Alcohol-related Liver Disease (ALD) represents almost half of all deaths attributable to liver disease (LD) in the US. Despite the large proportion of deaths from ALD, however, only 1.4% of all liver transplants were for patients with ALD. ALD presents a range of medical and ethical concerns for those who drive the policy and practices of liver transplantation (LT). While, historically, stringent eligibility criteria for LT precluded many with ALD from receiving a transplant, more recent research suggests such criteria may be misguided. The following review compares LT outcomes between ALD and non-ALD recipients and finds that LT recipients with ALD have equal, if not better, survival rates than those with non-ALD. The findings of this review suggest a need for revisiting transplant criteria for patients with ALD to ensure parity.

Background. Cross-sectional findings in community surveys of adults suggest that adolescent anxiety disorders are strong predictors of the subsequent onset of alcohol use, abuse and dependence. However, prospective data that follow a sample of adolescents into adulthood are needed to confirm these associations. Method. Baseline and 4-year follow-up data from the EDSP-Study, a prospective community survey of 3021 (2548 at follow-up) adolescents and young adults aged 14 to 24 years at baseline carried out in Munich, were used. DSM-IV anxiety disorders, alcohol use and alcohol use disorders were assessed with the Munich-Composite-International-Diagnostic-Interview (M-CIDI). Multiple logistic regression analysis, controlling for age, gender, other mental disorders, substance use disorders and antisocial behaviour was used to study the associations of baseline anxiety disorders with the subsequent onset and course of alcohol use and alcohol disorders. Results. Baseline social phobia significantly predicts the onsets of regular use and hazardous use and the persistence of dependence. Panic attacks significantly predict the onsets of hazardous use and abuse as well as the persistence of combined abuse/dependence. Panic disorder significantly predicts the persistence of combined abuse/dependence. Other anxiety disorders do not significantly predict any of the outcomes. Conclusions. Panic and social phobia are predictors of subsequent alcohol problems among adolescents and young adults. Further studies are needed to investigate the underlying mechanisms and the potential value of targeted early treatment of primary panic and social phobia to prevent secondary alcohol use disorders.

Rationale and objective: Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are disorders of learning and memory that often occur comorbidly. Exposure to trauma-related cues can increase alcohol intake in PTSD patients that are using alcohol to self-medicate. The recurrence of anxiety symptoms with subsequent alcohol use may initiate a destructive cycle where stress and alcohol exposure impair the function of the prefrontal cortex (PFC). While the incidence of these disorders has steadily increased, current therapies and treatments often lack efficacy. Thus, investigation into the underlying neurocircuitry responsible for the establishment and maintenance of these disorders is necessary to develop novel treatment targets. Methods: The present study examined the effects of ethanol exposure on the ability to create new learned associations around previously conditioned fear cues in a rat model. Animals were exposed to fear conditioning followed by chronic intermittent ethanol to translationally model trauma exposure followed by alcohol abuse. Optogenetics was used to inhibit the prelimbic (PrL) or infralimbic (IfL) cortex during fear memory reconsolidation, and fear behaviors were measured during subsequent extinction and spontaneous recovery tests. Results and conclusion Chronic ethanol exposure led to deficits in fear extinction learning and increased freezing during spontaneous recovery, both of which were prevented following inhibition of the PrL, but not the IfL, during memory reconsolidation. These results support the involvement of the PrL in fear learning and memory, and strongly suggest that the PrL could serve as a potential target for the treatment of the learning and memory deficits that occur following exposure to stress and alcohol.

Women with posttraumatic stress disorder (PTSD) often develop alcohol use disorders (AUD) resulting from the use of alcohol to self-medicate from negative affect. Research supports the relationship between comorbid PTSD and AUD, and studies with women additionally identify the role of rumination, or excessive thinking about distress and its causes, as a precipitating aspect leading to self-medication. Female-based data is sparse, however, regarding specific thought patterns and factors which trigger the need to self-medicate with alcohol. Numerous researchers have studied the relationship between stress, anxiety, and alcohol use, although, there exists a need for qualitative studies providing thick, rich information. Applying the self-medication model and rumination theory, the purpose of this study was to use a transcendental research framework as a lens to explore and describe the phenomenon of how women with comorbid PTSD and AUD make sense of their dual disorder. Qualitative data were gathered from in-depth interviews of 12 women who participated in Alcoholics Anonymous groups in a large Southeastern city. The women collectively described their lived experience with the phenomenon as an internally-focused strategy premised on the notion of a 'Higher Power.' They reported using this strategy to manage thoughts, feelings, and behaviors which triggered negative self-assessment and the need to self-medicate with alcohol. This research contributes to the literature by offering a more detailed understanding of comorbid PTSD and AUD. Positive social change can be achieved with a better understanding of the etiology of female trauma and the factors that trigger alcohol relapse in women with PTSD.

