George Moussas

The Alcohol Use Disorders Identification Test (AUDIT): reliability and validity of the Greek version

BackgroundProblems associated with alcohol abuse are recognised by the World Health Organization as a major health issue, which according to most recent estimations is responsible for 1.4% of the total world burden of morbidity and has been proven to increase mortality risk by 50%. Because of the size and severity of the problem, early detection is very important. This requires easy to use and specific tools. One of these is the Alcohol Use Disorders Identification Test (AUDIT).AimThis study aims to standardise the questionnaire in a Greek population.MethodsAUDIT was translated and back-translated from its original language by two English-speaking psychiatrists. The tool contains 10 questions. A score ≥ 11 is an indication of serious abuse/dependence. In the study, 218 subjects took part: 128 were males and 90 females. The average age was 40.71 years (± 11.34). From the 218 individuals, 109 (75 male, 34 female) fulfilled the criteria for alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and presented requesting admission; 109 subjects (53 male, 56 female) were healthy controls.ResultsInternal reliability (Cronbach α) was 0.80 for the controls and 0.80 for the alcohol-dependent individuals. Controls had significantly lower average scores (t test P < 0.001) when compared to the alcoholics. The questionnaires sensitivity for scores >8 was 0.98 and its specificity was 0.94 for the same score. For the alcohol-dependent sample 3% scored as false negatives and from the control group 1.8% scored false positives. In the alcohol-dependent sample there was no difference between males and females in their average scores (t test P > 0.05).ConclusionThe Greek version of AUDIT has increased internal reliability and validity. It detects 97% of the alcohol-dependent individuals and has a high sensitivity and specificity. AUDIT is easy to use, quick and reliable and can be very useful in detection alcohol problems in sensitive populations.

Changes in dopamine receptor responsivity during alcohol detoxification may predict relapse

In the search for clinical and biological variables that may predict relapse of alcohol dependent patients after detoxification, we followed up for 1 year male patients that had undergone successful detoxification. The patients had been tested earlier during their usual alcohol consumption and immediately after detoxification for the responsivity of D2 dopamine receptors (as measured by the increases in prolactin plasma levels caused by intramuscular administration of 5 mg of the dopamine receptor blocker haloperidol). Of the 18 patients, eight had not consumed alcohol for more than 6 months, and ten had relapsed within 6 months. Comparison of the clinical and neuroendocrine data for the two subgroups revealed no significant differences in age, amount of alcohol consumed during alcohol abuse, score in the Beck Depression Inventory, score in the Brief Michigan Alcoholism Screening Test, or prolactin responses to haloperidol before detoxification. In patients who relapsed, the duration of alcoholism was marginally shorter (P=0.055). Patients who did not relapse had significantly higher (P=0.003) prolactin responses to haloperidol in the test performed after detoxification as compared with patients who did relapse, and their responses were similar to those of a group of healthy male subjects. The results show that the increase in dopamine receptor responsivity that occurs after detoxification is a favourable factor for non-relapse; it may reflect recovery from down-regulation of the dopaminergic reward system caused by alcohol consumption.

Platelet monoamine oxidase and plasma dopamine-β-hydroxylase activities in non-abstinent chronic alcoholics. Relation to clinical parameters

Platelet monoamine oxidase (MAO) and plasma dopamine-beta-hydroxylase (DBH) activities were determined in 27 male non-abstinent chronic alcoholics. Compared to 24 normals, no significant difference in both enzyme activities was found. Alcoholics with at least one alcoholic first degree relative had a trend toward lower platelet MAO activity compared to those without such a history. Matched pair analysis showed that alcoholics of the former subgroup had significantly lower MAO activity than controls. Demented alcoholics had significantly reduced plasma DBH activity compared with the non-demented subgroup and with age, and sex, matched controls.

Dopamine receptor responsivity in alcoholic patients before and after detoxification

OBJECTIVE To assess central dopamine receptor responsivity in alcoholic patients during their usual alcohol consumption and after detoxification. METHOD Plasma prolactin levels were measured at 0, 30, 60, and 90 min after administration of 5 mg haloperidol i.m. in 21 hospitalized male alcoholic patients during usual alcohol consumption, and 13 days later (mean, range 7-17 days), after detoxification. The test was also performed in seven healthy male volunteers. The patterns of prolactin responses were compared using repeated measures analysis of variance. RESULTS The prolactin responses to haloperidol increased significantly after detoxification compared to those during usual alcohol consumption (state x time interaction P < 0.01; planned comparisons for times 0 and 90 min between states P = 0.03). Compared to controls, the responses of the patients before detoxification were lower (group-time interaction P = 0.001), and the difference was not significant after detoxification (P = 0.19). The magnitude of plasma prolactin (PRL) responses were not related to duration of alcohol abuse, score in the Brief Michigan Alcoholism Screening Test (BMAST) scale, or family history of alcoholism. CONCLUSIONS Alcohol detoxification is accompanied by a normalization of the low responsivity of central dopaminergic receptors during alcohol abuse. The data support the hypothesis of a participation of the central dopaminergic system in alcohol dependence.

