Gihyun Yoon

The Spanish version of the quality of life index: presentation and validation.

Latino or Spanish-speaking individuals constitute a substantial and growing population in the United States, in addition to their general presence, with cultural variations, throughout Latin America and the Iberian Peninsula. To respond to the needs of this population, a Spanish version of the Quality of Life Index (QLI-Sp) was developed. The QLI, in its various language versions, is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-rated quality of life. It is composed of 10 dimensions collated from the international literature, including aspects ranging from physical well-being to spiritual fulfillment, as well as a global perception of quality of life. Each item is to be rated on a 10-point line by Latino subjects according to their culture-informed understanding of that concept. The study samples included 60 Latino psychiatric patients (20 outpatient, 20 inpatient, and 20 partial hospitalization) and 20 Latino actively working hospital professionals. Mean time of completion was 2.4 minutes among health professionals and 3.6 minutes among patients. The vast majority of respondents (72% of patients and 1000% of professionals) judged the instrument as easy to use. The test-retest reliability correlation coefficient of the QLI-Sp mean score was .89. The discriminant validity of the QLI-Sp was documented by the highly significant difference obtained between the mean scores of the two samples selected to represent quite different levels of quality of life.

Functional Role of the Polymorphic 647 T/C Variant of ENT1 (SLC29A1) and Its Association with Alcohol Withdrawal Seizures

Background Adenosine is involved in several neurological and behavioral disorders including alcoholism. In cultured cell and animal studies, type 1 equilibrative nucleoside transporter (ENT1, slc29a1), which regulates adenosine levels, is known to regulate ethanol sensitivity and preference. Interestingly, in humans, the ENT1 (SLC29A1) gene contains a non-synonymous single nucleotide polymorphism (647 T/C; rs45573936) that might be involved in the functional change of ENT1. Principal Findings Our functional analysis showed that prolonged ethanol exposure increased adenosine uptake activity of mutant cells (ENT1-216Thr) compared to wild-type (ENT1-216Ile) transfected cells, which might result in reduced extracellular adenosine levels. We found that mice lacking ENT1 displayed increased propensity to ethanol withdrawal seizures compared to wild-type littermates. We further investigated a possible association of the 647C variant with alcoholism and the history of alcohol withdrawal seizures in subjects of European ancestry recruited from two independent sites. Analyses of the combined data set showed an association of the 647C variant and alcohol dependence with withdrawal seizures at the nominally significant level. Conclusions Together with the functional data, our findings suggest a potential contribution of a genetic variant of ENT1 to the development of alcoholism with increased risk of alcohol withdrawal-induced seizures in humans.

Safety of high-dose naltrexone treatment : Hepatic transaminase profiles among outpatients

Objectives: This study was carried out to test the hypothesis that the hepatic safety profile of prolonged high-dose oral naltrexone (150 mg/d) is acceptable if over-the-counter analgesic use is restricted. Methods: Data from 41 consecutive outpatients with impulse-control disorder receiving naltrexone therapy were analyzed. Results: The mean treatment duration was 328 days and the mean naltrexone dose was 142 mg/d. Pretherapy/posttherapy mean aspartate transaminase and alanine transaminase levels in the naltrexone-alone group were 21.79/22.54 and 21.74/21.49 U, respectively (all within reference range). Conclusions: Although limited in scope, these findings support the hypothesis that long-term use of high-dose oral naltrexone is safe in otherwise healthy patients with impulse-control disorders who restrict their intake of acetaminophen, aspirin, or nonaspirin nonsteroidal anti-inflammatory drugs (NSAID). However, confirming studies are needed.

