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Bibliography on Moderation vs. Abstinence, Moderation Management, and the Role of Naltrexone in the Treatment of Alcohol Problems

Compiled by Alexander DeLuca, M.D., 1/8/2003 - [Links are to full text articles where available]


Trick or Treatment - Teen drug programs turn curious teens into crackheads
Szalavitz,M.
Slate, 1/3/2003

Pharmacological relapse prevention in alcohol dependence: from animal models to clinical trials
Boening,J.A.; Lesch,O.M.; Spanagel,R.; Wolffgramm,J.; Narita,M.; Sinclair,D.; Mason,B.J.; Wiesbeck,G.A.
Alcohol Clin.Exp.Res., Vol 25, Iss 5, 127S-131S, 2001
Abstract
:
This article represents the proceedings of a symposium at the 2000 ISBRA Meeting in Yokohama, Japan. The chairs were Jobst August-Ludwig Boening and Otto Michel Lesch. The presentations were (1) Pharmacological validation of a new animal model of alcoholism, by Rainer Spanagel; (2) Persisting loss of control as main criterion for alcohol addiction in rats and mice, by Jochen Wolffgramm; (3) Role of NMDA receptor subunits associated with protein kinase C in the prevention of alcohol dependence, by Minoru Narita; (4) Long-term follow up of continued naltrexone treatment, by David Sinclair; (5) Pharmacological treatment trials with dopaminergic and serotonergic substances: Myths or facts? by Gerhard A. Wiesbeck; and (6) Methodology and behavioral therapy of the U.S. acamprosate study, by Barbara J. Mason


If you drink alcoholic beverages do so in moderation: what does this mean?

Dufour,M.C.
The Journal of Nutrition, Vol 131, Iss 2S, 552S-561S, 2001
Abstract:
The changes in content of the alcohol guideline of the various editions of the Dietary Guidelines for Americans from 1980 to 2000 are discussed. This is followed by a capsule summary of the history and evolution of the discipline of alcohol epidemiology compared with that of nutrition epidemiology. Methods of assessment are discussed, and issues surrounding the validity and reliability of self-report of alcohol consumption are then outlined. Relevant objectives from Healthy People 2010 are discussed. Surveillance of the alcohol guideline discloses that, at present, very few American drinkers follow the recommendations of the alcohol guideline. Indications for future research needs to address this issue conclude the discussion.


Five-year clinical course associated with DSM-IV alcohol abuse or dependence in a large group of men and women

Schuckit,M.A.; Smith,T.L.; Danko,G.P.; Bucholz,K.K.; Reich,T.; Bierut,L.
Am.J.Psychiatry, Vol 157, Iss 12, 2028-2035, 2000

Abstract:
Objectives:
The prognostic validity of the DSM-IV diagnoses of alcohol abuse and alcohol dependence was evaluated by examining the 5-year clinical course associated with those diagnoses in a large group of predominantly blue-collar men and women. Personal semistructured interviews were carried out 5 years after an initial evaluation with 1,346 (75%) of the approximately 1,800 men and women participating in the Collaborative Study on the Genetics of Alcoholism who were eligible for follow-up.
Methods
: About two-thirds of the 298 subjects with DSM-IV alcohol dependence at baseline maintained that diagnosis during the 5-year study period. Fifty-five percent of the 288 subjects with DSM-IV alcohol abuse at baseline continued to meet one or more of the 11 DSM-IV abuse/dependence criteria, and 3.5% went on to meet the criteria for dependence at follow-up. 
Results:
Among the 760 subjects with no alcohol diagnosis at baseline, 2.5% met the criteria for alcohol dependence and 12.8% for alcohol abuse at follow-up. Baseline characteristics that predicted the occurrence of any of the 11 DSM-IV abuse/dependence criteria during the 5-year interval included male gender, lack of marital stability, presence of several of the criteria for dependence, and history of illicit drug use.
Conclusions
: The data suggest that over 5 years the DSM-IV diagnosis of alcohol dependence predicts a chronic disorder with a relatively severe course, while DSM-IV alcohol abuse predicts a less persistent, milder disorder that does not usually progress to dependence


A comparison of correlates of DSM-IV alcohol abuse or dependence among more than 400 sons of alcoholics and controls

Schuckit,M.A.; Smith,T.L.
Alcohol Clin.Exp.Res., Vol 25, Iss 1, 1-8, 2001
Abstract:
BACKGROUND
: Alcohol dependence and abuse are defined as separate disorders. However, relatively few data are available about whether the same characteristics predict both syndromes.
METHODS
: Complete data were available from the 15 year follow-up of 411 men who originally had been evaluated from a university population at about age 20. Both baseline data gathered prospectively and the retrospective ratings in six domains of life functioning were analyzed for their relationship to the development of alcohol abuse or dependence during the follow-up.
RESULTS
: Baseline characteristics of a family history of substance use disorders, the quantity and frequency of drinking, the history of alcohol-related problems, and the level of response to alcohol all predicted future alcohol abuse or dependence, but only an alcoholic second-degree relative or a first-degree drug-dependent family member differentially predicted dependence. Logistic regression analyses revealed that similar baseline characteristics combined to predict dependence and, separately, abuse. When the domains of functioning during the 15 years were included, positive alcohol expectancies, poor coping mechanisms, low level of social support, and drinking in the environment contributed to both dependence and abuse, although the relationship was stronger for dependence.
CONCLUSIONS
: The predictors and correlates of alcohol abuse and dependence in this group of men were similar. Further research in additional populations and on other drugs is needed to determine if the two syndromes overlap sufficiently to be combined


Does affect mediate the association between daily events and alcohol use?

