Articles of Public Interest

IF 2.7 Q2 SUBSTANCE ABUSE
{"title":"Articles of Public Interest","authors":"","doi":"10.1111/acer.70167","DOIUrl":null,"url":null,"abstract":"<p>The authors of a new study have identified distinct personality profiles of people with impulsivity, with different attributes that influence whether a person engages in, or avoids, high-risk drinking. The study suggests that the link between impulsivity and high-risk drinking is more nuanced than commonly understood. The profiles, described in <i>Alcohol: Clinical and Experimental Research</i>, may give health care providers a framework to personalize interventions more effectively to prevent harms related to alcohol use.</p><p>People with impulsive personalities tend to be highly emotionally reactive or act without sufficiently considering potential consequences. Impulsivity is associated with high-risk drinking and substance use, but not all impulsive individuals engage in problem drinking. Researchers for this study sought to identify any particular characteristics of impulsive personalities that distinguished those who engage in risky drinking behaviors from those who do not.</p><p>Two hundred participants recently treated for psychiatric symptoms underwent comprehensive assessments of personality traits, cognitive function, psychological symptoms, risk-taking behaviors, and alcohol consumption patterns. Analyzing all the data, researchers identified three personality profiles. A ‘low risk’ profile had low levels of both impulsivity and alcohol use disorder. An ‘emotionally reactive’ profile was highly impulsive but had low levels of alcohol use disorder symptoms. And a ‘high risk’ profile, had both high impulsivity and high levels of alcohol use disorder symptoms.</p><p>Each profile displayed distinguishing characteristics that guide clinical treatment to reduce the risk of problematic alcohol use. For example, the emotionally reactive group scored higher in neuroticism and lower in conscientiousness, suggesting interventions targeting emotion regulation, such as cognitive-behavioral therapy. Individuals in this group also scored higher on ‘fun-seeking’ and may better engage with interventions that incorporate novelty and stimulation. The high-risk group exhibited cognitive deficits on performance-based tasks reflective of impairments in decision-making and reward sensitivity, which are associated with substance use disorders. Treatment tailored to this group might include cognitive remediation therapies to improve deficits in memory, attention, problem-solving, and executive function.</p><p>The findings suggest that incorporating personality assessments into personalized treatment plans that address individual differences in personality and cognitive ability may more effectively prevent and treat problem alcohol use.</p><p>Profiles of impulsivity and alcohol use: Unveiling personality, cognitive traits, and DSM diagnoses. C. Lau, D. Downie, R. M. Bagby, B. G. Pollock, A. C. Ruocco, L. Quilty. (https://doi.org/10.1111/acer.70116)</p><p>Medication for Alcohol Use Disorder (AUD) drops precipitously during pregnancy and is rarely resumed following delivery, according to an analysis of a large cohort of adults treated for AUD. In recent years, binge drinking and AUD rates during pregnancy have increased significantly in the United States, eclipsing even opioids. Evidence-based treatments for AUD include medications and counseling. Still, these are underused, including during pregnancy when both the health of the parent and the development of the fetus are at risk from alcohol consumption. This reflects, in part, the absence of clinical treatment guidelines, insufficient data on the safety of AUD medicines for the fetus, and stigma around substance use during pregnancy. For the study in <i>Alcohol: Clinical &amp; Experimental Research</i>, investigators drew from an extensive national medical claims database to explore rates of medicinal and psychosocial treatments for AUD before, during, and after pregnancy.</p><p>To understand how alcohol medication receipt compared between pregnant and non-pregnant patients who were receiving treatment for AUD, the authors matched 2,080 pregnant people with 7,564 non-pregnant peers. They subsequently tracked—trimester by trimester—receipt of alcohol medications in pregnant patients, comparing discontinuation rates in the pregnant population with rates during the equivalent period in non-pregnant patients. The authors found that in the 12 weeks before conception (and an equivalent timeframe for non-pregnant participants), 12% of the pregnant participants and 13% of the non-pregnant participants received medication for AUD, respectively. For both groups, the rate of alcohol medication receipt fell during pregnancy (or its equivalent period in non-pregnant peers); however, the observed decline was far more dramatic in the pregnant cohort. By the third trimester (or equivalent), 0.3% of pregnant people and 8% of nonpregnant people were receiving AUD medication, respectively. The rates of alcohol medication receipt for people who had given birth rose marginally in the 12 weeks following delivery.</p><p>The authors concluded that, in contrast to the concept of pregnancy as a window of opportunity for healthy behavior change, these data suggest that pregnancy may instead predict AUD treatment discontinuation. The study revealed major gaps in AUD treatment during pregnancy and the postpartum period, and highlighted opportunities for improving outcomes.