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1.
Talanta ; 251: 123816, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35963014

RESUMO

Benzodiazepines exhibit central nervous system depressive activity as well as sedative, hypnotic, and anticonvulsant properties, which enable to use them as medical treatment in anxiety, epilepsy, insomnia and alcohol withdrawal syndrome. However, from 2000s illegal benzodiazepine derivatives have started to emerge on illicit drug market as new psychoactive substances (NPSs) monitored in many countries. Analysis of both pharmaceutical drugs and NPSs from benzodiazepines group could be challenging, as usually very low concentrations need to be determined. Thus, an ultra-sensitive UHPLC-QqQ-MS/MS method was developed for simultaneous determination of 54 benzodiazepines (pharmaceutical drugs, NPS and their metabolites) and 3 z-drugs with one metabolite in biological fluid samples. The lower limit of quantification for most substances was 50 pg/mL, whereas for 17 substances as low as 10 pg/mL was achieved. Together with reduced sample volume to 100 µL it makes the developed method suitable for a sensitive multidrug toxicological analysis. Presented method was applied in routine toxicological practice as well as for the determination of benzodiazepines, z-drugs and their metabolites in 25 authentic biological fluids (blood, urine, vitreous humor and bile), both antemortem and postmortem. 19 different compounds, including benzodiazepines, their metabolites and z-drugs were determined. Antemortem blood concentrations were within 0.2-114.5 ng/mL, whereas concentrations in antemortem urine samples were 0.03-102.6 ng/mL. In postmortem specimens, concentrations ranged within 0.2-473.2 ng/mL, 0.5-94.1 ng/mL, 1.3-208.8 ng/mL and 41.5-42.0 ng/mL in blood, vitreous humor, urine and bile, respectively. The developed method is suitable for a forensic toxicology analysis, as well as clinical toxicology which is evidenced by the positive results of international proficiency tests.


Assuntos
Alcoolismo , Drogas Ilícitas , Síndrome de Abstinência a Substâncias , Anticonvulsivantes , Benzodiazepinas , Cromatografia Líquida de Alta Pressão/métodos , Humanos , Hipnóticos e Sedativos , Drogas Ilícitas/urina , Espectrometria de Massas em Tandem/métodos
2.
Neuropharmacology ; 222: 109309, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36334765

RESUMO

A major limitation of the most widely used current animal models of alcohol dependence is that they use forced exposure to ethanol including ethanol-containing liquid diet and chronic intermittent ethanol (CIE) vapor to produce clinically relevant blood alcohol levels (BAL) and addiction-like behaviors. We recently developed a novel animal model of voluntary induction of alcohol dependence using ethanol vapor self-administration (EVSA). However, it is unknown whether EVSA leads to an escalation of alcohol drinking per se, and whether such escalation is associated with neuroadaptations in brain regions related to stress, reward, and habit. To address these issues, we compared the levels of alcohol drinking during withdrawal between rats passively exposed to alcohol (CIE) or voluntarily exposed to EVSA and measured the number of Fos+ neurons during acute withdrawal (16 h) in key brain regions important for stress, reward, and habit-related processes. CIE and EVSA rats exhibited similar BAL and similar escalation of alcohol drinking and motivation for alcohol during withdrawal. Acute withdrawal from EVSA and CIE recruited a similar number of Fos+ neurons in the Central Amygdala (CeA), however, acute withdrawal from EVSA recruited a higher number of Fos+ neurons in every other brain region analyzed compared to acute withdrawal from CIE. In summary, while the behavioral measures of alcohol dependence between the voluntary (EVSA) and passive (CIE) model were similar, the recruitment of neuronal ensembles during acute withdrawal was very different. The EVSA model may be particularly useful to unveil the neuronal networks and pharmacology responsible for the voluntary induction and maintenance of alcohol dependence and may improve translational studies by providing preclinical researchers with an animal model that highlights the volitional aspects of alcohol use disorder.


