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BackgroundAlcohol use disorders (AUD) can lead to poor health outcomes. Little is known about AUD treatment among persons with HIV (PWH). In an integrated health system in Northern California, 2014-2017, we compared AUD treatment rates between PWH with AUD and persons without HIV (PWoH) with AUD.MethodsUsing Poisson regression with GEE, we estimated prevalence ratios (PRs) comparing the annual probability of receiving AUD treatment (behavioral intervention or dispensed medication), adjusted for sociodemographics, psychiatric comorbidities, insurance type, and calendar year. Among PWH, we examined independent AUD treatment predictors using PRs adjusted for calendar year only.ResultsPWH with AUD (N = 633; 93% men, median age 49) were likelier than PWoH with AUD (N = 7006; 95% men, median age 52) to have depression (38% vs. 21%) and a non-alcohol substance use disorder (SUD, 48% vs. 25%) (both P

Background: Psychotic-like experiences (PLEs) are common in the general population and have been linked to alcohol misuse and abuse. However, much of this research has been undertaken in Western countries. To address this deficit, the current study examined the association between PLEs and problem drinking in the Japanese general population., Methods: Data were used from 3717 adults (age 18-89) collected in an online survey in 2023. Information was obtained on PLEs with the PRIME Screen-Revised (PS-R), while problem drinking was assessed with the CAGE questionnaire (where a score of ≥ 2 was used to categorize cases). Logistic regression was used to examine the associations., Results: Problem drinking was prevalent in the study sample (12.5%). In an analysis that was adjusted for sociodemographic factors, self-rated health, smoking status and depressive symptoms, PLEs were associated with significantly higher odds for problem drinking in the total sample (OR: 1.70, 95%CI: 1.13-2.55). In a sex-stratified analysis PLEs were not linked to problem drinking in men (OR: 1.16, 95%CI 0.68-2.00), whereas women with PLEs had over 2.8 times higher odds for problem drinking (OR: 2.83, 95%CI: 1.54-5.21)., Conclusion: PLEs are associated with problem drinking in the Japanese general population and this association is especially pronounced in women. As problem drinking has been linked to a number of detrimental outcomes, future research should examine the potential effects of problem drinking in individuals with PLEs., Competing Interests: Declaration of Competing Interest No conflict declared, (Copyright © 2024. Published by Elsevier B.V.)

BackgroundNon-dependent alcohol and substance use patterns are prevalent among men who have sex with men (MSM), yet few effective interventions to reduce their substance use are available for these men. We evaluated whether an adapted brief counseling intervention aimed at reducing HIV risk behavior was associated with secondary benefits of reducing substance use among episodic substance-using MSM (SUMSM).Methods326 episodic SUMSM were randomized to brief Personalized Cognitive Counseling (PCC) intervention with rapid HIV testing or to rapid HIV testing only control. Both arms followed over 6 months. Trends in substance use were examined using GEE Poisson models with robust standard errors by arm. Reductions in frequency of use were examined using ordered logistic regression.ResultsIn intent-to-treat analyses, compared to men who received rapid HIV testing only, we found men randomized to PCC with rapid HIV testing were more likely to report abstaining from alcohol consumption (RR=0.93; 95% CI=0.89-0.97), marijuana use (RR=0.84; 95% CI=0.73-0.98), and erectile dysfunction drug use (EDD; RR=0.51; 95% CI=0.33-0.79) over the 6-month follow-up. PCC was also significantly associated with reductions in frequency of alcohol intoxication (OR=0.58; 95% CI=0.36-0.90) over follow-up. Furthermore, we found PCC was associated with significant reductions in number of unprotected anal intercourse events while under the influence of methamphetamine (RR=0.26; 95% CI=0.08-0.84).ConclusionThe addition of adapted PCC to rapid HIV testing may have benefits in increasing abstinence from certain classes of substances previously associated with HIV risk, including alcohol and EDD; and reducing alcohol intoxication frequency and high-risk sexual behaviors concurrent with methamphetamine use.

BackgroundThis study examined the concurrent and predictive validity of Type A/B alcohol dependence in the general population-a typology developed in clinical populations to gauge severity of dependence.MethodsData were drawn from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The sample included 1,172 alcohol-dependent drinkers at baseline who were reinterviewed three years later. Latent class analysis was used to derive Type A/B classification using variables replicating the original Type A/B typology. Predictive validity of the Type A/B classification was assessed by multivariable linear and logistic regressions.ResultsA two-class solution consistent with Babor's original Type A/B typology adequately fit the data. Type B alcoholics in the general population, compared to Type As, had higher alcohol severity and more co-occurring drug, mental, and physical health problems. In the absence of treatment services utilization, Type B drinkers had two times the odds of being alcohol dependent three years later. Among those who utilized alcohol treatment services, Type B membership was predictive of heavy drinking and drug dependence, but not alcohol dependence, three years later.ConclusionsFindings suggest that Type A/B classification is both generalizable to, and valid within, the US general population of alcohol dependent drinkers. Results highlight the value of treatment for mitigating the persistence of dependence among Type B alcoholics in the general population. Screening for markers of vulnerability to Type B dependence could be of clinical value for health care providers to determine appropriate intervention.