A short review on the aetiology and pathophysiology of alcoholism

Alcoholism is a chronic remitting and relapsing condition; its aetiology and pathophysiology remains largely obscure despite recent advances. This review summarises the current knowledge about the causation (biological or psychological) of alcohol addiction. This involves heredity, candidate genes, alcohol metabolism regulation and the influence of alcohol in the pathophysiology of the different neurotransmitter systems. Alcohol addiction is a multifactorial phenomenon where personality structure, individual state of mind and social influences are in constant interaction with brain neurobiology and pathophysiology. This disorder influences different sexes in different ways and causes major problems, especially in developed societies.

Platelet monoamine oxidase, plasma dopamine β-hydroxylase activity, dementia and family history of alcoholism in chronic alcoholics

ABSTRACT— The authors measured platelet monoamine oxidase (MAO) activity and plasma dopamine β‐hydroxylase activity in 36 male chronic alcoholics during a period of non‐abstinence, and in 29 normal controls. The influence of family history, dementia, chronicity of drinking and liver injury on the enzyme activities was also examined by multiple regression analysis. Platelet MAO was significantly lower in the alcoholic group. Both enzyme activities were negatively related to the presence of dementia, while low MAO activity was associated with positive family history (parents, sibs) of alcoholism.

Plasma cyclic AMP in non-abstinent chronic alcoholics. Relation to clinical parameters

Plasma cyclic AMP levels were determined in a group of 36 male chronic alcoholics during a period of their usual alcohol intake and compared to 29 normal controls. Significantly lower values (P less than 0.005) were found in the patient group. The possible influence of age, chronicity of drinking, family history of alcoholism, dementia and liver injury on plasma cAMP levels was examined by multiple regression analysis. No influence of those factors could be established except that demented alcoholics showed a trend toward higher levels than a non-demented subgroup. The role of reduced beta-adrenergic receptor activity during chronic alcohol ingestion is discussed in relation to the above findings.

Study of the association between MMPI and alcohol addiction type

Results The average age was 43,4 years ± of 8.1 and the years of education 10,7±:3,1. The average years of use were 20,08±9,10 and the average years of abuse were 8,03±6,31. For the whole sample the males surpassed the females in both parameters. Marital status: (28,6%) were single, (37,1%) married and (34,3%) divorced. There was negative family history for alcohol addiction in (57,1%) patients and (42,9%) had positive. Type of alcoholism: In (80%) it was type I and (20%) had type II. MMPI results: higher was the scale of psychopathy with an average 94,03 ±16, and the second scale schizophrenia with average 85,20±15,54. In the women the value in the introversion scale was smaller (44,28 vs 53.79 t test p<0.05 ). Patients (single and divorced) presented higher values in the scale of depression(65,77 vs 57,15 t test p<0.05). Positive heredity and the type of dependence did not differentiate the sample. The time of use was positively correlated with the Hypochondriasis, Depression, Histrionic as well as thee scales of Paranoia and Psychasthenia. The time of abuse was correlated with the psychasthenia scale (Spearman test p<0.05).The indicators of validity were within acceptable levels. The time of abuse was greater in the men that in the women.

Normal testosterone plasma levels in non-abstinent alcoholics.

Testosterone (T), prolactin (PRL), and luteinizing hormone (LH) levels were estimated in plasma of 32 male chronic alcoholics during a period of their usual alcohol consumption and compared to the values of 32 age-matched controls. T levels were not different from normals, while both PRL and LH were significantly elevated. The subgroup of patients with severe liver injury (n = 11) showed elevated PRL (2P less than 0.001), but normal LH and T, while patients with normal hepatic function (n = 21) showed normal PRL levels, elevated LH, and a tendency to elevated T levels.

P03-246 - Assessment of detoxification programmes for alcoholics with the OCDS questionnaire

Introduction The OCDS used for the assessment of obsessive and compulsive symptoms associated with alcohol intake and relapse may contribute significantly to the assessment of detoxification programmes. Aim of paper The assessment of patients after therapy, using OCDS. Subjects - method The OCDS was administered to 121 patients (94 males and 27 females) at the onset of treatment and upon its completion two months later. All patients were taking medication with naltrexone. Gender, age, education, years of alcohol use and abuse, alcoholism type (91 type I and 30 type II) were recorded. Results The averages years were: age 43,1±7,9, education 11,1±3,3, alcohol use 21,2±8,9, abuse 9,9±7,1. The average of the initial measurement was 27,2±8,2 significantly higher (paired t-test p 0.05) was observed, but lower improvement rate among females is indicated (18,7±10,9 VS 22.9±9.5 t-test p=0.05). Negative correlation between education and alcohol use and abuse (Pearson correlation p 0.05). Conclusion Although therapy seems effective in reducing symptoms, further studies must prove that positive results persist over time. The OCDS seems useful for assessing treatment and has follow-up reliability. The small number of females in the sample renders it unsafe to make any generalisations regarding gender related results in this study.