Alcohol and alcoholism最新文献

{"title":"Examining alcohol use disorder recovery definitions and demographic reporting in studies of structural brain recovery: an updated systematic review and extension.","authors":"Catherine D Trinh, Alana Egan, Rachel Girard, Sydney Iacoi, Diana Ho, Emily K Carter, Nathan E Cook, Nichea S Spillane","doi":"10.1093/alcalc/agag044","DOIUrl":"10.1093/alcalc/agag044","url":null,"abstract":"<p><strong>Introduction: </strong>The National Institute on Alcohol Abuse and Alcoholism's (NIAAA) definition of recovery from alcohol use disorder (AUD) expanded from an abstinence-based model to encompass remission from AUD symptoms and cessation from heavy drinking. However, many neuroimaging studies continue to use abstinence-based definitions of recovery. Many neuroimaging studies also report limited sample demographic information and diverse participants remain underrepresented in neuroimaging research. The aims of this systematic review were to: (i) update a review by Parvaz et al. (2022) on the topic of structural changes in the prefrontal cortex, (ii) apply the NIAAA's updated definition of recovery to studies in the original review and newly identified studies, and (iii) report demographic information from all included studies.</p><p><strong>Materials and methods: </strong>The original review was extended by searching PubMed and PsycInfo for articles published between May 2021 and June 2025. Demographic reporting practices were reviewed and the Newcastle-Ottawa Quality Assessment Scale was used to assess bias in all included articles.</p><p><strong>Results: </strong>There was one newly identified study which reported cessation from heavy drinking. However, the 19 original studies were abstinence-based and did not use the updated NIAAA definition of recovery. Demographic information in the 20 included studies was largely limited to age, sex assigned at birth, and educational attainment. Reporting on additional demographic information was scarce.</p><p><strong>Conclusions: </strong>Future neuroimaging studies should examine duration of alcohol use disorder symptom remission and cessation of heavy drinking as outcomes. Moreover, studies should include additional demographic information. These efforts would align with national guidelines and advance clinical science.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"61 5","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between post-traumatic stress disorder severity, drinking motives, and unhealthy alcohol use among women veterans.","authors":"Emily P Rabinowitz, Katherine Buckheit, Victoria E Carlin, Allyson R Smith, Qiuxi Huang, Joseph W Ditre, Kyle Possemato","doi":"10.1093/alcalc/agag050","DOIUrl":"10.1093/alcalc/agag050","url":null,"abstract":"<p><strong>Objective: </strong>Unhealthy drinking, defined as patterns of alcohol use that increase risk for adverse consequences, is common among US military veterans. Post-traumatic stress disorder (PTSD) severity has been positively associated with alcohol-related consequences and, less consistently, alcohol consumption among veterans. PTSD is highly heterogeneous, with specific symptom clusters showing varying patterns of association with indices of unhealthy drinking. Drinking motives, particularly coping-related motives, have also been associated with greater alcohol-related consequences and PTSD severity. Although women are the fastest growing veteran population, extant research examining links between PTSD severity, drinking motives, and unhealthy alcohol use has predominantly focused on men. The current study examined associations between PTSD severity and clusters, drinking motives, and unhealthy alcohol use among women veterans identified in primary care.</p><p><strong>Methods: </strong>Participants included 115 women veterans recruited from a Veterans Health Administration primary care clinic who completed an online survey and endorsed trauma exposure and unhealthy drinking.</p><p><strong>Results: </strong>The re-experiencing PTSD symptom cluster was uniquely associated with greater alcohol-related consequences (b = 0.41, SE = 0.12, P < .01) and overall unhealthy drinking (b = 0.37, SE = 0.16, P = .03). Coping, conformity, and social drinking motives were associated with greater alcohol consequences. Drinking to cope moderated the association between re-experiencing symptom severity and alcohol-related consequences (b = 0.20, SE = 0.06, P < .003).</p><p><strong>Conclusions: </strong>Results indicate that re-experiencing PTSD symptoms and drinking to cope motives are associated with alcohol-related consequences and that associations between PTSD severity and alcohol-related consequences are stronger among those with higher drinking to cope motives. Future research should target coping-motivated drinking within trauma-informed alcohol interventions.