BackgroundThere is limited data on the impact of anti-retroviral treatment (ART) initiation on alcohol consumption. We characterized predictors of abstaining from alcohol among HIV-infected individuals following ART initiation.MethodsWe analyzed data from a prospective cohort of HIV-infected adults in Mbarara, Uganda with quarterly measures of self-reported alcohol consumption, socio-demographics, health status, and blood draws. We used pooled logistic regression to evaluate predictors of becoming abstinent from alcohol for at least 90 days after baseline.ResultsAmong the 502 participants, 108 (21.5%) were current drinkers who consumed alcohol within 90 days of baseline, 206 (41.0%) were former drinkers, and 188 (37.5%) were lifetime abstainers at baseline. Among current drinkers, 67 (62.0%) drank at hazardous levels. 90 of current drinkers (83.3%) abstained from alcohol at least for 90 days over 3.6 median years of follow-up [IQR 2-4.8]; of those 69 (76.7%) remained abstinent for a median duration of follow-up of 3.25 years [1.6-4.5]. Becoming abstinent was independently associated with lower baseline AUDIT score (adjusted odds ratio [AOR] 0.95 [95%CI 0.91-0.99]), baseline physical health score (AOR 0.92 [0.87-0.97]), and decreases in physical health score at follow-up visits (AOR 0.92 [0.88-0.97)). Alcohol abstinence was most likely to start immediately after ART initiation (AORs for 6 month versus 3 month visit: 0.25 [0.10-0.61]; 9 month visit or later versus 3 month visit: 0.04 [0.02-0.09]).ConclusionsWe found that a large majority of drinkers starting ART reported that they became and remained abstinent from alcohol. ART initiation may be an opportune time to implement interventions for alcohol consumption and other health behaviors.

BackgroundAltered interoception, i.e., processing of stimuli from inside the body, has been considered an important component of drug-taking behavior. However, approaches to examine interoceptive sensitivity in humans have been limited. This study examined the hypothesis that adolescents with substance use disorder show altered interoceptive processing, measured by stimulating mechano-receptive C-fibers (MR-CF) via soft touch.MethodsAdolescents with substance use disorders (SUD, n=15) and comparison youth (CON, n=17) underwent functional magnetic resonance imaging (fMRI) during anticipation or reception of a positively valenced "Soft Touch" consisting of MR-CF stimulation to the palm or forearm. Visual analog scales (VAS) indexed subjective interoceptive experience (e.g., pleasantness, intensity).ResultsAcross all conditions, SUD displayed attenuated left posterior insula activation compared to CON. Greater left anterior insula and right lentiform nucleus activation was evident during the application of soft touch for SUD but not for CON. Whereas for CON, greater left anterior insula activation was associated with higher pleasantness ratings, pleasantness was linked to less anterior insula activation in SUD. Finally, within SUD, attenuated posterior insula activation was related to more recent cannabis use.ConclusionsSUD adolescents exhibit blunted somatovisceral processing of pleasant stimulation, heightened sensitivity in regions responsible for processing reward value, and altered relationships between interoceptive processing and subjective experience.

BackgroundOnly a minority of individuals who have substance use disorders receives treatment, and those who do typically have more severe disorders. The current study examines the relationship of help-seeking with remission from alcohol and/or drug dependence and other outcomes.MethodsData from the Wave 1 (2001-2002) and Wave 2 (2004-2005) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used to examine remission at Wave 2 among respondents who had past-year substance dependence disorders at Wave 1 (N=1262). Multi-group structural equation modeling was used to compare individuals with (n=356) and without (n=906) prior help-seeking at Wave 1 on subsequent help-seeking and other factors that influence outcomes.ResultsBaseline help-seekers sought help at higher levels over the follow-up period (31% vs. 8%) and had lower rates of remission (50% vs. 68%), as compared with those without prior help-seeking, respectively. Among baseline help-seekers, there were stronger relationships between baseline stress and mental disorders and having sought help since baseline; age and past-year level of stress at follow-up; level of stress and health status at follow-up; and social support and mental disorders at follow-up. Among baseline non-help-seekers, there were stronger relationships between being female and past-year stress at follow-up, and between having sought help since baseline and physical health status at follow-up.ConclusionsFindings extend our understanding of the factors associated with recovery from substance dependence, including "natural recovery", use of services outside of addiction treatment, and gender differences in help-seeking and remission.

