Substance use disorder risk assessment: positive emotional experiences with first time use and substance use disorder risk.

Introduction: Substance Use Disorder (SUD) screening tools used in current practice are designed to identify SUD once patients have begun regular dangerous drug use. While these screening tools are valuable, prevention and avoidance of SUD would save countless lives. The climbing number of deaths due to drug overdose make screening for and prevention of SUD imperative. This study addresses this care gap. The aim was to develop a simple screening tool for patients who may be prone to develop Alcohol Use Disorder (AUD) and/or SUD prior to addiction. It was hypothesized that participants with initially positive emotional experiences would be correlated with a future SUD diagnosis. Methods: The study involved a self-administered survey using a cross-sectional design and was carried out over one-month in the spring of 2021. Those patients who presented to the MAT clinic (SUD group) were seen in a separate area than the patients presenting for urgent care (Comparison group). Participants (N = 259) were voluntarily recruited from MAT and Urgent care: Patients receiving acute care were assigned to the Comparison (N = 126, 50.8% female, 5.7% non-white, 27.2% age < 34) and those receiving treatment for SUD were assigned to the MAT group (N =133, 40.8% female, 4.8% non-white, 36.8% ≤34). The survey questioned demographics (4 items), risk factors for AUD/SUD (6 items), information about first alcohol/opioid experiences (16 items), and factors for seeking AUD/SUD treatment and recovery (2 items). Feelings were categorized as positive (e.g., euphoria, happiness, self-confident), neutral (e.g., nothing, normal), or negative (e.g., depressed, sad, sick). Results: The MAT group felt more positive feelings with first usage of alcohol and opioids compared to the comparison group (p<.001). With first usage of opioids specifically, MAT (0.13 ± 0.04) and comparison (0.29 ± 0.07) groups differed (p <.001). Over half (55.3%), of the MAT participants reported feeling self-confident with first use of alcohol while only 29.7% of the comparison reported this (p<.001). Over three-fifths (63.7%) of the MAT group reported feeling of euphoria with the first usage of opioids compared to one-tenth (9.8%) in the comparison group (p<.001). Discussion: This retrospective cross-sectional report shows the first affective responses to substances may predict risk for future SUD and could be a prevention screening tool. Asking patients about positive feelings with first usage of alcohol/opioids could be a simple screening tool employed for prevention.

"I drink less and that's no small matter": a qualitative descriptive study of a managed alcohol program evaluation in Barcelona.

Background: The concurrence of homelessness and alcohol use disorder (AUD) has negative consequences in affected individuals. Managed alcohol programs (MAPs), a harm reduction strategy based on providing regular doses of alcohol to individuals with AUD, have emerged as a potential solution to reduce alcohol-related harms.Objectives: This study examined the impact of a MAP implemented in Barcelona on patterns of alcohol and other psychoactive substance use, health, and quality of life among people who use drugs and were experiencing homelessness. The research also incorporated a gender perspective and focused on individuals who had accessed a residential center.Methods: A descriptive qualitative design was used, employing semi-structured interviews with eight participants who were enrolled in the MAP (three women, five men) and four program professionals. Thematic analysis was used to analyze the resulting data.Results: The domains guiding the study appeared as outcome themes: patterns of use of alcohol and other substances, health, quality of life and impact on female-identified participants. Participants reported improved health due to reduced consumption of alcohol and other substances, better anxiety management, and reconnection to health services. The participants reported enhanced quality of life, including feeling safer, and better use of time, which had been spent on meeting their basic needs. Women reported that a key benefit of the program was living in a sexism-free environment.Conclusion: These results appear to demonstrate that harm reduction strategies prioritizing basic needs and adopting a gender-sensitive perspective can positively impact the health and quality of life of people experiencing homelessness with AUD.

Epidemiology and Health Care Burden of Alcohol Use Disorder.

Alcohol use disorder (AUD) is a chronic medical condition that affects over 29.5 million people and accounts for $249 billion in social and health care costs annually. Prevalence is higher among young adults, males, sexual and gender minorities, American Indians and Alaska Natives, and the uninsured. Despite its high prevalence and societal impact, AUD is often overlooked in health care settings. This has resulted in insufficient implementation of AUD screening as well as low levels of treatment uptake. Addressing these challenges requires recognition of the current epidemiology of AUD and role of social determinants of health.

