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NESARC Wave 2 demographic characteristics among past-year alcohol-dependent individuals in Wave 1 (N = 1,172)

NESARC Wave 2 demographic characteristics among past-year alcohol-dependent individuals in Wave 1 (N = 1,172)

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Background: We have previously reported on an empirical classification of Alcohol Dependence (AD) individuals into subtypes using nationally representative general population data from the 2001 to 2002 Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and latent class analysis. Our results suggested a typology...

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... were 312 AD subjects lost to attrition from Wave 1 to Wave 2. We conducted an attrition analysis and found that no specific AD subtype was overrepresented in the loss of subjects to follow-up (Pearson Chi-sq [df = 4] = 4.3; p = 0.37). Table 2 displays the demographic characteristics of these AD individuals subtyped at Wave 1 and carried forward to Wave 2 of the NESARC. ...

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... Additionally, it has been suggested that some microstructural deficits may reflect a pre-existing vulnerability to development of AD. 20,21 Studies seeking to distinguish subtypes of AD have tended to include a group characterised by a high occurrence of other forms of substance abuse and dependence. [22][23][24] Polydrug use by clients within treatment services has been long been recognised as a treatment issue, though this remains understudied, with inpatient prevalence rates of alcohol-polydrug dependence ranging from 47% to 64%. [25][26][27] Furthermore, emerging evidence has highlighted worse treatment outcomes-greater risk of relapse, lower treatment retention rates, higher mortality rates and a greater prevalence of psychiatric comorbidity. ...
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Evidence suggests that alcohol dependence (AD) is associated with microstructural deficits in white matter, but the relationship with lifetime alcohol exposure and the impact of polydrug dependence is not well understood. Using diffusion tensor magnetic resonance (MR) imaging, we examined white matter microstructure in relation to alcohol and polydrug dependence using data from the Imperial College Cambridge Manchester (ICCAM) platform study. Tract‐based spatial statistics were used to examine fractional anisotropy (FA) in a cohort of abstinent AD participants, most of whom had a lifetime history of dependence to nicotine. A further subgroup also had a lifetime history of dependence to cocaine and/or opiates. Individuals with AD had lower FA throughout the corpus callosum, and negative associations with alcohol and nicotine exposure were found. A group‐by‐age interaction effect was found showing greater reductions with age in the alcohol‐dependent group within corpus callosum, overlapping with the group difference. We found no evidence of recovery with abstinence. A comparison of alcohol‐only‐ and alcohol‐polydrug‐dependent groups found no differences in FA. Overall, our findings show that AD is associated with lower FA and suggest that these alterations are primarily driven by lifetime alcohol consumption and cigarette smoking, showing no relationship with exposure to other substances such as cocaine, opiates or cannabis. Reductions in FA across the adult lifespan are more pronounced in AD and offer further support for the notion of accelerated ageing in relation to alcohol dependence. These findings highlight there may be lasting structural differences in white matter in alcohol dependence, despite continued abstinence.
... Previous studies on alcohol use disorder have examined if different subgroups of patients have varying disease prognosis and treatment outcomes in clinical and general population settings; however, these studies were based on a younger population and had not investigated the differential risk of alcohol-, polydrug-and psychiatricrelated hospitalizations [59][60][61]. We demonstrated the possibility of using social service and longitudinal health-care data to follow the health outcome of older addiction service users in a context where the addiction care and treatment system is publicly funded and uncoordinated across municipal and regional systems. ...
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... One study speculates that the high rate of illicit drug use among those with ADHD may be explained by the accelerated gateway hypothesis, which proposes that the earlier onset of substance use among adolescents with ADHD leads to higher rates of cocaine and heroin abuse later in life (Dunne et al., 2015). However, it is also important to consider that the lower likelihood of alcohol use disorders in comparison to drug use disorders (excluding cannabis) in the current study may be influenced by the fact that many people do not develop alcohol use disorders until middle age (Moss et al., 2010) and thus may not have been reflected in our analysis. Lastly, we were able to control for a larger range of variables than past research, specifically, smoking, mental health, socioeconomic status and ACEs. ...