BackgroundAlcohol use is an important but understudied HIV risk factor among men who have sex with men (MSM), particularly in Latin America. We studied the relationship between problem drinking and sexual risk among MSM in Lima, Peru.MethodsWe recruited 718 participants from 24 neighborhoods for a study on sexually transmitted infections and community-building among MSM. Multivariate analysis was used to identify factors independently associated with problem drinking, which was defined via the CAGE Questionnaire.ResultsOf 718 participants, 58% met criteria for problem drinking. In univariate analysis, problem drinkers were significantly more likely to report failing to always use condoms, use alcohol or drugs prior to their most recent sexual encounter, report a history of sexual coercion and to engage in transactional sex. Problem drinkers also reported significantly higher numbers of recent and lifetime sexual partners. In multivariate analysis, factors independently associated with problem drinking included a history of sexual coercion [OR 1.8 95%, CI 1.2-2.6], having consumed alcohol prior to the most recent sexual encounter [OR 2.1 95%, CI 1.5-2.9], receiving compensation for sex in the last six months [OR 1.6, 95% CI 1.1-2.2] or having reported a prior HIV+ test [OR 0.5, 95% CI 0.2-0.9].DiscussionWe found a high prevalence of problem drinking among MSM in Lima, Peru, which was associated with increased sexual risk in our study. Of note, individuals who were already HIV-infected were less likely to be problem drinkers. Further studies and targeted interventions to reduce problem drinking among MSM are warranted.

BackgroundAlthough comorbid substance misuse is common in alcohol dependence, and polysubstance abusers (PSU) represent the largest group of individuals seeking treatment for drug abuse today, we know little about potential brain abnormalities in this population. Brain magnetic resonance spectroscopy studies of mono-substance use disorders (e.g., alcohol or cocaine) reveal abnormal levels of cortical metabolites (reflecting neuronal integrity, cell membrane turnover/synthesis, cellular bioenergetics, gliosis) and altered concentrations of glutamate and γ-aminobutyric acid (GABA). The concurrent misuse of several substances may have unique and different effects on brain biology and function compared to any mono-substance misuse.MethodsHigh field brain magnetic resonance spectroscopy at 4 T and neurocognitive testing were performed at one month of abstinence in 40 alcohol dependent individuals (ALC), 28 alcohol dependent PSU and 16 drug-free controls. Absolute metabolite concentrations were calculated in anterior cingulate (ACC), parieto-occipital (POC) and dorso-lateral prefrontal cortices (DLPFC).ResultsCompared to ALC, PSU demonstrated significant metabolic abnormalities in the DLPFC and strong trends to lower GABA in the ACC. Metabolite levels in ALC and light drinking controls were statistically equivalent. Within PSU, lower DLPFC GABA levels are related to greater cocaine consumption. Several cortical metabolite concentrations were associated with cognitive performance.ConclusionsWhile metabolite concentrations in ALC at one month of abstinence were largely normal, PSU showed persistent and functionally significant metabolic abnormalities, primarily in the DLPFC. Our results point to specific metabolic deficits as biomarkers in polysubstance misuse and as targets for pharmacological and behavioral PSU-specific treatment.

BackgroundHeavy alcohol consumption has been associated with risk-taking behaviors in intravenous drug users (IDU). However, limited information exists on the relationship between alcohol use and injecting and sexual risk in young adult IDU (

Background: Functional MRI visual cue reactivity studies have not considered that brain responses to various alcohol-containing beverage types may vary as a function of an individual's drinking patterns and preferences. This study tested whether the brain's reward system responds differently to visual cues associated with an individuals' most commonly consumed ("preferred") alcohol beverage compared with less commonly consumed ("non-preferred") alcohol beverages in individuals with alcohol use disorder (AUD)., Methods: Participants (N=70) with current AUD completed a standard visual alcohol cue reactivity procedure during fMRI and reported recent alcohol use through the Timeline Followback interview. Alcohol use patterns were used to infer drink preference. Repeated measure ANCOVAs were used to evaluate differences in subjective craving (alcohol urge) and neural reactivity to cues of individual's "preferred" versus "non-preferred" alcohol beverages., Results: Fifty-four (77%) participants were determined to have a "preferred" alcohol beverage, as defined by their pattern of alcohol use. These participants reported greater subjective alcohol urge (p=0.02) and activation in the anterior cingulate cortex (ACC) (p=0.005) and medial prefrontal cortex (mPFC) (p=0.001)) in response to visual cues associated with their "preferred" versus "non-preferred" alcohol beverage. Individuals with an alcohol preference did not differ from those with no alcohol preference on subjective or neural responses to their "preferred" and "non-preferred" alcohol cues., Discussion: Results suggest alcohol cue-elicited subjective and neural responses vary as a function of alcohol beverage preference in individuals with AUD and a behaviorally defined alcohol preference. Stronger ACC and mPFC activation may reflect greater subjective value of an individual's "preferred" alcohol beverage cue., Competing Interests: Declaration of Competing Interest No conflict of interest declared., (Copyright © 2024. Published by Elsevier B.V.)

