Gut microbiome in alcohol use disorder:Implications for health outcomes and therapeutic strategies-a literature review

Alcohol use disorder(AUD)represents a major public health issue which affects millions of people globally and consist a chronic relapsing condition associated with substantial morbidity and mortality.The gut microbiome plays a crucial role in maintaining overall health and has emerged as a significant contributor to the pathophysiology of various psychiatric disorders.Recent evidence suggests that the gut microbiome is intimately linked to the development and progression of AUD,with alcohol consumption directly impacting its composition and function.This review article aims to explore the intricate relationship between the gut microbiome and AUD,focusing on the implications for mental health outcomes and potential therapeutic strategies.We discuss the bidirectional communication between the gut microbiome and the brain,highlighting the role of microbiotaderived metabolites in neuroinflammation,neurotransmission,and mood regulation.Furthermore,we examine the influence of AUD-related factors,such as alcohol-induced gut dysbiosis and increased intestinal permeability,on mental health outcomes.Finally,we explore emerging therapeutic avenues targeting the gut microbiome in the management of AUD,including prebiotics,probiotics,and fecal microbiota transplantation.Understanding the complex interplay between the gut microbiome and AUD holds promise for developing novel interventions that could improve mental health outcomes in individuals with AUD.

Narrative minireview of the spatial epidemiology of substance use disorder in the United States:Who is at risk and where?

Drug overdose is the leading cause of death by injury in the United States.The incidence of substance use disorder(SUD)in the United States has increased steadily over the past two decades,becoming a major public health problem for the country.The drivers of the SUD epidemic in the United States have changed over time,characterized by an initial heroin outbreak between 1970 and 1999,followed by a painkiller outbreak,and finally by an ongoing synthetic opioid outbreak.The nature and sources of these abused substances reveal striking differences in the socioeconomic and behavioral factors that shape the drug epidemic.Moreover,the geospatial distribution of the SUD epidemic is not homogeneous.The United States has specific locations where vulnerable communities at high risk of SUD are concentrated,reaffirming the multifactorial socioeconomic nature of this epidemic.A better understanding of the SUD epidemic under a spatial epidemiology framework is necessary to determine the factors that have shaped its spread and how these patterns can be used to predict new outbreaks and create effective mitigation policies.This narrative minireview summarizes the current records of the spatial distribution of the SUD epidemic in the United States across different periods,revealing some spatiotemporal patterns that have preceded the occurrence of outbreaks.By analyzing the epidemic of SUD-related deaths,we also describe the epidemic behavior in areas with high incidence of cases.Finally,we describe public health interventions that can be effective for demographic groups,and we discuss future challenges in the study and control of the SUD epidemic in the country.

Effects of mindfulness-based interventions on depressive symptoms in patients with substance use disorders:a systematic review and meta-analysis

Objective:We examined the effects of mindfulness-based interventions(MBIs)on depressive symptoms in patients with substance use disorders(SUDs)and explored the moderating effects of participant,method,and intervention characteristics.Methods:We systematically searched 8 databases from their inception till November 2021.The inclusion criteria were primary studies evaluating MBIs in patients with SUDs with depression measured as an outcome,those including a control group,and those written in English.We used a random-effects model to compute effect sizes(ESs)using Hedges’g,a forest plot,and Q and I2 statistics as measures of heterogeneity;we also examined moderator analyses.Results:Nineteen studies included 1352 participants(age:38.6±7.0 years).Overall,MBIs showed significantly improved depression(g=0.67,95%confidence interval[CI]:0.29,1.05,I2=89%)compared to controls.With regard to moderators,providing MBIs as an individual plus group intervention had a greater effect(g=2.13)on reducing depressive symptoms than providing MBIs as a group intervention(g=0.64)or an individual intervention only(g=0.33,P=0.034).Using concealed allocation tended to reduce depressive symptoms(g=1.22)as compared to not using concealed allocation(g=0.48,P=0.086).No other quality indicators were demonstrated to have a moderating influence on the value of the ES.Conclusions:MBIs improved depressive symptoms in patients with SUDs.MBIs might be used as an adjunctive or alternative to conventional treatment for depressed patients with SUDs.