Assuntos
Alcoolismo , Núcleo Central da Amígdala , Masculino , Animais , Ratos , Etanol , Recompensa , Consumo de Bebidas Alcoólicas , Hábitos , Concentração Alcoólica no Sangue , Modelos Animais de Doenças
3.
Clin Liver Dis ; 27(1): 157-172, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36400463

RESUMO

The prevalence of alcohol consumption, alcohol use disorder (AUD), and alcohol-related liver disease (ALD) has exponentially increased over the last several years and rates continue to increase. Significant alcohol use can cause progression from steatosis in the liver to inflammation, fibrosis, and eventually cirrhosis. Additional risk factors for the progression of ALD disease include gender, race, and genetic predisposition. As such, it is essential for clinicians to understand and implement screening tools for early diagnosis of both AUD and ALD and be aware of emerging novel treatment options.


Assuntos
Alcoolismo , Hepatopatias Alcoólicas , Transplante de Fígado , Humanos , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/epidemiologia , Hepatopatias Alcoólicas/etiologia , Alcoolismo/complicações , Alcoolismo/terapia , Consumo de Bebidas Alcoólicas/efeitos adversos , Transplante de Fígado/efeitos adversos
4.
Addict Behav ; 136: 107461, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36063573

RESUMO

BACKGROUND: Several typologies have proposed two etiological pathways involved in the development of alcohol misuse which are associated with the internalizing and externalizing domains of psychopathology, respectively. This study's aim was to investigate this typology in a young adult sample, and test whether drinking motives, specifically drinking for negative or positive reinforcement, may provide a plausible mechanism characterizing these pathways. METHOD: Mixture modeling was conducted on a set of internalizing (anxiety, depression, neuroticism), externalizing (antisocial behavior, conscientiousness, sensation seeking, drug use), and alcohol misuse items (binge drinking, alcohol use disorder symptoms [AUDsx]) measured by self-report in a sample of 9,807 college students. Linear regression and chi-square tests were used to determine how latent class membership was associated with drinking motives, demographics, and personality characteristics. RESULTS: The model identified 3 latent classes: a Low Risk class (70%), an Internalizing class (19%) with elevated levels of internalizing traits/symptoms and AUDsx, and an Externalizing class (10%) with elevated levels of externalizing traits/symptoms and both binge drinking and AUDsx. All drinking motives were substantially elevated in the Internalizing and Externalizing (vs Low Risk) classes (p < 3.0E-10), while positive reinforcement motives were specifically elevated in the Externalizing (vs Internalizing) class (p < 2.0E-55). Personality comparisons further emphasized the relevance of class distinctions. CONCLUSIONS: These findings provide additional support for both a specific internalizing and a broadband externalizing association with subtypes of alcohol misuse. Drinking motives may be useful intermediate indicators of these different risk processes.


Assuntos
Alcoolismo , Consumo Excessivo de Bebidas Alcoólicas , Consumo de Bebidas Alcoólicas , Ansiedade , Etanol , Humanos , Motivação , Adulto Jovem
5.
Addict Behav ; 136: 107462, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36084413

RESUMO

AIMS: Recent studies have suggested that females respond more favourably to baclofen treatment for alcohol use disorder. Females are generally more likely to drink to regulate stress reactivity and negative affect. This study thus aimed to evaluate the role of sex on the effect of baclofen on the relationship between daily alcohol consumption, stress and craving. METHODS: A network analysis of fluctuations using vectorized autoregressive modelling was used to explore the relationship between daily surveys of alcohol consumption, stress and craving from daily diary data over 84 days from a randomised controlled trial of baclofen (30 mg or 75 mg per day) versus placebo in 104 participants with alcohol dependence (1, 2). Symptom interrelations across patients and across time were examined including temporal networks (time lagged), contemporaneous and between-subjects networks, and were examined for placebo and baclofen stratified by sex. RESULTS: Overall, between persons, there was a significant relationship between stress and drinking in placebo treated individuals in females (r = -0.70, p < 0.001) but not males (r = 0.32, p = 0.054) that was not observed in baclofen treated individuals. No relationship was observed between stress and drinking in the baclofen group for either sex (p's < 0.45). DISCUSSION: There appears to be some sex-specific differences whereby baclofen abolishes an overall association between stress and drinking in females, but this is not observed in males. Network analyses may assist in elucidating the mechanism of action of alcohol pharmacotherapies such as baclofen and understanding which symptoms and mechanisms are key for effective interventions.