</p><p>Discontinuation of treatment for alcohol use disorder during pregnancy and postpartum in the United States. C. Martin, J. Bello-Kottenstette, B. M. Galati, J. L. Buss, M. Terplan, H. Jones, K. T. Mitchell, S. Martins, R. Grucza, E. A. Suarez, K. Y. Xu. (https://doi.org/10.1111/acer.70117)</p><p>Changes in unhealthy alcohol use over time can be measured by a simple questionnaire at annual primary care visits. A study published in <i>Alcohol: Clinical and Experimental Research</i> found that in a primary care population that is regularly screened for alcohol use, decreased alcohol use scores are associated with reduced utilization of urgent care, emergency department, or inpatient treatments for mental health concerns. The findings may encourage clinicians to advise patients of the benefits of reducing their drinking and incentivize health care systems to invest in treatments for unhealthy alcohol use.</p><p>Prior studies have shown a clear association between alcohol use and acute mental health care utilization. The AUDIT-C is a validated questionnaire that patients are often asked to complete at their primary care visits to screen for unhealthy levels of alcohol use at that point in time. This study found that looking at changes in the AUDIT-C scores from one year to the next can identify changes in risk for acute mental health care utilization.</p><p>Researchers examined electronic health records of more than 100,000 patients. They found that those who had one- or two-category decreases in AUDIT-C scores from one year to the next (i.e., those who decreased their drinking) had significant reductions in mental health acute care utilization. Those who had stable scores from the first to the second AUDIT-C screening (i.e., those who had no change in drinking) had similar rates of utilization. These findings suggest that cutting down on drinking may be beneficial, even if people are not ready to stop drinking completely. Other studies have found that decreases in alcohol use are also associated with decreases in other health-related concerns, such as anxiety, depression, liver disease, hospitalization for any reason, and death.</p><p>These findings have implications for health care providers and insurers. Namely, primary care teams should follow changes in AUDIT-C scores over time and can advise patients of the mental health benefits of reducing drinking. Further, the findings might incentivize health care systems and insurers to integrate physical and mental healthcare when treating unhealthy alcohol use to improve patient health and reduce costs associated with expensive hospital-based mental health care.</p><p>The association between changes in AUDIT-C scores and acute mental health care utilization over the next year in a primary care population. M. L. Lee, H. Jack, T. E. Matson, M. Oliver, J. Bobb, D. Berger, K. Bradley, K. Hallgren. (https://doi.org/10.1111/acer.70125)</p><p>Alcohol withdrawal is associated with positive changes in the composition and function of the gut microbiome, improving our understanding of the gut's influence on physiological and behavioral health, including alcohol craving, a new study suggests. Current research may lead to new targets and probiotic treatments for alcohol use disorder (AUD). Dangerous drinking patterns are associated with negative changes in the gut microbiome, which are implicated in brain inflammation and unhealthy behaviors (such as impaired sociability in people with AUD, and depression and anxiety). Previous investigations suggest certain gut bacteria indirectly influence alcohol craving. For the study in Alcohol: Clinical &amp; Experimental Research, scientists in Germany focused on butyrate, an anti-inflammatory molecule and one of the short-chain fatty acids involved in regulating appetite and possibly alcohol craving.</p><p>Researchers worked with 63 people with AUD undergoing withdrawal therapy over 10-14 days, analyzing their blood and stool. They used metagenomic (“shotgun sequencing”) and statistical analysis to explore associations between changes to the microbiome and alcohol craving.</p><p>During alcohol withdrawal therapy, participants’ bacterial load increased, their gut microbiota composition became more like that of healthy people, and their alcohol cravings diminished. Researchers observed increases in certain bacteria that have anti-inflammatory properties, support butyrate production, and appear linked to psychological health. Changes in the abundance of several bacteria correlated with shifting levels of interleukins (ILs, proteins involved in the immune response, such as inflammation). The participants’ improved potential to synthesize butyrate likely led to higher butyrate levels, with the potential for more effective appetite regulation. In addition, declining levels of IL-8 point to its role in brain inflammation associated with alcohol craving and drinking. Decreasing levels of a particular bacterium suggest that it is linked to alcohol use.</p><p>The study helps illuminate connections between the gut and the brain that influence physical and mental health. The findings add to evidence that butyrate affects alcohol craving, possibly via its role in regulating appetite, and may be a potential therapeutic target. They highlight the association between certain interleukins, specific microbiome composition, and some disease outcomes, with inflammation potentially mediating the link between the gut microbiome and alcohol craving.</p><p>The effect of alcohol withdrawal therapy on gut microbiota in alcohol use disorder and its link to inflammation and craving. P. Proskynitopoulos, S. Woltemate, M. Rhein, I. Böke, J. Molks, S. Schröder, S. Bleich, H. Frieling, R. Geffers, A. Glahn, M. Vital. 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引用次数: 0