Alcohol-Associated Liver Diseases: Spectrum, Nomenclature, and Definitions.

Alcohol-associated liver disease (AALD) is a global health problem with increasing incidence with associated high morbidity and mortality. Patients with AALD have varied clinical presentation encompassing a spectrum ranging from alcoholic steatosis, alcoholic steatohepatitis to alcohol-associated fibrosis/cirrhosis, which can be either compensated or decompensated. We need uniformity in defining each of the stages of AALD, which will help in both research and patient care. Algorithmic approach using noninvasive tests like enhanced liver fibrosis score, elastography, and fibrosis-4 scores can help in early diagnosis in addition to the presence of any red flags (low albumin, low platelet count, and raised transaminases).

Diagnosis of Alcohol Use Disorder and Alcohol-Associated Liver Disease.

Harmful alcohol use and alcohol use disorder (AUD) are common worldwide, and rates of alcohol-associated liver disease (ALD) are also increasing. AUD is a disease that is treatable and can be diagnosed and managed, and recovery from AUD through abstinence or reductions in drinking is possible. Management of AUD among individuals with ALD is increasingly being addressed via integrated medical and psychosocial treatment teams that can support reductions in drinking and prevent progression of liver disease. Early diagnosis of AUD and ALD can improve lives and reduce mortality.

Integrated Multidisciplinary Care Model to Manage the Dual Pathology of Alcohol Use Disorder and of Liver Disease.

Alcohol-associated liver disease (ALD) is the most common cause of liver disease and an indication for liver transplantation. Identification of ALD at an earlier stage and treatment of concomitant alcohol use disorder (AUD) could potentially prevent or delay the progression to advanced stages of ALD like alcohol-associated cirrhosis and alcohol-associated hepatitis. However, screening for alcohol use is often not performed and treatment of AUD is rarely administered in ALD patients, due to several barriers at the level of patients, clinicians, and administrative levels.

Barriers to Alcohol Use Disorder Treatment in Patients with Alcohol-Associated Liver Disease.

The cornerstone in managing alcohol-associated liver disease is the treatment of alcohol use disorder (AUD). Several barriers prevent the implementation of adequate treatment and integrated care models. There are patient-level barriers, including the lack of self-awareness of AUD and being ashamed of AUD. There are clinician-level barriers, including lack of training and discomfort in managing patients with AUD. There are system-level barriers, including challenges related to insurance-based health care systems, and the general reluctance to invest in AUD by organizations focused on for-profit milestones. Therefore, it is imperative to develop multidisciplinary hepatology/addiction integrated care approaches.

The pharmacological management of alcohol-related cirrhosis: what's new?

INTRODUCTION: Alcohol use disorder (AUD) is present in the majority of patients with alcohol-associated liver disease (ALD), which leads to about 50% of cirrhosis-related hospitalizations and over 25% of deaths worldwide. Patients with ALD often present at an advanced stage, like cirrhosis with its complications and alcohol-associated hepatitis (AH), which has high short-term mortality. Current treatments are limited, with the limited benefit of glucocorticoids only in the short-term among patients with AH, highlighting an urgent need for novel therapies. AREAS COVERED: This review applies the PIRO (Predisposition, Injury, Response, Organ dysfunction) concept to ALD, understanding an ongoing process of liver damage, and opportunities to address and halt the progression. We also highlight the significance of treating AUD to improve long-term outcomes in ALD. EXPERT OPINION: Personalized therapies targeting specific genetic profiles and multiple pathogenic pathways are crucial in managing ALD. Emerging therapies like gut-liver-brain axis modulators like fecal microbiota transplant and probiotics, interleukin-22, granulocyte-colony stimulating factor (G-CSF) and stem cells, epigenetic regulators of inflammation and regeneration are encouraging with the potential of efficacy in patients with ALD. Liver transplantation (LT) is a definitive therapy for advanced cirrhosis with increasing impetus on early LT select patients with active alcohol use.

Assessment of Reduction in Stimulus Generalization of Ethanol-Seeking During Recovery: A Rapid Procedure.