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... Disorder severity is one of the most robust factors associated with seeking treatment for AUD (17,30,51,52,55,59,70,78,79). Early research on this topic suggests that one's perceived severity of their drinking problem plays a key role in treatment entry and is associated with greater depressive levels, alcohol dependence symptoms, and negative life events (80). ...
... Results suggest a lag of approximately 10 years between the first onset of AUD and the decision to seek formal treatment (12). Regarding "who" is most likely to seek treatment, the literature suggests that men are more likely to seek treatment than women (49,54,(58)(59)(60)(61)(62), along with individuals with more severe AUD presentations (17,30,51,52,55,59,70,78,79). Some health disparities are noted in regard to "who" seeks treatment, with minority groups facing delays to treatment and receiving lower quality care. ...
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... Such differences may have prognostic significance, as for instance patients whose lives function better have a later onset of AUD, and patients who have less family history of alcohol problems, are more likely to recover (e.g. Moss et al. 2010). However, other patient-specific differences may be as important as their characteristics. ...
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... [2] Alcohol can be a significant contributing factor to many medical conditions. [3] The medical consequences of drinking alcohol may manifest in any organ system of the body. [4] An estimated 4% to 40% of medical and surgical patients experience problems related to alcohol intoxication or abuse. ...
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... In summary, participants were free of psychiatric, neurological, physical, and medical conditions known or suspected to adversely affect brain neurobiology and/or neurocognition, except for DSM-IV anxiety disorders (post-traumatic stress disorder was exclusionary), depressive disorders, hepatitis C, hypertension, and type-2 diabetes in ALC. These comorbidities were allowed in ALC because they are highly prevalent in AUD (Mertens, Weisner, Ray, Fireman, & Walsh, 2005;Moss, Chen, & Yi, 2010). Substance dependence (other than nicotine from tobacco smoking) within the 5 years preceding study enrollment was exclusionary for ALC. ...
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... Therefore, it is not clear if this status is a transient one, and what proportion of the members of this group may develop severe dependence symptoms in their latter life. Further research utilizing a longitudinal design would address the transition from one group to another either from a low risk of dependence to a severe dependence group, or vice versa from a severe dependence group toward the group with light use or no use at all [34]. The present study was unable to capture this dynamic change among the community sample recruited. ...
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Background: Different classification models have been proposed to explain the heterogeneity of alcohol-related problems in general populations. Such models suggest quantitatively or qualitatively different symptom endorsement characteristics between subgroups of alcohol drinkers. Objectives: The present study aimed to identify homogenous subgroups of drinkers in a general population sample in addition to examining the relationship between the subgroups and psychopathological symptoms. Method: Data of past-year alcohol users (n = 1,520) were analyzed from the nationally representative sample of the National Survey on Addiction Problems in Hungary 2015. Latent class analysis (LCA) was conducted to identify subgroups of drinkers based on the dichotomous indicator items of the Alcohol Use Disorders Identification Test questionnaire. Multinomial logistic regression and multiple comparisons were performed to explore the relationship between latent classes and socio-demographical variables and psychopathological symptoms. Results: LCA suggested a 3-class model: "Light alcohol drinkers" (71.6%), "Alcohol drinkers with low risk of dependence" (19.3%), and "Alcohol drinkers with severe dependence symptoms" (9.1%). More severe subgroups showed significantly higher level of anxiety, depression, hostility, obsessive-compulsivity, interpersonal sensitivity, and psychiatric or alcohol use disorder-related treatment involvement. Male gender, younger age, lower level of educational achievement, and earlier onset of the first alcoholic drink were associated with membership of more severe subgroups. Conclusions: The present results indicated that severity-based subgroups of drinkers can be discriminated. Approximately 9% of the alcohol users showed severe symptoms of alcohol dependence. The present data also supported the association between more severe forms of alcohol consumption, and internalizing and externalizing characteristics. Although the 2 at-risk classes of alcohol drinkers did not differ in terms of alcohol consumption-related measures, they were distinguished by the level of harmful consequences due to alcohol use, psychopathological symptoms and psychiatric treatment history.
