the 2 groups. Given the high rate of psychological morbidity found after CF trauma, patients with these injuries should be screened for symptoms soon after injury and provided with resources for treatment.

Hangover Symptoms, Heavy Episodic Drinking, and Depression in Young Adults: A Cross-Lagged Analysis.

OBJECTIVE: The objective of this study was to examine associations between symptoms of alcohol hangover and depression, both cross-sectionally and prospectively. METHOD: Data were from a survey of young adults (N = 986, 60% female) initially recruited as part of an observational study of youth smoking. Participants reported past-year hangover symptoms, past-year frequency of heavy episodic drinking (HED), and past-week depression symptoms on two occasions separated by 1 year. Path analysis was used to evaluate prospective, directional associations linking symptoms of depression and hangover after taking into account their stabilities and cross-sectional associations. Individual differences in HED frequency were accounted for to permit interpretation of residual hangover score variance in terms of susceptibility to hangover effects. RESULTS: Past-week depression and past-year hangover symptoms were associated at Time 1. Path analysis indicated that Time 1 depression symptoms were associated with elevated hangover symptoms a year later at Time 2. In contrast, Time 1 hangover symptoms did not predict future depression. CONCLUSIONS: Depression symptoms are associated with current and future hangover susceptibility. Hangover and depression overlap symptomatically and are empirically associated with one another, suggesting the possibility that common underlying causal mechanisms may contribute to both phenomena.

Osteoarthritis is associated with symptoms of common mental disorders among former elite athletes.

PURPOSE: The primary aim was to establish the association between osteoarthritis (OA) and the occurrence and comorbidity of symptoms of common mental disorders (CMD: distress, anxiety/depression, sleep disturbance, adverse alcohol use) in a group of former elite athletes (rugby, football, ice hockey, Gaelic sports and cricket). A secondary aim was to explore this association in the subgroups of sports. METHODS: Cross-sectional analysis was performed on the baseline questionnaires from five prospective cohort studies conducted between April 2014 and January 2016 in former elite athletes of rugby, football, ice hockey, Gaelic sports and cricket. The presence of OA (diagnosed by a medical professional) was examined with a single question, and symptoms of CMD were evaluated through multiple validated questionnaires (4DSQ, GHQ-12, PROMIS, AUDIT-C). RESULTS: There was a significant association between OA and symptoms of distress (OR 1.7, 95 % CI 1.2-2.6), sleep disturbance (OR 1.6, 95 % CI 1.1-2.3), adverse alcohol use (OR 1.8, 95 % CI 1.2-2.6) and a comorbidity of symptoms of CMD (OR 1.5, 95 % CI 1.0-2.1) in former elite athletes. CONCLUSION: OA might be a risk factor for developing symptoms of CMD in former elite athletes. The clinical relevance of this study is that an interdisciplinary approach to the clinical care and support of former elite athletes after their careers is advocated as the interaction between the physical and mental health issues occurring on the long term is complex. Monitoring OA among former elite athletes should be empowered while strategies to prevent symptoms worsening should be developed and implemented. The self-awareness, prevention and care of mental health problems that might occur after a professional sports career should also be addressed. LEVEL OF EVIDENCE: Level III.

Impact of alcohol consumption and body mass index on mortality from nonneoplastic liver diseases, upper aerodigestive tract cancers, and alcohol use disorders in Korean older middle-aged men: Prospective cohort study.

