Materiały źródłowe

• #1 Treatment for Alcohol Use Disorder: Progress in Predicting Treatment Outcome and Validating Non-Abstinent Endpoints

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6167145/

  An emerging framework for multimodal assessment of addictions (Kwako et al., 2016), and expanded definitions of acceptable endpoints for alcohol treatment trials (Food and Drug Administration, 2006) are informing efforts toward personalized treatment of alcohol use disorder (AUD). […] The six articles in this virtual issue of Alcoholism: Clinical and Experimental Research illustrate recent progress in identifying predictors of alcohol treatment outcome, and pioneering work on the stability and validity of promising non-abstinent (e.g., low-risk drinking) clinical trial endpoints. […] Reliable predictors of AUD treatment outcome can not only help to identify for whom an intervention may be most effective, but can aid in the early detection of potential non-responders, so that alternative interventions can be offered to meet specific needs.

• #2 Predicting alcohol use disorder remission: a longitudinal multimodal multi-featured machine learning approach | Translational Psychiatry

  https://www.nature.com/articles/s41398-021-01281-2

  Predictive models for recovering from alcohol use disorder (AUD) and identifying related predisposition biomarkers can have a tremendous impact on addiction treatment outcomes and cost reduction. […] To predict this difference in AUD recovery status, we analyzed the initial data using multimodal, multi-features machine learning applications including EEG source-level functional brain connectivity, Polygenic Risk Scores (PRS), medications, and demographic information. […] Results highlight the importance of increasing genetic homogeneity of analyzed groups, identifying sex, and ancestry-specific features to increase prediction scores revealing biomarkers related to AUD remission. […] The present study, therefore, aims to create an ML model, predicting future AUD remission among individuals who had met criteria for active DSM-5 AUD at their first interview but no longer meet criteria for current DSM-5 AUD at their next interview.

• #3 Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking | Addiction Science & Clinical Practice | Full Text

  https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-024-00443-z

  Research is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). […] The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption. […] The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. […] Among the most well studied factors, is dependence severity, in which a lower degree of dependency has shown to be associated with a higher ability to attain a lower consumption level than individuals with a higher symptom burden. […] A lower baseline consumption level predicted lower consumption at 52 weeks, -and a less severe AUD at baseline predicted a lower level of AUD symptoms at 52 weeks. […] Moreover, a lower level of impaired control over alcohol consumption, and a lower baseline level of AUD predicted a reduction of symptom burden of AUD at 52 weeks.

• #4 Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10882804/

  Research is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). […] The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption. […] The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. […] Among the most well studied factors, is dependence severity, in which a lower degree of dependency has shown to be associated with a higher ability to attain a lower consumption level than individuals with a higher symptom burden. […] The study identified that a lower baseline AUD severity and a lower level of impaired control predicted a reduction in AUD (DSM-5) symptom burden at 52 weeks. […] The current study corroborated previous research on predictors of favorable treatment outcomes in AUD; being a lower baseline alcohol consumption and a lower level of impaired control over alcohol consumption, in treatment-seeking sample of AUD with low levels of psychiatric comorbidity.

• #5 Treatment for Alcohol Use Disorder: Progress in Predicting Treatment Outcome and Validating Non-Abstinent Endpoints

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6167145/

  The inability to recognize emotions in others has been associated with interpersonal problems and poorer alcohol treatment outcomes in cross-sectional research (Kornreich et al., 2016). […] These findings suggest the potential for objective assessment of facial emotion recognition to identify patients at risk for worse treatment outcomes. […] These results suggest that Cloninger type 2 scores and Lesch subtypes show some promise in identifying patients, particularly females, at risk for hospital readmission after detoxification. […] Thus, decreased macrostructural integrity, specifically smaller volumes of the right rostral and caudal ACC and total right frontal gray matter at treatment entry, in addition to psychiatric and demographic characteristics, could serve as markers of relapse risk.