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"61 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes towards addressing alcohol consumption by healthcare professionals: a cross-sectional study among older adults in the Netherlands.","authors":"Wendy Wagenaar, Andrea D Rozema, Jurre M van der Mast, Rob H L M Bovens, Jolanda J P Mathijssen","doi":"10.1093/alcalc/agag031","DOIUrl":"10.1093/alcalc/agag031","url":null,"abstract":"<p><strong>Aims: </strong>Hazardous alcohol consumption represents a substantial health risk for older adults (aged 55 and above). Although healthcare professionals play a key role in addressing alcohol consumption, findings are mixed regarding older adults' attitudes toward alcohol-related conversations with different professionals. This study examined older adults' attitudes towards alcohol-related conversations with GPs, practice nurses, district nurses and volunteers, and explored associations with socio-demographic characteristics and alcohol consumption.</p><p><strong>Methods: </strong>A cross-sectional web-based survey (N = 424) was conducted among older adults in the Netherlands, recruited via a national association. Alcohol consumption was assessed using the AUDIT-C and participants were classified as abstainers, low-risk or high-risk drinkers. Attitudes were assessed using six statements. Multivariable logistic regression examined associations between socio-demographic characteristics, alcohol consumption and attitudes.</p><p><strong>Results: </strong>Support for routinely asking about alcohol consumption was highest for GPs (60.4%, 95% CI 55.7-65.1), followed by practice nurses (55.0%, 95% CI 50.2-59.7), district nurses (46.7%, 95% CI 41.9-51.5) and volunteers (17.5%, 95% CI 13.8-21.1). Older adults aged 75 and above were more likely to view alcohol consumption as a personal matter and less likely to discuss with GPs (OR 0.66, 95% CI 0.43-1.00) or district nurses (OR 0.60, 95% CI 0.38-0.94) than those younger than 75. High-risk drinkers were less supportive of district nurses routinely addressing alcohol consumption (OR 0.54, 95% CI 0.29-0.99) than abstainers and low-risk drinkers.</p><p><strong>Conclusions: </strong>Attitudes towards alcohol-related conversations differ across professionals, with GPs viewed most favourably and volunteers least. This highlights the need to avoid treating professionals as interchangeable when addressing alcohol consumption.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"61 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretable machine learning for rare events: an inverse probability weighted application to understanding glucagon-like peptide-1 receptor agonists use and incident alcohol-related disorder.","authors":"Rinoj Gautam, Hao Wang, Bo Zhou, Rolake Neba, Usha Sambamoorthi","doi":"10.1093/alcalc/agag045","DOIUrl":"https://doi.org/10.1093/alcalc/agag045","url":null,"abstract":"<p><strong>Objective: </strong>Large administrative datasets enable investigation of rare outcomes, but accurate individual-level prediction remains challenging. Emerging evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs), used to treat diabetes and obesity, may reduce alcohol craving and intake. We examined predictors of incident alcohol-related disorder (ARD) using inverse probability-weighted (IPW) machine learning models, focusing on GLP-1 RA use.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the MarketScan Multi-State Medicaid Database (N = 96 460). Type 2 diabetic adults aged 18-64 years with GLP-1 RA prescription coverage (2022-2023) and no ARD in 2022 were included. Baseline variables included demographics, social risk factors (Z-codes), comorbidities, insurance characteristics, and GLP-1 RA use. Propensity scores were used to derive stabilized IPW weights to adjust for confounding in GLP-1 RA exposure. An Extreme Gradient Boosting model with IPW was trained using a 70/30 train-test split with five-fold cross-validation and probability calibration. Performance was evaluated using Area Under the Receiver Operating Characteristics Curve (AUROC), recall, and precision. Model interpretability was assessed using SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>GLP-1 RAs were used by 21.7% of individuals; 2.1% (N = 2004) developed incident ARD. The model demonstrated modest discrimination (AUROC = 0.67). Recall and precision were 0.28 and 0.05, respectively. SHAP analysis ranked GLP-1 RA use as the sixth most influential predictor and showed an association with lower predicted ARD risk.</p><p><strong>Conclusion: </strong>Predicting rare outcomes remains difficult, particularly for identifying positive cases. Interpretable machine learning identified GLP-1 RA use as an important feature associated with lower predicted ARD risk, warranting further investigation.