Assuntos
Alcoolismo , Baclofeno , Consumo de Bebidas Alcoólicas/tratamento farmacológico , Alcoolismo/tratamento farmacológico , Baclofeno/farmacologia , Baclofeno/uso terapêutico , Fissura , Feminino , Humanos , Masculino , Caracteres Sexuais
6.
Addict Behav ; 136: 107468, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36087497

RESUMO

Online racism has been associated with alcohol-related coping, likely to deal with mental health symptoms that arise from experiencing racial discrimination in online settings. Thus, we examined online racism as a risk factor for alcohol-related problems by examining depressive/anxiety symptoms and coping-related drinking motives as mediators among Black, Latina/o/x, and Asian emerging adults in the U.S. We hypothesized that online racism would be associated with greater alcohol use severity through depressive/anxiety symptoms and coping-related drinking motives sequentially. With data from 322 participants (Mage = 23.28; Black, n = 108; Latina/o/x, n = 118; and Asian, n = 96), we conducted a multi-group path analysis of online racism (Perceived Online Racism Scale) linked to alcohol use (Alcohol Use Disorders Identification Test) via depressive (Patient Health Questionnaire-9)/Anxiety (Generalized Anxiety Disorder-7) symptoms and coping-related drinking motives (Drinking Motives Questionnaire-Revised Short Form). The hypothesized indirect pathway was significant in all groups. The direct effect was also significant for Latina/o/x and Asian groups. For the Black group, the direct effect was not significant, highlighting the salience of the mental health symptoms and drinking motives in explaining the link between online racism and alcohol use. Collectively, the results help to contextualize the risks of alcohol-related problems from experiencing contemporary forms of racial trauma such as online racial discrimination and provide implications for intervention development.


Assuntos
Transtornos Relacionados ao Uso de Álcool , Alcoolismo , Racismo , Adaptação Psicológica , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Ansiedade/psicologia , Hispânico ou Latino , Humanos , Motivação , Racismo/psicologia
7.
Behav Brain Res ; 436: 114087, 2023 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-36057379

RESUMO

BACKGROUND: The phenomenon of alcohol analgesia and tolerance can facilitate misuse and lead to the development of alcohol use disorder (AUD). Numerous alcohol-induced behaviors are genetically influenced; however, it is unknown if alcohol analgesia has a genetic contribution. Rodent studies have shown that alcohol responses differ vastly between two widely studied inbred strains of mice, C57BL/6 J (B6) and DBA/2 J (D2). Here, we used B6 and D2 mice as an initial behavioral genetic analysis of acute alcohol-induced antinociception. METHODS: The antinociceptive effect of orally-administered alcohol was characterized using the hot plate test in B6 and D2 mice of both sexes. Using the opioid receptor antagonist naloxone, the involvement of the opioid system was assessed. Locomotor activity and blood alcohol concentrations were also measured. Ovariectomized mice were used to evaluate the influence of ovarian sex hormones on alcohol-induced antinociception. RESULTS: Alcohol induced an antinociceptive effect in B6 and D2 male mice in a time- and dose-dependent manner. In addition, D2 male mice were more sensitive to the antinociceptive effect of alcohol than B6 male mice. However, locomotion is not impeded by the tested doses of alcohol in B6 mice. Female D2 and B6 mice failed to show significant antinociceptive effects in alcohol dose-response studies. In addition, alcohol-induced antinociception was still not evident in ovariectomized female mice. Male mice of both strains developed tolerance to this effect after repeated administration of alcohol. Strain differences were found in blood alcohol concentration. Finally, no difference was found in the blockade of alcohol antinociception by 2 mg/kg naloxone. CONCLUSION: Our results indicate that the antinociceptive effects of alcohol in the hot plate test are influenced by strain and sex. These findings support further genetic analysis of alcohol-induced antinociception to identify operative mechanisms and better assess the contribution of this phenotype to AUD.