Armeli,S.; Tennen,H.; Affleck,G.; Kranzler,H.R.
J Stud.Alcohol, Vol 61, Iss 6, 862-871, 2000
Abstract:
OBJECTIVE:
We examined the within-person associations among positive and negative daily events, positive and negative affect, desire to drink, and alcohol consumption in a sample of heavy drinkers.
METHOD
: Forty-six subjects (25 men; mean [SD] age = 47.0 [9.3] years) who were enrolled in an 8-week treatment program for heavy drinkers were studied using a daily diary methodology.
RESULTS
: Multilevel regression analyses indicated that individuals reported stronger desire to drink and greater consumption on days in which more positive and negative nonwork events occurred. Lower levels of desire to drink and number of drinks were reported on days with more positive work events. Negative work events had a marginal positive association with daily desire to drink. Daily positive and negative affect uniquely predicted greater daily consumption and desire to drink, but only weak evidence was found for their mediating role in the association between daily events and the criterion variables. Several of the within-person associations among affect and the criterion variables varied as a function of number of lifetime symptoms of alcohol dependence and treatment condition.
CONCLUSIONS
: These findings generally support the dual-process (i.e., tension-reduction and experience-enhancement) motivational model of alcohol consumption. However, the observed associations among events, affect and alcohol-related behavior suggests that these pathways are complex, with each being comprised of affective and cognitive subpathways


Behavior change patterns and strategies distinguishing moderation drinking and abstinence during the natural resolution of alcohol problems without treatment

King,M.P.; Tucker,J.A.
Psychology of Addictive Behaviors, Vol 14, Iss 1, 48-55, 2000
Abstract:
Behavior change patterns and strategies involved in natural resolutions that resulted in stable moderation drinking or abstinence were investigated, using untreated problem drinkers with different drinking statuses. Participants' drinking practices and problems, resolution patterns, behavior-change strategies, and barriers to help seeking were assessed during structured interviews. Collaterals verified participants' reports. Most abstinent resolutions were initiated abruptly. Moderation resolutions were achieved more gradually and entailed changes in drinking practices like those emphasized in behavioral self-control treatments. Participants' desire to solve their own problem and concerns about available interventions deterred help seeking, even though help was widely available. These data suggest that variability exists in how drinking problems are resolved and that interventions should support the several successful resolution patterns


Naltrexone alters subjective and psychomotor responses to alcohol in heavy drinking subjects

McCaul,M.E.; Wand,G.S.; Eissenberg,T.; Rohde,C.A.; Cheskin,L.J.
Neuropsychopharmacology, Vol 22, Iss 5, 480-492, 2000
Abstract:
Preclinical studies support endogenous opioid system involvement in alcohol reinforcement and consumption; however, recent clinical trials and human laboratory studies have provided mixed findings of the effects of naltrexone (a non-selective opioid antagonist) on alcohol responses. ngs of liking, best effects and desire to drink.


The relationships of a family history of alcohol dependence, a low level of response to alcohol and six domains of life functioning to the development of alcohol use disorders
Schuckit,M.A.; Smith,T.L.
J.Stud.Alcohol
, Vol 61, Iss 6, 827-835, 2000
Abstract:
OBJECTIVE
: Numerous biological and sociocultural factors have been proposed as potentially important to the risk for alcohol use disorders. This study evaluates the relationships to alcohol abuse or dependence of several additional potential trait and state characteristics when studied in the context of a family history of alcohol dependence (FH) and the level of response (LR) to alcohol.
METHOD
: Data were generated from the successful 15-year follow-up of 97% of 453 sons of alcohol dependent men and controls; of these, 315 men were appropriate for the current analyses. Personal interviews were used to gather data from the subjects and additional informants to study the relationships among FH, LR as determined 15 years previously, and retrospective ratings over the recent 15 years for six additional domains of life functioning. These were evaluated as correlates of a diagnosis of an alcohol use disorder in both a 3-step hierarchical and a 7-step structured series of regressions for the subjects with complete data.
RESULTS
: LR, FH and measures from all of the domains except stress had significant zero-order correlations with alcohol abuse or dependence. The hierarchical regression revealed that LR and FH remained significant when considered in the context of the five remaining domains. Both trait-like characteristics (behavioral undercontrol, alcohol expectancies and ways of coping) and state-like domains (nurturance in the social support system and the amount of drinking in the environment) added significantly to the analyses. A heuristic model of the relationship among these variables was tested in a structured series of regressions with a final R2 of 0.22. Future prospective study of the offspring of these subjects will help evaluate potential causal implications of these findings.
CONCLUSIONS
: Prospective studies, measuring both biological and environmental factors, are needed for optimal understanding of the performance of such characteristics in real-life conditions


The 5-year clinical course of high-functioning men with DSM-IV alcohol abuse or dependence

Schuckit,M.A.; Smith,T.L.; Landi,N.A.
Am.J.Psychiatry, Vol 157, Iss 12, 2028-2035, 2000