Previously, we developed a procedure which showed that longer histories of reinforced alternative behavior decrease the risk of relapse caused by a range of stimuli which had previously occasioned drinking. The decrease in relapse risk was likely due to a decrease in attention to the stimuli over the course of repeated engagement in the alternative behavior. However, this previous procedure was time consuming and did not mirror the procedure we used to observe changes in relapse risk. This study aimed at replicating the previous relationship between the duration of engaging in an alternative behavior and shift in stimulus generalization for drinking using a procedure that allows longitudinal analysis over time and is consistent with other procedures we have developed. Rats were trained to respond for ethanol in the presence of one stimulus (16kHz tone; food Fixed Ratio (FR)150 and ethanol FR5), and for food in the under another stimulus (8kHz tone; food and ethanol FR5). Then, recovery-like sessions with food predominant responding occurred in the presence of only the low-cost food stimulus. During these sessions, rats were exposed to non-reinforced graded stimuli alternation from 8 to 16kHz alternating with the reinforced low-cost food stimulus. The number of responses on each (food and ethanol) lever before completing 5 responses on either lever was the main measure. Consistent with the earlier procedure, the current procedure showed that graded variation of tone from 8 to 16kHz produced a graded increase in responding for ethanol compared to responding for food. In addition, longer periods of engaging in recovery-like responding shift the generalization function downwards. This procedure confirms the earlier pattern of stimulus generalization over longer periods of behavior consistent with recovery. This strengthens our hypothesis that shifts in attention to alcohol-related stimuli are important to the development of relapse resistance during recovery.

Depressive symptoms, avoidant coping, and alcohol use: differences based on gender and posttraumatic stress disorder in emerging adults.

Trauma exposure and alcohol use often co-occur. Unveiling predictors of drinking behavior, including among those with varying levels of trauma exposure, can inform behavioral health prevention and treatment efforts in at-risk populations. The current study examined associations between depressive symptoms, avoidant coping, gender, and alcohol use among emerging adults with and without trauma exposure and posttraumatic stress disorder (PTSD). Participants were 238 emerging adults between the ages of 21 and 30 years (M = 24.75; SD = 2.61) in one of three groups: trauma-exposed with PTSD (n = 70); trauma-exposed with no PTSD (n = 83); or a no trauma (control) group (n = 85). Demographics, parental alcohol problems, depressive symptoms, and avoidant coping were examined as predictors of drinks per drinking day. Chi-square, t-test, bivariate, and group path analysis were conducted. Among participants, men consumed greater amounts of alcohol than women across all three groups. Group assignment based on trauma history and PTSD significantly moderated the association between avoidant coping and alcohol use such that avoidant coping had a significant effect on alcohol use among participants in the trauma-exposed and PTSD groups. There was also a significant group × gender × avoidant coping interaction such that, among participants in the control group, men had attenuated alcohol use at low levels of avoidant coping and increased at high levels of avoidant coping. No effects of race were observed. Results highlight the importance of avoidant coping as a risk factor for problematic drinking, unveiling a specific intervention target for reducing co-occurring PTSD and problematic alcohol use.

Treatment of Alcohol Use Disorder: Behavioral and Pharmacologic Therapies.

The prevalence of alcohol use disorder (AUD) has significantly increased over the last decade, leading to an increase in alcohol-associated liver disease (ALD) rates worldwide. Despite this prominence, AUD in ALD remains undertreated and carries significant implications in the progression to end-stage ALD and increased mortality. In efforts to bridge this gap, interprofessional and integrated AUD treatment is necessary for patients with ALD to ensure early detection and an appropriately targeted level of care. Although pharmacotherapy, psychotherapy, and psychosocial interventions independently play a role in treating AUD, a combination of these evidence-based modalities often results in lasting change.

Affective dynamics surrounding craving, non-heavy alcohol use and binge drinking in female patients with alcohol use disorder and controls: An experience sampling method study.