• #6 Predicting alcohol use disorder remission: a longitudinal multimodal multi-featured machine learning approach | Translational Psychiatry

  https://www.nature.com/articles/s41398-021-01281-2

  Our central hypothesis was that model based on multidimensional features will result in a better prediction than singular modality and that being married, employed, and taking medication will predict remission. […] Significant ML SVM models were calculated predicting remission from AUD for individuals who were previously diagnosed as AUD DSM-5. […] The AA male group combined feature model of PRS, EEG-FC, marital status, and employment status achieved the highest accuracy of 86.04%. […] Several discriminative features were identified for each of the models revealing novel predisposition sex and ancestry-specific AUD remission biomarkers. […] Overall, our findings suggest that wide range of multidimensional features with high internal homogeneity groups will formulate better predictive models.

• #7 Predicting alcohol use disorder remission: a longitudinal multimodal multi-featured machine learning approach | Translational Psychiatry

  https://www.nature.com/articles/s41398-021-01281-2

  The continued AUD group showed a lower level of DMN connectivity confirming previous findings of aberrant DMN function in AUD and across psychiatric conditions such as depression, schizophrenia, and autism. […] Our findings demonstrate the importance of embedded ancestry and sex in the analysis towards the formulation of personalized prediction model. […] We further show that the model based on various features from different areas of health (genetics, electrophysiology, medication, and demographic data) outperform prediction models based on features derived from a single domain. […] We identified specific robust features of PRS and EEG functional connectivity for each sex/ancestry group, further expanding our knowledge of the predisposition biomarkers including genetics and brain mechanisms underlying the process of remission from AUD.

• #8 “Natural recovery” from alcohol use disorder: What characteristics predict successful low-risk drinking one year later? – Recovery Research Institute

  https://www.recoveryanswers.org/research-post/natural-recovery-alcohol-use-disorder-low-risk-drinking/

  The authors used a statistical technique that creates profiles of individuals based on pre-resolution drinking behaviors, degree of alcohol dependence, number of alcohol-related problems, and the perceived reward value of drinking. […] Drinking outcomes based on the entire one-year follow-up were: 1) Resolved abstinent, i.e., continuously abstinent (n = 273), 2) resolved non-abstinent, i.e., drinking within low-risk guidelines (i.e., lower risk drinking only, no relapses or alcohol-related problems; n = 80), or 3) unstable resolution, i.e., one or more relapses to alcohol use disorder defined as any daily drinking in excess of NIAAA heavy drinking thresholds (n = 140). […] Findings from this study suggest that successful low-risk drinking during the post-resolution year is most likely among individuals with lower alcohol dependence, fewer functional problems related to drinking, and less money spent on alcohol versus money saved prior to resolving their problem.

• #9 “Natural recovery” from alcohol use disorder: What characteristics predict successful low-risk drinking one year later? – Recovery Research Institute

  https://www.recoveryanswers.org/research-post/natural-recovery-alcohol-use-disorder-low-risk-drinking/

  Taken together, these results suggest that it’s not drinking quantity that best predicts likelihood of being able to drink within low risk guidelines, but rather alcohol dependence severity and having a history of drinking problems and consequences. […] These findings should however be considered in light of several of significant methodological issues in this study. […] Findings from this study suggest that successful low-risk drinking is most likely among individuals with lower alcohol dependence, fewer functional problems related to drinking, and who spend less money on alcohol compared to other things. […] Additionally, results suggest that heavier alcohol use in and of itself does not necessarily predict less success moderating alcohol use, although individuals drinking large quantities of alcohol would likely have less success achieving low-risk drinking.

• #10 “Natural recovery” from alcohol use disorder: What characteristics predict successful low-risk drinking one year later? – Recovery Research Institute

  https://www.recoveryanswers.org/research-post/natural-recovery-alcohol-use-disorder-low-risk-drinking/

  Taken together, these findings bring to light the importance of using multidimensional severity indicators that encompass functional variables in addition to drinking practices to predict drinking outcomes among those attempting to change their alcohol use behaviors outside the confines of traditional addiction treatment programs.