BackgroundPersonalized treatment for psychopathologies, in particular alcoholism, is highly dependent upon our ability to identify patterns of genetic and environmental effects that influence a person's risk. Unfortunately, array-based whole genome investigations into heritable factors that explain why one person becomes dependent upon alcohol and another does not, have indicated that alcohol's genetic architecture is highly complex. That said, uncovering and interpreting the missing heritability in alcohol genetics research has become all the more important, especially since the problem may extend to our inability to model the cumulative and combinatorial relationships between common and rare genetic variants. As numerous studies begin to illustrate the dependency of alcohol pharmacotherapies on an individual's genotype, the field is further challenged to identify new ways to transcend agnostic genomewide association approaches. We discuss insights from genetic studies of alcohol related diseases, as well as issues surrounding alcohol's genetic complexity and etiological heterogeneity. Finally, we describe the need for innovative systems-based approaches (systems genetics) that can provide additional statistical power that can enhance future gene-finding strategies and help to identify heretofore-unrealized mechanisms that may provide new targets for prevention/treatments efforts. Emerging evidence from early studies suggest that systems genetics has the potential to organize our neurological, pharmacological, and genetic understanding of alcohol dependence into a biologically plausible framework that represents how perturbations across evolutionarily robust biological systems determine susceptibility to alcohol dependence.

BackgroundLittle is known about the effects of alcohol dependence on cortical concentrations of glutamate (Glu) or gamma aminobutyric acid (GABA). We used proton magnetic resonance spectroscopy (MRS) to study cross-sectionally and longitudinally the concentrations of these in alcohol dependent individuals (ALC) during early abstinence from alcohol.MethodsTwenty ALC were studied at about one week of abstinence from alcohol (baseline) and 36 ALC at five weeks of abstinence and compared to 16 light/non-drinking controls (LD). Eleven ALC were studied twice during abstinence. Participants underwent clinical interviewing, blood work, neuropsychological testing, structural imaging and single-volume proton MRS at 4Tesla. Absolute concentrations of Glu, GABA and those of other (1)H MRS-detectable metabolites were measured in the anterior cingulate (ACC), parieto-occipital cortex (POC) and dorso-lateral prefrontal cortex (DLPFC). Relationships of metabolite levels to drinking severity and neurocognition were also assessed.ResultsALC at baseline had lower concentrations of Glu, N-acetylaspartate (NAA), choline- (Cho) and creatine-containing metabolites (Cr) than LD in the ACC, but had normal GABA and myo-inositol (mI) levels. At five weeks of abstinence, metabolite concentrations were not significantly different between groups. Between one and five weeks of abstinence, Glu, NAA and Cho levels in the ACC increased significantly. Higher cortical mI concentrations in ALC related to worse neurocognitive outcome.ConclusionThese MRS data suggest compromised and regionally specific bioenergetics/metabolism in one-week-abstinent ALC that largely normalizes over four weeks of sustained abstinence. The correlation between mI levels and neurocognition affirms the functional relevance of this putative astrocyte marker.

BackgroundThis study examined stability of remission in patients who were abstainers and non-problem users at 1-year after entering private, outpatient alcohol and drug treatment. We examined: (a) How does risk of relapse change over time? (b) What was the risk of relapse for non-problem users versus abstainers? (c) What individual, treatment, and extra-treatment characteristics predicted time to relapse, and did these differ by non-problem use versus abstinence?MethodsThe sample consisted of 684 adults in remission (i.e., abstainers or non-problem users) 1 year following treatment intake. Participants were interviewed at intake, and 1, 5, 7, 9, and 11 years after intake. We used discrete-time survival analysis to examine when relapse is most likely to occur and predictors of relapse.ResultsRelapse was most likely at 5-year, and least likely at 11-year follow-up. Non-problem users had twice the odds of relapse compared to abstainers. Younger individuals and those with fewer 12-step meetings and shorter index treatment had higher odds of relapse than others. We found no significant interactions between non-problem use and the other covariates suggesting that significant predictors of outcome did not differ for non-problem users.ConclusionsNon-problem use is not an optimal 1-year outcome for those in an abstinence-oriented, heterogeneous substance use treatment program. Future research should examine whether these results are found in harm reduction treatment and self-help models, or in those with less severe problems. Results suggest treatment retention and 12-step participation are prognostic markers of long-term positive outcomes for those achieving remission at 1 year.