BACKGROUND AND AIMS: Studies show that higher levels of positive affect (PA) and lower levels of negative affect (NA) are related to craving and alcohol consumption at a daily level in men, but little is known on these associations at a momentary level, and whether they are present in women. This study measured the dynamics of within-person NA and PA surrounding craving, non-heavy alcohol use and binge drinking in women with alcohol use disorder (AUD) and female controls without AUD. METHODS: 53 female patients with AUD and 75 female controls, all recruited in Belgium, were included in an experience sampling study where they reported on momentary NA, PA, craving and alcohol use in daily life over a period of 12 months. Assessments occurred eight times a day on Thursdays, Fridays and Saturdays in seven bursts of three weeks. RESULTS: Within-person NA at a previous assessment (t-1) predicted craving at the current assessment (t0) in patients with AUD in a positive linear [ß = 0.043; 95% confidence interval (CI) = 0.002, 0.057; P = 0.041] and quadratic fashion (ß = 0.034; CI = 0.011, 0.057; P = 0.004). Within-person PA at t-1 predicted craving at t0 in patients with AUD with a positive quadratic relation (ß = 0.042; CI = 0.08, 0.065; P < 0.001). Within-person NA at t-1 negatively predicted non-heavy alcohol use at t0 in a linear fashion in controls (ß = -0.495; CI = -0.677, -0.312; P < 0.001) and patients with AUD (ß = -0.276; CI = -0.421, -0.132; P < 0.001). Within-person PA at t-1 significantly predicted non-heavy alcohol use at t0 with a positive linear term (ß = 0.470; CI = 0.329, 0.610; P < 0.001) in controls, but with a positive linear term (ß = 0.399; CI = 0.260, 0.454; P < 0.001) and a positive quadratic term (ß = 0.203; CI = 0.060, 0.347; P = 0.003) in patients with AUD. Within-person NA at t-1 predicted binge drinking at t0 in patients with AUD with a significant quadratic term (ß = 0.236; CI = 0.060, 0.412; P = 0.008), but not for controls. Within-person PA at t-1 predicted binge drinking at t0 in patients with AUD with a significant quadratic term (ß = 0.378; CI = 0.215, 0.542; P < 0.001), and this was also the case for controls (ß = 0.487; CI = 0.158, 0.770; P < 0.001). Non-heavy alcohol use at t0 predicted lower levels of NA at t+1 in both patients with AUD (ß = -0.161; SE = 0.044; CI = -0.248, 0.074; P = 0.001) and controls (ß = -0.114; CI = -0.198, -0.029; P = 0.010). Non-heavy alcohol use at t0 also predicted higher levels of PA at t+1 in both patients with AUD (ß = 0.181; CI = 0.088, 0.274; P < 0.001) and controls (ß = 0.189; CI = 0.101, 0.278; P < 0.001). CONCLUSIONS: The momentary relation between affect and craving or alcohol use seems to be non-linear in female patients with alcohol use disorder, whereby a worse mood predicts subsequent alcohol use, though more for binge drinking than for non-heavy alcohol use.

The TMEM132B-GABAA receptor complex controls alcohol actions in the brain.

Alcohol is the most consumed and abused psychoactive drug globally, but the molecular mechanisms driving alcohol action and its associated behaviors in the brain remain enigmatic. Here, we have discovered a transmembrane protein TMEM132B that is a GABAA receptor (GABAAR) auxiliary subunit. Functionally, TMEM132B promotes GABAAR expression at the cell surface, slows receptor deactivation, and enhances the allosteric effects of alcohol on the receptor. In TMEM132B knockout (KO) mice or TMEM132B I499A knockin (KI) mice in which the TMEM132B-GABAAR interaction is specifically abolished, GABAergic transmission is decreased and alcohol-induced potentiation of GABAAR-mediated currents is diminished in hippocampal neurons. Behaviorally, the anxiolytic and sedative/hypnotic effects of alcohol are markedly reduced, and compulsive, binge-like alcohol consumption is significantly increased. Taken together, these data reveal a GABAAR auxiliary subunit, identify the TMEM132B-GABAAR complex as a major alcohol target in the brain, and provide mechanistic insights into alcohol-related behaviors.

Associations of Minority Stressors, Alcohol Use Disorder, Resilience, and HIV Testing Self-Efficacy Among Community-Based Black Men Who Have Sex with Men in a Southern U.S. City: A Causal Mediation and Moderation Analysis.