Alcohol use is a leading risk factor for the global disease burden including liver diseases. However, the combined effect of alcohol use and body mass index (BMI) on alcohol-related diseases has seldom been examined. We examined whether alcohol consumption and BMI could act together to increase mortality from nonneoplastic liver diseases, upper aero-digestive tract (UADT) cancers, and alcohol use disorders (AUD) in middle-aged Korean men.107,735 men (mean age, 58.8 years) participated in a postal survey in 2004 and were followed until 2010, by linkage to national death records. Hazard ratios (HRs) of cause-specific death were calculated after adjustment for confounders.Each 5-drink (approximately 45 g alcohol) higher weekly alcohol consumption was associated with increased mortality, by approximately 70% for nonneoplastic liver disease mortality (HR = 1.70, P < 0.001), approximately 60% for UADT cancer mortality (HR = 1.64, P < 0.001), and approximately 70% for AUD mortality (HR = 1.71, P < 0.001). Generally, BMI was inversely associated with these alcohol-related diseases (HR per each 5 kg/m higher BMI = 0.18-0.46, P < 0.001 for each cause), while, in participants with BMI ≥25 kg/m, each 5 kg/m higher BMI was also associated with an elevated mortality from nonneoplastic liver diseases of approximately 150% (HR = 2.52, P = 0.001). Men with BMI < 21 kg/m and weekly alcohol consumption ≥14 drinks showed markedly higher mortality from nonneoplastic liver diseases (HR = 5.7), alcoholic liver diseases (HR = 9.3), UADT cancers (HR = 10.5), and esophageal cancer (HR = 15.5), compared to men drinking less than 1 drink/wk with BMI ≥25 kg/m. The combined effect of low BMI and high weekly alcohol consumption was 2.25- to 3.29-fold greater than the additive effect of each factor for these alcohol-related diseases (P < 0.05 for each cause).Alcohol consumption and low BMI were related to deaths from nonneoplastic liver diseases, UADT cancers, and AUD, with evidence of a supra-additive combined effect of both factors. High BMI was also related to deaths from nonneoplastic liver diseases. Men with a low BMI (<23 kg/m) are suggested to be prone to the harmful effects of alcohol.

Alcohol and substance abuse, depression and suicide attempts after Roux-en-Y gastric bypass surgery.

BACKGROUND: Small studies suggest that subjects who have undergone bariatric surgery are at increased risk of suicide, alcohol and substance use disorders. This population-based cohort study aimed to assess the incidence of treatment for alcohol and substance use disorders, depression and attempted suicide after primary Roux-en-Y gastric bypass (RYGB). METHODS: All patients who underwent primary RYGB in Sweden between 2001 and 2010 were included. Incidence of hospital admission for alcohol and substance use disorders, depression and suicide attempt was measured, along with the number of drugs prescribed. This cohort was compared with a large age-matched, non-obese reference cohort based on the Swedish population. Inpatient care and prescribed drugs registers were used. RESULTS: Before RYGB surgery, women, but not men, were at higher risk of being diagnosed with alcohol and substance use disorder compared with the reference cohort. After surgery, this was the case for both sexes. The risk of being diagnosed and treated for depression remained raised after surgery. Suicide attempts were significantly increased after RYGB. The adjusted hazard ratio for attempted suicide in the RYGB cohort after surgery compared with the general non-obese population was 2·85 (95 per cent c.i. 2·40 to 3·39). CONCLUSION: Patients who have undergone RYGB are at an increased risk of being diagnosed with alcohol and substance use, with an increased rate of attempted suicide compared with a non-obese general population cohort.

Do Consumers Want More Nutritional and Health Information on Wine Labels? Insights from the EU and USA.

The global strategy to reduce the harmful use of alcohol launched in 2010 by the World Health Organization includes, amongst several areas of recommended actions, providing consumer information about, and labelling, alcoholic beverages to indicate alcohol-related harm. Labelling requirements worldwide for alcoholic drinks are currently quite diverse and somewhat limited compared to labelling on food products and on tobacco. In this context, the current paper contributes to the academic and political debate on the inclusion of nutritional and health information on wine labelling, providing some insights into consumer interest in, and preferences for, such information in four core wine-producing and -consuming countries: Italy, France, Spain, and the United States of America. A rating-based conjoint analysis was performed in order to ascertain consumer preferences for different formats of additional information on wine labels, and a segmentation of the sample was performed to determine the existence of homogeneous groups of consumers in relation to the degrees of usefulness attached to the nutritional and health information on wine labels. Our results highlight the interest expressed by European and United States consumers for introducing nutrition and health information on wine labels. However, the results of conjoint analysis show some significant differences among stated preferences of the information delivery modes in different countries. In addition, segmentation analysis reveal the existence of significant differences between consumer groups with respect to their interest in receiving additional information on wine labels. These differences are not only linked to the geographic origin of the consumers, or to socio-demographic variables, but are also related to wine consumption habits, attitudes towards nutritional information, and the degree of involvement with wine. This heterogeneity of consumer preferences indicates a need for a careful consideration of wine labelling regulations and merits further investigation in order to identify labelling guidelines in terms of the message content and presentation method to be used.

A Screening Tool for Assessing Alcohol Use Risk among Medically Vulnerable Youth.

