Choosing appropriate language to reduce the stigma around mental illness and substance use disorders

Neuropsychopharmacology, Год журнала: 2021, Номер 46(13), С. 2230 - 2232

Опубликована: Июль 19, 2021

Язык: Английский

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Hazardous drinking and alcohol use disorders

Nature Reviews Disease Primers, Год журнала: 2022, Номер 8(1)

Опубликована: Дек. 22, 2022

Язык: Английский

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Alcohol Use Disorder Treatment: Problems and Solutions

The Annual Review of Pharmacology and Toxicology, Год журнала: 2024, Номер 64(1), С. 255 - 275

Опубликована: Янв. 23, 2024

Alcohol use disorder (AUD) afflicts over 29 million individuals and causes more than 140,000 deaths annually in the United States. A heuristic framework for AUD includes a three-stage cycle—binge/intoxication, withdrawal/negative affect, preoccupation/anticipation—that provides starting point exploring heterogeneity of with regard to treatment. Effective behavioral health treatments US Food Drug Administration–approved medications are available but greatly underutilized, creating major treatment gap. This review outlines challenges that face alcohol field closing this gap offers solutions, including broadening end points approval AUD; increasing uptake screening, brief intervention, referral treatment; addressing stigma; implementing definition recovery; engaging early educating health-care professionals public about associated misuse. Additionally, focuses on potential targets development by utilizing model addiction domains dysfunction mediating neurobiology AUD.

Язык: Английский

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GLP-1 receptor agonists are promising but unproven treatments for alcohol and substance use disorders

Nature Medicine, Год журнала: 2023, Номер 29(12), С. 2993 - 2995

Опубликована: Ноя. 24, 2023

Язык: Английский

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Overview of Alcohol Use Disorder

American Journal of Psychiatry, Год журнала: 2023, Номер 180(8), С. 565 - 572

Опубликована: Авг. 1, 2023

Alcohol is regularly consumed throughout most of the world, including by nearly half U.S. population age 12 or older. Heavy drinking, which also common, contributes to multiple adverse medical, psychiatric, and social outcomes more than 140,000 deaths annually in United States. It major risk factor for alcohol use disorder (AUD), whose current prevalence 11%. However, AUD undertreated, with less 15% individuals a lifetime diagnosis receiving any treatment. Risk equally genetic environmental. responsive psychosocial treatments, cognitive-behavioral therapy motivational enhancement therapy. affects neurotransmitter systems, thus pharmacotherapy effective. The three medications approved States treat AUD-disulfiram, naltrexone (oral long-acting injectable formulations), acamprosate-are underprescribed, despite being considered first-line treatments clinical practice guidelines. Two not treating AUD, topiramate gabapentin, have shown efficacy are used off-label. Recent studies novel drug candidates, psychedelics phosphodiesterase-4 inhibitors, promising additions treatment although they require further evaluation before clinically. Despite growing availability efficacious pharmacological it remains highly stigmatized condition. Research aimed at enhancing identification precision therapeutics, could broaden acceptability treatment, benefiting affected their families reducing stigma associated disorder.

Язык: Английский

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Baclofen for alcohol use disorder

Cochrane library, Год журнала: 2023, Номер 2023(1)

Опубликована: Янв. 13, 2023

Язык: Английский

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Outcomes After Initiation of Medications for Alcohol Use Disorder at Hospital Discharge

JAMA Network Open, Год журнала: 2024, Номер 7(3), С. e243387 - e243387

Опубликована: Март 29, 2024

Importance US Food and Drug Administration–approved medications for alcohol use disorder (MAUD) are significantly underused. Hospitalizations may provide an unmet opportunity to initiate MAUD, but few studies have examined clinical outcomes of patients who these at hospital discharge. Objective To investigate the association between discharge MAUD initiation 30-day posthospitalization outcomes. Design, Setting, Participants This cohort study was conducted among with Medicare Part D had alcohol-related hospitalizations in 2016. Data were analyzed from October 2022 December 2023. Exposures Discharge defined as oral naltrexone, acamprosate, or disulfiram pharmacy fills within 2 days Main The primary outcome a composite all-cause mortality return (emergency department visits readmissions) 30 Secondary included components separately, diagnoses, care mental health follow-up Propensity score 3:1 matching modified Poisson regressions used compare received did not receive MAUD. Results There 6794 unique individuals representing 9834 (median [IQR] age, 54 [46-62] years; 3205 females [32.6%]; 1754 Black [17.8%], 712 Hispanic [7.2%], 7060 White [71.8%] patients). Of these, 192 (2.0%) involved initiation. After propensity matching, associated 42% decreased incidence (incident rate ratio, 0.58 [95% CI, 0.45 0.76]; absolute risk difference, −0.18 −0.26 −0.11]). These findings consistent secondary (eg, incident ratio hospital, 0.56 0.43 0.73]) except mortality, which rare both groups 3.00 0.42 21.22]). 51% 0.49 0.34 0.71]; −0.15 −0.22 −0.09]). Conclusion relevance In this study, after hospitalization large reduction days. support efforts increase uptake