Abstract

The authors of a new study have identified distinct personality profiles of people with impulsivity, with different attributes that influence whether a person engages in, or avoids, high-risk drinking. The study suggests that the link between impulsivity and high-risk drinking is more nuanced than commonly understood. The profiles, described in Alcohol: Clinical and Experimental Research, may give health care providers a framework to personalize interventions more effectively to prevent harms related to alcohol use.

People with impulsive personalities tend to be highly emotionally reactive or act without sufficiently considering potential consequences. Impulsivity is associated with high-risk drinking and substance use, but not all impulsive individuals engage in problem drinking. Researchers for this study sought to identify any particular characteristics of impulsive personalities that distinguished those who engage in risky drinking behaviors from those who do not.

Two hundred participants recently treated for psychiatric symptoms underwent comprehensive assessments of personality traits, cognitive function, psychological symptoms, risk-taking behaviors, and alcohol consumption patterns. Analyzing all the data, researchers identified three personality profiles. A ‘low risk’ profile had low levels of both impulsivity and alcohol use disorder. An ‘emotionally reactive’ profile was highly impulsive but had low levels of alcohol use disorder symptoms. And a ‘high risk’ profile, had both high impulsivity and high levels of alcohol use disorder symptoms.

Each profile displayed distinguishing characteristics that guide clinical treatment to reduce the risk of problematic alcohol use. For example, the emotionally reactive group scored higher in neuroticism and lower in conscientiousness, suggesting interventions targeting emotion regulation, such as cognitive-behavioral therapy. Individuals in this group also scored higher on ‘fun-seeking’ and may better engage with interventions that incorporate novelty and stimulation. The high-risk group exhibited cognitive deficits on performance-based tasks reflective of impairments in decision-making and reward sensitivity, which are associated with substance use disorders. Treatment tailored to this group might include cognitive remediation therapies to improve deficits in memory, attention, problem-solving, and executive function.

The findings suggest that incorporating personality assessments into personalized treatment plans that address individual differences in personality and cognitive ability may more effectively prevent and treat problem alcohol use.