Background: Black men who have sex with men (BMSM) face multiple minority stressors (e.g., homophobia, racism, and presumed HIV status) that may indirectly erode their confidence in pursuing HIV testing uptake through exacerbating alcohol use disorder (AUD). Objectives: Using cross-sectional data from 203 community-based BMSM (71.4% as homosexual with a mean age of 26 years) living in a Southern US city, we conducted a causal mediation and moderation analysis to investigate in/direct pathways linking minority stressors, AUD risk, and self-efficacy of HIV testing, including how resilience may moderate these associations. Results: Our mediation analysis revealed that AUD risk accounted for 32.1% of the total effect of internalized homonegativity (ßtotal effect = -0.424; SE=0.071; p<0.001), 28.6% of the total effect of experienced homophobia (ßtotal effect = -0.684; SE=0.122; p<0.001), and 15.3% of the total effect of perceived HIV stigma (ßtotal effect = -0.361; SE=0.164; p<0.05) on HIV testing self-efficacy. Resilience significantly moderated the associations of experienced homophobia (ß = -0.049; SE=0.011; p<0.001), internalized homonegativity (ß = -0.065; SE=0.027; p<0.01), and perceived HIV stigma (ß = -0.034; SE=0.013; p<0.05) with AUD risk. Resilience also significantly moderated the associations of experienced homophobia (ß = -0.073; SE=0.021; p<0.01), internalized homonegativity (ß = -0.082; SE=0.012; p<0.001), perceived HIV stigma (ß = -0.037; SE=0.039; p<0.05), and AUD risk (ß = -0.021; SE=0.015; p<0.05) with HIV testing self-efficacy. Conclusions: Our study provides important implications in identifying multilevel sources for building resilience among BMSM to buffer the effects of minority stress on AUD risk and improve HIV testing outcomes.

[Factors influencing hospital readmission rates in alcohol use disorder]. / Einflussfaktoren auf die Rehospitalisierungsrate bei Alkoholabhängigkeit.

BACKGROUND: According to data from the Federal Statistical Office, the diagnosis of alcohol use disorder (AUD) (F 10) is the second most common main diagnosis for hospital treatment. Those affected by this disorder are often repeatedly hospitalized at short intervals due to relapses; however, little is known about the factors that influence readmission rates after initial treatment. AIM OF THE STUDY: The aim of this retrospective analysis is to analyze the effects of treatment type (qualified withdrawal treatment (QE) versus physical detoxification) and discharge mode on the probability of readmission in alcohol-dependent patients after inpatient treatment. MATERIAL AND METHODS: Data from 981 male and female alcohol-dependent patients who completed either qualified withdrawal treatment (QE) (68% men; mean age 47.6 years) or inpatient detoxification (74% men; mean age 48.0 years) were analyzed. Predictors of regular discharge were determined separately for both types of treatment using stepwise logistic regression. RESULTS: Patients who had completed a qualified withdrawal treatment were significantly more likely to be regularly discharged. Regular completion of the qualified withdrawal treatment (QE) led to a relative reduction in the readmission rate of 25.64% within 1 year compared to a physical detoxification. CONCLUSION: In order to prevent readmission and chronic courses of alcohol use disorder (AUD), qualified withdrawal treatment should always be recommended to affected patients instead of physical detoxification. Aktuelle Daten des Statistischen Bundesamtes für das Jahr 2022 zeigen, dass die Diagnose "Psychische und Verhaltensstörungen durch Alkohol (F 10.X)" die zweithäufigste Hauptdiagnose bei Krankenhausbehandlungen darstellt [13]. Im Gesundheitssystem entstehen durch dieses Erkrankungsbild und seine somatischen und psychischen Folgeerkrankungen jährlich ca. 10 Mrd. € direkte Kosten [13]. Dieser Sachverhalt wird dadurch kontrastiert, dass die Krankenkassen die qualifizierte Entzugsbehandlung (QE) als leitliniengerechte Goldstandardtherapie [4] wiederholt infrage stellen [10].

Blunted reward-related activation to food scenes distinguishes individuals with alcohol use disorder in a pilot case-control fMRI pilot study.

