JAMA Psychiatry: Substance Abuse/Alcoholism Topic Collection

A Prospective Assessment of Reports of Drinking to Self-medicate Mood Symptoms With the Incidence and Persistence of Alcohol Dependence Drinking to Self-medicate Mood Symptoms

Crum RM, Mojtabai R, Lazareck S, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Mood disorders and alcohol dependence frequently co-occur. Etiologic theories concerning the comorbidity often focus on drinking to self-medicate or cope with affective symptoms. However, there have been few, if any, prospective studies in population-based samples of alcohol self-medication of mood symptoms with the occurrence of alcohol dependence. Furthermore, it is not known whether these associations are affected by treatment or symptom severity.

Objective

To evaluate the hypothesis that alcohol self-medication of mood symptoms increases the probability of subsequent onset and the persistence or chronicity of alcohol dependence.

Design

Prospective study using face-to-face interviews—the National Epidemiologic Survey on Alcohol and Related Conditions.

Setting

Nationally representative survey of the US population.

Participants

Drinkers at risk for alcohol dependence among the 43 093 adults surveyed in 2001 and 2002 (wave 1); 34 653 of whom were reinterviewed in 2004 and 2005 (wave 2).

Main Outcomes and Measures

Association of alcohol self-medication of mood symptoms with incident and persistent DSM-IV alcohol dependence using logistic regression and the propensity score method of inverse probability of treatment weighting.

Results

The report of alcohol self-medication of mood symptoms was associated with an increased odds of incident alcohol dependence at follow-up (adjusted odds ratio [AOR], 3.10; 95% CI, 1.55-6.19; P = .002) and persistence of dependence (AOR, 3.45; 95% CI, 2.35-5.08; P < .001). The population-attributable fraction was 11.9% (95% CI, 6.7%-16.9%) for incident dependence and 30.6% (95% CI, 24.8%-36.0%) for persistent dependence. Stratified analyses were conducted by age, sex, race/ethnicity, mood symptom severity, and treatment history for mood symptoms.

Conclusions and Relevance

Drinking to alleviate mood symptoms is associated with the development of alcohol dependence and its persistence once dependence develops. These associations occur among individuals with subthreshold mood symptoms, with DSM-IV affective disorders, and for those who have received treatment. Drinking to self-medicate mood symptoms may be a potential target for prevention and early intervention efforts aimed at reducing the occurrence of alcohol dependence.

Brain Imaging Biomarkers to Predict Relapse in Alcohol Addiction Brain Imaging Biomarkers and Alcohol Relapse

Volkow ND, Baler RD. — Wed, 01 May 2013 00:00:00 GMT

Nearly 15 million Americans 12 years of age and older were dependent on or abused alcohol in 2010. The high prevalence of problem alcohol use worldwide has been estimated to cause 2.5 million deaths each year, not to mention the exorbitant costs associated with excess morbidity and loss of productivity. The chronic and relapsing nature of alcoholism, just like that of every other substance use disorder, is one of the major obstacles to its successful treatment. This is why the search for predictive biomarkers to help clinicians select and monitor a therapeutic course of action and to help researchers evaluate new therapeutic interventions is so urgent.

Disrupted Ventromedial Prefrontal Function, Alcohol Craving, and Subsequent Relapse Risk Disrupted vmPFC Function and Alcohol Relapse Risk

Seo D, Lacadie CM, Tuit K, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Alcohol dependence is a chronic relapsing illness; stress, alcohol-related cues, and neutral-relaxing states significantly influence craving and relapse risk. However, neural mechanisms underlying the association between these states and alcohol craving and relapse risk remain unclear.

Objectives

To identify neural correlates associated with alcohol craving and relapse outcomes in 45 treatment-engaged, 4- to 8-week abstinent alcohol-dependent (AD) patients, and to compare brain responses of 30 demographically matched AD patients and 30 healthy control subjects during stress, alcohol, and neutral-relaxing cues.

Design

Functional magnetic resonance imaging study while participants were engaging in brief individualized script-driven imagery trials of stress, alcohol cues, and neutral-relaxing scenarios, and a prospective clinical outcome design to assess alcohol relapse 90 days postdischarge from inpatient treatment in the AD group.

Settings

Inpatient treatment setting in a community mental health center and hospital-based research unit.

Patients

Forty-five recovering AD patients in inpatient treatment for examining relapse, and 30 healthy control subjects demographically matched to 30 AD patients (subgroup of the relapse sample) for group comparisons.

Intervention

Twelve-step recovery–based addiction treatment for the patient group.

Main Outcomes and Measures

Brain response, alcohol craving, and relapse outcome measures (time to relapse and relapse severity).

Results

Increased ventromedial prefrontal cortex (vmPFC) and anterior cingulate cortex (ACC) activation during neutral-relaxing trials was correlated with high alcohol cue–induced and stress-induced craving in early recovering AD patients (x = 6, y = 43, z = −6; P < .01, whole-brain corrected). This vmPFC/ACC hyperactivity significantly predicted subsequent alcohol relapse, with a hazards ratio greater than 8 for increased relapse risk. Additionally, vmPFC/ACC hyperactivation during neutral trials and reduced activity during stress trials were each predictive of greater days of alcohol used after relapse (P < .01, whole-brain corrected). In contrast, matched control subjects showed the reverse pattern of vmPFC/ACC responses to stress, alcohol cues, and relaxed trials (F = 6.42; P < .01, whole-brain corrected).

Conclusions and Relevance

Findings indicate that disrupted vmPFC/ACC function plays a role in jeopardizing recovery from alcoholism and may serve as a neural marker to identify those at risk for alcohol relapse.