The Relationship between Students’ Anxiety and Internet Use Disorders: A Meta-Analysis

Theoretical models have predicted a positive association between anxiety and Internet use disorders.However,thefindings of previous studies are conflicting,with some reporting a positive association and others proposing no relationship between the two.To explore the true relationship between the two and analyze the reasons for the differences,100 primary studies involving 108,539 subjects were entered into a meta-analysis.The results showed that(1)there was a significant positive correlation between students’anxiety and Internet use disorder(r=0.330);(2)the moderating effect of anxiety type was significant.(3)The moderating effects of the measurement instrument for Internet use disorder,the measurement instrument for anxiety,the subject’s grade level,the subject’s region,and the type of publication were not significant.The question of how the different anxiety types of students and IUD have different mechanisms of action needs to be further explored.

Management of Opioid Use Disorder in Sickle Cell Anaemia amidst Growing Menace in the General Population

Nigeria has a very high number of sickle cell disease (SCD) population with addition of 150,000 babies born annually with the disease. Early infant diagnosis and good care make many of these babies survive to adulthood. Severe pain requiring moderately strong or very strong analgesics is a common presentation of patients with Sickle Cell Anaemia. Paediatricians find ready usefulness of Opioids which are very useful for the painful episodes among these patients. Therefore, the chances of abuse and addiction to these medications become very high and constitute additional burden on the deficient manpower in the health sector. Opioid Use Disorder among Sickle Cell Disease patients has subtle presentation, so a high index of suspicion is required to make both the diagnosis and referral to treatment centres. In this review, the epidemiology, pain pathophysiology, behavioural and pharmacologic therapy have been re-examined.

An Overview of the Connection between Hoarding Disorder and Substance Use Disorder

This essay explores the connections between Hoarding Disorder and Substance Use Disorder,two distinct mental health conditions with clear diagnostic criteria in the DSM-5.Hoarding Disorder,marked by excessive possession accumulation and difficulties in letting go,affects 2-6%of the global population,leading to severe consequences.Potential causes include genetic predisposition,neural issues,and traumatic experience.Substance Use Disorder is influenced by more societal factors.Both disorders share a comorbidity in Attention-Deficit/Hyperactivity Disorder(ADHD).Network analysis shows a strong direct relationship between Hoarding Disorder and ADHD,while social influences increase ADHD prevalence in Substance Use Disorder individuals.Moreover,both disorders benefit from Cognitive Behavioral Therapy(CBT).Exposure and Ritual Prevention effectively address hoarding symptoms,while CBT for Substance Use Disorder focuses on the interplay between thoughts,emotions,and actions.Despite being classified as a mental illness in DSM-5,Hoarding Disorder receives less attention than Substance Use Disorder.This essay aims to raise awareness of Hoarding Disorder by highlighting its commonalities with Substance Use Disorder in terms of causes,comorbidities,and treatment approaches.

Alcohol and drug use disorders in adult attentiondeficit/hyperactivity disorder:Prevalence and associations with attention-deficit/hyperactivity disorder symptom severity and emotional dysregulation

BACKGROUND High risk of alcohol and drug use disorders in people with attentiondeficit/hyperactivity disorder(ADHD)calls for exploratory research of relationships with clinical features of ADHD.AIM To estimate prevalence of alcohol/drug use disorders and associations with ADHD symptom severity and emotional dysregulation,in adults with ADHD.METHODS This observational cross-sectional clinical study consisted of patients admitted to a private psychiatric outpatient clinic in Oslo,Norway(2014-2018).Five-hundred and fifty-eight eligible patients diagnosed with ADHD(Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)criteria)agreed to participate.Alcohol and drug use disorders were diagnosed using the Mini International Neuropsychiatric Interview(MINI).Dependence and abuse were merged into“use”disorder as in MINI version 7.0/DSM-5.Questions were related both to lifetime and the past 12-mo.ADHD severity was assessed by the Adult ADHD Self Report Scale(ASRS).Subdivisions of the ASRS questionnaire as inattentive items and hyperactive/impulsivity items were recorded separately.Emotional dysregulation was assessed by the eight-item version of Barkley’s Current Behavior Scale-Self Report.RESULTS The 12-mo prevalence was 5.3%for alcohol use disorder and 13.7%for drug use disorder.The lifetime prevalence was 12.0%for alcohol use disorder and 27.7%for drug use disorder.Men had higher rates of both alcohol use disorder and drug use disorder compared to women.The prevalence of drug use disorder was more than twice that of alcohol use disorder for both sexes.The drugs most participants reported having used were(in descending order):Amphetamine(19.1%),cannabis(17.1%),cocaine or ecstasy(7.4%),benzodiazepines(7.4%),and heroin or other opioids(2.9%).Lifetime drug use disorder was significantly associated with both hyperactivity-impulsivity symptoms and emotional dysregulation symptom severity.Lifetime alcohol use disorder,on the other hand,was not significantly associated with ADHD symptoms or emotional dysregulation when adjusted for gender and age.CONCLUSION Patients with ADHD have a high lifetime prevalence of drug use disorder,which is associated with higher levels of hyperactivity-impulsivity symptoms and emotional dysregulation.