Assuntos
Alcoolismo , Concentração Alcoólica no Sangue , Analgésicos Opioides , Animais , Etanol/farmacologia , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos DBA , Naloxona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Dor/tratamento farmacológico
8.
Behav Brain Res ; 436: 114089, 2023 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-36063970

RESUMO

Increasing evidence suggests that individuals with alcohol use disorder (AUD) present with a disrupted glutamatergic system that underlies core components of addictive disorders, including drug relapse and low impulse control. N-acetylcysteine (NAC) is a cystine prodrug that has been found to promote glutamate homeostasis and drug abstinence. However, no studies to date have evaluated NAC's effect on impulsivity in substance use disorders. Here we determined whether NAC would decrease alcohol-intake behaviors, in addition to improving impulse control, in long-term alcohol drinking male Wistar-Han rats. Before the start of the experiments, all rats were exposed to long-term intermittent access to 20% ethanol for at least seven weeks. Next, in different groups of rats, the effect of NAC (60 and/or 90 mg/kg) was evaluated on (i) voluntary alcohol drinking using a two-bottle free choice paradigm, (ii) the motivation to self-administer alcohol under a progressive ratio schedule of reinforcement, and (iii) relapse-like drinking using the alcohol deprivation effect model. Finally, (iv) NAC's effect on impulse control was evaluated using the five-choice serial reaction time task. Results showed that NAC administration at 90 mg/kg significantly reduced relapse-like drinking and improved impulse control. In contrast, NAC had no effect on levels of alcohol drinking or motivation to drink alcohol. In conclusion, our findings continue to support the use of NAC as an adjuvant treatment for the maintenance of abstinence in AUD. Moreover, we provide evidence for NAC's efficacy in improving impulse control following drinking, which warrants further investigation in substance use settings.


Assuntos
Alcoolismo , Pró-Fármacos , Acetilcisteína/farmacologia , Acetilcisteína/uso terapêutico , Consumo de Bebidas Alcoólicas/tratamento farmacológico , Alcoolismo/tratamento farmacológico , Animais , Cistina , Etanol/farmacologia , Glutamatos/uso terapêutico , Masculino , Pró-Fármacos/uso terapêutico , Ratos , Ratos Wistar , Recidiva , Autoadministração
9.
BMJ Case Rep ; 15(9)2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36318639

RESUMO

We describe the case of a woman in her 60s admitted to the intensive care unit after a first generalised tonic-clonic seizure in the context of alcohol withdrawal. She was placed under invasive mechanical ventilation due to persistence of coma despite antiepileptic treatment. Despite continuous sedation with propofol, the frequency and intensity of seizure increased. Seizures were very similar to epileptic tonic-clonic seizures and were recorded with video and electroencephalogram (EEG). A diagnosis of tetanus was considered after a scalp wound was discovered. The patient's husband revealed that a trismus had appeared a few days before hospital admission after a head trauma. EEG showed a pattern of diffuse spikes, which disappeared after a cisatracurium bolus. The diagnosis of tetanus was later confirmed by cultures from wound samples. Therefore, severe tetanus can mimic both the clinical and EEG features of status epilepticus and could be added to the differential diagnosis of epilepsy.


Assuntos
Alcoolismo , Epilepsia , Estado Epiléptico , Síndrome de Abstinência a Substâncias , Tétano , Feminino , Humanos , Tétano/tratamento farmacológico , Alcoolismo/tratamento farmacológico , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Convulsões/tratamento farmacológico , Estado Epiléptico/tratamento farmacológico , Eletroencefalografia , Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico
10.
Alcohol Res ; 42(1): 11, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36320345

RESUMO

This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world's largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, "Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research," devoted to key topics within the field of alcohol research. This article is based on Dr. Mason's presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift.


Assuntos
Dissuasores de Álcool , Transtornos Relacionados ao Uso de Álcool , Alcoolismo , Estados Unidos , Humanos , Alcoolismo/diagnóstico , National Institute on Alcohol Abuse and Alcoholism (U.S.) , Consumo de Bebidas Alcoólicas , National Institutes of Health (U.S.) , Dissuasores de Álcool/uso terapêutico , Naltrexona/uso terapêutico
11.
Afr Health Sci ; 22(Spec Issue): 93-107, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321113

RESUMO

Introduction: There is a rise in alcohol and other drug (AOD) abuse in the country but details of the practice are scanty. This paper provides characteristics of clients in the rehabilitation centres, their AOD related practices before and early months of COVID-19, and correlates of repeat treatment. Methods: The study was conducted in 10 rehabilitation centres in Kampala Metropolitan area. Characterization of AOD clients involved descriptive analysis while comparison of AOD related practices pre-and during COVID-19 lockdown was carried out using interrupted time series analysis. Modified Poisson regression model was used to analyse the repeat treatment. Results: The clients were mostly male (85%), single (57%) and had attained secondary education (84%). Nearly a third of them (29%) were unemployed while 68% were aged between 15-34 years. The commonest substances used were alcohol (52%), cannabis (19%), cocaine (13%) and opioids (8%). The commonest sources of substances were street dealers (52%) and friends (37%). COVID-19 did not change the pattern of AOD use except for Opioids. Repeat treatment was associated with being male, seeking care in private facilities, being casual labourer/self-employed. Conclusion: Intervention programs should target the educated, the unemployed, young men, their friends, street drug dealers and AOD hotspots.