Язык: Английский

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Psilocybin-induced changes in neural reactivity to alcohol and emotional cues in patients with alcohol use disorder: an fMRI pilot study

Scientific Reports, Год журнала: 2024, Номер 14(1)

Опубликована: Фев. 7, 2024

Abstract This pilot study investigated psilocybin-induced changes in neural reactivity to alcohol and emotional cues patients with use disorder (AUD). Participants were recruited from a phase II, randomized, double-blind, placebo-controlled clinical trial investigating psilocybin-assisted therapy (PAT) for the treatment of AUD (NCT02061293). Eleven adult completed task-based blood oxygen dependent functional magnetic resonance imaging (fMRI) approximately 3 days before 2 after receiving 25 mg psilocybin (n = 5) or 50 diphenhydramine 6). Visual emotionally valanced (positive, negative, neutral) stimuli presented block design. Across both cues, increased activity medial lateral prefrontal cortex (PFC) left caudate, decreased insular, motor, temporal, parietal, occipital cortices, cerebellum. Unique negative supramarginal gyrus activity; unique positive right hippocampus activity. Greater PFC caudate engagement concomitant insula, cerebellar disengagement suggests enhanced goal-directed action, improved regulation, diminished craving. The robust brain observed this warrant larger neuroimaging studies elucidate mechanisms PAT. Trial registration : NCT02061293.

Язык: Английский

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Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE‐4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department

Academic Emergency Medicine, Год журнала: 2024, Номер 31(5), С. 425 - 455

Опубликована: Май 1, 2024

Abstract The fourth Society for Academic Emergency Medicine (SAEM) Guidelines Reasonable and Appropriate Care in the Department (GRACE‐4) is on topic of emergency department (ED) management nonopioid use disorders focuses alcohol withdrawal syndrome (AWS), disorder (AUD), cannabinoid hyperemesis (CHS). SAEM GRACE‐4 Writing Team, composed physicians experts addiction medicine patients with lived experience, applied Grading Recommendations Assessment Development Evaluation (GRADE) approach to assess certainty evidence strength recommendations regarding six priority questions adult ED AWS, AUD, CHS. Team reached following recommendations: (1) (over age 18) moderate severe AWS who are being admitted hospital, we suggest using phenobarbital addition benzodiazepines compared alone [ low very ]; (2) AUD desire cessation, a prescription one anticraving medication (2a) naltrexone (compared no prescription) prevent return heavy drinking (2b) contraindications naltrexone, acamprosate and/or reduce (2c) gabapentin days improve symptoms (3a) presenting CHS haloperidol or droperidol (in usual care/serotonin antagonists, e.g., ondansetron) help symptom (3b) CHS, also offering topical capsaicin ].

Язык: Английский

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Once-Weekly Semaglutide in Adults With Alcohol Use Disorder

JAMA Psychiatry, Год журнала: 2025, Номер unknown

Опубликована: Фев. 12, 2025

Importance Preclinical, observational, and pharmacoepidemiology evidence indicates that glucagon-like peptide 1 receptor agonists (GLP-1RAs) may reduce alcohol intake. Randomized trials are needed to determine the clinical significance of these findings. Objective To evaluate effects once-weekly subcutaneous semaglutide on consumption craving in adults with use disorder (AUD). Design, Setting, Participants This was a phase 2, double-blind, randomized, parallel-arm trial involving 9 weeks outpatient treatment. Enrollment occurred at an academic medical center US from September 2022 February 2024. Of 504 potential participants assessed, 48 non–treatment-seeking AUD were randomized. Intervention received (0.25 mg/week for 4 weeks, 0.5 1.0 mg week) or placebo weekly clinic visits. Main Outcomes Measures The primary outcome laboratory self-administration, measured pretreatment posttreatment (0.5 mg/week). Secondary exploratory outcomes, including prospective changes craving, assessed Results Forty-eight (34 [71%] female; mean [SD] age, 39.9 [10.6] years) Low-dose reduced amount consumed during self-administration task, medium large effect sizes grams (β, −0.48; 95% CI, −0.85 −0.11; P = .01) peak breath concentration −0.46; −0.87 −0.06; .03). Semaglutide treatment did not affect average drinks per calendar day number drinking days, but significantly −0.41; −0.73 −0.09; .04) −0.39; .01), also predicting greater reductions heavy over time relative 0.84; 0.71 0.99; .04). A significant treatment-by-time interaction indicated predicted cigarettes subsample individuals current cigarette −0.10; −0.16 −0.03; .005). Conclusions Relevance These findings provide initial low-dose can some justifying larger GLP-1RAs disorder. Trial Registration ClinicalTrials.gov Identifier: NCT05520775

Язык: Английский

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