Profiles of impulsivity and alcohol use: Unveiling personality, cognitive traits, and DSM diagnoses. C. Lau, D. Downie, R. M. Bagby, B. G. Pollock, A. C. Ruocco, L. Quilty. (https://doi.org/10.1111/acer.70116)

Medication for Alcohol Use Disorder (AUD) drops precipitously during pregnancy and is rarely resumed following delivery, according to an analysis of a large cohort of adults treated for AUD. In recent years, binge drinking and AUD rates during pregnancy have increased significantly in the United States, eclipsing even opioids. Evidence-based treatments for AUD include medications and counseling. Still, these are underused, including during pregnancy when both the health of the parent and the development of the fetus are at risk from alcohol consumption. This reflects, in part, the absence of clinical treatment guidelines, insufficient data on the safety of AUD medicines for the fetus, and stigma around substance use during pregnancy. For the study in Alcohol: Clinical & Experimental Research, investigators drew from an extensive national medical claims database to explore rates of medicinal and psychosocial treatments for AUD before, during, and after pregnancy.

To understand how alcohol medication receipt compared between pregnant and non-pregnant patients who were receiving treatment for AUD, the authors matched 2,080 pregnant people with 7,564 non-pregnant peers. They subsequently tracked—trimester by trimester—receipt of alcohol medications in pregnant patients, comparing discontinuation rates in the pregnant population with rates during the equivalent period in non-pregnant patients. The authors found that in the 12 weeks before conception (and an equivalent timeframe for non-pregnant participants), 12% of the pregnant participants and 13% of the non-pregnant participants received medication for AUD, respectively. For both groups, the rate of alcohol medication receipt fell during pregnancy (or its equivalent period in non-pregnant peers); however, the observed decline was far more dramatic in the pregnant cohort. By the third trimester (or equivalent), 0.3% of pregnant people and 8% of nonpregnant people were receiving AUD medication, respectively. The rates of alcohol medication receipt for people who had given birth rose marginally in the 12 weeks following delivery.

The authors concluded that, in contrast to the concept of pregnancy as a window of opportunity for healthy behavior change, these data suggest that pregnancy may instead predict AUD treatment discontinuation. The study revealed major gaps in AUD treatment during pregnancy and the postpartum period, and highlighted opportunities for improving outcomes.

Discontinuation of treatment for alcohol use disorder during pregnancy and postpartum in the United States. C. Martin, J. Bello-Kottenstette, B. M. Galati, J. L. Buss, M. Terplan, H. Jones, K. T. Mitchell, S. Martins, R. Grucza, E. A. Suarez, K. Y. Xu. (https://doi.org/10.1111/acer.70117)

Changes in unhealthy alcohol use over time can be measured by a simple questionnaire at annual primary care visits. A study published in Alcohol: Clinical and Experimental Research found that in a primary care population that is regularly screened for alcohol use, decreased alcohol use scores are associated with reduced utilization of urgent care, emergency department, or inpatient treatments for mental health concerns. The findings may encourage clinicians to advise patients of the benefits of reducing their drinking and incentivize health care systems to invest in treatments for unhealthy alcohol use.

Prior studies have shown a clear association between alcohol use and acute mental health care utilization. The AUDIT-C is a validated questionnaire that patients are often asked to complete at their primary care visits to screen for unhealthy levels of alcohol use at that point in time. This study found that looking at changes in the AUDIT-C scores from one year to the next can identify changes in risk for acute mental health care utilization.

Researchers examined electronic health records of more than 100,000 patients. They found that those who had one- or two-category decreases in AUDIT-C scores from one year to the next (i.e., those who decreased their drinking) had significant reductions in mental health acute care utilization. Those who had stable scores from the first to the second AUDIT-C screening (i.e., those who had no change in drinking) had similar rates of utilization. These findings suggest that cutting down on drinking may be beneficial, even if people are not ready to stop drinking completely. Other studies have found that decreases in alcohol use are also associated with decreases in other health-related concerns, such as anxiety, depression, liver disease, hospitalization for any reason, and death.

These findings have implications for health care providers and insurers. Namely, primary care teams should follow changes in AUDIT-C scores over time and can advise patients of the mental health benefits of reducing drinking. Further, the findings might incentivize health care systems and insurers to integrate physical and mental healthcare when treating unhealthy alcohol use to improve patient health and reduce costs associated with expensive hospital-based mental health care.