Over 2.1 million United States military service members have deployed to support Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Nearly 40% of OEF/OIF service members meet criteria for an alcohol use disorder post-deployment. Minimal research has addressed alcohol misuse among military healthcare professionals despite the prevalence of alcohol abuse among civilian providers. This study explored whether military healthcare professionals involved with OIF/OEF operations have increased risk for alcohol misuse (i.e., problem drinking, heavy weekly drinking, heavy episodic drinking). Three evidence-based hypotheses were evaluated: (a) among OEF/OIF military personnel, healthcare professionals would have an increased likelihood of alcohol misuse compared to service members in other occupations; (b) personnel who screen positive for PTSD would be more likely to screen positive for alcohol misuse outcomes versus personnel who screen negative for PTSD; and (c) personnel with enlisted status would be more likely to endorse alcohol misuse compared to personnel with officer status. Participants were drawn from 81,247 military personnel enrolled in the Millennium Cohort Study, a prospective, longitudinal cohort study investigating health consequences of military service. Chi-square tests of independence identified significantly different demographic characteristics between participants in the first and second enrollment panels and resulted in participants being divided into subgroups based upon their enrollment panel and baseline alcohol use. Participants who had complete data at baseline and all follow-up waves were included in the primary multinomial logistic regression analyses used to identify variables associated with each alcohol use outcome over time. Results suggested that being a healthcare professional did not influence alcohol misuse outcomes. A positive screening for PTSD was associated with greater endorsement of alcohol misuse outcomes across most participant subgroups, and holding enlisted status was associated with problem drinking and heavy episodic drinking in some participant subgroups. Additional variables associated with alcohol misuse outcomes included being younger, male, using tobacco, and belonging to the National Guard/Reserve. The results of this study suggest that, while alcohol-related interventions may not need to be tailored to specific occupations, alcohol use screening and treatment should continue to be focused on at-risk groups to enhance troop health and functioning.

No description available.

Alcohol Use Disorder (AUD) has multiple health and social consequences which negatively affect individuals’ lives. However, the decision to utilize treatment is influenced by a variety of social factors. The stigma associated with AUD may impact individuals’ willingness to seek treatment after drinking is viewed as an issue. A highly stigmatized disorder, perceptions of AUD may be influenced by medical/moral lay theories, responsibility attributions and implicit theories. Once treatment is sought, support from others during the recovery process has been associated with treatment retention rates and success. Lay recovery beliefs, such as change perceptions, influence the amount of support offered to individuals during treatment. 249 college students completed assessments to measure their beliefs regarding medical/moral lay theories, responsibility attributions and implicit theories for AUD. Participants also completed questionnaires on social distance and perceptions of change. This study’s results indicate that medical/moral lay theories and responsibility attributions are linked to stigmatizing attitudes towards AUD. Responsibility attributions and implicit theories interact to influence stigma. It was also found that perceived likelihood of change is influenced by responsibility attributions, while perceived possibility of change is linked to medical/moral lay theories, responsibility attributions and implicit theories. Such relationships between the evaluated lay beliefs and stigmatizing attitudes may have important implications for programs aimed to reduce negative attitudes towards AUD.

Background: Current national prevalence estimates of DSM-5 diagnosed substance use disorders (SUDs) among adults with justice system involvement are lacking. Methods: This study drew from NESARC-III data (n = 36,309; 2012–2013), a nationally representative U.S. sample, to examine current and lifetime alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses among adults reporting current or prior drug-related, alcohol-related, and general legal problems. Results: Adults reporting current alcohol-related legal problems were 22 times more likely to have a current AUD diagnosis (AOR = 22.0, 95% CI = 12.1; 40.1) and 15 times more likely to have had a lifetime AUD diagnosis (AOR = 15.2, 95% CI = 7.5; 30.9) than adults without alcohol-related legal problems. Adults with lifetime drug-related legal problems were 3–5 times more likely to have a current (AOR = 2.6, 95% CI = 2.1; 3.2) and lifetime (AOR = 5.1, 95% CI = 4.3; 6.1) DUD diagnosis, with stimulant use disorder being the most prevalent (AOR = 5.4, 95% CI = 4.5; 6.5). Adults with general legal problems were around 3 times more likely to have a current AUD (AOR = 3.2, 95% CI = 2.6; 4.0) or DUD (AOR = 3.5, 95% CI = 2.8; 4.4). Women with any type of legal problem were more likely to have SUD diagnoses than men. Conclusions: SUD diagnoses are prevalent among adults reporting legal problems, particularly those involving alcohol. There is a continued need for community-based addiction prevention and intervention efforts, especially for women with justice system involvement.

