A pilot study of brief heart rate variability biofeedback to reduce craving in young adult men receiving inpatient treatment for substance use disorders.

The present pilot study investigated the implementation feasibility, and efficacy for reducing alcohol and drug craving, of a brief, 3-session heart rate variability biofeedback (HRV BFB) intervention added to a traditional 28-day substance abuse disorder inpatient treatment program. Forty-eight young adult men received either treatment as usual (TAU) plus three sessions of HRV BFB training over 3 weeks, or TAU only. Participants receiving HRV BFB training were instructed to practice daily using a hand-held HRV BFB device. HRV BFB training was well tolerated by participants and supported by treatment staff. Men receiving TAU + HRV BFB demonstrated a greater, medium effect size reduction in alcohol and drug craving compared to those receiving TAU only, although this difference did not reach statistical significance. In addition, an interaction effect was observed in analyses that accounted for baseline craving levels, wherein heart rate variability (HRV) levels at treatment entry were predictive of changes in craving in the TAU group only. Low baseline levels of HRV were associated with increases in craving, whereas higher baseline HRV levels were associated with greater decreases in craving from start to end of treatment. In the TAU + HRV BFB group, however, there was no such association. That is, HRV BFB appeared to dissociate individual differences in baseline HRV levels from changes in craving. Given that alcohol and drug craving often precipitates relapse, HRV BFB merits further study as an adjunct treatment to ameliorate craving experienced by persons with substance use disorders.

Human monocytic cells direct the robust release of CXCL10 by bronchial epithelial cells during rhinovirus infection.

BACKGROUND: Human rhinovirus (HRV) infections are a major cause of exacerbations in chronic respiratory conditions such as asthma and chronic obstructive pulmonary disease, but HRV-induced immune responses of the lower airway are poorly understood. Earlier work examining cytokine release following HRV infection has focused on epithelial cells because they serve as the principal site of viral replication, and internalization and replication of viral RNA appear necessary for epithelial cell mediator release. However, during HRV infection, only a small proportion of epithelial cells become infected. As HRV-induced cytokine levels in vivo are markedly elevated, this observation suggests that other mechanisms independent of direct viral infection may induce epithelial cell cytokine release. OBJECTIVE: Our aim was to test for the importance of interactions between human bronchial epithelial cells (HBECs) and monocytic cells in the control of mediator release during HRV exposure. METHODS: In vitro models of HRV serotype-16 (HRV16) infection of primary HBECs and human monocytic cells, in mono or co-culture, were used. We assessed HRV16-induced CXCL10 and CCL2 protein release via ELISA. RESULTS: Co-culture of human monocytic and bronchial epithelial cells promoted a synergistic augmentation of CXCL10 and CCL2 protein release following HRV16 challenge. Transfer of conditioned media from HRV16-treated monocytic cells to epithelial cultures induced a robust release of CXCL10 by the epithelial cells. This effect was greatly attenuated by type I IFN receptor blocking antibodies, and could be recapitulated by IFN-alpha addition. CONCLUSIONS: Our data indicate that epithelial CXCL10 release during HRV infection is augmented by a monocytic cell-dependent mechanism involving type I IFN(s). Our findings support a key role for monocytic cells in the amplification of epithelial cell chemokine production during HRV infection, and help to explain how an inflammatory milieu is created in the lower airways even in the absence of extensive viral replication and epithelial infection.

The selective effects of alcohol on automatic and effortful memory processes.

Automatic and effortful memory processes were evaluated in a 2-session, within-subjects design involving an alcohol challenge and a no-alcohol condition. Free recall of a 90-word list measured effortful processing. Estimation of word frequency from the same list measured automatic processing. Acute intoxication was hypothesized to diminish effortful but not automatic memory processes. Healthy, male volunteers (n = 36) completed the 2 conditions 1 week apart. Presentation frequency influenced both free recall and frequency estimation, with both measures increasing as presentation frequency increased. Free recall was significantly lower in the alcohol than in the no-alcohol condition, but frequency estimation was not differentially affected. The data showed that an alcohol challenge dissociated automatic and effortful memory processes in volunteers. The authors discuss potential neurobiological substrates that may account for alcohol's selective disruption of effortful, verbal, episodic memory processing.