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"61 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148292885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between alcohol consumption and inflammatory biomarkers in a large, diverse, community-based sample.","authors":"Shannon Scott, Shivali Mishra, Jayme M Palka, Anand Rohatgi, E Sherwood Brown","doi":"10.1093/alcalc/agag032","DOIUrl":"10.1093/alcalc/agag032","url":null,"abstract":"<p><strong>Background: </strong>Alcohol intake is linked to systemic inflammation with some studies suggesting a U-shaped relationship. However, little is known about associations between alcohol consumption and novel biomarkers like glycoprotein acetyls (GlycA) and galectin-3 (Gal-3), which may offer earlier, more stable, and more sensitive detection of inflammation.</p><p><strong>Objectives: </strong>To examine relationships between alcohol use and levels of high-sensitivity C-reactive protein (hs-CRP), GlycA, and Gal-3 in a large, diverse, community-based sample.</p><p><strong>Methods: </strong>Cross-sectional data from a community-based cohort (N = 2159) were analyzed. Alcohol use was treated both as continuous (drinks per week, DPW) and as a five-level ordinal variable (alcohol use group: never, past, light, moderate, and heavy drinkers). Analyses of covariance (ANCOVAs) compared mean inflammation levels (GlycA, Gal-3, and hs-CRP) across alcohol use groups, adjusting for covariates related to alcohol and inflammation. Linear regressions examined associations between DPW and inflammation.</p><p><strong>Results: </strong>ANCOVAs revealed a significant association between alcohol use groups and Gal-3 levels (P = .031). Post-hoc pairwise comparisons showed that past drinkers had higher Gal-3 levels than light (P = .004), moderate (P = .012), and never drinkers (P = .044). Regressions showed no significant relationships between DPW and any inflammation biomarkers.</p><p><strong>Discussion: </strong>Gal-3, but not GlycA or hs-CRP, was elevated in past drinkers compared to light, moderate, and never drinkers. These findings may reflect inflammation related to unmeasured illness among past drinkers that prompted alcohol cessation, rather than a direct alcohol effect. Future studies with longitudinal designs and objective alcohol measures are warranted to clarify causality and reduce potential self-report bias.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"61 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147939871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct association between maternal adverse childhood experiences and offspring age at initiation of regular alcohol use.","authors":"Krystle McConnell, Jessica Gleason, Edmond Shenassa","doi":"10.1093/alcalc/agag038","DOIUrl":"10.1093/alcalc/agag038","url":null,"abstract":"<p><strong>Aims: </strong>To estimate the extent to which maternal adverse childhood experiences (ACEs) predict offspring age at initiation of regular alcohol use, directly and indirectly via offspring ACEs.</p><p><strong>Methods: </strong>This was a retrospective cohort study using data collected from a nationally representative sample of mothers enrolled in the National Longitudinal Survey of Youth 1979 and their offspring who were enrolled in a separate cohort. Maternal and offspring ACEs were retrospectively self-reported. Age of initiation of regular alcohol use was collected via offspring report. We fit causal mediation models to determine associations between maternal ACEs and offspring age at initiation of regular alcohol use, including unmediated and mediated effects. Models were adjusted for generation-specific confounders. Offspring who reported living with a problem drinker or alcoholic were removed from the sample in a sensitivity analysis.</p><p><strong>Results: </strong>Among 4277 offspring born to 2326 mothers, the majority were born to mothers who reported no ACEs (58.7%), who had at least a high school education (76.6%), and were married (62.4%). For every one-unit increase in maternal ACEs, offspring engaged in regular alcohol use 0.17 years earlier, of which approximately 28.9% of the total effect [β = -0.17 (95% CI: -0.25, -0.08)] is mediated by offspring ACEs. Findings were confirmed in sensitivity analyses.</p><p><strong>Conclusion: </strong>Maternal ACEs were associated with earlier offspring regular alcohol use in a dose-dependent manner, independent of offspring ACEs, and other known intergenerational determinants of alcohol use. Maternal ACE screening and early service provision may provide a novel opportunity to delay alcohol use.