BACKGROUND: Alcohol use disorder (AUD) is thought to bias the neurocircuitry underlying reward processing and motivation to preferentially attend to conditioned alcohol cues over natural rewards. The present case-control pilot study evaluated this hypothesis using novel natural reward paradigms. METHODS: Twenty-eight participants (AUD, n = 14, light drinkers, n = 14) were recruited-AUD participants reported 44.0% heavy drinking days (%HDD) and 4.67 drinks/day over the preceding 90 days. Functional magnetic resonance imaging (fMRI) data were acquired during the administration of three separate picture-viewing paradigms of alcohol cues, food scenes, and social reward, respectively. Independent samples t-tests were performed to compare groups' fMRI data and exploratory correlation analyses were performed to examine associations with clinical characteristics of AUD. RESULTS: Food scenes elicited abnormally low reward-related activation, within the superior frontal gyrus and caudate bilaterally, among AUD participants. Lower activation to food scenes within the superior frontal gyrus was, in turn, associated with higher levels of past-month %HDD among AUD participants, specifically, along with craving and alcohol dependence severity when examined across the full sample. Contrasting reward types (e.g., alcohol cues vs. food scenes) did not reveal "preferential" activation to differentiate groups. CONCLUSIONS: Heavy drinking appears associated with reduced responsivity to natural rewards, specifically food rather than social cues. Neural mechanisms underlying the high prevalence of malnutrition among individuals with AUD may involve some combination of blunted approach-related affect and reduced craving-related motivation to eat when food is present, resulting in limited engagement of cortico-striato-thalamic motor circuitry supporting food acquisition. However, given the preliminary nature of this pilot study, such formulations remain tentative until larger follow-up studies can be conducted. From a potential translational standpoint, the ability of promising therapeutics to demonstrate increased responsivity to natural rewards, specifically nutritive reward may serve as a valuable complementary efficacy indicator for future clinical neuroimaging trials in AUD.

Major Depression in Comorbidity with Substance use Disorders: Patients' Features and Clinical-Neurobiological Rationale of Antidepressant Treatments.

The frequent co-occurrence of major depressive disorder (MDD) and substance use disorders (SUDs) entails significant clinical challenges. Compared to patients with MDD alone, patients with MDD and SUD often show increased anhedonia, emotional blunting, and impaired cognitive function. These symptoms lead to an inability to control cravings, more substance use, increased relapse rates, and poor adherence to the treatment. This fosters a detrimental cycle leading to more severe depressive symptoms, functional impairment, and chronicity, culminating in heightened morbidity, mortality, and healthcare resource utilization. Data on antidepressant treatment of MDD-SUD patients are inconclusive and often conflicting because of a number of confounding factors in clinical trials or difficulty in dissecting the specific contributions of pharmacological versus psychological interventions in real-world studies. The patient's unique clinical features and specific SUD and MDD subtypes must be considered when choosing treatments. Ideally, drug treatment for MDD-SUD should act on both conditions and address core symptoms such as anhedonia, craving, and cognitive dysfunction while ensuring minimal emotional blunting, absence of drug interactions, and no addictive potential. This approach aims to address unmet needs and optimize the outcomes in a clinical population often underrepresented in treatment paradigms.

Long-term Efficacy and Safety of Sodium Oxybate in Treating Alcohol Use Disorder: A Systematic Review and Meta-Analysis.

BACKGROUND: Worldwide, three million deaths each year are reported due to the harmful use of alcohol. To date, only a few drugs have been approved for the treatment of Alcohol Use Disorder (AUD). This systematic review and meta-analysis aim to assess the long-term efficacy and safety of sodium oxybate (SMO) treatment in patients with AUD. METHODS: We followed the PRISMA statement guidelines and searched PubMed and ISI Web of Science to retrieve the studies of interest. In total, 13 studies on long-term (>12 weeks) SMO administra- tion in patients with AUD were included in this systematic review, and 7 were included in the meta- analysis. RESULTS: Overall, the abstinence rate after 12 weeks of treatment was similar in the SMO and placebo groups, while it was significantly in favour of SMO compared to Naltrexone (NTX). The completion rate was similar in all three conditions. Mean corpuscular volume (MCV) levels favoured SMO over NTX, while Alcohol Craving Scale (ACS) scores did not favour SMO. The incidence of adverse reactions varied widely between studies. CONCLUSION: SMO in the chronic treatment of patients with AUD showed no superiority to placebo in our analysis of published RCTs, although many observational studies reported its beneficial effect in the long term. On the contrary, SMO was superior to NTX treatment on abstinence. The rate of study completion was similar in the three groups. Safety was not an issue in any of the studies included. Further studies are needed to better assess SMO efficacy and safety in the long term.