Assuntos
Alcoolismo , COVID-19 , Transtornos Relacionados ao Uso de Substâncias , Masculino , Humanos , Adolescente , Adulto Jovem , Adulto , Feminino , Uganda , Controle de Doenças Transmissíveis , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Centros de Reabilitação , Analgésicos Opioides
12.
Subst Abuse Treat Prev Policy ; 17(1): 72, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36320048

RESUMO

BACKGROUND: According to the National Alcohol Beverage Control Association, twelve states in the United States (U.S.) have government retail monopolies on spirits/liquor sales. With a new federal minimum legal sales age for tobacco (raised from 18 to 21, the minimum legal sales age for alcohol), we examine possible unintended consequences of a hypothetical policy change restricting retail tobacco sales to state-run spirits/liquor stores in alcohol control states, which has been proposed as a tobacco endgame strategy. METHODS: We used cross-sectional survey data from 14,821 randomly-selected adults ages 21 and older who responded to the 2015 or 2020 U.S. National Alcohol Survey (51.8% female; 65.8% identified as non-Hispanic White, 12.4% as Black or African American, 14.2% as Hispanic or Latinx; 34.0% had a low level of education), including 2,274 respondents (18.9%) residing in one of the alcohol control states (representing 42.2 million (M) adults ages 21+). We estimated associations between tobacco measures (lifetime smoking status, lifetime daily smoking, past-year daily smoking) and alcohol measures (drinking status, beverage choices, lifetime alcohol use disorder (AUD) status, recovery status) overall and for specific subgroups. RESULTS: In control states, 55.1% of people who smoked daily in the past year also reported lifetime AUD, including an estimated 3.56 M adults ages 21 + who reported prior (but not current) AUD. The association of daily smoking with lifetime AUD was stronger among those with low education compared to those with higher education. Further, 58.8% of people in recovery from an alcohol and/or drug problem (1.49 M adults ages 21+) smoked daily, and this was more marked among women than men in control states. CONCLUSION: There could be negative consequences of an endgame strategy to restructure tobacco retail sales, including increased risk for relapse to drinking among people who smoke daily, especially among women and people with low levels of education. Strategies to mitigate unintended harms would be needed if such a policy were implemented.


Assuntos
Alcoolismo , Adulto , Masculino , Feminino , Estados Unidos , Humanos , Adulto Jovem , Estudos Transversais , Tabaco , Bebidas Alcoólicas , Consumo de Bebidas Alcoólicas , Recidiva
13.
Georgian Med News ; (328-329): 53-57, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36318842

RESUMO

The objective - of the research is to study the contribution of the genealogical constituent in the genesis of the formation of recurrent depressive disorders. A group of 108 patients with RDR who were in the main group and 46 persons without mental disorders who were in the comparison group were examined. To estimate the genealogical component, 297 relatives of the main group and 167 relatives of the comparison group were evaluated. The set of research methods included: clinical-psychopathological, clinical-genealogical and methods of statistical processing of the obtained data. A substantial accumulation of psychiatric disorders in the pedigrees of the patients with RDD was established, which indicates a significant role of hereditary factors in the occurrence of clinical forms of this pathology: the rate of relatives with mental disorders was statistically higher in the pedigrees of patients with RDR than in those in the comparison group (in the main group the rates of staying under observation by a psychiatrist and presence of depression in relatives exceeded 6-8 times, the rate of suicidal behavior 2.6-5.0 times, propensity to alcohol dependence 1.5-2.0 times (p < 0.05) similar rates in the comparison group. At estimation of gender aspects of hereditary burdening it has been established, that at increase of severity of DDR course the burdening of patients' family trees with mental disorders increased: the frequency of female relatives with depression (50.00 %) and male relatives with depression (20.00 %) and alcohol addiction (41.70 %) increased. The results indicate the need to consider heredity factors in the diagnosis, risk assessment of the severity of depression and its recurrence.