Craving variations in patients with substance use disorder and gambling during COVID-19 lockdown:The Italian experience

BACKGROUND Following the development of the coronavirus disease-2019(COVID-19)pandemic in Italy,a strict lockdown was imposed from March 9 to May 5,2020.The risks of self-medication through alcohol or psychoactive substance abuse were increased,as well as the tendency to adopt pathological behaviors,such as gambling and internet addiction.AIM To evaluate the impact of the COVID-19 pandemic and associated containment measures on craving in a group of patients suffering from substance use disorder and/or gambling disorder who were in treatment in outpatient units or in residency programs as inpatients.METHODS One hundred and fifty-three patients completed a structured questionnaire evaluating craving and other behaviors using a visual analogue scale(VAS).Forty-one subjects completed a pencil and paper questionnaire during the interview.The clinician provided an online questionnaire to 112 patients who had virtual assessments due to lockdown restrictions.Statistical analyses were performed using Statistica version 8.0.Quantitative parameters are presented as the mean±SD and qualitative parameters as number and percentage per class.The Kolmogorov-Smirnov test was used to check for normality of distributions.Analysis of variance and Duncan post hoc test were employed to analyze differences among subgroup means.The associations between variables were measured using Pearson's correlation.A P value of<0.05 was considered significant.RESULTS The variation in craving between the present and the month before showed VASrelated reductions of craving in 57%,increases in 24%,and no significant change in 19%of the sample.The level of craving was significantly higher(F=4.36;P<0.05)in outpatients(n=97;mean=3.8±3.1)living in their own home during the quarantine compared with inpatients(n=56;mean=2.8±2.8)in residential programs.Craving for tetrahydrocannabinol was the greatest(4.94,P<0.001)among various preferred substances.CONCLUSION The unexpected result of this study may be explained by a perceived lack of availability of substances and gambling areas and/or decreased social pressure on a subject usually excluded and stigmatized,or the acquisition of a new social identity based on feelings of a shared common danger and fate that overshadowed the sense of exclusion and rejection in the abuser.

Alcohol use disorder and liver injury related to the COVID-19 pandemic

Alcohol use disorder is a complex and heterogeneous phenomenon that can be studied from several points of view by focusing on its different components.Alcohol is a hepatotoxin whose metabolism creates profound alterations within the hepatocyte.The liver is the central organ in the metabolism of alcohol,a process that also involves other organs and tissues such as the brain,heart and muscles,but the most relevant organ is the liver.The anatomopathological alterations in the liver associated with the prolonged use of alcohol range from the simple accumulation of neutral fats in the hepatocytes,to cirrhosis and hepatocellular carcinoma.Alcohol abuse frequently leads to liver disease such as steatosis,steatohepatitis,fibrosis,cirrhosis,and tumors.Following the spread of coronavirus disease 2019(COVID-19),there was an increase in alcohol consumption,probably linked to the months of lockdown and smart working.It is known that social isolation leads to a considerable increase in stress,and it is also recognized that high levels of stress can result in an increase in alcohol intake.Cirrhotic patients or subjects with liver cancer are immunocompromised,so they may be more exposed to COVID-19 infection with a worse prognosis.This review focuses on the fact that the COVID-19 pandemic has made the emergence of alcohol-induced liver damage a major medical and social problem.