BackgroundThe treatment of alcohol and other drugs is now more commonly framed in terms of a chronic condition which requires ongoing monitoring. A model which includes continuing access to health care may optimize outcomes. Most studies of chronic care models have not included health care and have only examined short term effects.MethodsThe sample (n = 783) included consecutive admissions in ten public and private alcohol and other drug (AOD) treatment programs followed over seven years. The outcome was remission which was defined as alcohol and drug abstinence or non-problem use.ResultsIn the private sample, receiving health care services predicted remission across the seven years; however this did not occur in the public sample. More patients in the public treatment sample received AOD treatment readmissions each year, while more of those in the private sector received psychiatric and general health visits. Except for drug problem severity, there were no other clinical differences between the samples. There were no differences in the proportions of patients in the two sectors who received the full spectrum of chronic care services. In the final models, 12-step participation was markedly significant for both samples.ConclusionsModels of chronic care for substance use need to consider differences between private and public treatment and should take into account that individuals may not always have access, or avail themselves of services that may optimize long-term outcomes.

This study examined the association between stopping smoking at 1 year after substance use treatment intake and long-term substance use outcomes. Nine years of prospective data from 1185 adults (39% female) in substance use treatment at a private health care setting were analyzed by multivariate logistic generalized estimating equation models. At 1 year, 14.1% of 716 participants who smoked cigarettes at intake reported stopping smoking, and 10.7% of the 469 non-smokers at intake reported smoking. After adjusting for sociodemographics, substance use severity and diagnosis at intake, length of stay in treatment, and substance use status at 1 year, those who stopped smoking at 1 year were more likely to be past-year abstinent from drugs, or in past-year remission of drugs and alcohol combined, at follow-ups than those who continued to smoke (OR=2.4, 95% CI: 1.2-4.7 and OR=1.6, 95% CI: 1.1-2.4, respectively). Stopping smoking at 1 year also predicted past-year alcohol abstinence through 9 years after intake among those with drug-only dependence (OR=2.4, 95% CI: 1.2-4.5). We found no association between past-year alcohol abstinence and change in smoking status at 1 year for those with alcohol dependence or other substance use diagnoses when controlling for alcohol use status at 1 year. Stopping smoking during the first year after substance use treatment intake predicted better long-term substance use outcomes through 9 years after intake. Findings support promoting smoking cessation among smoking clients in substance use treatment.

This study examined the association between stopping smoking at 1 year after substance use treatment intake and long-term substance use outcomes. Nine years of prospective data from 1185 adults (39% female) in substance use treatment at a private health care setting were analyzed by multivariate logistic generalized estimating equation models. At 1 year, 14.1% of 716 participants who smoked cigarettes at intake reported stopping smoking, and 10.7% of the 469 non-smokers at intake reported smoking. After adjusting for sociodemographics, substance use severity and diagnosis at intake, length of stay in treatment, and substance use status at 1 year, those who stopped smoking at 1 year were more likely to be past-year abstinent from drugs, or in past-year remission of drugs and alcohol combined, at follow-ups than those who continued to smoke (OR=2.4, 95% CI: 1.2-4.7 and OR=1.6, 95% CI: 1.1-2.4, respectively). Stopping smoking at 1 year also predicted past-year alcohol abstinence through 9 years after intake among those with drug-only dependence (OR=2.4, 95% CI: 1.2-4.5). We found no association between past-year alcohol abstinence and change in smoking status at 1 year for those with alcohol dependence or other substance use diagnoses when controlling for alcohol use status at 1 year. Stopping smoking during the first year after substance use treatment intake predicted better long-term substance use outcomes through 9 years after intake. Findings support promoting smoking cessation among smoking clients in substance use treatment.

BackgroundMethadone-maintained (MM) clients who engage in excessive alcohol use are at high risk for HIV and hepatitis B virus (HBV) infection. Nurse-led hepatitis health promotion (HHP) may be one strategy to decrease alcohol use in this population.ObjectiveTo evaluate the impact of nurse-led HHP, delivered by nurses compared to motivational interviewing (MI), delivered by trained therapists in group sessions or one-on-one on reduction of alcohol use.MethodsA three-arm randomized, controlled trial, conducted with 256 MM adults attending one of five MM outpatient clinics in the Los Angeles area. Within each site, moderate-to-heavy alcohol-using MM participants were randomized into one of three conditions: (1) nurse-led hepatitis health promotion group sessions (n=87); (2) MI delivered in group sessions (MI-group; n=79), or (3) MI delivered one-on-one sessions (MI-single, n=90).ResultsSelf-reported alcohol use was reduced from a median of 90 drinks/month at baseline to 60 drinks/month at 6-month follow-up. A Wilcoxon sign-rank test indicated a significant reduction in alcohol use in the total sample (p