BACKGROUND: In an effort to reduce barriers to screening for alcohol use in pediatric primary care, the National Institute on Alcoholism and Alcohol Abuse (NIAAA) developed a two-question Youth Alcohol Screening Tool derived from population-based survey data. It is unknown whether this screening tool, designed for use with general populations, accurately identifies risk among youth with chronic medical conditions (YCMC). This growing population, which comprises nearly one in four youth in the US, faces a unique constellation of drinking-related risks. METHOD: To validate the NIAAA Youth Alcohol Screening Tool in a population of YCMC, we performed a cross-sectional validation study with a sample of 388 youth ages 9-18 years presenting for routine subspecialty care at a large children's hospital for type 1 diabetes, persistent asthma, cystic fibrosis, inflammatory bowel disease, or juvenile idiopathic arthritis. Participants self-administered the NIAAA Youth Alcohol Screening Tool and the Diagnostic Interview Schedule for Children as a criterion standard measure of alcohol use disorders (AUD). Receiver operating curve analysis was used to determine cut points for identifying youth at moderate and highest risk for an AUD. RESULTS: Nearly one third of participants (n = 118; 30.4%) reported alcohol use in the past year; 86.4% (106) of past year drinkers did not endorse any AUD criteria, 6.8% (n = 8) of drinkers endorsed a single criterion, and 6.8% of drinkers met criteria for an AUD. Using the NIAAA tool, optimal cut points found to identify youth at moderate and highest risk for an AUD were ≥ 6 and ≥12 drinking days in the past year, respectively. CONCLUSIONS: The NIAAA Youth Alcohol Screening Tool is highly efficient for detecting alcohol use and discriminating disordered use among YCMC. This brief screen appears feasible for use in specialty care to ascertain alcohol-related risk that may impact adversely on health status and disease management.

Is cannabis use associated with an increased risk of onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States.

BACKGROUND: The relationship between cannabis use and alcohol use disorders (AUDs) over time remains unclear. The current study used longitudinal data from adults in the United States (U.S.) to investigate the association between cannabis use and risk of onset and persistence of AUDs three years later. METHODS: The study used data from respondents who completed both waves of the National Epidemiological Study of Alcohol Use and Related Disorders (NESARC; Wave 1, 2001-2001; Wave 2, 2004-2005) and for whom the age of first cannabis use preceded the age of any AUD. Incident AUDs were examined among respondents with no lifetime AUD diagnosis at Wave 1 (n=27,461). Persistent AUDs were examined among respondents with a lifetime AUD diagnosis at Wave 1 (n=2,121). RESULTS: Among adults with no history of AUD, cannabis use at Wave 1 was associated with increased incidence of an AUD three years later relative to no cannabis use (Odds Ratio (OR)=5.43; 95% Confidence Interval (CI)=4.54-6.49). Among adults with a history of AUD, cannabis use at Wave 1 was associated with increased likelihood of AUD persistence three years later relative to no cannabis use (OR=1.74; 95% CI=1.56-1.95). These relationships remained significant after controlling for demographics, psychiatric disorders, and other substance use disorders. CONCLUSIONS: Cannabis use is associated with increased risk of AUD onset and persistence over the course of three years among U.S. adults. Community-based and clinical programs aimed at preventing or treating problematic alcohol use may benefit from integrating information about cannabis use in order to improve outcomes.

Alcohol and Other Addictive Disorders Following Bariatric Surgery: Prevalence, Risk Factors and Possible Etiologies.

Bariatric surgery is currently the most effective intervention for significant and sustained weight loss in obese individuals. While patients often realize numerous improvements in obesity-related comorbidities and health-related quality of life, a small minority of patients have less optimal outcomes following bariatric surgery. The literature on the emergence of alcohol use disorders (AUDs) following bariatric surgery has grown in the past several years and collectively provides convincing evidence that a significant minority of patients develop new-onset AUDs following bariatric surgery. Rouxen-Y gastric bypass (RYGB) has generally been associated with the risk of developing an AUD, while laparoscopic adjustable gastric banding generally has not, in several large studies. One theory that has been discussed at some length is the idea of 'addiction transfer' wherein patients substitute one 'addiction' (food) for a new 'addiction' (alcohol) following surgery. Animal work suggests a neurobiological basis for increased alcohol reward following RYGB. In addition, several pharmacokinetic studies have shown rapid and dramatically increased peak alcohol concentrations following RYGB. The prevalence of alcohol and other addictive disorders and potential etiological contributors to post-operative AUDs will be explored.

