Danielle Barry

Overweight and Obesity Are Associated With Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Objective: This study evaluated associations between body mass index (BMI) and psychiatric disorders. Methods: Data from 41,654 respondents in the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Results: After controlling for demographics, the continuous variable of BMI was significantly associated with most mood, anxiety, and personality disorders. When persons were classified into BMI categories of underweight, normal weight, overweight, obese, and extremely obese, both obese categories had significantly increased odds of any mood, anxiety, and alcohol use disorder, as well as any personality disorder, with odds ratios (ORs) ranging from 1.21 to 2.08. Specific Diagnostic and Statistical Manual of Mental Disorders-revision IV mood and personality disorders associated with obesity included major depression, dysthmia, and manic episode (ORs, 1.45–2.70) and antisocial, avoidant, schizoid, paranoid, and obsessive-compulsive personality disorders (ORs, 1.31–2.55). Compared with normal weight individuals, being moderately overweight was significantly associated with anxiety and some substance use disorders, but not mood or personality disorders. Specific anxiety disorders that occurred at significantly higher rates among all categories of persons exceeding normal weight were generalized anxiety, panic without agoraphobia, and specific phobia (ORs, 1.23–2.60). Being underweight was significantly related to only a few disorders; it was positively related to specific phobia (OR, 1.31) and manic episode (OR, 1.83), and negatively associated with social phobia (OR, 0.60), panic disorder with agoraphobia (OR, 0.40), and avoidant personality disorder (OR, 0.59). Conclusion: These data provide a systematic and comprehensive assessment of the association between body weight and psychiatric conditions. Interventions addressing weight loss may benefit from integrating treatment for psychiatric disorders. NIAAA = National Institute on Alcohol Abuse and Alcoholism; NESARC = National Epidemiologic Survey on Alcohol and Related Conditions; AUDADIS = Alcohol Use Disorder and Associated Disabilities Interview Schedule; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition; BMI = body mass index; OR = odds ratio; CI = confidence intervals.

Neurocognitive impairment associated with alcohol use disorders: implications for treatment.

Between 50% and 80% of individuals with alcohol use disorders experience mild to severe neurocognitive impairment. There is a strong clinical rationale that neurocognitive impairment is an important source of individual difference affecting many aspects of addiction treatment, but empirical tests of the direct influence of impairment on treatment outcome have yielded weak and inconsistent results. The authors address the schism between applied-theoretical perspectives and research evidence by suggesting alternative conceptual models of the relationship between neurocognitive impairment and addiction treatment outcome. Methods to promote neurocognitive recovery and ways in which addiction treatments may be modified to improve psychosocial adaptation are suggested. Specific suggestions for future research that may help clarify the complex relations between neurocognitive impairment and addiction treatment are outlined.

Gender Differences in Associations Between Body Mass Index and DSM-IV Mood and Anxiety Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

PURPOSE The purpose of this study is to examine gender differences in associations between body mass index (BMI) and affective disorders. METHODS We used logistic regression to examine the effects of BMI and gender on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mood and anxiety disorders in a sample of 40,790 adults. RESULTS Obesity (BMI >30.0) was associated with increased risk for any mood disorder, major depressive disorder, and dysthymic disorder, in both men and women (odds ratios [ORs], 1.35-1.88). Risk of bipolar I and II disorders was elevated in obese women (ORs, 1.70-2.41) but not men. Overweight (BMI = 25.0-29.9) predicted increased risk for any mood disorder and bipolar I disorder in women but not in men (ORs, 1.16-1.44). Obesity was associated with increased odds of any anxiety disorder and specific phobia in men and women (ORs, 1.35-1.79). Obese women were additionally at increased risk for social phobia. Overweight predicted increased risk of social phobia and specific phobia for women but not for men (ORs, 1.27-1.37). CONCLUSIONS Obese individuals of both genders are at increased risk for a range of mood and anxiety disorders, but women who are even moderately overweight experience increased risks for some disorders as well.

Obesity and Its Relationship to Addictions: Is Overeating a Form of Addictive Behavior?