This prospective study (n=190) examined correlates of alcohol use from baseline data of a longitudinal trial conducted among moderate and heavy alcohol users receiving methadone maintenance therapy (MMT). The sample included MMT clients who were 18-55 years of age, and were receiving MMT from five large methadone maintenance clinics in the Los Angeles area. Half of the sample was heavy drinkers and nearly half (46%) reported heroin use. Using a structured questionnaire, correlates of heavy alcohol use included White and Hispanic ethnicity, and fair or poor physical health combined with older age (> or =50 years). We also found that MMT clients who were younger than 50 years, regardless of health status, were more likely to be heavy drinkers. Compared with moderate alcohol consumers, a greater number of heavy alcohol users also experienced recent victimization. To optimize MMT, alcohol screening should be part of routine assessment and alcohol treatment should be made available within MMT programs. Moreover, special consideration should be provided to the most vulnerable clients, such as the younger user, those with a long-term and current history of heavy drug use, and those victimized and reporting fair or poor health. In addition, promoting attention to general physical and mental health problems within MMT programs may be beneficial in enhancing health outcomes of this population.

Although the dramatic rise of methamphetamine use in the general population has been well-documented, little is known about methamphetamine use in the homeless population. This study examines self-reported methamphetamine use and its correlates among a sample of 664 urban homeless adults in Los Angeles. Over one-quarter of the overall sample, and 60% of whites, disclosed lifetime methamphetamine use. Less than 10% of African-Americans reported ever using methamphetamine. Approximately one-tenth of respondents reported current methamphetamine use; almost 90% of current users shared straws to snort methamphetamine and half used it daily. Logistic regression analysis in younger (18-39) and older (40+) respondents revealed that white ethnicity, polydrug use and binge drinking were independently associated with lifetime methamphetamine use, regardless of age. Injection drug use (IDU) was also an important correlate of methamphetamine use for older African-Americans. IDU was not important for the younger group. Findings suggest that there is need for greater surveillance of methamphetamine use among homeless whites and Hispanics, and methamphetamine-use prevention and reduction targeted to younger, polydrug-using, alcohol-binging homeless adults.