Abstract:
OBJECTIVE
: One goal of diagnostic criteria is to predict the course of clinically relevant future problems. This study evaluated the ability of the DSM-IV categories of alcohol abuse and alcohol dependence to predict the onset and cessation of the 11 DSM-IV abuse/dependence criterion items.
METHOD
: The DSM-IV categorical approach was used to determine alcohol diagnoses for 435 highly educated young adult men, who constituted 97.3% of the 447 men appropriate for this study. Structured face-to-face follow-up interviews were administered 5 years later.
RESULTS
: At the beginning of the study, 14.5% (N=63) of the subjects were alcohol dependent, 18.2% (N=79) reported alcohol abuse, and 67.4% (N=293) carried no alcohol diagnosis. Across these three diagnostic groups, 68.3%, 46.8%, and 15.4%, respectively, experienced at least one of the 11 DSM-IV abuse/dependence criterion items over the next 5 years. Only 11.4% of those who reported alcohol abuse went on to develop alcohol dependence. In addition to their diagnosis, characteristics that predicted subsequent problems with alcohol included a family history of alcoholism, higher levels of alcohol intake and a greater number of alcohol problems in the 10 years preceding the diagnosis, and a history of drug use.
CONCLUSIONS
: Even in this highly educated and high-functioning group of men, alcohol abuse and dependence predicted the onset and cessation of alcohol-related problems


Genetics of the risk for alcoholism

Schuckit,M.A.
Am.J.Addict
., Vol 9, Iss 2, 103-112, 2000
Abstract:
This paper reviews the literature on the importance of genetic influences in the development of alcohol abuse and dependence (alcoholism). The alcohol use disorders are fairly typical of most complex genetic conditions in that multiple genetic influences combine together to explain approximately 40% to 60% of the risk. One useful approach for identifying specific genes related to alcoholism involves identifying a population in which known genetic factors are controlled and using genome scan and/or case-control, association approaches to search for specific genes. Several characteristics, or endophenotypes, have been identified as both genetically influenced and contributing toward the risk for alcoholism, including alcohol-metabolizing enzymes, the low level of response to alcohol, and electrophysiological measures. The potential importance of each of these characteristics is reviewed, and data relating to the search for specific genetic material for each endophenotype are presented. These findings are placed in the perspective of the impact that they are likely to have on both prevention and treatment efforts in the alcohol field


Behavioral symptoms and psychiatric diagnoses among 162 children in nonalcoholic or alcoholic families

Schuckit,M.A.; Smith,T.L.; Radziminski,S.; Heyneman,E.K.
JA - Am.J.Psychiatry, Vol 157, Iss 11, 1881-1883, 2000
Abstract:
OBJECTIVE:
People with alcoholic relatives have high rates of alcohol abuse and dependence as adults, but their patterns of problems earlier in life are less clear. Many studies have not controlled for parental disorders other than alcoholism or for parents' socioeconomic status and general life functioning. The authors' goal was to conduct a study controlling for such factors.
METHOD
: Personal structured interviews and a behavioral checklist were administered to the parents of 162 children 7 years old or older whose fathers had participated in the 15-year follow-up of 453 sons of alcoholics with no history of antisocial personality disorder and sons of nonalcoholic comparison subjects originally selected from a university population.
RESULTS
: There was no significant relationship between a family history of alcoholism and childhood diagnoses of conduct, oppositional, or attention deficit disorders or with behavioral checklist summary scores. However, children with alcoholic relatives apparently have a slightly higher risk for drug abuse or dependence than those without alcoholic relatives.
CONCLUSIONS
: Once familial antisocial disorders and familial socioeconomic status are controlled for, a family history of alcoholism does not appear to relate to childhood externalizing disorders


Can light or moderate drinking benefit mental health?

Chick,J.
Y1 - 1999
JA - Eur.Addict.Res., Vol 5, Iss 2, 74-81, 1999
Abstract
:
Observational studies in several cultures show light and moderate drinking to be associated with better emotional and social adjustment than abstinence. However, adjustments for pre-existing personality characteristics and socialisation need to be made, and abstainers who are ex-drinkers must be excluded. There is still insufficient evidence to suggest that emotional health can be improved by light or moderate drinking. For cognition, consumption of up to 65 g/day is not associated with chronic inefficiencies. With regard to cognitive decline in older people, emerging evidence suggests the possibility that such decline may be reduced by light drinking. The elderly in institutions probably benefit from a 'social hour' when alcoholic beverage is available. Doctors considering giving advice to drink to improve health should be very cautious and note a number of caveats


Pharmacologic treatments for drug and alcohol dependence

Kranzler,H.R.; Amin,H.; Modesto-Lowe,V.; Oncken,C.
Psychiatric Clinics of North America, Vol 22, Iss 2, 401, 1999
Abstract
:
Although psychosocial methods remain the most widely used approach for the treatment of patients with substance-use disorders, pharmacotherapy has come to play an increasing role in such treatment. Individual and group counseling and 12-step programs are basic elements of most rehabilitation programs for alcohol and drug dependence. Although medications are commonly used to treat withdrawal from alcohol, sedatives, opioids, or nicotine, their role in the rehabilitation of patients dependent on these substances remains limited. Notable exceptions to this include opioid-agonist maintenance and medications used to treat comorbid psychiatric disorders in patients with a substance-used disorder. This article focuses on medications that serve to augment psychosocial therapies in the rehabilitative treatment of patients with opioid, nicotine, alcohol, and cocaine dependence