Suicidal ideation and suicide attempts in five groups with different severities of gambling: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND AND OBJECTIVES Problem and pathological gamblers show high rates of suicidal behavior. However, previous research of suicide among this population has been inconsistent. Discrepancies may stem from methodological issues, including variable use of suicide nomenclature and selection bias in study samples. Furthermore, earlier research has rarely examined gambling severity aside from problem or pathological categories. This study utilized subgroups derived from a nationally representative data set, examining different characteristics of suicidal behavior and several gambling levels, including subclinical groups. METHODS Participants included 13,578 individuals who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and provided information on gambling behavior, lifetime suicidal ideation, and/or lifetime suicide attempts. Five gambling groups were derived using DSM-IV criteria for pathological gambling; non-gambling, low-risk gambling, at-risk gambling, problem gambling, and pathological gambling. RESULTS Problem gambling was associated with suicidal ideation [adjusted odds ratio (AOR) = 1.64, 95% confidence interval (CI) = 1.19-2.26] and suicide attempts [(AOR) = 2.42, 95% (CI) = 1.60-3.67] after adjustment for sociodemographic variables. Pathological gambling was associated with suicidal ideation [(AOR) = 2.86, 95% (CI) = 1.98-4.11] and suicide attempts [(AOR) = 2.77, 95% (CI) = 1.72-4.47) after adjustment for sociodemographic variables. DISCUSSION, CONCLUSIONS, AND SCIENTIFIC SIGNIFICANCE Our results from this population sample reinforce increased rates of suicidal behavior amongst smaller, clinical samples of problem and pathological gamblers. Education for providers about gambling is recommended, including screening for gambling-related symptoms such as suicidal behavior.

Impact of the number of parents with alcohol use disorder on alcohol use disorder in offspring: a population-based study.

OBJECTIVE Although parental alcohol use disorder (AUD) increases risk for alcohol problems in offspring, no studies have evaluated the odds of AUD in offspring based on the number of biological parents with AUD (0, 1, or 2) in a population-based national sample. The purpose of this study was to investigate the relationship between the number of AUD parents and prevalence of AUD in offspring. METHOD This study utilized data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, which assessed AUD using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (main outcome variable). We analyzed the sample (n = 40,374) to investigate the effect of the number of AUD parents on lifetime AUD in offspring. In a subgroup analysis, gender differences were examined. RESULTS 22% of adults in the United States had at least 1 biological parent with AUD. Compared with offspring of non-AUD parents, offspring of 1 AUD parent had a 2.5-fold increase (AOR = 2.51; 95% CI, 2.38-2.66) and offspring of 2 AUD parents had a 4.4-fold increase (AOR = 4.44; 95% CI, 3.93-5.02) in the odds of lifetime AUD. Each additional AUD parent increased the odds of AUD in offspring in an additive pattern. Female offspring were more vulnerable to the impact of parental AUD than male offspring (OR = 1.17 in offspring of 1 AUD parent; OR = 1.48 in offspring of 2 AUD parents). CONCLUSIONS Offspring of AUD parents had heightened odds of lifetime AUD, with an additive parental effect. Awareness of this risk can be useful for clinicians to educate individuals with AUD parents about prevention and intervention.

Safety, tolerability, and feasibility of high-dose naltrexone in alcohol dependence: an open-label study.

Prior trials testing standard‐dose naltrexone (50 mg/day) have generated mixed results in the treatment of alcohol dependence. The purpose of this study was to evaluate the short‐term safety, tolerability, and feasibility of high‐dose naltrexone (150 mg/day) for treating alcohol‐dependent patients with prominent alcohol craving.

Correlates of major depressive disorder with and without comorbid alcohol use disorder nationally in the veterans health administration

BACKGROUND AND OBJECTIVES This study assesses medical and psychiatric comorbidities, service utilization, and psychotropic medication prescriptions in veterans with comorbid major depressive disorder (MDD) and alcohol use disorder (AUD) relative to veterans with MDD alone. METHODS Using cross-sectional administrative data (fiscal year [FY]2012: October 1, 2011-September 30, 2012) from the Veterans Health Administration (VHA), we identified veterans with a diagnosis of current (12-month) MDD nationally (N = 309,374), 18.8% of whom were also diagnosed with current (12-month) AUD. Veterans with both MDD and AUD were compared to those with MDD alone on sociodemographic characteristics, current (12-month) medical and psychiatric disorders, service utilization, and psychotropic prescriptions. We then used logistic regression analyses to calculate odds ratio and 95% confidence interval of characteristics that were independently different between the groups. RESULTS Dually diagnosed veterans with MDD and AUD, relative to veterans with MDD alone, had a greater number of comorbid health conditions, such as liver disease, drug use disorders, and bipolar disorder as well as greater likelihood of homelessness and higher service utilization. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Dually diagnosed veterans with MDD and AUD had more frequent medical and psychiatric comorbidities and more frequently had been homeless. These data suggest the importance of assessing the presence of comorbid medical/psychiatric disorders and potential homelessness in order to provide appropriately comprehensive treatment to dually diagnosed veterans with MDD and AUD and indicate a need to develop more effective treatments for combined disorders.