Cessation from cocaine use.

This study explores factors that are related to cessation of cocaine use versus continued use in a non-clinical sample of American adolescents and young adults interviewed at three points in time. At time 3, cocaine stoppers (n = 104) and current users (n = 267) are compared in terms of age and sex, patterns of contemporary and prior drug use, life-style characteristics and a selected group of social learning variables. The data indicate that cocaine stoppers and users have similar patterns of alcohol, marijuana, cigarette, cocaine and other drug use at time 1 and time 2, but that users have higher time 3 frequencies of alcohol, marijuana and other drug use. In addition, those youth who stop are more likely to be married and have children, although the groups do not differ in terms of career/school status. The data lend partial support to a social learning perspective and indicate that differential associations (friends' use) and punishments (negative consequences) are most strongly related to cessation. In addition, users report more dependency symptoms than do stoppers.

Cognitive functioning in young "social drinkers": is there impairment to detect?

Literature on the cognitive effects of nonexcessive alcohol use suggests that relatively high-quantity-per-occasion use may be related to subsequent decreases in sober-state abstracting skills in adults, but provides no clear prediction for youth. The need to identify persistent alcohol-intake effects on cognition is particularly acute for the period of adolescence and young adulthood because even slight damage may impair developmentally significant skills. We examine the relation between multiple measures of neuropsychological status and both continuous and categorical measures of alcohol-use patterns in an age- and sex-stratified sample of 1,308 18-, 21-, and 24-year-olds. The results of correlational and hierarchial regression analyses suggest that cognitive performance bears little direct relation to drinking behaviors in young nonclinical males and females. Although the data provide no strong support for the hypothesis of a causal relationship between alcohol use and cognitive functioning, there is a slight suggestion that frequent high-quantity consumption may become a salient parameter of use as subjects age. Prospective longitudinal data are needed to explore the directional causality of effects.

Adolescence-limited versus persistent delinquency: extending Moffitt's hypothesis into adulthood.

The authors examined how neuropsychological, personality, and environmental risk factors and their interactions were related to trajectories of delinquent behavior from adolescence to adulthood. Four waves of longitudinal data from 698 male participants, ages 12-18 at Time 1 and ages 25-31 at Time 4, were included in the analyses. Using a growth mixture model approach, 4 trajectories were identified: nondelinquents, adolescence-limited delinquents, adolescence-to-adulthood-persistent delinquents, and escalating delinquents. Five risk factors distinguished escalating from persistent delinquents and 5 also distinguished nondelinquents from the 3 delinquency trajectories. Persistent delinquents scored significantly higher than adolescence-limited delinquents on only one risk factor, disinhibition. Overall, few of the factors that are related to childhood-to-adolescence persistence were associated with persistence in delinquency beyond adolescence.

Early childhood feeding practices in northern Cameroon.

Following the identification of differences in disease patterns among infants from households of different social groups (Moslem and non-Moslem) in northern Cameroon, 534 mothers and their children 0-23 months old were studied to determine early childhood feeding practices in the 2 groups. Several significant differences were revealed. Compared with non-Moslem infants, Moslems were more likely to be given animal milk instead of breast milk before the age of 3 d. On average, millet pap was introduced to Moslem babies between their 1st and 2nd months and to non-Moslem babies between their 3rd and 4th months. Moslem mothers more commonly prepared pap with oil or cow butter as an ingredient. Moslem mothers also planned to wean their children at an earlier age than non-Moslems and were less likely to report boiling their children's drinking water. Moslem mothers of infants less than 5 months old were likely to believe their breast milk was insufficient. The implications of these findings on the higher incidence of infant diarrhoea, stunting and early childhood death among Moslems are discussed.

Infant disease patterns in northern Cameroon.