Alcohol Use Disorders and Associated Factors among an Elderly Community Sample in Nigeria: A Cross-Sectional Survey

Background: Alcohol Use Disorders (AUDs) in the elderly are associated with impairments in physical, psychological, social and cognitive functioning. Both the elderly men and women who drink alcohol are at a greater risk of social isolation and economic deprivation and the women in particular are in the danger of rapid development of dependence a phenomenon termed “telescoping” dependence. This study seeks to determine the prevalence of alcohol use disorders as well as their associated factors among the elderly in Jos South LGA, Plateau State, Nigeria. Methods: A community-based cross-sectional study of elderly (≥60 years) men and women. A total of 400 out of a total of 422 elderly community dwellers identified were interviewed with the aid of a composite questionnaire incorporating the socio-demography, Alcohol Smoking and Substance Involvement Screening Test (ASSIST), Mini International Neuropsychiatric Interview (MINI) and the 12-item General Health Questionnaire (GHQ-12). Results: The lifetime and current prevalence of alcohol use were 69.8% and 45.5% respectively. The prevalence of AUDs was (n = 52, 13.0%). AUDs was significantly associated with being male (OR = 2.57, 95%CI: 1.35 - 3.77, p < 0.01). Participants with AUDs were more likely to report difficulty ambulating (χ2 = 0.34, 0.56), cardiovascular (χ2 = 0.42, p = 0.52), respiratory (χ2 = 0.55, p = 0.46), and digestive (χ2 = 0.17, p = 0.68) problems, though not statistically significant. Similarly, no significant associations were seen with probable psychiatric co-morbidity (χ2 = 2.35, p = 0.13) and chronic pain (χ2 = 0.52, p = 0.47). Conclusions: Alcohol use and use disorders were common in this elderly cohort. AUDs were associated with poorer health indices.

Long-Term Suboxone Maintenance Therapy for Opioid Use Disorder: 2 Case Reports

The medical profession is divided in its approach to treating patients with addiction issues, particularly in regards to the treatment of opioid use disorder with Suboxone (buprenorphine/naloxone). Here we present two cases of patients who have achieved over 11 years of sobriety with long-term Suboxone maintenance therapy. Their stories help to demonstrate that Suboxone is a viable long-term treatment option for severe opioid addiction. While life-long Suboxone use can lead to physical dependence on the drug, this is far from simply replacing one addiction with another. Some providers may feel that physical dependence on a medication does not represent appropriate or adequate treatment of opioid use disorder;however, when compared with the grave potential consequences of severe opioid use disorder, the potential benefits of achieving sobriety with Suboxone maintenance far outweigh the risks.

Telehealth for Substance Use Disorders Treatment in Nigeria: Implementation Strategies Post-COVID-19

The COVID-19 pandemic has changed the way healthcare services are delivered. These changes will likely persist as countries recover from the economic crises following lockdowns. In developing countries, services for substance use disorders (SUDs) are inadequate and as countries prioritize infectious diseases, individuals with SUDs may suffer further neglect. This paper is a narrative review of peer-reviewed and grey literature on the current challenges with SUD treatment in Nigeria assesses how telehealth may positively affect access to evidence-based treatments and suggests strategies for implementation considering the unique challenges and opportunities in the country. If prioritized in her policy, telehealth has the potential to improve treatment outcomes for SUDs in Nigeria.

Pilot Study of Problem Gambling in Specialized Substance Use Disorder Treatment—High Lifetime Prevalence of Problem Gambling in Opioid Maintenance Treatment Patients

Problem gambling is over-represented in patients treated for substance use disorders, but substance-specific prevalence of problem gambling is rarely reported. In specialized addiction treatment facilities for opioid maintenance treatment and for alcohol and prescription drug dependence, respectively, 129 patients were screened for problem gambling using the NODS-CLiP. The lifetime prevalence of problem gambling was markedly higher in opioid maintenance treatment (61 percent) than in alcohol and prescription drug dependence treatment (11 percent, p < 0.001). When controlling for gender and age, problem gambling remained significantly associated with opioid maintenance treatment. The present study demonstrated a very high prevalence of lifetime problem gambling in opioid maintenance treatment patients. This calls for active screening for problem gambling in substance use disorder patients, and mainly in treatment for opioid dependence.

A Novel Application of Blockchain Technology and Its Features in an Effort to Increase Uptake of Medications for Opioid Use Disorder

The opioid crisis has impacted the lives of millions of Americans.Digital technology has been applied in both research and clinical practice to mitigate this public health emergency.Blockchain technology has been implemented in healthcare and other industries outside of cryptocurrency,with few studies exploring its utility in dealing with the opioid crisis.This paper explores a novel application of blockchain technology and its features to increase uptake of medications for opioid use disorder.

