Self-reported alcohol topography, past alcohol use history, and current alcohol cravings

Introduction: Drinking topography is the idea that how a person drinks, in addition to how much they drink, can influence the immediate and long-term effects of alcohol consumption. Measures are often crude, and there has been little effort to associate such measures with disease status. Methods: To address these gaps, an online survey was completed by 734 U.S. participants. They described how they usually drank using a series of 20 words (e.g., chug, nip, nurse, shots). A latent class analysis was performed to identify clusters of descriptors. Past alcohol use history, as measured by the Alcohol Use Disorders Identification Test (AUDIT), and current alcohol cravings, as measured by the Desires for Alcohol Questionnaire (DAQ), were then regression on class assignment. The analysis was adjusted for age, sex, race, ethnicity, marital status, income, and education level. Results: Three LCA classes were accepted, with the class characterized by the words shot, swig, gulp, chug, and guzzle having significantly higher AUDIT (b[95% CI] = 1.22 [0.98, 1.46], p < 0.001) and DAQ (b[95% CI] = 12.9 [10.5, 15.3], p < 0.001) scores relative to the class characterized by sample, sip, and nurse. The third class predominantly used drink and sip, and was not significantly different from the sample class (p's = 0.290-0.471). Conclusions: Measuring drinking topography offers a unique way to identify individuals at risk of an alcohol use disorder or those who may be resistant to treatment. It may also be useful in determining drinking motives. However, additional research is needed.

“If I knew I could get that every hour instead of alcohol, I would take the cannabis”: need and feasibility of cannabis substitution implementation in Canadian managed alcohol programs

Background While there is robust evidence for strategies to reduce harms of illicit drug use, less attention has been paid to alcohol harm reduction for people experiencing severe alcohol use disorder (AUD), homelessness, and street-based illicit drinking. Managed Alcohol Programs (MAPs) provide safer and regulated sources of alcohol and other supports within a harm reduction framework. To reduce the impacts of heavy long-term alcohol use among MAP participants, cannabis substitution has been identified as a potential therapeutic tool. Methods To determine the feasibility of cannabis substitution, we conducted a pre-implementation mixed-methods study utilizing structured surveys and open-ended interviews. Data were collected from MAP organizational leaders (n = 7), program participants (n = 19), staff and managers (n = 17) across 6 MAPs in Canada. We used the Consolidated Framework for Implementation Research (CFIR) to inform and organize our analysis. Results Five themes describing feasibility of CSP implementation in MAPs were identified. The first theme describes the characteristics of potential CSP participants. Among MAP participants, 63% (n = 12) were already substituting cannabis for alcohol, most often on a weekly basis (n = 8, 42.1%), for alcohol cravings (n = 15, 78.9%,) and withdrawal (n = 10, 52.6%). Most MAP participants expressed willingness to participate in a CSP (n = 16, 84.2%). The second theme describes the characteristics of a feasible and preferred CSP model according to participants and staff. Participants preferred staff administration of dry, smoked cannabis, followed by edibles and capsules with replacement of some doses of alcohol through a partial substitution model. Themes three and four highlight organizational and contextual factors related to feasibility of implementing CSPs. MAP participants requested peer, social, and counselling supports. Staff requested education resources and enhanced clinical staffing. Critically, program staff and leaders identified that sustainable funding and inexpensive, legal, and reliable sourcing of cannabis are needed to support CSP implementation. Conclusion Cannabis substitution was considered feasible by all three groups and in some MAPs residents are already using cannabis. Partial substitution of cannabis for doses of alcohol was preferred. All three groups identified a need for additional supports for implementation including peer support, staff education, and counselling. Sourcing and funding cannabis were identified as primary challenges to successful CSP implementation in MAPs.

The foraging gene affects alcohol sensitivity, metabolism and memory in Drosophila

The genetic basis of alcohol use disorder (AUD) is complex. Understanding how natural genetic variation contributes to alcohol phenotypes can help identify mechanisms underlying the genetic contribution of AUD. Recently, a single nucleotide polymorphism in the human foraging (for) gene ortholog, Protein Kinase cGMP-Dependent 1 (PRKG1), was found to be associated with stress-induced risk for alcohol abuse. However, the mechanistic role that PRKG1 plays in AUD is not well understood. We use natural variation in the Drosophila for gene to describe how variation of cGMP-dependent protein kinase (PKG) activity modifies ethanol-induced phenotypes. We found that variation in for affects ethanol-induced increases in locomotion and memory of the appetitive properties of ethanol intoxication. Further, these differences may stem from the ability to metabolize ethanol. Together, this data suggests that natural variation in PKG modulates cue reactivity for alcohol, and thus could influence alcohol cravings by differentially modulating metabolic and behavioral sensitivities to alcohol.