• #11 Designing clinical trials to address alcohol use and alcohol-associated liver disease: an expert panel Consensus Statement | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-024-00936-x

  Most patients with alcohol-associated liver disease (ALD) engage in heavy drinking defined as 4 or more drinks per day (56g) or 8 (112g) or more drinks per week for women and 5 or more drinks per day (70g) or 15 (210g) or more drinks per week for men. […] Although abstinence from alcohol after diagnosis of ALD improves life expectancy and reduces the risk of decompensation of liver disease, few studies have evaluated whether treatment of alcohol use disorders will reduce progression of liver disease and improve liver-related outcomes. […] Continued consumption of alcohol 280g per week after a diagnosis of advanced liver disease increased all-cause mortality (HR 1.98; 95% CI (1.213.24)) and the risk of decompensated liver disease (HR 1.62; 95% CI (1.022.56)). […] Conversely, abstinence is associated with improved life expectancy and in some cases recompensation.

• #12 Designing clinical trials to address alcohol use and alcohol-associated liver disease: an expert panel Consensus Statement | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-024-00936-x

  Evidence from observational studies suggests that reducing alcohol use should improve both liver-related and alcohol-related outcomes in patients with ALD, but this hypothesis requires empirical confirmation and clinical trials are urgently needed. […] We propose that clinical trials that focus primarily on the effect of alcohol use on the progression of SLD use a threshold of more than 140g per week in women and 210g per week in men, consistent with the NIAAA or CDC definition of heavy drinking and in alignment with the recently proposed multisociety Delphi consensus nomenclature for defining MetALD and ALD. […] The most important clinical outcome is to prevent hepatic decompensation, defined by jaundice, ascites, encephalopathy, variceal haemorrhage or progression of portal hypertension as defined by Baveno criteria.

• #13 Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study | The BMJ

  https://www.bmj.com/content/357/bmj.j2353

  Higher alcohol consumption over the 30 year follow-up was associated with increased odds of hippocampal atrophy in a dose dependent fashion. […] Alcohol consumption, even at moderate levels, is associated with adverse brain outcomes including hippocampal atrophy. […] There was no protective effect of light drinking (1-7 units/week) over abstinence. […] Compared with abstinence, higher alcohol consumption was also associated with increased odds of abnormally rated hippocampal atrophy (defined as score 0 on Scheltens visual rating scale). […] The risk of right sided hippocampal atrophy was significantly greater at 14 alcohol units a week compared with abstinence. […] Higher average alcohol consumption across the study was inversely associated with white matter integrity. […] Higher alcohol consumption over the study predicted faster decline on lexical fluency but not semantic fluency or word recall.

• #14 Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study | The BMJ

  https://www.bmj.com/content/357/bmj.j2353

  There was no evidence of a protective effect of light drinking over abstinence on brain structure or function. […] The finding that alcohol consumption in moderate quantities is associated with multiple markers of abnormal brain structure and cognitive function has important potential public health implications for a large sector of the population.

• #15 Treatment for Alcohol Use Disorder: Progress in Predicting Treatment Outcome and Validating Non-Abstinent Endpoints

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6167145/

  Importantly, analyses of change in WHO drinking risk categories could provide further support for non-abstinent endpoints, as well as the potential utility of a harm reduction approach for some individuals. […] Results suggest that low-risk drinking, in addition to a goal of abstinence, may show benefit across a range of psychosocial and psychiatric outcomes over an extended follow-up period for some individuals in treatment for an AUD. […] Recent findings regarding the stability of low-risk drinking during and following treatment (Witkiewitz, Wilson, et al., 2017), and relatively favorable outcomes of low-risk (versus heavy) drinking through longer-term follow-up (Kline-Simon et al., 2017), provide further support for the usefulness of a non-abstinent, harm reduction-based outcome (e.g., low-risk drinking) for some individuals. […] Predicting who would benefit from a goal of abstinence and who might be appropriate for a non-abstinent, low-risk drinking goal remains a priority for future research.

• #16 Designing clinical trials to address alcohol use and alcohol-associated liver disease: an expert panel Consensus Statement | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-024-00936-x

  In decompensated ACLD, the primary purpose of treatment is to reduce mortality, but there are multiple threats to life in this setting. […] Thus, there is room for innovative trial designs that use hierarchical end points such as the win ratio used in heart failure trials or the Desirability of Outcome Ranking and Response (DOOR) approach used in sepsis trials.

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