Assuntos
Alcoolismo , Transtorno Depressivo Maior , Humanos , Ideação Suicida , Projetos de Pesquisa , Medição de Risco
14.
Addiction ; 117(12): 3024-3036, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36321607

RESUMO

BACKGROUND AND AIMS: This article summarizes the findings and conclusions of the third edition of Alcohol: No Ordinary Commodity. The latest revision of this book is part of a series of monographs designed to provide a critical review of the scientific evidence related to alcohol control policy from a public health perspective. DESIGN: A narrative summary of the contents of the book according to five major issues. FINDINGS: An extensive amount of epidemiological evidence shows that alcohol is a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. Trends in alcohol products and marketing are described, indicating that a large part of the global industry has been consolidated into a small number of transnational corporations that are expanding their operations in Asia, Africa and Latin America. The main part of the book is devoted to a review of strategies and interventions designed to prevent or minimize alcohol-related harm. Overall, the most effective strategies to protect public health are taxation that decreases affordability and restrictions on the physical availability of alcohol. A total ban on alcohol marketing is also an effective strategy to reduce consumption. In addition, drink-driving counter-measures, brief interventions with at-risk drinkers and treatment of drinkers with alcohol dependence are effective in preventing harm in high-risk contexts and groups of hazardous drinkers. CONCLUSION: Alcohol policy is often the product of competing interests, values and ideologies, with the evidence suggesting that the conflicting interests between profit and health mean that working in partnership with the alcohol industry is likely to lead to ineffective policy. Opportunities for implementation of evidence-based alcohol policies that better serve the public good are clearer than ever before as a result of accumulating knowledge on which strategies work best.


Assuntos
Consumo de Bebidas Alcoólicas , Alcoolismo , Humanos , Consumo de Bebidas Alcoólicas/prevenção & controle , Política de Saúde , Marketing , Impostos
15.
J Clin Psychiatry ; 84(1)2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36350590

RESUMO

Comorbidity is common with posttraumatic stress disorder, and alcohol use disorder (AUD) is among the most common co-occurring disorders. When viewed through the lens of avoidance behaviors, AUD can shape an individual's response to distressing trauma reminders by dulling the emotional response and promoting disengagement from the traumatic memory. Over time, this response strengthens posttraumatic distress by reinforcing the belief that traumatic memories and their emotional responses are themselves dangerous and intolerable. In turn, this belief may impede treatment progress. Concurrent trauma-focused therapy and AUD treatment can serve to establish more adaptive coping strategies. Reducing reliance on alcohol for coping while engaging safely and effectively with trauma memories allows the individual to process the memories, build tolerance to emotional distress, and ultimately reframe maladaptive trauma-related beliefs and decrease the intensity of reactions. This case presents concurrent psychopharmacology and cognitive processing therapy for co-occurring posttraumatic stress disorder and AUD. We explore how alcohol use, and emotional avoidance more broadly, become targets for change.


Assuntos
Alcoolismo , Terapia Cognitivo-Comportamental , Psicofarmacologia , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Alcoolismo/epidemiologia , Comorbidade
17.
Addict Sci Clin Pract ; 17(1): 62, 2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36348370

RESUMO

BACKGROUND: Alcohol use disorder (AUD) and anxiety disorders (AnxD) are prevalent health concerns in clinical practice which frequently co-occur (AUD-AnxD) and compound one another. Concurrent AUD-AnxD poses a challenge for clinical management as approaches to treatment of one disorder may be ineffective or potentially counterproductive for the other disorder. CASE PRESENTATION: We present the case of a middle-aged man with anxiety disorder, AUD, chronic pain, and gamma-hydroxybutyrate use in context of tapering prescribed benzodiazepines who experienced severe alcohol withdrawal episodes during a complicated course of repeated inpatient withdrawal management. After medical stabilization, the patient found significant improvement in symptoms and no return to alcohol use with a regimen of naltrexone targeting his AUD, gabapentin targeting both his AUD and AnxD, and engagement with integrated psychotherapy, Alcoholics Anonymous, and addictions medicine follow-up. CONCLUSION: Proper recognition and interventions for AUD and AnxD, ideally with overlapping efficacy, can benefit individuals with comorbid AUD-AnxD. Gabapentin, tobacco cessation, and integrated psychotherapy have preliminary evidence of synergistic effects in AUD-AnxD. Meta-analysis evidence does not support serotoninergic medications (e.g. selective serotonin reuptake inhibitors) which are commonly prescribed in AnxD and mood disorders as their use has not been associated with improved outcomes for AUD-AnxD. Additionally, several double-blind placebo-controlled randomized trials have suggested that serotonergic medications may worsen alcohol-related outcomes in some individuals with AUD. Areas for future investigation are highlighted.


