Needs of Female Outpatients with Alcohol Use Disorder: Data from an Italian Study

Aims: Alcohol use disorder (AUD) is a common mental disorder characterized by sex-gender differences (SGDs). The present study was aimed at evaluating attitudes displayed by Italian AUD treatment services towards investigating the presence of SGDs in their patients and implementing gender-specific treatments for female AUD patients. Methods: Potential SGDs were initially investigated in a sample of AUD outpatients, subsequently followed by a national survey on the adoption of specific interventions for female AUD outpatients. Results: The presence of SGDs was confirmed in a sample of 525 (332 men; 193 women) AUD outpatients, including a higher prevalence of anxiety and mood disorders, and episodes of violence and trauma among female AUD outpatients compared to males. Despite the presence of these SGDs, only less than 20% of a total of 217 Italian AUD treatment services reported the implementation of specific strategies for female AUD outpatients. The majority of services (94%) reported investigating episodes of violence and/or trauma, largely resorting to specific procedures only when these issues were detected. Conclusions: Our findings confirm the presence of SGDs among AUD outpatients, including a higher prevalence of anxiety and mood disorders and episodes of violence and trauma among females compared to males. However, only a small number of services has adopted a gender medicine approach in AUD treatment. These results underline the urgency of investigating the specific needs of female, male, and non-binary AUD patients in order to personalize and enhance the effectiveness and appeal of AUD treatment

Gamma Hydroxybutyric Acid (GHB) for the Treatment of Alcohol Dependence: A Review

Gamma-hydroxybutyric acid (GHB) is a short-chain fatty acid structurally similar to the inhibitory neurotransmitter γ-aminobutyric acid. Clinical trials have demonstrated that 50–100 mg/kg of GHB fractioned into three or six daily doses is able to suppress alcohol withdrawal symptoms and facilitates the maintenance of abstinence from alcohol. These studies have also shown that GHB craving episodes are a very limited phenomenon (about 10–15%). Thus, physicians with access should consider the clinical efficacy of GHB as a valid pharmacological tool for the treatment of alcohol addiction

A brief up-date of the use of sodium oxybate for the treatment of alcohol use disorder

The treatment of alcohol use disorder (AUD) with sodium oxybate (SMO) or gamma-hydroxybutyric acid (GHB) was introduced in Italy and Austria more than 20 years and 15 years ago, respectively, and it is now widely employed to treat alcohol withdrawal syndrome (AWS) and to maintain alcohol abstinence. These indications derive from its similar structure to the inhibitory neurotransmitter -amino-butyric acid (GABA), exerting an ethanol-mimicking effect, because it binds to GABAB receptors. Craving for, and abuse of, SMO remain a controversial issue; even though these unfavorable effects are evident in poly-drug addicted patients and in those with psychiatric diagnosis of borderline personality disorder. In addition, despite cases of severe intoxication and deaths being widely documented when GHB is used as “street drug”; its clinical use remains safe. Thus, the aim of the present review is to examine the role of SMO in the treatment of AUD, its possible implications in reducing alcohol consumption, and cases of abuse, and severe intoxication due to SMO during its clinical use in the treatment of AUD

Sindrome da astinenza protratta da alcol: il ruolo del sodio ossibato...e non solo

La sindrome da astinenza protratta (SAP) è definita come la presenza di segni e sintomi sostanza-specifici persistenti tipici della sindrome astinenziale acuta. I sintomi della SAP includono ansia, ostilità, irritabilità, depressione, instabilità del tono dell’umore, astenia, insonnia, difficoltà di concentrazione, riduzione della libido, sensazione di fastidio fisico o dolore non imputabile ad altre cause

Alcohol use disorders in the elderly: A brief overview from epidemiology to treatment options

Alcohol-use-disorders (AUDs) afflict 1-3% of elderly subjects. The CAGE, SMAST-G, and AUDIT are the most common and validated questionnaires used to identify AUDs in the elderly, and some laboratory markers of alcohol abuse (AST, GGT, MCV, and CDT) may also be helpful. In particular, the sensitivity of MCV or GGT in detecting alcohol misuse is higher in older than in younger populations. The incidence of medical and neurological complications during alcohol withdrawal syndrome in elderly alcoholics is higher than in younger alcoholics. Chronic alcohol abuse is associated with tissue damage to several organs. Namely, an increased level of blood pressure is more frequent in the elderly than in younger adults, and a greater vulnerability to the onset of alcoholic liver disease, and an increasing risk of breast cancer in menopausal women have been described. In addition, the prevalence of dementia in elderly alcoholics is almost 5 times higher than in non-alcoholic elderly individuals, approximately 25% of elderly patients with dementia also present AUDs, and almost 20% of individuals aged 65 and over with a diagnosis of depression have a co-occurring AUD. Moreover, prevention of drinking relapse in older alcoholics is, in some cases, better than in younger patients; indeed, more than 20% of treated elderly alcohol-dependent patients remain abstinent after 4. years. Considering that the incidence of AUDs in the elderly is fairly high, and AUDs in the elderly are still underestimated, more studies in the fields of epidemiology, prevention and pharmacological and psychotherapeutic treatment of AUDs in the elderly are warranted. © 2012 Elsevier Inc