Impaired or not impaired: The accuracy of the Montreal Cognitive Assessment in detecting cognitive impairment among patients with alcohol use disorder.

BACKGROUND: Cognitive impairments are common in alcohol use disorder (AUD), but only a few studies have investigated the accuracy of the Montreal Cognitive Assessment (MoCA) in this population. We examined the accuracy and precision of the MoCA in detecting cognitive impairment in a sample of patients with AUD. In addition, we investigated whether the MoCA predicts premature discontinuation from treatment. METHOD: A sample of 126 persons with AUD undergoing treatment in specialist health services were administered the MoCA and a battery of 12 neuropsychological tests. Five cognitive domains were derived from the reference tests. A composite total score from these tests was used as a reference criterion for determining correct and incorrect classifications for the MoCA. We analyzed the optimal cut-off score for the MoCA and the accuracy and agreement of classification between the MoCA and the reference tests. RESULTS: Receiver operating characteristic (ROC) curve analyzes yielded an area under the curve (AUC) of 0.77 (95% CI [0.67, 0.87]). Applying 25 as the cut-off, MoCA sensitivity was 0.77 and specificity 0.62. The PPV was 0.53. The NPV was 0.84. Using a cut-off score of 24 yielded a lower sensitivity 0.60, but specificity was significantly better i.e., 0.79. PPV was 0.68. The NPV was 0.82. Kappa agreement between MoCA and the reference tests was fair to moderate, 0.38 for the cut-off of 25, and 0.44 for the cut-off of 24. MoCA did not predict discontinuation from treatment. CONCLUSIONS: Our findings indicate limitations in the classification accuracy of the MoCA in predicting cognitive impairment in AUD. Achieving the right balance between accurately identifying impaired cases without including too many false positives can be challenging. Further, MoCA does not predict discontinuation from treatment. Overall, the results do not support MoCA as a time-efficient screening instrument.

Implications of the shift to DSM-5 for alcohol use disorder prevalence estimates in the National Survey on Drug Use and Health.

BACKGROUND AND AIMS: The Substance Abuse and Mental Health Services Administration's annual National Survey on Drug Use and Health (NSDUH) is a commonly used source for estimating trends in alcohol use disorders (AUD) in the United States. From 2015 to 2019 the annual prevalence of people diagnosed with either Diagnostic and Statistical Manual 4th edition (DSM-IV) alcohol abuse or dependence ranged from 5.3 to 5.9%. More recent estimates, using the DSM 5th edition (DSM-5) AUD diagnostic formulation, have been higher, with AUD base rates ranging from 10.1 to 10.7% from 2020 to 2022. This study aimed to compare the past 12-month base rates of AUD in the United States general population when using the DSM-5 versus DSM-IV AUD (i.e. abuse or dependence) and assess the AUD severity of individuals captured with each diagnostic formulation using DSM-5 AUD symptom counts. METHODS: We examined descriptive trends in the rate of past-year NSDUH AUD diagnoses from 2015 to 2022. We contrasted them with trends in drinking behavior: the percentage of individuals who had ever reported drinking and the number of drinking days and binge drinking days for those who drink. We also analyzed the concordance between DSM-IV and DSM-5 AUD diagnoses in the 2020 NSDUH, which concurrently assessed AUD with both diagnostic formulations. RESULTS: The transition to DSM-5 AUD formulation coincided with a drastic increase in AUD prevalence rates that occurred without increases in drinking behavior. In 2020 NSDUH data, the estimated past-year DSM-5 AUD prevalence rate was 10.1% compared with a 5.4% rate of past-year DSM-IV abuse or dependence. The DSM-5 AUD formulation captured more mild-severity individuals than the DSM-IV formulation. CONCLUSIONS: Higher recent base rates of alcohol use disorders (AUD) in the National Survey on Drug Use and Health are likely, at least partially, explained by measurement changes in AUD; specifically, the shift from DSM-IV abuse or dependence to DSM-5 AUD. The DSM-5 formulation appears substantially more inclusive than the DSM-IV formulation, leading to a larger number of mild severity individuals being captured.