... Data on alcohol consumption over time are limited. One source is the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative study that has been used to study the epidemiology of AUD and substance use disorders [19][20][21] and transitions from first use to dependence. 22 However, NESARC captured alcohol consumption at only 2 time points 3 years apart; therefore, it cannot by itself be used to produce long-term drinking trajectories. ...
Article
Background. There is a lack of data on alcohol consumption over time. This study characterizes the long-term drinking patterns of people with lifetime alcohol use disorders who have engaged in treatment or informal care. Methods. We developed multinomial logit models using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to estimate short-term transition probabilities (TPs) among the 4 World Health Organization drinking risk levels (low, medium, high, and very high risk) and abstinence by age, sex, and race/ethnicity. We applied an optimization algorithm to convert 3-year TPs from NESARC to 1-year TPs, then used simulated annealing to calibrate TPs to a propensity-scored matched set of participants derived from a separate 16-year study of alcohol consumption. We validated the resulting long-term TPs using NESARC-III, a cross-sectional study conducted on a different cohort. Results. Across 24 demographic groups, the 1-year probability of remaining in the same state averaged 0.93, 0.81, 0.49, 0.51, and 0.63 for abstinent, low, medium, high, and very high-risk states, respectively. After calibration to the 16-year study data ( N = 420), resulting TPs produced state distributions that hit the calibration target. We find that the abstinent or low-risk states are very stable, and the annual probability of leaving the very high-risk state increases by about 20 percentage points beyond 8 years. Limitations. TPs for some demographic groups had small cell sizes. The data used to calibrate long-term TPs are based on a geographically narrow study. Conclusions. This study is the first to characterize long-term drinking patterns by combining short-term representative data with long-term data on drinking behaviors. Current research is using these patterns to estimate the long-term cost effectiveness of alcohol treatment.
... Based on the 11 AUD criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), fifth edition (American Psychiatric Association 2013), there are 2,048 combinations that could result in an AUD diagnosis (Lane and Sher, 2015). In view of such heterogeneity, attempts have been made to subtype affected individuals based on etiology, drinking patterns, course, personality traits, and comorbid psychopathology (Babor et al., 1992;Cloninger et al., 1993;Jellinek, 1960;Lesch and Walter, 1996;Moss et al., 2010). ...
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Background: Precision medicine aims to identify those patients who will benefit the most from specific treatments. Recent work found large effects of naltrexone among "reward drinkers," defined as individuals who drink primarily for the rewarding effects of alcohol. This study sought to replicate and extend these recent findings by examining whether the desire to drink mediated the effect of naltrexone among reward drinkers. Methods: We conducted a secondary analysis of a 12-week randomized clinical trial of daily or targeted naltrexone among problem drinkers (n=163), with a focus on 86 individuals (n=45 naltrexone, n=41 placebo) who received daily medication. Interactive voice response technology was used to collect daily reports of drinking and desire to drink. Factor mixture models were used to derive reward and relief phenotypes. Moderation analyses were used to evaluate naltrexone effects, with phenotype as a moderator variable. Multilevel mediation tested average desire to drink as a mediator. Results: Results indicated four phenotypes: low reward/low relief; low reward/high relief; high reward/low relief; and high reward/high relief. There was an interaction between the high reward/low relief subgroup (n=10) and daily naltrexone versus placebo on drinks per drinking day (p=.03), percent heavy drinking days (p=.004), and daily drinking (p=.02). As compared to placebo, individuals in the high reward/low relief phenotype who received daily naltrexone had significantly fewer drinks per drinking day (Cohen's d=2.05) and had a lower proportion of heavy drinking days (Cohen's d=1.75). As hypothesized, reductions in average desire to drink mediated the effect of naltrexone on average daily drinking among the high reward/low relief drinkers (moderated mediation effect: p=.029). Conclusion: This theory-driven study replicates the empirical finding that naltrexone is particularly efficacious among high reward/low relief drinkers. Our study brings the field a step closer to the potential of using a precision medicine approach to treating alcohol use disorder. This article is protected by copyright. All rights reserved.