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"61 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating acute and post-acute COVID-19 symptoms among patients with and without alcohol-related cirrhosis: implications for quality management.","authors":"Dhweeja Dasarathy, Jeremy W Luk, Amy M Shui, Robert J Wong, Ramsey Cheung, Alexander Monto, Michael J Ostacher, Steven L Batki, Hannah R Snyder, Michael J Peluso, Derek Satre, Mandana Khalili","doi":"10.1093/alcalc/agag043","DOIUrl":"10.1093/alcalc/agag043","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported symptoms following COVID-19 exposure have been understudied in cirrhosis. This study evaluated type, severity, and persistence of symptoms along with impact on quality of life (QOL) post-SARS-CoV-2 infection in a cohort with and without alcohol-related cirrhosis.</p><p><strong>Methods: </strong>Patients with cirrhosis receiving care in hepatology clinics at three institutions were surveyed for symptoms and liver disease QOL (LDQOL) using standardized instruments following SARS-CoV-2 infection. Acute (<30 days), post-acute (≥30 days since onset), and Long COVID (≥3 months) symptoms were compared by cirrhosis etiology and decompensated status. Associations between severe COVID-19 symptoms and LDQOL were examined using multivariable models.</p><p><strong>Results: </strong>156 patients with prior COVID-19 exposure had a median age of 66.5 years; 18% were female; 43% had alcohol-related liver disease (ALD); and 42% decompensated cirrhosis. Among 208 surveys conducted, the median (Q1, Q3) number of symptoms reported was 6 (3, 10), with 66% reporting at least one severe/very severe symptom and 21% had Long COVID. There were no significant differences in symptoms by cirrhosis etiology or decompensation except those with ALD had higher post-acute symptoms compared to non-ALD (RR 2.17, P = .04). Moreover, the total number of severe symptoms was inversely associated with LDQOL. For each additional severe symptom reported, LDQOL decreased by 1.12 points after adjusting for age, sex, ALD, decompensated cirrhosis, and MELD-Na score (95% CI -1.70 to -0.53, P = .001).</p><p><strong>Conclusions: </strong>Assessing severity and persistence of post-COVID-19 exposure symptoms can help clinicians address patient-reported QOL concerns, optimize cirrhosis management, and inform integrated care for ALD and AUD.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"61 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Song audio features are associated with the presence of alcohol references in popular music lyrics.","authors":"Gedefaw D Alen, Emmanuel Kuntsche, Dan Anderson-Luxford, Zhen He, Benjamin Riordan","doi":"10.1093/alcalc/agag041","DOIUrl":"10.1093/alcalc/agag041","url":null,"abstract":"<p><strong>Aims: </strong>Preliminary evidence suggests that exposure to alcohol-related content in popular music is associated with drinking behaviour, especially amongst young people. Guided by Uses and Gratifications Theory, which posits that audiences select music to satisfy psychological and social needs, alcohol references, and specific audio features may co-occur as part of shared emotional and social experiences. This study assessed whether song audio features are associated with alcohol references in lyrics and whether they could support population-level surveillance of alcohol-related media exposure.</p><p><strong>Methods: </strong>We analyzed 6110 Billboard Top 100 songs released between 1959 and 2020, extracting Spotify audio features for each track. Logistic regression models were used to examine associations between audio features and the presence of alcohol references in lyrics.</p><p><strong>Results: </strong>Alcohol references were found in 16.1% of songs, with prevalence increasing significantly over time. Songs with higher danceability (OR = 1.35, P < .001), speechiness (OR = 1.39, P < .001), liveness (OR = 1.09, P = .021), positive valence (OR = 1.11, P = .041) and major mode (OR = 1.18, P = .042) more likely to contain alcohol references. Higher acousticness (OR = 0.82, P < .001) and instrumentalness (OR = 0.85, P = .015) were associated with lower odds. Loudness, tempo, and energy were not significantly associated.</p><p><strong>Conclusions: </strong>Audio features may help identify songs more likely to contain alcohol references in music and may have potential utility for monitoring alcohol-related messaging across large volumes of popular music. Such tools could complement broader public health efforts to reduce alcohol exposure, especially amongst young people.