Obesity is a major public health problem and notoriously difficult to treat. There are many parallels between obesity/overeating and addictions to alcohol and drugs. This paper discusses similarities between obesity and addictive disorders, including common personality characteristics, disruptive behavior syndromes, and brain mechanisms. Although there are important differences between overeating and other addictive behaviors, an addiction model of overeating may effectively inform prevention and treatment of obesity.

Associations between body mass index and substance use disorders differ by gender: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Alcohol, illicit drugs, and nicotine can affect appetite and body weight, but few epidemiologic studies have examined relationships between body mass index (BMI) and substance use disorders. This study used logistic regression to examine effects of BMI and gender on risk for DSM-IV substance use disorders in a sample of 40 364 adults. Overweight and obesity were associated with increased risk for lifetime alcohol abuse and dependence in men but not women. Overweight and obesity were associated with decreased risk for past-year alcohol abuse in women. BMI was not associated with illicit drug use disorders. Overweight and obese men were at decreased risk for both lifetime and past-year nicotine dependence. Overweight women were at increased risk for lifetime nicotine dependence, and obese women were at decreased risk for past-year nicotine dependence. Further research is needed to identify reasons for observed gender differences in relationships between BMI and substance use disorders.

Exercise-related activities are associated with positive outcome in contingency management treatment for substance use disorders.

Exercise has been proposed as an adjunct intervention for substance use disorders due to its many benefits in terms of mental and physical health. This study investigated the association between completion of exercise-related activities and substance use disorders treatment outcome in a sample of 187 participants undergoing intensive outpatient treatment with contingency management. The sample was divided into two groups based upon whether or not an individual completed an exercise-related activity. Individuals who engaged in exercise-related activities (n=45) were found to achieve longer durations of abstinence during treatment than individuals who did not complete an exercise-related activity (n=142). Overall, these findings suggest that exercise may be of benefit to individuals undergoing substance use disorders treatment. Methods for implementing an exercise intervention within substance use disorders treatment are discussed.

Short-term neuropsychological recovery in clients with substance use disorders

BACKGROUND Cognitive impairments are frequently observed in clients who enter treatment programs for substance abuse. The potential for early recovery of cognitive abilities is suggested by previous research; however, the extent of improvement and risk factors that may help predict individual differences in rates of recovery remain unclear. This study is a 6-week follow-up and retest of an original sample of 197 men and women who had received a broad neuropsychological assessment at addiction treatment entry. The aim was to examine the potential clinical significance of changes in cognitive functioning and the extent to which differential recovery was predictable from client background information. METHODS Fifteen neuropsychological tests were readministered to 169 of 197 clients 6 weeks after treatment entry. Structural equation modeling was used to estimate separately the practice effects and recovery in four cognitive domains: executive function, memory, information processing speed, and verbal ability. Client background information included age, sex, education, substance use and consequences, psychopathology, medical problems, familial alcoholism history, and childhood behavior problems. RESULTS A four-factor model of latent neuropsychological ability that was previously identified at treatment entry was replicated at follow-up. Statistically significant increases in the means of the four latent abilities were found. Memory showed a medium effect size improvement. Executive function, verbal ability, and information processing speed, however, showed only small effect size improvements, suggesting limited clinical significance. Substance use between treatment entry and follow-up, antisocial personality disorder, negative use consequences, less education, and medical problems were modestly predictive of less recovery. CONCLUSION Cognitive recovery in the first 6 weeks of treatment is possible, but, with the possible exception of memory, improvement may be minor in terms of clinical relevance.

A randomized trial adapting contingency management targets based on initial abstinence status of cocaine-dependent patients.

OBJECTIVE Contingency management (CM) reduces drug use, but questions remain regarding optimal targets and magnitudes of reinforcement. We evaluated the efficacy of CM reinforcing attendance in patients who initiated treatment with cocaine-negative samples, and of higher magnitude abstinence-based CM in patients who began treatment positive. METHOD Initially cocaine-negative patients (n = 333) were randomized to standard care (SC), SC + CM reinforcing submission of negative samples with

FAS and CFL Forms of Verbal Fluency Differ in Difficulty: A Meta-analytic Study

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Comparable Efficacy of Contingency Management for Cocaine Dependence Among African American, Hispanic, and White Methadone Maintenance Clients

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