Introduction: Compulsory care as an intervention to treat alcohol-use disorder has been acontroversial practice, and the law on care of misusers in certain cases (LVM) often comesunder criticism from different areas of Swedish society.  Aim: The purpose of this paper was to conduct a historical and ethical analysis pertaining tothe use of compulsory care for alcohol-use in Sweden. Method: Text was analysed using a hermeneutical approach. Historical information wasgathered through 3 different types of sources: academical dissertation, laws, andgovernmental investigations. Empirical data regarding LVM was gathered through asystematic search in psycinfo, Cochrane, and pubmed Results: Compulsory care against alcohol-use disorder started in 1913, The initial iteration ofthis was utilitarian. There has always been a heavy class-element to Swedish alcohol politics,especially before the 1950s. The legislation surrounding compulsory care has not drasticallychanged, nor has the characteristics of the individuals sanctioned under the laws. The mainethical conflicts are between individual autonomy and integrity, and the states responsibilitytowards its populace. Conclusions: The process of LVM is still reminiscent of earlier iterations of the law, and thediscussions surrounding compulsory care on a legislative level has not changed drasticallyduring the last 50 years. The efficacy of the intervention is not apparent, the process ofdefining who needs the intervention is not transparent, and it is not apparent that the socialwelfare board is equipped to make these decisions. This adds to the already dubious ethicaldilemmas regarding autonomy and integrity inherent to compulsory care.

Post-traumatic stress disorder (PTSD) is a debilitating disorder with a prevalence rate of approximately 5%. Unfortunately, this disorder is commonly associated with another debilitating disorder, alcohol use disorder (AUD). Of the 5% of people diagnosed with PTSD, 30%-59% also suffer from AUD. Currently, there are limited effective treatment options for those suffering from comorbid PTSD/AUD. Previous research has suggested that biological sex differentially impacts PTSD comorbid with AUD, however, the underlying mechanisms are enigmatic. The goal of this study was to better understand the underlying mechanisms that mediate sex differences in a rodent model of comorbid PTSD/AUD by analyzing specific behavioral tasks and changes in neuronal function of specific brain regions. Chronic inflammation has been implicated in PTSD and AUD respectively, with differences between sexes being observed. Females tend to express elevated levels of inflammation in both disorders compared to males in brain regions such as, the hippocampus, amygdala, and prefrontal cortex. Tumor necrosis factor α (TNF-α) is a proinflammatory cytokine that is released during neuronal inflammation. To further examine these sex differences, a comorbid PTSD/AUD rodent model was implemented using restraint stress (RS) and chronic intermittent ethanol use (CIE). Following the exposure to RS and CIE a fear conditioning procedure was implemented to assess changes in future stress sensitivity. The fear conditioning paradigm was accomplished by conditioning the animal to pair a tone with a foot shock, followed by extinction of that behavior in a different context where the animal received the tone but no foot shock. Thereafter, the animal was placed back in the context they received the foot shock, known as context renewal, but acquired no tone or foot shock. The behavior in these different contexts was analyzed to test memory and stress sensitivity. Brain tissue was collected to analyze TNF-α protein expression in regions associated with learning, memory, and addiction such as, the prelimbic cortex (PrL), infralimbic cortex (IfL), and the hippocampus. The results of the fear conditioning revealed that the females froze more altogether compared to the males, and there was more freezing of the females with RS and CIE during context renewal. It is expected that TNF-α protein expression will be significantly elevated in females when compared to males, regardless of treatment group. Females exposed to RS and CIE will have significantly higher TNF-α levels when compared to all other treatment groups. Finally, increases in TNF-α protein expression will be region specific with the PrL and IfL regions exhibiting significantly greater expression than the hippocampus. This study will aid in better understanding the sex differences and lead to better treatment options that are sex-dependent for those diagnosed with comorbid PTSD/AUD.