Natural resolution of alcohol problems without treatment: environmental contexts surrounding the initiation and maintenance of stable abstinence or moderation drinking

King,M.P.; Tucker,J.A.
Addict.Behav., Vol 23, Iss 4, 537-541, 1998
Abstract:
Environmental contexts surrounding the natural resolution of alcohol problems were investigated using untreated former problem drinkers who had maintained stable abstinence (n = 18) or moderation drinking (n = 17) for more than 2 years (M = 7.1 years resolved). Untreated active problem drinkers (n = 17) served as controls. During structured interviews, events were assessed retrospectively over a 4-year period that spanned the 2 years before and the 2 years after stable behavior change was initiated or over a matched recall interval for controls. Collaterals verified participant reports. Compared to nonresolved controls, both resolved groups reported improved life circumstances during the first year of maintenance, which concurs with treatment outcome studies showing that the circumstances during the posttreatment interval influence long-term outcomes. These positive changes diminished over time, however, among moderation drinkers only as their drinking remained normalized, which suggests that tolerating life changes during maintenance is a feature of successful moderation


New treatment options for substance abuse from a public health viewpoint

Sinclair,J.D.
Annals of Medicine, Vol 30, Iss 4, 406-411, 1998
Abstract:
Naltrexone is the first safe and effective pharmaceutical adjunct for use in the treatment of alcohol abuse. Theoretically it could be effective also as a means for terminating methadone maintenance and in the treatment of other forms of substance abuse. Two general types of protocols have been used with naltrexone. One protocol is similar to the protocol appropriate for use with disulfiram; it is designed to preclude use of the substance while on naltrexone. The other protocol is based on preclinical research showing that opioid antagonists can cause extinction of alcohol drinking; it is designed to maximize the effects from extinction. The results from the clinical trials are consistent with the conclusion that the major benefits from naltrexone treatment, regardless of protocol, are being caused by extinction. The extinction protocol is better from the position of public health, increasing the range of patients who can be treated, reducing the total cost and allowing patients to be treated with dignity. Pharmacological extinction is a new form of medicine, shown to be highly accessible and effective in treating excessive drinking and providing interesting possibilities for the treatment of other learned behavioural disorders


Acceptability of the controlled-drinking goal among alcohol treatment agencies in New South Wales, Australia

Donovan,M.; Heather,N.
Y1 - 1997
JA - J Stud.Alcohol, Vol 58, Iss 3, 253-256, 1997
Abstract:
OBJECTIVE
: A survey was conducted to estimate the acceptability of the controlled drinking goal among treatment services in New South Wales (NSW), Australia, and to compare results with similar surveys carried out elsewhere.
METHOD
: Of all identified alcohol treatment services (N = 295) in NSW, 179 (61%) responded to a mailed questionnaire with useable returns.
RESULTS
: Nearly three-quarters of respondents endorsed controlled drinking but half of these reported allocating less than 25% of their clients to this goal. Community-based services and alcohol treatment units were significantly more likely to endorse controlled drinking than were residential or private facilities. Community-based services and alcohol treatment units were also more likely to base the appropriateness of controlled drinking on professional experience and research evidence, whereas residential and private facilities relied more on the disease model or agency policy in making this determination. Respondents with tertiary qualifications were more likely to endorse controlled drinking than those without such qualifications, and these respondents were more likely to be found in community-based services and alcohol treatment units.
CONCLUSIONS
: The results show widespread support for the controlled drinking goal among NSW alcohol treatment services. This is similar to the reported status of controlled drinking in Britain and Norway and stands in marked contrast to the comparative reluctance of treatment services in North America to endorse the controlled drinking goal


The SECCAT Survey: II. The Alcohol Related Problems Questionnaire as a proxy for resource costs and quality of life in alcoholism treatment. Study of Socio-Economic Consequences and Costs of Alcoholism and Treatment

Patience,D.; Buxton,M.; Chick,J.; Howlett,H.; McKenna,M.; Ritson,B.
Alcohol Alcohol, Vol 32, Iss 1, 79-84, 1997
Abstract:
An interview was obtained with 212 patients who had, at a point 12 months previously, been in contact with an alcohol problems clinic. Quality of life (SF-36) was measured and for the preceding 6 months the cost of health and social service resource use was estimated, together with the total abstinent (or controlled drinking) days accrued. Alcohol related health, personal and social problems experienced during that period were elicited using a brief 11-item questionnaire, the Alcohol Related Problems Questionnaire (ARPQ). The estimate of costs correlated more strongly with the ARPQ score (r = -0.32, P = 0.0001) than with abstinent days (r = 0.03, n.s.) or controlled drinking months (r = -0.21, P = 0.002). The lack of relation of total abstinent days to cost is partly because abstainers tended to use considerable alcohol problems clinic resources. ARPQ scores indicating more problems were associated with lower quality of life. The ARPQ can serve as a proxy for resource use and quality of life in alcoholism treatment


Bait and Switch in Project Match: What NIAAA Research Actually Shows About Alcohol Treatment

Peele,S.
PsychNews International
Abstract:
Project MATCH was an extremely expensive clinical trial in which a volunteer, selected group of mainly alcohol dependent patients who had a small number of outpatient sessions of three different types of therapy with a highly trained and monitored staff reduced their drinking substantially over a year period. However, the primary purpose of the study was to show that alcoholics with different profiles will respond better to different sorts of treatment, so that overall outcomes can be improved by proper matching of alcoholics with treatment type. Project MATCH results disproved the matching hypothesis, which prominent clinical researchers had pushed for years (Allen & Kadden, 1995; IOM, 1990; Mattson, 1994; Miller, 1989).