Substance Use Disorders and Adoption: Findings from a National Sample

Background Prior research has shown that adoptees have a higher rate of substance use disorders (SUDs) than nonadoptees. But these findings have not been verified with a population-based sample of adult adoptees in the United States. Also, no previous adoption study has measured the prevalence of each specific substance use disorder (SUD). We aimed to compare lifetime prevalence rates and odds ratios of SUDs in adopted and nonadopted adults. Methods and Findings The data come from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The main outcome measure was the prevalence of lifetime SUDs in adopted (n = 378) and nonadopted adults (n = 42503). Adoptees and nonadoptees were compared to estimate the odds of lifetime SUDs using logistic regression analysis. Adoptees had higher prevalence rates of lifetime SUDs than nonadoptees. Overall, adoptees had a 1.87-fold increase (adjusted odds ratio [AOR] 1.87, 95% CI 1.51–2.31) in the odds of any lifetime SUD compared to nonadoptees. For each SUD, adoptees had higher odds for alcohol abuse/dependence (AOR 1.84), nicotine dependence (AOR 1.78), cannabis abuse/dependence (AOR 1.77), cocaine abuse/dependence (AOR 2.54), amphetamine abuse/dependence (AOR 3.14), hallucinogen abuse/dependence (AOR 2.85), opioid abuse/dependence (AOR 2.21), and other drug abuse/dependence (AOR 2.87) compared to nonadoptees. This study also identified two adoption-specific risk factors (Hispanic, never married) associated with any lifetime SUD. Conclusions This study demonstrated an increased risk of lifetime SUDs in adopted adults. The findings can be useful for clinicians and policy makers to provide education, prevention, and support for adoptees and their families.

Substance use disorder among adoptees: a clinical comparative study.

Goals of the study were to assess whether adoptees in treatment for Substance Use Disorder (SUD) (1) were over-, equi-, or under-represented in a clinical sample of patients with (SUD) and (2) differed demographically and clinically from non-adoptees with SUD. Sample consisted of 608 patients in two alcohol-drug treatment programs. Data collection included the Childhood Problems Scale, the Minnesota Substance Abuse Problem Scale, and the Minnesota Substance Abuse Treatment Questionnaire, and the Michigan Assessment-Screening Test/Alcohol-Drug. Findings showed that the prevalence of adoptees among SUD patients was 14 times higher than expected (95% Confidence Interval, 10 to 18 times). Adoptees reported childhood histories similar to those of non-adoptees with “any parental SUD”, but they more closely resembled non-adoptees without parental SUD in regard to SUD severity and SUD treatment.Conclusion is that adoptees and their adoptive families should be alert to the increased risk of SUD among adoptees. Clinicians can expect that adoptees should manifest milder levels of SUD morbidity, similar to “non-heredity” SUD.

Social and behavioral problems among five gambling severity groups.

Gambling has been associated with various social and behavioral problems, but previous analyses have been limited by sample bias regarding gambling symptom severity range and the role of antisocial personality disorder (ASPD). This study utilized a nationally representative data set and examined various characteristics of behavioral problems and ASPD among five gambling severity groups. Participants were 42,038 individuals who took part in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and provided information on social and behavioral problems, ASPD, and gambling. Using DSM-IV criteria, we derived five gambling groups from the total sample: non-gambling, low-risk, at-risk, problem, and pathological gambling. Associations between all problematic behaviors and nearly every gambling severity level were significant prior to adjustment for sociodemographic variables and ASPD. Following the adjustment, all significant associations persisted, with the exception of sexual coercion. In the adjusted model, the financially oriented behaviors had the strongest associations with gambling. All gambling severity levels were associated with an increased risk for a number of problematic behaviors and social problems in comparison to non-gamblers.Further examination of gambling problems in financial and criminal justice settings is recommended.