Assuntos
Alcoolismo , Síndrome de Abstinência a Substâncias , Pessoa de Meia-Idade , Masculino , Humanos , Alcoolismo/complicações , Alcoolismo/epidemiologia , Alcoolismo/terapia , Gabapentina/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/epidemiologia , Ansiedade , Comorbidade , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
PLoS One ; 17(11): e0274166, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36355666

RESUMO

BACKGROUND: Despite a considerable reduction in alcohol consumption, Russia has one of the highest levels of alcohol-attributable burden of disease worldwide due to heavy episodic drinking patterns. Further improvement of alcohol control measures, including early provision of screening and brief interventions (SBI), is needed. The legislative framework for delivering SBI in Russia was introduced in 2013. As part of the creation and validation of a Russian version of the Alcohol Use Disorders Identification Test (AUDIT), the present contribution explored challenges in using the AUDIT in Russia to inform a subsequent validation study of the tool. METHODS: Qualitative in-depth expert interviews with patients and healthcare professionals from four primary healthcare and narcology facilities in Moscow. A total of 25 patients were interviewed, 9 from a preventive medicine hospital, 8 from a polyclinic, and 9 from narcology clinics. Also, 12 healthcare professionals were interviewed, 5 of whom were primary healthcare doctors and 7 were narcologists. RESULTS: Patients and healthcare professionals expressed difficulties in dealing with the concept of a "standard drink" in the AUDIT, which is not used in Russia. Various patients struggled with understanding the meaning of "one drinking occasion" on the test, mainly because Russian drinking patterns center around festivities and special occasions with prolonged alcohol intake. Narcology patients had specific difficulties because many of them experienced zapoi-a dynamic drinking pattern with heavy use and a withdrawal from social life, followed by prolonged periods of abstinence. Surrogate alcohol use was described as a common marker of alcohol dependence in Russia, not accounted for in the AUDIT. CONCLUSIONS: The provided analyses on the perception of the Russian AUDIT in different patient and professional groups suggest that a series of amendments in the test should be considered to capture the specific drinking pattern and its potential harms.


Assuntos
Alcoolismo , Humanos , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Moscou/epidemiologia , Federação Russa/epidemiologia , Pesquisa Qualitativa , Atenção Primária à Saúde
20.
Psychiatr Pol ; 56(3): 433-452, 2022 Jun 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-36342978

RESUMO

Alcohol addiction is one of the most common health problems. Long-term consumption of high doses of ethanol leads to numerous adaptive changes in the central and peripheral nervous systems, most notably a decrease in the activity of inhibitory GABAergic pathways and an increase in the activity of excitatory glutamatergic pathways. Up to half of patients may develop alcohol withdrawal syndrome (AWS) when they stop drinking alcohol. This article contains the recommendations of the Polish Psychiatric Association and the Pharmacotherapy Section of the Polish Society for Addiction Research for the pharmaco�therapy of AWS. This paper presents the aetiopathogenesis, neurotransmitter and receptor mechanisms, symptoms and diagnostic criteria of AWS, medications used in the treatment of alcohol withdrawal syndromes, management of uncomplicated and complicated alcohol withdrawal syndromes, and discusses the management of special populations. First­line drugs in the management of AWS are benzodiazepines (BDZ). Most studies have not shown a su�periority of any BDZ in the treatment of AWS. The decision to choose a formulation should be based on its pharmacokinetic properties, comorbidities, and the patient's current condi�tion. The most commonly used BDZs are diazepam, lorazepam, oxazepam, and clorazepate.


Assuntos
Alcoolismo , Síndrome de Abstinência a Substâncias , Humanos , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Alcoolismo/tratamento farmacológico , Polônia , Benzodiazepinas/uso terapêutico , Etanol/efeitos adversos
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