Can we subtype alcoholism? A latent class analysis of data from relatives of alcoholics in a multicenter family study of alcoholism

Bucholz,K.K.; Heath,A.C.; Reich,T.; Hesselbrock,V.M.; Kramer,J.R.; Nurnberger,J.I.,Jr.; Schuckit,M.A.
Alcohol Clin.Exp.Res., Vol 20, Iss 8, 1462-1471
Abstract:
We attempt to identify distinctive subtypes of alcoholics using latent class analysis with data from 2551 relatives of alcoholic probands, all participants in the Collaborative Study of the Genetics of Alcoholism. Latent class analysis is a multivariate technique using cross-classified data to identify unobserved ("latent") classes that explain the relationships among observed variables. Data on 37 life-time symptoms of alcohol dependence from 1360 female and 1191 male relatives were analyzed, with a 4 class solution selected as the best fitting among the 2 through 6 class solutions that were examined. We observed the following classes: class 1, nonproblem drinkers (39.6% male, 50% female); class 2, mild alcoholics (persistent desire to stop, tolerance, and blackouts) (31.8% male, 28.7% female); class 3, moderate alcoholics (social, health, and emotional problems) (18.9% male, 14.6% female); and class 4, severely affected alcoholics (withdrawal, inability to stop drinking, craving, health, and emotional problems) (9.7% male, 6.7% female). There was little evidence for the construct of alcohol abuse; endorsement probabilities for abuse symptoms (e.g., arrest and DWIs) were very low for all classes, whereas hazardous use was common among men in class 1. In addition to those in class 3 and class 4, a majority of men in class 2 qualified for DSM-III-R alcohol dependence, suggesting a biomodal distribution of drinkers and alcoholics, with little nondependent problem drinking among men in this high-risk sample. We conclude that, in this sample, alcoholism is not differentiated by symptom profiles but rather lies on a continuum of severity, with the possible exception of withdrawal, which characterized only class 4 individuals


Recovering from an All-or-Nothing Approach to Alcohol

Peele,S.
Y1 - 1996
JF - Psychology Today
Abstract:
American attitudes toward alcohol are paradoxical: we focus almost exclusively on abstinence, yet we frequently drink to excess. Every year $2 billion is spent advertising and promoting alcohol's intoxicating nature at the same time $10 billion is used to treat people who can't handle their liquor.


Recent developments in the pharmacotherapy of alcohol dependence

Schuckit,M.A.
J Consult Clin.Psychol., Vol 64, Iss 4, 669-676, 1996
Abstract:
The effectiveness of a treatment for alcohol dependence can be appropriately determined only after controlling for the usual clinical course of alcoholism, subgroups of alcohol-dependent individuals, and placebo effects. The results of appropriate treatment trials must also be interpreted in light of the side effects and costs, and there must be assurances that the overall improvement in functioning observed with the drug is significant enough to outweigh the liabilities. In addition, medications are almost always used in combination with education, counseling, and behavioral therapies, and the impact of these additional treatments must be considered. Viewed from this perspective, 3 medications are quite promising regarding their potential future impact in the alcohol field, including naltrexone, the medication with the most available data in the United States. There are additional data regarding buspirone and acamprosate. Intriguing results have also been generated regarding medications that affect serotonin and dopamine brain activity and with alcohol-sensitizing drugs such as disulfiram. However, none of these medications has been proven to be clinically effective in the routine treatment of the average alcoholic. It is hoped that future research will help identify subgroups of alcohol-dependent men and women who are most likely to respond to specific pharmacological treatments


An 8-year follow-up of 450 sons of alcoholic and control subjects

Schuckit,M.A.; Smith,T.L.
JA - Arch.Gen.Psychiatry, Vol 53, Iss 3, 202-210, 1996
Abstract:
BACKGROUND
: Between 1978 and 1988, 453 sons (age range, 18-29 years) of alcoholic and control subject were evaluated for their level of reaction (LR) to alcohol. This article presents the results of the 8.2-year follow-up of 450 of these men. The three goals were (1) to attempt to replicate results of the follow-up of the first 223 subjects, (2) to evaluate the potential impact of the quantity and frequency of drinking at the time of the original study on the relationship between LR and alcoholic outcome (ALC), and, most importantly, (3) to test if the relationship between family history (FH) and ALC might be mediated by LR in a subset of the sample.
METHODS
: Face-to-face structured follow-up interviews were carried out with the subjects and separately with an additional informant, and blood samples, as well as urine specimens, were obtained for determination of state markers of heavy drinking and drug toxicology screens.
RESULTS
: First, the rate of development of DSM-III-R abuse and dependence on alcohol was 14.1% and 28.6%, respectively, for family history positive (FHP) subjects, compared with 6.6% and 10.8%, respectively, for family history negative (FHN) men. Second, neither consideration of the quantity nor the frequency of drinking at the time of the original study, nor their combination, effectively diminished the relationships between LR and ALC. Third, among men who drank and demonstrated the 15% highest and lowest scores of LR at about the age of 20 years (ie, 30% of the relevant population), the correlation between FH and ALC was greatly reduced when LR was considered, but the correlation between LR and ALC was not greatly diminished when the impact of FH was evaluated.
CONCLUSIONS
: In this sample of moderately functional white men, the development of alcoholism occurred in relationship to an FH of alcoholism, but alcohol abuse or dependence was unrelated to prior psychiatric disorders. For this group, LR at the age of 20 years was associated with future alcoholism in a manner that was independent of the drinking practices at the time of the original study. At least among those men with clearly high and low LR scores, these data are consistent with the conclusion that LR might be a mediator of the alcoholism risk