Caring for Opioid-dependent Pregnant Women: Prenatal and Postpartum Care Considerations.

Pregnancy is an opportune time to identify opioid dependence, facilitate conversion to opioid maintenance treatment, and coordinate care with specialists in addiction medicine, behavioral health, and social services. Comprehensive prenatal care for opioid-dependent women involves the evaluation and the management of co-occurring psychiatric disorders, polysubstance use, infectious diseases, social stressors, and counseling regarding the importance of breastfeeding, contraception, and neonatal abstinence syndrome. Although the complex psychiatric, social, and environmental factors faced by this population pose significant challenges to obstetric care providers, the development of strong patient-provider relationships can facilitate the ability to deliver efficient and effective health care during pregnancy.

Familial factors associated with development of alcohol and mental health comorbidity.

BACKGROUND AND AIMS: Co-occurring mental health and alcohol problems appear to be associated with greater health burdens than either single disorder. This study compares familial and individual contributions to development of comorbid alcohol/mental problems and tests whether these differ from single disorders. DESIGN: Women (n = 6703) were recruited during pregnancy to the longitudinal Mater-University of Queensland Study of Pregnancy (MUSP). Mother/offspring dyads were followed over 21 years. SETTING: Mater-Misericordiae Public Hospital, Brisbane, Australia. PARTICIPANTS: Primary offspring from the MUSP with full psychiatric information at 21 years and maternal information at age 14 (n = 1755). MEASUREMENTS: Structured interviews at age 21 yielded a four-category outcome using mental health and alcohol modules of the Composite International Diagnostic Interview (no disorder, alcohol only, mental health only and comorbid alcohol/mental health). Multinomial logistic regression models were adjusted for gender, maternal mental health and substance use, family environment and adolescent behaviour. FINDINGS: Maternal smoking [odds ratio (OR) = 1.56; 95% confidence interval (CI) = 1.09-2.22 versus no-disorder] and low mother-offspring warmth (OR = 3.19; 95% CI = 1.99-5.13) were associated with mental health/alcohol comorbidity in young adults, as were adolescent drinking (OR = 2.22; 95% CI = 1.25-3.96), smoking (OR = 2.24; 95% CI = 1.33-3.77) and attention/thought problems (OR = 2.04; 95% CI = 1.18-3.52). Some differences were seen from single disorders. In a subsample with paternal data, fathers' drinking problems (OR = 2.41; 95% CI = 1.10-5.29) were more associated strongly with offspring mental health/alcohol comorbidity than both single disorders (P < 0.05). CONCLUSIONS: Maternal smoking and low mother-child warmth appear to be related to alcohol, mental health and comorbid disorders at age 21, possibly via constituent alcohol and mental health disorders. Adolescent drinking and attention/thought problems appear to be associated with comorbid disorders but not with individual alcohol and mental health disorders.

The roles of acceptance and catastrophizing in rehabilitation following anterior cruciate ligament reconstruction.

OBJECTIVES: The purpose of this study was to determine if pain catastrophizing and experiential acceptance predicted depression, pain intensity, and maladaptive behaviour following anterior cruciate ligament reconstruction. DESIGN: Patients who had undergone anterior cruciate ligament surgery completed assessment within 2 weeks of surgery (N=44) and again 6 months post-surgery (N=26). METHODS: Predictor measures were the Pain Catastrophizing Scale and the Acceptance and Action Questionnaire. Outcome measures included the depression scale of the Depression Anxiety and Stress Scale, numerical rating scale of pain intensity, and the alcohol and substance misuse subscale of the Brief Coping Orientations to the Problem Experience inventory. Demographic variables and athletic identity were also measured. RESULTS: Higher pain catastrophizing scores were associated with greater pain intensity and depressive symptoms in the 2-week post-operative period. Lower acceptance scores in the 2-week post-operative period were predictive of more severe depression scores at 6 months, even after controlling for early post-operative depression and athletic identity. Lower acceptance was also associated with greater use of alcohol and other substances, reportedly to cope with the stress of being injured. CONCLUSIONS: This study highlights the importance of acceptance in an athletic population undergoing rehabilitation after ACL reconstruction.