Telehealth interventions for alcohol use disorder:A systematic review

Alcohol use disorder(AUD)is a worldwide problem for individuals of varying ages and backgrounds and is associated with the underlying cause of alcoholic liver disease,liver cirrhosis,liver cancer,or many other common diseases and health conditions.Existing treatments such as cognitive behavioral therapy(CBT)have been demonstrated as an evidence-based treatment to aid individuals struggling with AUD.However,these treatments have excessive costs and time demand with trained experts.In this paper,we examine the efficacy and long-term impacts of digitally delivered CBT and other online telehealth tools and apps for AUD patients.Results show the effectiveness in the ability of digitally delivered CBT to decrease alcohol use in AUD patients.The additional use of online technologies and smartphone apps for post-CBT care demonstrates that such computer-aided apps could have long-term effects when it is continually employed,which opens the door for AUD patients who were not seeking treatment elsewhere.Further longitudinal examination research is needed to evaluate the lasting effects in liver health and other chronic diseases associated with digitally delivered alcohol reduction for AUD patients.

Advances in neuroimaging studies of alcohol use disorder(AUD)

Alcohol use disorder(AUD)is a worldwide problem and themost common substance use disorder.Chronic alcohol consumptionmay have negative effects on the body,the mind,the family,and even society.With the progress of current neuroimaging methods,an increasing number of imaging techniques are being used to objectively detect brain impairment induced by alcoholism and serve a vital role in the diagnosis,prognosis,and treatment assessment of AUD.This article organizes and analyzes the research on alcohol dependence concerning the main noninvasive neuroimaging methods,structural magnetic resonance imaging,functional magnetic resonance imaging,and electroencephalography,as well as the most common noninvasive brain stimulation-transcranial magnetic stimulation,and intersperses the article with joint intra-and intergroup studies,providing an outlook on future research directions.

Fentanyl and xylazine crisis:Crafting coherent strategies for opioid overdose prevention

The United States is in the throes of a severe opioid overdose epidemic,primarily fueled by the pervasive use of fentanyl and the emerging threat of xylazine,a veterinary sedative often mixed with fentanyl.The high potency and long duration of fentanyl is compounded by the added risks from xylazine,heightening the lethal danger faced by opioid users.Measures such as enhanced surveillance,public awareness campaigns,and the distribution of fentanylxylazine test kits,and naloxone have been undertaken to mitigate this crisis.Fentanyl-related overdose deaths persist despite these efforts,partly due to inconsistent policies across states and resistance towards adopting harm reduction strategies.A multifaceted approach is imperative in effectively combating the opioid overdose epidemic.This approach should include expansion of treatment access,broadening the availability of medications for opioid use disorder,implementation of harm reduction strategies,and enaction of legislative reforms and diminishing stigma associated with opioid use disorder.

Is transcranial magnetic stimulation useful in posttraumatic disorders?

Dear editor, We have read with great interest the recent paper by Herrold et al. （2014） published in Neural Regeneration Research. There is evidence that approximately 20-90% of patients with mild traumatic brain injury develop posttraumatic symptoms, and 40% of these patients have persistent symptoms after trauma （Bazarian et al., 1999; Koski et al., 2015）. Therefore, mild traumatic brain injury becomes an important cause of temporary disability. Indeed, posttraumatic disorders have a significant epidemiological relevance, even though it is still undervalued in most of the trauma centers （Bazarian et al., 1999） and there is no specific treatment method （Koski et al., 2015）. Recently, many neurological and posttraumatic stress disorders had been treated with noninvasive brain stimulation （Boggio et al., 2010; Fox et al., 2012）.

Alcohol associated liver disease and bariatric surgery:Current perspectives and future directions

Bariatric surgery is a routinely performed procedure and is associated with a reduction in all-cause mortality in patients with obesity.However,bariatric sur-gery has also been linked to increased alcohol use with up to 30%of these patients developing alcohol use disorder(AUD).The mechanism of AUD after bariatric surgery is multifactorial and includes anatomic,metabolic,and neurohumoral changes associated with post-surgical anatomy.These patients are at increased risk of alcohol associated liver disease and,in some cases,require liver trans-plantation.In this article,we provide a scoping review of epidemiology,patho-physiology,and clinical outcomes of alcohol-related health conditions after bariatric surgery.