Alcohol challenges in young men from alcoholic pedigrees and control families: a report from the COGA project

Schuckit,M.A.; Tsuang,J.W.; Anthenelli,R.M.; Tipp,J.E.; Nurnberger,J.I.,Jr.
JA - J.Stud.Alcohol, Vol 57, Iss 4, 368-377, 1996
Abstract:
OBJECTIVE:
Alcoholism is a complex disorder that demonstrates genetic heterogeneity. Genetic linkage studies of alcohol dependence also suffer from the probability that many individuals who inherit an enhanced risk never develop the clinical syndrome. Thus, studies of genetic influences in alcohol abuse or dependence would benefit from the identification of characteristics of an individual that are associated with the probability of developing the disorder. A reduced responsivity to alcohol has been reported to characterize almost 40% of sons of alcoholics and to predict future alcohol abuse or dependence a decade later. This study explores the existence of this characteristic in a more heterogeneous sample that is part of a genetic pedigree study of families of alcoholics.
METHOD
: Eighteen to 30 year old subjects who were sons of alcohol dependent fathers and who were drinkers but not alcohol dependent were selected from pedigrees of alcoholics at all six sites of the Collaborative Study on the Genetics of Alcoholism (COGA) study. Family history negative controls matched on demography and substance use histories were selected for each subject. Data were obtained on 20 pairs of high-risk and low-risk men (40 subjects) following a challenge with 0.72 g/kg (0.9 ml/kg) of ethanol. Evaluations included measures of subjective feelings of intoxication and body sway, and changes in cortisol, ACTH and prolactin.
RESULTS
: The data corroborate a lower level of intensity of response to alcohol in the sons of alcoholics especially as measured by changes in cortisol, with similar but less robust changes in subjective feelings and other measures.
CONCLUSIONS
: The results expand upon earlier studies by using a more heterogeneous population of men at high alcoholism risk. The data highlight the possible usefulness of the reduced response to alcohol as an adjunct to future linkage analyses


Neurobehavioral aspects of the pharmacotherapy of alcohol dependence

Anton,R.F.; Kranzler,H.R.; Meyer,R.E.
Clin.Neurosci., Vol 3, Iss 3, 145-154, 1995
Abstract:
A neurobehavioral basis for the pharmacologic treatment of alcoholism is beginning to emerge. Preclinical and clinical findings have provided valuable information on which to build bridges of understanding regarding the biological causes and treatment of alcoholism. Reinforcement and stress reduction are prominent in the initiation of alcohol use, while neuroadaptation to chronic alcohol exposure and Pavlovian conditioning of alcohol-like effects appear to be involved in the development of alcohol dependence. Impulsivity may play a crucial role in the rapidity with which alcohol dependence develops. This article presents a model that attempts to integrate these neurobehavioral phenomena with neurochemical systems. The pharmacological agents that have been studied for the treatment of alcoholism are reviewed in the context of this model. While medications that affect the serotonin system have been the most widely studied for the treatment of alcoholism, their clinical effects have been modest or inconsistent. Medications that affect dopaminergic neurotransmission have received less research attention, and their potential clinical utility may be limited by their side effect profile. The most efficacious agents for the treatment of alcoholism have been the opiate antagonists, including naltrexone. Naltrexone recently received approval from the U.S. Food and Drug Administration for relapse prevention in alcoholism. A number of recent clinical and animal studies suggest potential mechanisms of action for opiate antagonists in the treatment of alcoholism. Knowledge in this field is advancing rapidly. Developments in neurobiology, coupled with improvements in both animal models of alcohol self-administration and clinical trial methodology will surely further our understanding of the pathophysiology and pharmacotherapy of alcohol dependence


Alcoholism and affective disorder: clinical course of depressive symptoms

Brown,S.A.; Inaba,R.K.; Gillin,J.C.; Schuckit,M.A.; Stewart,M.A.; Irwin,M.R.
American Journal of Psychiatry, Vol 152, Iss 1, 45-52, 1995
Abstract:
OBJECTIVE:
This study compared the severity of and the change in depressive symptoms among men with alcohol dependence, affective disorder, or both disorders during 4 weeks of inpatient treatment.
METHOD
: After their primary and secondary psychiatric disorders were defined with the use of criteria based on chronology of symptoms, 54 unmedicated men entering treatment for alcohol dependence or affective disorder were assessed for 4 consecutive weeks with the Hamilton Depression Rating Scale.
RESULTS
: The findings indicate that the rate of remission of depressive symptoms was consistent with the primary diagnosis. Depressive symptoms remitted more rapidly among the men with primary alcoholism than among those with primary affective disorder. However, a minimum of 3 weeks of abstinence from alcohol appeared to be necessary to consistently differentiate the groups with dual diagnoses on the basis of their current depressive symptoms. Alcohol dependence occurring in conjunction with primary affective disorder did not intensify presenting depressive symptoms or retard the resolution of such symptoms.
CONCLUSIONS
: Diagnoses of alcohol dependence and affective disorder based on symptom chronology appear to have prognostic significance with respect to remission of depressive symptoms in men with both diagnoses. Depressive symptoms of dysphoric mood, dysfunctional cognitions, vegetative symptoms, and anxiety/agitation showed different rates and levels of remission across the primary diagnostic groups


