Amandine Luquiens

Patient preferences and perspectives regarding reducing alcohol consumption: role of nalmefene

Alcohol use disorder is a major public health issue. The absolute mortality burden of alcohol-attributable death has increased over the last 20 years. However, access to care remains very poor and many people with alcohol use disorder are untreated. The main limiting factor for access to care in alcohol use disorder appears to be the reluctance to engage in abstinence. Risk reduction is a developing approach in the treatment of alcohol use disorders, drawing its inspiration, with quite a delay, from the decades-long dominant approach in other substance use disorders. A paradigm shift has recently occurred that places more of an emphasis on reducing alcohol as a therapeutic strategy for patients with alcohol use disorder, to better meet the patients’ preferences and needs. The development and recent approval of nalmefene, in alcohol-dependent adults with a high drinking risk level, contributes to enlarging the therapeutic arsenal for alcohol dependence, strengthening the legitimacy of alcohol reduction strategies.

The Efficacy of Three Modalities of Internet-Based Psychotherapy for Non-Treatment-Seeking Online Problem Gamblers: A Randomized Controlled Trial.

Background Internet-based interventions targeted at the most at-risk gamblers could reduce the treatment gap for addictive disorders. Currently, no clinical trial has included non–treatment-seeking patients who have been recruited directly in their gambling environment. This study was the first exclusively Internet-based randomized controlled trial among non–help-seeking problem gamblers with naturalistic recruitment in their gambling environment. Objective The aim of this study was to assess the efficacy of three modalities of Internet-based psychotherapies with or without guidance, compared to a control condition, among problem gamblers who play online poker. Methods All active poker gamblers on the Winamax website were systematically offered screening. All problem poker gamblers identified with a Problem Gambling Severity Index (PGSI) score of ≥5 were eligible to be included in the trial. Problem gamblers were randomized into four groups: (1) waiting list (control group), (2) personalized normalized feedback on their gambling status by email, (3) an email containing a self-help book to be downloaded with a Cognitive Behavioral Therapy (CBT) program without guidance, and (4) the same CBT program emailed weekly by a trained psychologist with personalized guidance. Efficacy was assessed based on the change in PGSI between baseline and 6 weeks (end of treatment) or 12 weeks (maintenance) and supported by player account-based gambling data automatically collected at the three time points. Results All groups met high attrition rates (83%), but the group with guidance had a significantly higher dropout rate than the other three groups, including the control group. Although all groups showed some improvement, with a mean decrease of 1.35 on the PGSI, no significant difference in efficacy between the groups was observed. One-third of the problem gamblers fell below the problem gambling threshold at 6 weeks. Conclusions Guidance could have aversively affected problem gamblers who had not sought help. Despite the lack of significant difference in efficacy between groups, this naturalistic trial provides a basis for the development of future Internet-based trials in individuals with gambling disorders. Comorbidities, natural course of illness, and intrinsic motivation seem to be critical issues to consider in future designs. Trial Registration ANSM 2013-A00794-41

Associations between substance use disorders and suicide mortality risk should be adjusted for tobacco use disorder

In January 2014, Bohnert et al. [1] reported inAddiction an excess risk of death by suicide in individuals diagnosed with tobacco use disorder. Their findings derived from a cohort of the US Veterans Health Administration (VHA) records and included all individuals who received VHA services in fiscal year (FY) 2005 and who were alive at the beginning of FY 2006 (n = 4863086). In an unadjusted, bivariate model, tobacco use disorder was associated significantly with an increased risk of suicide [hazard ratio (HR) = 1.88; 95% confidence interval (CI) = 1.76–2.02). After adjustment for a number of confounders—including substance use disorders—the association, although attenuated, remained significant (HR = 1.36; 95% CI = 1.27–1.46). This paper added strong evidence to the already well-demonstrated increased independent risk of suicide death among smokers [2–5]. The reading of the recent paper of Bohnert et al. [6] in the same journal triggered some level of surprise. The authors, reportedly using the same database of individuals who received VHA services in FY 2005 andwhowere alive at the beginning of FY 2006 (n = 4863086), aimed to estimate associations between substance use disorders and suicide. The authors specified HRs between each alcohol, cocaine, cannabis, opioid, amphetamine, psychostimulant and sedatives use disorders, but not tobacco use disorder and death by suicide, in unadjusted and adjusted models. In the adjusted models, adjustment was made for many possible confounders (age, Charlson comorbidity index, co-occurring psychiatric conditions such as depression, schizophrenia, bipolar disorder, posttraumatic stress disorder and other anxiety disorders) but, astonishingly, not for tobacco use disorder or smoking. Thus, the authors demonstrated in 2014 [1] that tobacco use disorder was associated significantly with suicide mortality after adjusting for substance use disorders. The 2017 paper by the same authors [2] using the same database seems to ignore their own previous finding.

Self-medication of achalasia with cannabis, complicated by a cannabis use disorder.

Achalasia is a rare esophagus motility disorder. Medical, endoscopic and surgical treatments are available, but all endorse high relapse rates. No data has been published to date reporting a therapeutic effect of cannabis use neither in achalasia nor on its influence on manometric measurements. We report the case of a patient diagnosed with achalasia. He could benefit from a large panel of therapeutic interventions, but none of them was effective over the time. He first used cannabis at age 20 and identified benefits regarding achalasia symptoms. He maintained regular moderate cannabis use for 9 years, with minimal digestive inconvenience. A manometry performed without cannabis premedication was realized at age 26 and still found a cardiospasm. Cannabis use could explain the gap between functional symptoms assessment and manometry measurement. Further investigations are warranted to explore a therapeutic effect of cannabis in achalasia and possible influence on outcome measurements.

Health-related quality of life in alcohol dependence: Similar cross-cultural impact beyond specific drinking habits

ABSTRACT This study explores sociocultural differences in alcohol-related impact on quality of life between France and United Kingdom. We included 38 alcohol-dependent patients in France and United Kingdom in 10 focus groups. We used a text-mining approach. Three classes of each corpus regarded identical themes across the countries: (a) core impact on quality of life, (b) drinking habits, (c) sources of help. Core impact was similar between the two countries. Main differences were in drinking habits and referral to sources of help. Despite differences in drinking habits, the domains of life impacted by alcohol were non–country specific.

Letter by Aubin et al Regarding Article, “Association of Coffee Consumption with Total and Cause-Specific Mortality in 3 Large Prospective Cohorts”

In their recent analysis of the Nurses’ Health Study (NHS), the NHS 2, and the Health Professionals Follow-up Study (HPFS), Ding et al1 reported that coffee consumption, either caffeinated or decaffeinated, was nonlinearly associated with mortality. Compared with no consumption, coffee consumption of 1 to 5 cups/d was associated with a lower risk of mortality, whereas coffee consumption of >5 cups/d was not associated with risk of mortality. When the analysis was restricted to never smokers, coffee consumption was associated with lower risk of total mortality and mortality resulting …