The epidemiology of common diseases of infants seen in district health service clinics in a culturally heterogeneous population in northern Cameroon was studied. Significantly higher incidences were found for respiratory tract infection in infants of non-Moslem households, and for diarrhoea in infants of Moslem households. A subsequent interview survey of parents of children aged 0-5 years revealed a higher prevalence of smokers and millet stalk kitchens in the compounds of non-Moslems. Other possible risk factors were explored. The findings indicated that in this area the influence of culture on disease in infants is strong, and epidemiological differences among cultural groups should be considered in the design of disease control programmes in the community.

The effect of repeated occasions of alcohol intoxication on two processes involved in the visual discrimination of movement.

The focus of this study was the effect of repeated episodes of alcohol intoxication on two processes involved in visual movement discrimination: visual sensitivity and decision-making. Four female subjects were asked to discriminate between a stationary light signal and one that changed position in the center of a dark visual field. Prior to each of 15 alcohol testing sessions, a dose of .66 ml of 95% USP ethanol per kg body weight was administered to each subject and BAL was sampled frequently within sessions. Differences in subjects' pre- and postalcohol performance were evaluated within the framework of a psychophysical model that mathematically characterizes the problem of movement discrimination and yields independent estimates of visual sensitivity and decisional aspects of subjects' performance. Evidence for specificity in the development of sensory versus decisional process tolerance to intoxication effects was found. The major result was that each subject made large and statistically reliable shifts in decisional criteria during the time course of the blood alcohol curve within alcohol testing sessions, even when visual sensitivity had adapted to alcohol intake effects. The results of this study illustrate the utility of tracing acute intake effects over repeated occasions of intoxication, and empirically testing subjects' assumed decisional strategies when modeling these effects.

Stability of neuropsychological assessments early in alcoholism treatment.

OBJECTIVE: Current trends in managed mental health care have telescoped the assessment and treatment of individuals diagnosed with an alcohol or other drug use disorder. Yet, there is limited empirical information about the short-term stability of neuropsychological status and other person characteristics that are useful to assess early in treatment. This study examined the stability of neuropsychological test scores within the first 3 weeks following diagnosis of an alcohol use disorder. METHOD: An eclectic neuropsychological battery made up of commonly used, sensitive tests of abstraction, executive functions, memory, visuospatial abilities and verbal ability was administered to female and male alcohol use disordered individuals within 3 days of treatment entry (or following detoxification), 3-5 days later and 21 days later. The three test administrations were completed by 35, 32 and 24 subjects, respectively. RESULTS: Across tests, the average stability coefficient (Pearson correlation) was .82 between Days 3 and 5, .86 between Days 5 and 21, and .79 between Days 3 and 21. Intraclass correlations ranged from .79 to .98 across tests (mean = .92). Clinical stability, defined as the likelihood that a test score fell consistently above or below a standardized impairement cutoff score, was also good. Across tests, percent agreement in impairment diagnoses for the same three time intervals averaged 84%, 92% and 87%, respectively. The chance-corrected kappa (Kappa) coefficients of diagnostic agreement were generally moderate to substantial from Day 3 to Days 5 or 21, and mostly substantial from Day 5 to 21. CONCLUSIONS: Early assessments of neuropsychological status were psychometrically stable, and also provided reasonably stable indicants of clinically significant impairment. It was likely that the data provided lower bound estimates of the stability of impairment classifications due to the repeated measures design and power limitations.

Familial alcoholism and premorbid cognitive deficit: a failure to replicate subtype differences.

Recent evidence suggests that offspring of alcoholics are heterogeneous in many areas of functioning. This study focuses on extending our understanding of the vulnerability and resilience of young adults with a positive family history of alcoholism (FH+) within the domain of neurocognitive functioning. Specifically, we test the hypothesis that cognitive vulnerability is linked to genetic pedigree by systematically examining a broad range of cognitive abilities in several distinct family history subtypes represented by alcoholism on the part of a first-degree relative only, a second-degree relative only, or both a first- and second-degree relative. Compared to an age-matched control group with no family history of alcoholism (FH-), FH+ subjects, on the average, reported somewhat less formal education than did FH- subjects. However, no substantive differences in cognitive functioning were obtained among any family history subtypes. Nor were any predicted yet nonsignificant trends in the ordering of mean cognitive performance levels observed across groups. These results strongly suggest that cognitive deficits do not generally obtain in community samples of premorbid FH+ subjects, and, further, that specific genetic pedigrees, as defined in this study, do not contribute to variability in neuropsychological functioning. A typological approach wherein subtypes of FH+ individuals are defined multidimensionally may be necessary to capture sources of neurocognitive vulnerability in premorbid offspring.

