Risk/Benefit Discussion of Alcohol Use Disorder Medications: Behavioral Economic Considerations and General Recommendations

Background and Objectives: Behavioral economic purchase tasks are widely used to assess drug demand in substance use disorder research. Comorbid alcohol use is common among cigarette smokers and associated with greater difficulty in quitting smoking. However, demand for alcohol and cigarettes in this population has not been fully characterized. The present study addressed this gap by examining alcohol and cigarette demand among treatment-seeking smokers with alcohol use disorder (AUD).Methods: Alcohol and cigarette demand was assessed among 99 smokers with AUD. We conducted Principal Component Analysis (PCA) and correlational analyses on the demand indices.Results: Participants showed higher demand for alcohol than for cigarettes, as evidenced lower elasticity (resistance to increasing price) and higher Omax (maximum response output for drug). PCA revealed a two-factor structure (Persistence and Amplitude) for both alcohol and cigarette demand indices. Cigarette-related demand indices were positively correlated with nicotine dependence, but alcohol-related demand indices were not associated with alcohol dependence, suggesting dissociation between alcohol demand and use behaviors.Discussion and Conclusions: Our results suggest that smokers with AUD were more resistant to price elevations in relation to reducing alcohol consumption as compared to cigarette consumption, suggesting preferential demand for alcohol over cigarettes. However, it is unclear how acute substance exposure/withdrawal impacts the demand indices.Scientific Significance: Potentially differential alcohol and cigarette demands among smokers with AUD should be considered in the concurrent treatment of smoking and alcohol.

Download Full-text

DSM-5 alcohol use disorder features among treatment-seeking older adults

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911/a000550 ◽

2018 ◽

Vol 64 (4) ◽

pp. 185-196 ◽

Cited By ~ 2

Author(s):

Silke Behrendt ◽

Barbara Braun ◽

Randi Bilberg ◽

Gerhard Bühringer ◽

Michael Bogenschutz ◽

...

Keyword(s):

Older Adults ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

The Elderly ◽

Treatment Seeking ◽

Controlled Clinical Trial ◽

Dsm 5 ◽

Wide Range ◽

And Gender ◽

International Multicenter

Abstract. Background: The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial “ELDERLY-Study” with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims: To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results: Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion: European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors.

Download Full-text

Persönliche vs. computerbasierte Alkoholintervention für Krankenhauspatienten: Studiendesign

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911.a000394 ◽

2015 ◽

Vol 61 (6) ◽

pp. 347-355 ◽

Cited By ~ 2

Author(s):

Jennis Freyer-Adam ◽

Sophie Baumann ◽

Inga Schnuerer ◽

Katja Haberecht ◽

Ulrich John ◽

...

Keyword(s):

Public Health ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Identification Test ◽

Disorder Identification

Zusammenfassung. Ziel: Persönliche Beratungen können bei stationären Krankenhauspatienten Alkoholkonsum und Mortalität reduzieren. Sie sind jedoch mit hohen Kosten verbunden, wenn aus Public-Health-Erfordernis viele Menschen einer Bevölkerung erreicht werden müssen. Computerbasierte Interventionen stellen eine Alternative dar. Jedoch ist ihre Wirksamkeit im Vergleich zu persönlichen Beratungen und im Allgemeinkrankenhaus noch unklar. Eine quasi-randomisierte Kontrollgruppenstudie „Die Bedeutung der Vermittlungsform für Alkoholinterventionen bei Allgemeinkrankenhauspatienten: Persönlich vs. Computerisiert“ soll dies untersuchen. Design und Methoden werden beschrieben. Methode: Über 18 Monate sind alle 18- bis 64-jährigen Patienten auf Stationen der Universitätsmedizin Greifswald mittels Alcohol Use Disorder Identification Test (AUDIT) zu screenen. Frauen/Männer mit AUDIT-Consumption ≥ 4/5 und AUDIT < 20 werden einer von drei Gruppen zugeordnet: persönliche Intervention (Beratungen zur Konsumreduktion), computerbasierte Intervention (individualisierte Rückmeldebriefe und Broschüren) und Kontrollgruppe. Beide Interventionen erfolgen im Krankenhaus sowie telefonisch bzw. postalisch nach 1 und 3 Monaten. In computergestützten Telefoninterviews nach 6, 12, 18 und 24 Monaten wird Alkoholkonsum erfragt. Schlussfolgerung: Das Studienvorhaben, sofern erfolgreich umgesetzt, ist geeignet die längerfristige Wirksamkeit einer persönlichen und computerbasierten Intervention im Vergleich zu untersuchen.

Download Full-text