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"61 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13256229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Day-to-day links between negative affect, distress intolerance, and alcohol use.","authors":"Korine B Cabrera, Kathleen M Palm Reed","doi":"10.1093/alcalc/agag051","DOIUrl":"https://doi.org/10.1093/alcalc/agag051","url":null,"abstract":"<p><strong>Objective: </strong>Negative reinforcement models theorize that state negative affect should predict alcohol use; however, research examining the relationship between heightened negative affect and same-day drinking has produced equivocal results. Focusing on alcohol craving, a psychological mechanism that has clear implications on behavior, as an outcome may help elucidate this process. Further, it may be that an individual's ability to tolerate distress associated with negative affect drives cravings for alcohol to alleviate such emotions. Thus, the goal of this study was to investigate the extent to which state-level distress intolerance mediates associations between negative affect and alcohol craving and use using a longitudinal daily diary design among a diverse, national sample of drinkers.</p><p><strong>Methods: </strong>One week of daily diary data from 82 participants (n = 530 observations) endorsing problematic past-year alcohol use were analyzed using a multilevel mediation model.</p><p><strong>Results: </strong>Day-to-day fluctuations in negative affect were significantly associated with heightened distress intolerance and alcohol craving, but not consumption. Multilevel mediation analyses revealed that, controlling for participants' average levels of negative affect and distress intolerance, day-to-day distress intolerance mediated the relation between negative affect and alcohol craving.</p><p><strong>Conclusions: </strong>Elevated state distress intolerance is a proximal risk factor for heightened alcohol craving among people with a range of alcohol use severity. This study underscores the importance of conceptualizing and assessing distress intolerance as a state-level construct. Findings also emphasize the need to focus on craving to better understand processes that drive alcohol use from a negative reinforcement model perspective.</p><p><strong>Public health significance statement: </strong>Individuals who have difficulty managing daily stress or negative emotions may experience stronger urges to drink alcohol. This study demonstrates that momentary intolerance of distress helps explain the link between negative emotions and alcohol craving. Interventions aimed at improving in-the-moment distress tolerance may help reduce alcohol cravings and, in turn, lower the risk of problematic drinking.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"61 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of risk factors associated with phenobarbital dose escalation for the treatment of alcohol withdrawal in the critically ill.","authors":"Madison Puryear, Adam Smith, Bruce Doepker, David Kasick, Demond Handley, BrookeAnne Magrum","doi":"10.1093/alcalc/agag040","DOIUrl":"10.1093/alcalc/agag040","url":null,"abstract":"<p><strong>Aims: </strong>While there are risk stratification tools for alcohol withdrawal syndrome (AWS), there are no well-established risk factors associated with phenobarbital escalation; the primary aim was to identify risk factors associated with needing phenobarbital dose escalation for AWS management.</p><p><strong>Methods: </strong>This single-center, retrospective, cohort study evaluated adult patients with diagnosed AUD admitted to a surgical or medical intensive care unit of a large academic medical center within 24 hours of the initial phenobarbital dose for AWS management if admitted between 1 December 2021 and 1 December 2024.</p><p><strong>Results: </strong>This study included 169 patients, 54 (32.0%) required dose escalation. The univariable analysis demonstrated that patients in the dose escalation group had a significantly higher percentage of preceding Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised scores (CIWA-Ar) scores ≥15, required more concomitant continuous infusion sedation, higher body mass indexes, and shorter times between phenobarbital administration and detectable blood alcohol levels, mechanical ventilation, and hospital admission. In a final multivariable logistic regression model, CIWA-Ar score ≥ 15 (OR: 2.41, (95% CI: 1.25-4.69; P = 0.008) was the only variable helping predict phenobarbital dose escalation.</p><p><strong>Conclusion: </strong>Based on our analysis, elevated CIWA-Ar scores may be the best predictor of phenobarbital dose escalation to treat severe AWS in the critically ill. These findings reinforce the importance of early intervention and dynamic clinical reassessment of phenobarbital dosing in the management of patients with AWS. Further prospective clinical trials are needed to assess risk factors in patients that require escalated treatment for AWS.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"61 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}