Immediate, quantitative estimation of blood alcohol concentration from saliva.

OBJECTIVE: Reliable, valid, and noninvasive methods to quantitatively estimate blood alcohol concentration (BAC) are important in forensic, work place, medical and research settings. To date, noninvasive methods for quantitatively estimating BAC have primarily used breath testing. This study evaluated a new device for estimating BAC via saliva that is unique in providing on-the-spot, quantitative results in 2 minutes. The Q.E.D-A150 test (STC Technologies, Inc., Bethlehem, Pa.) is based on the enzymatic oxidation of alcohol by alcohol dehydrogenase. Saliva alcohol concentration (SAC) is read directly from the test device. METHOD: In each of three sessions, 24 male and 15 female social drinkers, aged 21-28 years, provided yoked breath and saliva samples prior to, and at five times following, a dose of 1.0 g (men) or 0.9 g (women) alcohol per kg lean body mass. RESULTS: Intertest reliability, determined by two simultaneous saliva samples, was very high for each measurement time (r's = .97 to .99), for each subject (4's = .95 to .99) and across all observations (r = .98). The coefficient of variation was below 5% in 97% of paired observations. The correlation between breath and saliva estimates was .94 across all observations and ranged from .92 to .98 across measurement times. The difference between breath and saliva estimates was significantly larger on the ascending limb than on the descending limb of the blood alcohol curve at comparable BACs. On the average, SAC estimates were 6 mg/dl higher than breath during ascending BACs and 3 mg/dl higher than breath during descending BACs. Individual differences in the ratio of SAC to breath measures of BAC ranged from 0.99 to 1.15 (average = 1.06). Test performance was not affected by gender, drinking pattern or cigarette smoker status. CONCLUSIONS: The Q.E.D.-A150 device had good reliability and validity for the noninvasive, quantitative estimation of BACs.

Models of functional organization as a method for detecting cognitive deficits: data from a sample of social drinkers.

Literature on the cognitive deficits associated with social drinkers' chronic use of alcohol at moderate to heavy levels is equivocal. As an alternative to detecting impairment through measures of mean performance levels, the functional organization of cognitive skills in infrequent and heavy alcohol users was compared. Subjects (N = 364) were adolescent and young adult participants in a longitudinal study of health status and psychoactive substance use. LISREL was used to identify group invariance in the number and nature of cognitive components underlying performance. Results showed that a model with three cognitive components (general intelligence/abstraction, spatial relations/visual-motor speed, and immediate memory) best represented performance in both infrequent use and heavy use groups. There were some group differences in the role of unspecified processing components, but no clear evidence for alcohol-related shifts in functional organization was found. The hypothesis of cognitive compensation, which highlights methodological problems in deficit-detection research, is evaluated with respect to the potential value of using changes in functional organization, that is, the latent structure of performance, to uncover the neurotoxic effects of alcohol or other drug use. More definitive tests of the compensation hypothesis will require prospective, within-subject comparisons of functional organization in clinical as well as nonclinical samples.

Effects of executive function impairment on change processes and substance use outcomes in 12-step treatment.

OBJECTIVE: A strong clinical rationale exists to hypothesize that neuropsychological impairment interferes with treatment-initiated change, thereby leading to poor outcome. This study examined the relationship of executive function impairment, change process factors and substance use outcomes in a sample of substance users in intensive 12-step treatment. METHOD: Participants were 118 individuals entering residential or intensive day treatment at two traditional treatment programs. Participants were assessed at entry into treatment, at discharge from treatment, and at 1 and 6 months following treatment. Participants were administered a battery of measures to assess executive function impairment, processes hypothesized to mediate change in 12-step treatment, negative prognostic indicators and substance use outcomes. RESULTS: More than half the sample showed some form of executive function impairment. Executive function impairment did not directly predict worse substance use outcomes nor difficulty acquiring or maintaining change processes. However, impairment significantly moderated the relationship between change processes and outcome. Change processes were strongly related to outcome for unimpaired individuals but weakly related for impaired individuals. CONCLUSIONS: Executive function impairment is not a significant predictor of poor treatment response in 12-step treatment. However, analyses suggest that impaired and unimpaired individuals traverse different pathways in achieving equivalent outcomes.