The association between changes in AUDIT-C scores and acute mental health care utilization over the next year in a primary care population. M. L. Lee, H. Jack, T. E. Matson, M. Oliver, J. Bobb, D. Berger, K. Bradley, K. Hallgren. (https://doi.org/10.1111/acer.70125)

Alcohol withdrawal is associated with positive changes in the composition and function of the gut microbiome, improving our understanding of the gut's influence on physiological and behavioral health, including alcohol craving, a new study suggests. Current research may lead to new targets and probiotic treatments for alcohol use disorder (AUD). Dangerous drinking patterns are associated with negative changes in the gut microbiome, which are implicated in brain inflammation and unhealthy behaviors (such as impaired sociability in people with AUD, and depression and anxiety). Previous investigations suggest certain gut bacteria indirectly influence alcohol craving. For the study in Alcohol: Clinical & Experimental Research, scientists in Germany focused on butyrate, an anti-inflammatory molecule and one of the short-chain fatty acids involved in regulating appetite and possibly alcohol craving.

Researchers worked with 63 people with AUD undergoing withdrawal therapy over 10-14 days, analyzing their blood and stool. They used metagenomic (“shotgun sequencing”) and statistical analysis to explore associations between changes to the microbiome and alcohol craving.

During alcohol withdrawal therapy, participants’ bacterial load increased, their gut microbiota composition became more like that of healthy people, and their alcohol cravings diminished. Researchers observed increases in certain bacteria that have anti-inflammatory properties, support butyrate production, and appear linked to psychological health. Changes in the abundance of several bacteria correlated with shifting levels of interleukins (ILs, proteins involved in the immune response, such as inflammation). The participants’ improved potential to synthesize butyrate likely led to higher butyrate levels, with the potential for more effective appetite regulation. In addition, declining levels of IL-8 point to its role in brain inflammation associated with alcohol craving and drinking. Decreasing levels of a particular bacterium suggest that it is linked to alcohol use.

The study helps illuminate connections between the gut and the brain that influence physical and mental health. The findings add to evidence that butyrate affects alcohol craving, possibly via its role in regulating appetite, and may be a potential therapeutic target. They highlight the association between certain interleukins, specific microbiome composition, and some disease outcomes, with inflammation potentially mediating the link between the gut microbiome and alcohol craving.

The effect of alcohol withdrawal therapy on gut microbiota in alcohol use disorder and its link to inflammation and craving. P. Proskynitopoulos, S. Woltemate, M. Rhein, I. Böke, J. Molks, S. Schröder, S. Bleich, H. Frieling, R. Geffers, A. Glahn, M. Vital. (https://doi.org/10.1111/acer.70128)