Objective: Growing evidence suggests an abnormal metabolism of kynurenine in individuals with alcohol use disorder (AUD). This systematic review and meta-analysis was aimed at assessing the possible differences in kynurenine metabolites between individuals with AUD and controls., Methods: We searched PubMed, Embase, and Web of Science databases and included any clinical studies comparing the peripheral blood levels of at least one metabolite, between individuals with AUD and controls without AUD. Random-effects meta-analyses were conducted to generate pooled standardized mean differences (SMD). Subgroup analyses and meta-regression analyses were conducted., Results: A total of seven eligible studies with 572 participants were included. The peripheral blood levels of kynurenine (SMD = 0.58; p = 0.004) along with the ratio of kynurenine and tryptophan (SMD = 0.73; p = 0.002) were higher in individuals with AUD, while kynurenic acid levels (SMD = -0.81; p = 0.003) were reduced in individuals with AUD compared to controls. The peripheral blood levels of tryptophan along with the ratio of kynurenic acid and kynurenine were unaltered. Subgroup analyses confirmed these results., Conclusion: Our results suggested a shift in the tryptophan metabolism to the kynurenine pathway and a down-regulation of the potentially neuroprotective kynurenic acid in individuals with AUD., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Acute alcohol responses such as tolerance to alcohol-induced motor impairment and heightened sensitivity to alcohol-induced disinhibition are associated with heavier drinking. Additionally, certain cognitive characteristics may also indicate problem-drinking. For example, cognitive and emotional preoccupation (CEP) with alcohol is associated with heavier drinking. However, it is not clear if cognitive markers have value as predicators of heavier drinking beyond that of well-established alcohol response markers. The current study sought to test the predictive potential of CEP in the context of two well-documented alcohol response markers of heavy drinking., Methods: Data aggregated from three studies comprised a sample of 94 young adult drinkers with no history of alcohol use disorder. Participants' motor coordination (grooved pegboard) and behavioral disinhibition (cued go/no-go) were assessed following consumption of 0.65g/kg alcohol and a placebo. CEP was measured via the Temptation and Restraint Inventory (TRI)., Results: Drinkers who expressed both alcohol response markers reported drinking higher doses regardless of their level of CEP. Among drinkers who expressed low sensitivity to both disinhibition and motor impairment, higher CEP was associated with higher typical quantities. Low sensitivity to motor impairment functioned as a standalone marker of heavier drinking., Conclusions: The findings suggest that a combination of tolerance to motor impairment and high alcohol-induced disinhibition may be sufficient to promote heavier consumption even in the absence of cognitive markers associated with problem drinking. Results also suggest that cognitive characteristics may drive early drinking and contribute to the development of tolerance to acute alcohol effects., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: This study aimed to test the causal effect of different text message interventions on reducing alcohol consumption indirectly by altering desire to get drunk., Methods: Participants were young adults randomized to interventions with different behavior change techniques: self-monitoring alone (TRACK); pre-drinking plan feedback (PLAN); post-drinking alcohol consumption feedback (USE); pre- and post-drinking goal feedback (GOAL); and a combination of techniques (COMBO) who completed at least 2 days of both pre- and post-drinking assessments over 12 weeks of intervention exposure. On the two days per week they planned to drank alcohol, participants were asked to report desire to get drunk (0 "none" to 8 "completely"). The next day, participants reported drinking quantity. Outcomes included binge drinking (defined as 4+ drinks for a woman and 5+ drinks for a man) and drinks per drinking day. Mediation was tested using path models of simultaneous between-person and within-person effects using maximum likelihood estimation., Results: At the between-person level, controlling for race and baseline AUDIT-C and within-person associations, 35.9 % of the effects of USE and 34.4 % of the effects of COMBO on reducing binge drinking were mediated through desire to get drunk. 60.8 % of the effects of COMBO on reducing drinks per drinking day were mediated through desire to get drunk. We did not find significant indirect effects for any other text-message intervention., Discussion: Findings support the hypothesized mediation model where desire to get drunk partially mediates the effects of a text message intervention using a combination of behavior change techniques on reducing alcohol consumption., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Brian Suffoletto reports financial support was provided by National Institute on Alcohol Abuse and Alcoholism. Tammy Chung reports financial support was provided by National Institute on Alcohol Abuse and Alcoholism., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The cannabinoid cannabidiol (CBD) is currently under investigation as a pharmacotherapy for alcohol use disorder. The aim of the present study was to examine whether acute and chronic treatment with pure CBD would decrease alcohol seeking and consumption behaviors or alter drinking patterns in male baboons with extensive histories of daily alcohol intake (1 g/kg/day)., Methods: Seven male baboons self-administered oral alcohol (4% w/v) in a validated chained schedule of reinforcement (CSR) procedure that modeled periods of anticipation, seeking, and consumption. In Experiment 1, CBD (5-40 mg/kg) or vehicle (peanut oil, USP) was administered orally 15- or 90-minutes prior to the start of the session. In Experiment 2, oral doses of CBD (10-40 mg/kg) or vehicle were administered for 5 consecutive days during ongoing alcohol access under the CSR. In addition, behavioral observations were conducted to assess potential drug side effects (e.g., sedation, motor incoordination) following chronic CBD treatment immediately after the session and 24-hours after drug administration., Results: Across both experiments, baboons self-administered an average of 1 g/kg/day of alcohol under baseline conditions. Administration of acute or chronic CBD (150-1200 mg total CBD dose/day) that encompassed the purported therapeutic dose range did not significantly reduce alcohol seeking, self-administration or intake (g/kg). Drinking patterns (i.e., number of drinks/bouts, bout duration, nor interdrink interval) also were not altered. There were no observable behavioral disruptions following CBD treatment., Conclusions: In sum, the current data do not support use of pure CBD as an effective pharmacotherapy to reduce ongoing excessive drinking., Competing Interests: Conflict of interest EW and CM have received funds from MyMD pharmaceuticals, Inc. and MIRA-1 Pharmaceuticals, Inc for contract preclinical research. EW received support for clinical research projects funded by Cultivate Biologics LLC, and Canopy Growth Corp. The research reported in the manuscript is not related to the above contracted research. CAZ has no conflicts to report., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Growing evidence indicates that the crosstalk between the central nervous system and the periphery plays an important role in the pathophysiology of neuropsychiatric conditions, including addictive disorders. Fibroblast growth factor 21 (FGF21) is part of the liver-brain axis and regulates energy homeostasis, metabolism, and macronutrient intake. In addition, FGF21 signaling modulates alcohol intake and preference, and changes in FGF21 levels are observed following alcohol consumption. To further elucidate the relationship between alcohol use and FGF21, we assessed serum FGF21 concentrations in 16 non-treatment seeking individuals with alcohol use disorder (AUD) in a naturalistic outpatient setting, as well as a controlled laboratory experiment that included alcohol cue-reactivity, alcohol priming, and alcohol self-administration in a bar-like setting. FGF21 levels were stable during the outpatient phase when participants received placebo and had no significant lifestyle changes. During the bar-like laboratory experiment, a robust increase in serum FGF21 concentrations was found after the 2-hr alcohol self-administration session (F 3, 49 = 23.39, p < 0.001). Percent change in FGF21 levels positively correlated with the amount of alcohol self-administered but did not reach statistical significance. No significant changes in FGF21 levels were found after exposure to alcohol cues or consuming the priming drink. Given the bidirectional link between FGF21 and alcohol, targeting the FGF21 system may be further examined as a potential pharmacotherapy for AUD., Competing Interests: Conflict of interest None., (Published by Elsevier B.V.)