Transdiagnostic dimensions in obsessive-compulsive and related disorders: associations with internalizing and externalizing symptoms

Background Hierarchical structural models of psychopathology rarely extend to obsessive-compulsive spectrum disorders. The current study sought to examine the higher-order structure of the obsessive-compulsive and related disorders (OCRDs) in DSM-5: obsessive-compulsive disorder (OCD), hoarding disorder (HD), body dysmorphic disorder (BDD), trichotillomania (hair-pulling disorder; HPD) and excoriation (skin-picking) disorder (SPD). Methods Adult patients in a partial hospital program (N = 532) completed a dimensional measure of the five OCRDs. We used confirmatory factor analysis to identify the optimal model of the comorbidity structure. We then examined the associations between the transdiagnostic factors and internalizing and externalizing symptoms (i.e. depression, generalized anxiety, neuroticism, and drug/alcohol cravings). Results The best fitting model included two correlated higher-order factors: an obsessions-compulsions (OC) factor (OCD, BDD, and HD), and a body-focused repetitive behavior (BFRB) factor (HPD and SPD). The OC factor, not the BFRB factor, had unique associations with internalizing symptoms (standardized effects = 0.42–0.66) and the BFRB factor, not the OC factor, had small marginally significant unique association with drug/alcohol cravings (standardized effect = 0.22, p = 0.088). Conclusions The results mirror findings from twin research and indicate that OCD, BDD, and HD share liability that is significantly associated with internalizing symptoms, but this liability may be relatively less important for BFRBs. Further research is needed to better examine the associations between BFRBs and addictive disorders.

Acute Effect of Eating Sweets on Alcohol Cravings in a Sample with At-Risk Drinking

Background Alcohol craving, or the desire to drink alcohol, has been identified as a key experience preceding alcohol use. Alcoholics Anonymous has long claimed that individuals can allay alcohol cravings by eating sweets. Empirical tests of this strategy are limited to a few preclinical studies in rats, and there is no existing experiment testing the acute effect of eating sweets on alcohol cravings in humans. Purpose The current study sought to experimentally test the acute effect of eating sweets on alcohol cravings in a sample with at-risk drinking. Methods After being exposed to an alcohol cue, individuals with at-risk drinking (N = 150) were randomly assigned to eat sweets (n = 60), eat calorie-equivalent bland food (n = 60), or watch a video (n = 30). Caloric amounts were manipulated. Individuals with at-risk drinking were then exposed to a second alcohol cue. Changes in alcohol cravings from after the first to after the second alcohol cue were measured via visual analog scale and heart rate. Results There were no significant between-group differences in changes in alcohol cravings. Caloric amounts did not modify effects. Conclusions Experimental findings did not provide evidence to support the clinical lore that eating sweets can reduce alcohol cravings, albeit only acutely and for those with at-risk drinking. Other empirically supported strategies for managing alcohol cravings (e.g., pharmacotherapies, mindfulness) could instead be promoted.

Effect of A Very Low-Calorie Ketogenic Diet on Food and Alcohol Cravings, Physical and Sexual Activity, Sleep Disturbances, and Quality of Life in Obese Patients

Psychological well-being and hunger and food control are two relevant factors involved in the success of weight-loss therapy in treating obesity. Thus, this study aims to evaluate food and alcohol cravings, physical and sexual activity, sleep, and life quality (QoL) in obese patients following a very low-calorie ketogenic (VLCK) diet, as well as the role of weight lost and ketosis on these parameters. A battery of psychological test was performed in twenty obese patients (12 females, 47.2 ± 10.2 year and BMI of 35.5 ± 4.4) through the course of a 4-month VLCK diet on four subsequent visits: baseline, maximum ketosis, reduced ketosis, and endpoint. Each subject acted as their own control. Relevantly, the dietary-induced changes in body composition (7.7 units of BMI lost, 18 kg of fat mass (1.2 kg of visceral fat mass)) were associated with a statistically significant improvement in food craving scores, physical activity, sleepiness, and female sexual function. Overall, these results also translated in a notable enhancement in QoL of the treated obese patients. Therefore, the rapid and sustained weight and fat mass (FM) loss induced by the VLCK diet is associated with good food control and improvements in the psychological well-being parameters in obese subjects, which could contribute to the long-term success of this therapy.