Age of first use: its reliability and predictive utility.

OBJECTIVE: The purpose of this study was: (1) to assess the utility of age of first licit use and age of first illicit use as predictors of alcohol and drug use at ages 20 and 30; and (2) to examine the reliability of retrospectively recalled ages of onset of use. METHOD: Subjects (N = 839) from the Rutgers Health and Human Development Project provided four waves of longitudinal data spanning the age range from 15 to 31. RESULTS: Retrospective recall of age of onset revealed a fair degree of relative agreement but a lack of absolute agreement because of an upward shift in recalled ages as individuals became older. Repeated measures ANOVAS revealed normative declines in alcohol and drug use from 20 to 30 even though individual differences in use remained quite stable across time. Regression analyses indicated that: (1) age of first licit use as recalled at age 18 did not predict alcohol or drug use at age 20; (2) age of first illicit use was a weak predictor of alcohol use at 20 but a fairly strong predictor of drug use at 20; and (3) neither age predicted use or use consequences at age 30. CONCLUSIONS: In the general population, illicit drug use and heavier alcohol use are, regardless of age of onset, adolescence-limited phenomena for most individuals. Findings suggest that intervention efforts need to be aimed simultaneously at delaying the onset of illicit use and reducing use levels among young adult users.

The correspondence between saliva and breath estimates of blood alcohol concentration: advantages and limitations of the saliva method.

Increased awareness of the devastating effects of alcohol misuse on our highways, workplaces and families, as well as on the individual, has resulted in increased social pressure to enforce driving-while-intoxicated laws and to develop educational, prevention and treatment programs. One aspect of this movement is to develop improved sobriety testing to ensure that laws are properly and fairly enforced and that there is compliance with abstinence in treatment. Although sophisticated blood and breath testing devices are available, field tests suggest that saliva alcohol tests based on alcohol-oxidase methodology offer advantages in portability, ease of administration, and cost and time efficiency. We evaluated the validity and reliability of a simple saliva test, based on the enzymatic oxidation of alcohol by alcohol oxidase, for estimating blood alcohol concentration. Ten subjects consumed various doses of alcohol and multiple saliva samples were obtained using alcohol sensitive saliva strips that change color in proportion to the concentration of alcohol. The reflectance values of reacted saliva strips were read by meter and estimates of blood alcohol concentration in the range of 10-90 mg/dl were compared to simultaneous estimates obtained from breath analysis using a Breathalyzer Model 900A. We also examined how alcohol levels changed over time in alcohol reacted saliva strips. The results of regression analysis indicated that the saliva strips and the Breathalyzer gave reasonably close estimates (r = 0.89-.90) of blood alcohol concentration. Correlation coefficents for the values of saliva samples read by meter measured at 10 minutes and at 18 days after collection ranged from .90 to 1.00, showing high test-retest reliability despite storage.(ABSTRACT TRUNCATED AT 250 WORDS)

Utility of component-process approaches for understanding complex alcohol-related behavior within an executive functioning framework: comment on Giancola (2000).

P. R. Giancola's (2000) macroconstruct framework of executive functions (EF) characterizes how cognitive processes work together to inhibit aggressive responding in provocative situations, and how alcohol intoxication increases the likelihood of aggression by disrupting these processes. His framework can be considered within contemporary controversies in cognitive neuroscience research: how interrelated EF operate, which brain areas are involved in cognitive control, the specificity of EF impairment to different behaviors, and how to operationalize EF to examine different questions. Giancola highlighted the use of one broad, multidimensional, EF construct for predicting aggressive behavior. His macroconstruct framework can also be used to examine component information-processing operations. Component-process approaches may facilitate integrative research at multiple levels and add to the specificity of EF impairment-aggression linkages.