Effects of alcohol moderation on blood pressure and intracellular cations in mild essential hypertension

Hsieh,S.T.; Saito,K.; Miyajima,T.; Lin,C.M.; Yokoyama,M.
Am.J.Hypertens
., Vol 8, Iss 7, 693-703, 1995
Abstract:
It is known that moderation of alcohol intake reduces blood pressure, although the exact mechanism has not yet been established. To clarify the hypotensive mechanism of alcohol reduction, we evaluated the change in cellular magnesium and sodium metabolism during alcohol reduction in mild hypertensive patients. tensives. Intraerythrocyte magnesium (P < .01) and intraplatelet free magnesium (P < .05) concentrations were significantly lower in drinkers than in nondrinkers.


Acceptance of moderate drinking by alcohol treatment services in the United States

Rosenberg,H.; Davis,L.A.
J.Stud.Alcohol
, Vol 55, 167-172, 1994
Abstract:
This study was designed to survey the acceptance of moderate drinking as an outcome goal by alcohol treatment services in the United States. Of a sample of 330 randomly selected services, there were 312 potential respondents of whom 196 (63%) returned surveys that were usable. Three-quarters of respondents reported that nonabstinence was not an acceptable outcome goal for patients in their program; however, 17% of these acceptable for patients in other alcohol programs or for their own patients after discharge. Of the remaining one-quarter of respondents who found moderate drinking acceptable for their patients, 80% worked in outpatient programs and 70% reported moderate drinking as appropriate for only 1-25% of their clientele. Respondents endorsing moderate drinking rated the following factors as important when selecting outcome goals: severity of physiological dependence, drinking history, psychological dependence, previous treatment, criminal behavior and liver function test results


One-year incidence rate of major depression and other psychiatric disorders in 239 alcoholic men

Schuckit,M.A.; Irwin,M.; Smith,T.L.
Addiction, Vol 89, Iss 4, 441-445, 1994
Abstract:
The rate of depressive symptoms among alcoholics is high, but many of these syndromes appear to be alcohol-induced mood disorders and might not represent major depressive episodes independent of heavy drinking. The present study examines one aspect of the relationship between alcoholism and depression by evaluating the incidence of new episodes of major depressive disorders among alcohol-dependent men during the year following treatment. One year following discharge from an alcohol treatment program, structured face-to-face interviews were carried out with 239 primary alcoholic men, as well as additional informants. Approximately 4% of the men developed depressive episodes while drinking heavily, but only 2.1% demonstrated major depressions independent of heavy alcohol intake. There was no evidence of an increased incidence of any other major psychiatric disorder during the year of follow-up. These results are consistent with prospective studies of children of alcoholics and of longitudinal evaluations of general population samples. They do not indicate that in the present sample most primary alcohol-dependent men have elevated rates for major depressive disorders independent of alcohol-induced mood syndromes. However, it is likely that in the context of heavy drinking severe, although temporary, depressive episodes are likely to be observed


Alcohol cue exposure directed at a goal of moderate drinking

Heather,N.; Tebbutt,J.; Greeley,J.
J Behav.Ther.Exp.Psychiatry, Vol 24, Iss 2, 187-195, 1993
Abstract:
A novel form of moderation-oriented cue exposure treatment for alcohol dependence is illustrated in a single case study. Formal clinic-based cue exposure following a priming dose of the client's preferred beverage is succeeded by supervised and then unsupervised in vivo practice at resisting continued drinking in tempting situations. Improvements on a range of outcome measures seen up to 12-month follow-up were supported by the results of an analogue measure of desire to drink. The potential place of this form of treatment in the range of services offered to problem drinkers is discussed


Prediction of controlled drinking by alcoholics and problem drinkers. [Review]

Rosenberg,H.
Psychological Bulletin, Vol 113, Iss 1, 129-139, 1993
Ther.Exp.Psychiatry, Vol 24, Iss 2, 187-195, 1993
Abstract:
Recent research was reviewed on the following factors as predictors of controlled drinking (CD) by alcoholics and problem drinkers: severity of dependence, client attitudes and beliefs about controlled drinking and abstinence, previous treatment, pretreatment drinking style, psychological and social stability, demographic characteristics, family history of drinking, referral source, and posttreatment adjustment and drinking. No single personal characteristic has been consistently predictive, but there is convincing evidence that a lower severity of dependence and a persuasion that CD is possible are associated with CD after treatment. Prediction of CD might be improved by an approach that assesses the influence of three types of variables: enduring personal characteristics, changeable social and psychological characteristics, and transient precipitating events.