Purpose: To test the efficacy of two interventions to reduce alcohol use and increase viral suppression compared to a control in persons with HIV (PWH)., Methods: In a three-arm (1:1:1) randomized controlled trial (N = 269), we compared in-person counselling (45-70 minutes, two sessions over three months) with interim monthly booster phone calls (live call arm) or twice-weekly automated booster sessions (technology arm) to a brief advice control arm. We enrolled PWH self-reporting unhealthy alcohol use (Alcohol Use Disorders Identification Test - Consumption, prior three months, women ≥3, men ≥4). Primary outcomes were number of self-reported drinking days (NDD) in the prior 21 and biomarker phosphatidylethanol (PEth) at six and nine months and viral suppression (<40 copies/mL) at nine months; we adjusted for sex and baseline outcomes., Results: At baseline, mean 21-day NDDs were 9.4 (95 % CI: 9.1-9.8), mean PEth was 407.8 ng/mL (95 % CI: 340.7-474.8), and 89.2 % were virally suppressed. At follow-up, there were significant reductions in mean NDDs for the live call versus control arm (3.5, 95 % CI:2.1-4.9, p < 0.001) and for the technology versus control arm (3.6, 95 % CI: 2.2-5.1, p < 0.001). The mean PEth differences compared to the control arm were not significant, i.e. 36.4 ng/mL (95 % CI: -117.5 to 190.3, p = 0.643) for the live call and -30.9 ng/mL (95 % CI: -194.8 to 132.9, p = 0.711) for the technology arm. Nine-month viral suppression compared to the control was similar in the live call and in the technology arm., Conclusion: Intervention effects were found on self-reported NDD but not PEth or viral suppression, suggesting no treatment effect. (NCT #03928418)., Competing Interests: Conflict of interest Dr. Hahn received consulting fees from Pear Therapeutics in 2022., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Sex-related steroid hormones and proteins may contribute to the sex differences in the characteristics and health consequences of alcohol use disorder. This study aimed to examine the associations between alcohol dependence (AD) and sex-related hormones/proteins using a population-based dataset., Methods: We retrieved serum total testosterone (TT) and estradiol (TE2), sex hormone binding globulin (SHBG), and albumin levels along with clinical data from the UK Biobank. Hormone/protein levels were compared between AD (lifetime AD and/or related diagnoses; 2218 males; 682 females) and control (no aforementioned diagnoses and AUDIT<8; 198,058 males; 250,830 females) groups with sex-dependent linear regression models adjusting for age and body mass index. Moderation and mediation analyses were performed to test whether SHBG was a moderator and/or mediator between hormones and AD or current drinking., Results: AD males had higher TT, TE2, and SHBG levels but lower bioavailable testosterone, bioavailable estradiol, and albumin levels than controls (p adjusted <0.001). After adjusting for menopause, AD females had higher TT and lower albumin levels than controls (p adjusted <0.001). These differences remained after accounting for current drinking frequency (p < 0.001). SHBG moderated TT's effect on AD in males (p interaction <0.001). SHBG was a positive mediator between TT and AD in both sexes and between TE2 and AD in males (p < 0.001), but a negative mediator between TT and current drinking in controls (both sexes) and AD males (p < 0.001)., Conclusions: Testosterone and estradiol levels are altered in males and females with AD distinctly regardless of current drinking frequency. SHBG may play a critical role in these associations., Competing Interests: Declaration of Competing Interest No conflict declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Alcohol use disorder is associated with difficulties in emotion regulation and cognitive reappraisal. Family history of harmful alcohol use increases risk of substance use disorders, but no studies have examined whether family history is associated with altered neural activation during cognitive reappraisal relative to passive viewing of negative images in a sample of young adults without current substance use disorders., Methods: Participants (N = 75 with positive [n = 31] or negative [n = 44] family histories of harmful alcohol use) completed the emotion regulation task during an MRI scan, and the Emotion Regulation Questionnaire to assess use of emotion regulation and suppression strategies. Whole-brain analyses and amygdala region of interest analyses using linear mixed-effects models assessed family history group and cue effects on neural activation during the task., Results: The groups did not differ on trait reappraisal, suppression, or negative emotion following reappraisal. In general, group effects in whole-brain and amygdala activation during the cognitive reappraisal contrast indicated small effect sizes (2.2% of voxels had d>0.20) that were not significantly different. Participants with positive family histories engaged the right middle and superior frontal gyri to a greater extent than participants with negative family histories during the decrease-negative cue (t = 4.14, p = .001)., Conclusions: For at-risk young adults without current harmful substance use, family history of harmful alcohol use does not appear to be associated with disrupted emotion regulation when instructed to apply cognitive reappraisal. Reappraisal may be a feasible therapeutic target for those who develop a substance use disorder with associated emotion dysregulation., Competing Interests: Conflict of Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier B.V. All rights reserved.)