Recent developments in alcoholism:psychology.

During the past decade, the concerns of psychological research within alcohol studies have been far ranging and even within the areas of personality and neurocognition, the literature is voluminous and many faceted. This chapter focuses on aspects of the personality system that appear to increase vulnerability to excessive alcohol or other drug use or the experience of use-related problems as well as issues related to temporal stability and change in intrapersonal development and drinking behaviors. The bulk of the neurocognitive literature reviewed deals with the impairments that accrue as a direct or indirect consequence of excessive alcohol consumption. While the individual empirical studies are often, by necessity, narrow in focus, the import of intrapersonal sources of vulnerability and the processes and mechanisms through which these may drive and moderate alcohol and other drug use behaviors and outcomes will be more fully understood within the context of conceptual models and research approaches that are complex, multilevel, and integrative.

Carbon dioxide exchange of lettuce plants under hypobaric conditions.

Growth of plants in a Controlled Ecological Life Support System (CELSS) may involve the use of hypobaric pressures enabling lower mass requirements for atmospheres and possible enhancement of crop productivity. A controlled environment plant growth chamber with hypobaric capability designed and built at Ames Research Center was used to determine if reduced pressures influence the rates of photosynthesis (Ps) and dark respiration (DR) of hydroponically grown lettuce plants. The chamber, referred to as a plant volatiles chamber (PVC), has a growing area of about 0.2 m2, a total gas volume of about 0.7 m3, and a leak rate at 50 kPa of <0.1%/day. When the pressure in the chamber was reduced from ambient to 51 kPa, the rate of net Ps increased by 25% and the rate of DR decreased by 40%. The rate of Ps increased linearly with decreasing pressure. There was a greater effect of reduced pressure at 41 Pa CO2 than at 81 Pa CO2. This is consistent with reports showing greater inhibition of photorespiration (Pr) in reduced O2 at low CO2 concentrations. When the partial pressure of O2 was held constant but the total pressure was varied between 51 and 101 kPa, the rate of CO2 uptake was nearly constant, suggesting that low pressure enhancement of Ps may be mainly attributable to lowered partial pressure of O2 and the accompanying reduction in Pr. The effects of lowered partial pressure of O2 on Ps and DR could result in substantial increases in the rates of biomass production, enabling rapid throughput of crops or allowing flexibility in the use of mass and energy resources for a CELSS.

Carbon dioxide exchange of lettuce plants under hypobaric conditions.

Growth of plants in a Controlled Ecological Life Support System (CELSS) may involve the use of hypobaric pressures enabling lower mass requirements for atmospheres and possible enhancement of crop productivity. A controlled environment plant growth chamber with hypobaric capability designed and built at Ames Research Center was used to determine if reduced pressures influence the rates of photosynthesis (Ps) and dark respiration (DR) of hydroponically grown lettuce plants. The chamber, referred to as a plant volatiles chamber (PVC), has a growing area of about 0.2 m2, a total gas volume of about 0.7 m3, and a leak rate at 50 kPa of <0.1%/day. When the pressure in the chamber was reduced from ambient to 51 kPa, the rate of net Ps increased by 25% and the rate of DR decreased by 40%. The rate of Ps increased linearly with decreasing pressure. There was a greater effect of reduced pressure at 41 Pa CO2 than at 81 Pa CO2. This is consistent with reports showing greater inhibition of photorespiration (Pr) in reduced O2 at low CO2 concentrations. When the partial pressure of O2 was held constant but the total pressure was varied between 51 and 101 kPa, the rate of CO2 uptake was nearly constant, suggesting that low pressure enhancement of Ps may be mainly attributable to lowered partial pressure of O2 and the accompanying reduction in Pr. The effects of lowered partial pressure of O2 on Ps and DR could result in substantial increases in the rates of biomass production, enabling rapid throughput of crops or allowing flexibility in the use of mass and energy resources for a CELSS.