Gamma hydroxybutirric acid (GHB) withdrawal does not occur at therapeutic dosage

No abstract availabl

Alcohol use disorder and GABAB receptor gene polymorphisms in an Italian sample: haplotype frequencies, linkage disequilibrium and association studies

Background: Alcohol use disorder (AUD) is a complex trait with genetic and environmental influences. Several gene variants have been associated with the risk for AUD, including genes encoding the sub-units of the γ-aminobutyric acid (GABA) receptors. Aim: This study evaluated whether specific single nucleotide polymorphisms (SNPs) in genes encoding GABAB receptor sub-units can be considered as candidates for the risk of AUD. Subjects and methods: Seventy-four AUD subjects and 128 Italian controls were genotyped for 10 SNPs in genes encoding GABA-B1 and GABA-B2 sub-units (GABBR1 and GABBR2). Allele, genotype, and haplotype frequencies were tested for the association with the AUD trait. Results: A significant difference between AUD individuals and controls was observed at genotype level for rs2900512 of GABBR2 gene. The homozygous T/T genotype was not found in the controls, whereas it was over-represented in the AUD individuals. Under the recessive model (T/T vs C/T + C/C) this result was statistically significant, as well as the Odds Ratio for the association with the AUD trait. Conclusions: The results provide preliminary data on the association between GABAB receptor gene variation and risk of AUD. To confirm this finding, studies with larger samples and additional characterisation of the phenotypic AUD trait are required

Diagnosi di abuso e dipendenza da bevande alcoliche

none9La multifattorialità dell'alcolismo richiede una valtazione multidimensionale del paziente per giungere ad una corretta diagnosi. I principali strumenti diagnostici di cui avvalersi sono: il Manuale Statistico e Diagnostico delle Malattie Pschichiatriche - 4° edizione - Testo Rivisto nel 2000 (DSM-IV-TR), il colloquio, i questionari, l'esame obiettivo e gli esami di laboratorio.noneTREVISANI F CAPUTO F; CAPUTO, FABIO; Lorenzini F; VIGNOLI, TEO; Conconi A; Tudini M; Pariali MC; Degli Esposti P; Pierini G; BERNARDI, MAUROCaputo, Fabio; Lorenzini, F; Vignoli, Teo; Conconi, A; Tudini, M; Pariali, Mc; Degli Esposti, P; Pierini, G; Bernardi, Maur

Symptoms of protracted alcohol withdrawal in patients with alcohol use disorder: a comprehensive systematic review

Background: Alcohol withdrawal syndrome (AWS) is characterized by different phases (acute, early and protracted). Protracted alcohol withdrawal (PAW) presents some symptoms, which may persist for several weeks, months or even years after drinking cessation. Methods: We conducted a systematic review of the literature in major scientific databases on select-ed AWS symptoms (craving, sleep disorders, and anhedonia) in patients with alcohol use disorder. Results: Of the 102 eligible publications (70 RCTs and 32 cohort studies), 88 provided data on crav-ing, 21 on sleep disorders, and 1 on anhedonia. Overall, 37 studies assessed craving using the Obsessive Compulsive Drinking Scale (OCDS). Pooled OCDS decreased from 24.2 at baseline to 18.8 at 1 week, 10.3 at 1 month and 9.7 at 3 months. The corresponding estimates for treated individuals were 23.9, 18.8, 8.7, and 8.8, and for non-treated subjects, they were 25.3, 13.9, 13.2, and 11.4, respectively. In 4 studies assessing sleep disorders using the Epworth Sleeping Scale (ESS), the scale remained sta-ble in time, i.e., 7.3 at baseline, 7.3 at 1 week, 7.2 at 1 month, and 7.1 at 3 months. Conclusion: This study confirms the presence of PAW after the resolution of the acute phase of AWS. The pharmacological approach to managing PAW may ensure a more rapid reduction of symptoms in three weeks. We highlight the importance of studying PAW and the ability of pharmacological treatment to reduce its symptoms. This review protocol is registered in Prospero (registration number: CRD42020211265). Summary: This systematic review summarizes literature on major symptoms of protracted alcohol withdrawal in patients with alcohol use disorder. The pharmacological approach to manage protracted alcohol withdrawal ensures a more rapid reduction of symptoms (craving in particular), achiev-ing in three weeks similar results obtained only after almost 6 months without treatment