Abstract Image

公共利益物品
作者的结论是,与怀孕是健康行为改变的机会之窗的概念相反,这些数据表明,怀孕可能预示着AUD治疗的中断。该研究揭示了孕期和产后AUD治疗的主要差距,并强调了改善结果的机会。美国孕期和产后酒精使用障碍的中止治疗C. Martin, J. Bello-Kottenstette, B. M. Galati, J. L. Buss, M. Terplan, H. Jones, K. T. Mitchell, S. Martins, R. Grucza, E. A. Suarez, K. Y. Xu(https://doi.org/10.1111/acer.70117)Changes)可以在每年的初级保健就诊时通过简单的问卷调查来衡量长期以来不健康饮酒的情况。发表在《酒精:临床与实验研究》上的一项研究发现,在定期进行酒精使用筛查的初级保健人群中,酒精使用评分降低与紧急护理、急诊科或精神健康问题住院治疗的使用减少有关。这一发现可能会鼓励临床医生建议患者减少饮酒的好处,并激励医疗保健系统投资于治疗不健康的酒精使用。先前的研究表明,酒精使用与急性精神保健利用之间存在明确的关联。AUDIT-C是一份经过验证的问卷,患者经常被要求在初级保健就诊时填写,以筛查当时不健康的酒精使用水平。本研究发现,观察每年AUDIT-C评分的变化,可以识别急性精神卫生保健使用风险的变化。研究人员检查了10万多名患者的电子健康记录。他们发现,从一年到下一年,那些在AUDIT-C得分中有一到两项下降的人(即那些减少饮酒的人)在心理健康急症护理方面的使用率显著降低。那些在第一次到第二次审计- c筛选中得分稳定的人(即那些饮酒没有变化的人)的使用率相似。这些发现表明,减少饮酒可能是有益的,即使人们还没有准备好完全戒酒。其他研究发现,酒精使用的减少也与其他健康相关问题的减少有关,如焦虑、抑郁、肝病、因任何原因住院和死亡。这些发现对卫生保健提供者和保险公司有启示意义。也就是说,初级保健团队应该跟踪AUDIT-C评分随时间的变化,并可以向患者建议减少饮酒对心理健康的好处。此外,研究结果可能会激励医疗保健系统和保险公司在治疗不健康的酒精使用时将身心健康结合起来,以改善患者的健康状况,并降低与昂贵的医院精神卫生保健相关的成本。在初级保健人群中,审计- c评分变化与来年急性精神卫生保健利用之间的关系M. L. Lee, H. Jack, T. E. Matson, M. Oliver, J. Bobb, D. Berger, K. Bradley, K. Hallgren。(https://doi.org/10.1111/acer.70125)Alcohol一项新的研究表明,戒断与肠道微生物群的组成和功能的积极变化有关,提高了我们对肠道对生理和行为健康的影响的理解,包括对酒精的渴望。目前的研究可能会导致酒精使用障碍(AUD)的新靶点和益生菌治疗。危险的饮酒模式与肠道微生物群的负面变化有关,这与脑部炎症和不健康行为(如AUD患者的社交能力受损、抑郁和焦虑)有关。先前的研究表明,某些肠道细菌会间接影响对酒精的渴望。在《酒精:临床与实验研究》杂志上的这项研究中,德国的科学家们把重点放在了丁酸盐上。丁酸盐是一种抗炎分子,也是一种短链脂肪酸,与调节食欲和可能的酒精渴望有关。研究人员对63名AUD患者进行了10-14天的戒断治疗,分析了他们的血液和粪便。他们使用宏基因组(“霰弹枪测序”)和统计分析来探索微生物组变化与酒精渴望之间的关系。在戒酒治疗期间,参与者的细菌负荷增加了,他们的肠道微生物群组成变得更像健康人,他们对酒精的渴望也减少了。研究人员观察到某些细菌的增加,这些细菌具有抗炎特性,支持丁酸盐的产生,似乎与心理健康有关。几种细菌丰度的变化与白细胞介素(il,参与免疫反应的蛋白质,如炎症)水平的变化有关。 参与者合成丁酸盐的潜力的提高可能导致更高的丁酸盐水平,从而更有效地调节食欲。此外,IL-8水平的下降表明它在与酒精渴望和饮酒相关的脑部炎症中起作用。一种特定细菌水平的下降表明它与饮酒有关。这项研究有助于阐明肠道和大脑之间影响身心健康的联系。这一发现进一步证明,丁酸盐可能通过调节食欲来影响对酒精的渴望,可能是一种潜在的治疗靶点。他们强调了某些白细胞介素、特定微生物组组成和某些疾病结局之间的联系,炎症可能介导肠道微生物组和酒精渴望之间的联系。酒精戒断治疗对酒精使用障碍患者肠道微生物群的影响及其与炎症和渴望的联系P. Proskynitopoulos, S. Woltemate, M. Rhein, I. Böke, J. Molks, S. Schröder, S. Bleich, H. Frieling, R. Geffers, A. Glahn, M. Vital。(https://doi.org/10.1111/acer.70128)
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