Subjective predictions of outcome among alcoholics

Schuckit,M.A.; Smith,T.L.; Irwin,M.;
Addiction, Vol 88, Iss 10, 1361-1367
Abstract:
This study examines the importance of Subjective Staff Ratings as predictors of the 3- and 12- month outcomes in 375 male primary alcoholic inpatients. For short-term outcome, while combinations of more usual predictors including two aspects of the pretreatment drinking history, evidence of a stable personal relationship, prior alcoholic hospitalizations, employment status, and posttreatment recovery home placement explained up to 5% of the variance on three measures of short-term outcome, Subjective Ratings alone explained up to 6%. The combination of Subjective Ratings and objective historical data explained up to 9% of the variance. The data indicate that it is difficult to accurately predict short term outcome among primary alcoholics, that the Subjective Ratings of prognosis by the treatment staff are important predictors of short-term outcome which do not overlap greatly with more traditional predictors, but that these ratings appear to add little to the longer term outcome prediction

Drugs to decrease alcohol drinking
Sinclair,J.D.
Annals of Medicne, Vol 22, Iss 5, 357-362, 1990
Abstract:
A wide variety of drugs have been tested in experimental animals and several have been found that reduce voluntary alcohol drinking. The available evidence suggested that the same drugs also reduce alcohol drinking in alcoholics. Various factors limited or prevented the clinical use of the these drugs. Our working hypothesis has been that alcohol drinking is a learned response, reinforced primarily from alcohol in the brain, and that an alcoholic is a person in which this response and the related craving have become so strong that they dominate the behaviour and interfere with normal functioning. Learned responses are extinguished if they are made repeatedly while the reinforcement is blocked, and opiate antagonists appear to block the reinforcement from alcohol. A series of experiments support the hypothesis that drinking alcohol while an antagonist is present extinguishes the alcohol-drinking response in rats. The antagonists are non-addictive and at least naloxone appears to be safe. Clinical trials are now needed, but the present results suggest that this extinction procedure might be a useful adjunct to the treatment of alcoholism

Definitions of non-abstinent and abstinent categories in alcoholism treatment outcome classifications: a review and proposal
Heather,N.; Tebbutt,J.
Drug Alcohol Depend., Vol 24, Iss 2, 83-93, 1989
Abstract:
Dispute about the relative frequencies of abstinent and non-abstinent outcomes following alcoholism treatment cannot be resolved in the absence of consensually-agreed definitions of such outcome categories. A review of influential outcome studies reveals wide differences in how controlled drinking and even abstinence have been defined and it is reasonable to suppose that this is partly responsible for striking variations in rates reported in the literature. Some requirements of a more satisfactory definitional scheme are described and a proposal made which, if accepted, might help to resolve issues relating to the frequency of non-abstinent outcomes

Evaluation of a controlled drinking minimal intervention for problem drinkers in general practice (the DRAMS scheme)
Heather,N.; Campion,P.D.; Neville,R.G.; Maccabe,D.
J R.Coll.Gen.Pract., Vol 37, Iss 301, 358-363, 1987

Effectiveness of a controlled drinking self-help manual: one-year follow-up results
Heather,N.; Robertson,I.; MacPherson,B.; Allsop,S.; Fulton,A.
Br.J Clin Psychol., Vol 26 ( Pt 4), 279-287, 1987
Abstract:
Following the description of six-month follow-up results by Heather et al. (1986), this article reports one-year follow-up for a cohort of media-recruited problem drinkers sent either a controlled drinking self-help manual or a general advice and information booklet. Among those remaining in the sample, mean reduction in drinking at six months had been retained at the one-year point. This stability of reduced consumption included respondents showing evidence of late dependence or high consumption at initial assessment. When respondents who had received other forms of treatment had been excluded, the results confirmed the superior effectiveness of the self-help manual in enabling problem drinkers to reduce consumption. Evidence for a superior outcome among respondents interviewed by telephone, rather than contacted solely by post, was again observed. Some limited evidence is presented as to the reliability and validity of self-reports of consumption in the main sample

Treatment of alcohol dependence: abstinence or controlled drinking? [editorial]
Chick,J.
JA - Br.J.Hosp.Med., Vol 36, Iss 4, 241, 1986

Treatment of alcohol dependence: abstinence or controlled drinking?
Chick,J.
Br.J.Hosp.Med
., Vol 36, Iss 4, 241, 1986

A comparison of minimal versus intensive controlled drinking treatment interventions for problem drinkers
Robertson,I.; Heather,N.; Dzialdowski,A.; Crawford,J.; Winton,M.
Br.J Clin Psychol., Vol 25 ( Pt 3), 185-104, 1986
Abstract:
Thirty-seven problem drinkers with problems of low to moderate severity were randomly allocated to two groups, one receiving 'minimal' treatment of three or four sessions' assessment and advice, and the other 'intensive' treatment of one or more of a selection of individually tailored, cognitive-behavioural therapies lasting an average of 9.1 sessions. The two groups were followed up an average of 15.5 months after termination of treatment. Analysis of covariance revealed that the intensive group reduced consumption significantly more than the minimal group. Also, the intensive group showed a significantly greater increase in the number of days abstinent in the month prior to follow-up. Analysis of covariance also showed that, in spite of their small numbers (n = 7), women increased their days abstinent by a significantly greater amount and reported a significantly greater reduction in number of days drinking between 10 and 20 units. Overall, successful outcome was associated with higher pre-treatment employment and higher alcohol consumption although, given the large numbers of measures, these findings could have occurred by chance

                           

 

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