Nicolas Simioni

The dose–effect relationship of baclofen in alcohol dependence: A 1-year cohort study

Our aim is to study the relationship between dose of baclofen and effectiveness in alcohol dependence.

Interventions for Increasing Subsequent Alcohol Treatment Utilisation Among Patients with Alcohol Use Disorders from Somatic Inpatient Settings: A Systematic Review

AIMS Alcohol Use Disorders (AUDs) are common in medical and surgical hospital wards. Brief Interventions (BIs) for reducing alcohol use and consequences are generally inefficacious in this population. Because there is evidence that receipt of formal treatment could be useful, we performed a systematic review to determine efficacious interventions for increasing subsequent alcohol treatment from these settings. METHODS A systematic literature search of articles published prior to December 2013 to identify articles describing randomised controlled trials (RCTs) in three electronic databases: PubMed, PsycINFO and The Cochrane Library. Data were extracted independently by one reviewer and were checked by a second reviewer. Because of heterogeneity between study groups in treatment utilisation during the follow-up, a meta-analysis was considered inappropriate and a qualitative synthesis was conducted. RESULTS From the 5030 identified records, only 5 RCTs, including 1113 patients with AUDs, met inclusion criteria. No evidence of efficacy in increasing subsequent treatment utilisation was reported for inpatient BIs alone, but interventions with post-discharge sessions might be beneficial. Increased treatment utilisation was generally associated with favourable drinking outcomes. CONCLUSIONS Given the small number of included studies and the presence of several alternative methodological explanations for the present findings, no firm conclusions could be drawn on efficacious interventions for increasing subsequent treatment utilisation among somatic inpatients with AUDs. However the findings support efforts to explore this under-researched area.

Early relapse in alcohol dependence may result from late withdrawal symptoms

Alcohol dependence has two distinct clinical features: (1) Physiological Dependence (PD), which characterizes the pharmacological tolerance that alcohol progressively induces in the brain and (2) Alcohol Addiction (AA), which is the behavioral conditioning of alcohol drinking resulting from the chronic activation of the reward system. PD results from a progressive imbalance between excitatory and inhibitory neurotransmission systems and leads to the occurrence of Alcohol Withdrawal Syndrome (AWS), which is prevented by benzodiazepines in cases of alcohol cessation. AA is considered to persist much longer and results from a disruption of the dopaminergic mesolimbic pathway, which is treated by anticraving drugs. Relapse in alcohol dependence is usually considered to be the result of AA. However, 50% of the relapses in alcohol occur within the first month after alcohol cessation. During this period, it has been shown that many patients experience anxious symptoms that have been neurobiologically related to withdrawal symptoms and PD. Thus, we hypothesize that early relapses are more the consequence of late symptoms of PD than AA. From this standpoint, we propose that prolonged treatment with benzodiazepines may reduce the first-month relapse rate.

Resurgence of anorexic symptoms during smoking cessation in patients with a history of anorexia nervosa: An unseen problem?—Report of two cases

This report describes a resurgence of anorexic symptoms during a smoking cessation program in two patients with a history of anorexia nervosa. These two events were identified among patients lost to follow-up by using a strategy implemented to limit early drop out. In both cases, the resurgence of anorexic symptoms occurred rapidly after having reached abstinence from tobacco and was described as a response to the weight gain they had experienced just after the start of smoking cessation. The smoking cessation process itself was considered as the most plausible explanation for these two events. Given the potential serious consequences, further research is needed to determine whether such events are frequent during smoking cessation but being unseen because of being hidden in the loss to follow-up. This report also suggests that systematic screening for both binge eating and anorexic behaviors during smoking cessation is warranted.

Is there really no evidence of the efficacy of brief alcohol interventions for increasing subsequent utilization of alcohol‐related services? Commentary on the paper by Glass et al. (2015)

Keywords: Alcohol; alcohol misuse; alcohol treatment utilization; brief alcohol interventions; brief interventions; treatment utilization

Prevalence and predictors of no lifetime utilization of mental health treatment among people with mental disorders in France: findings from the ‘Mental Health in General Population’ (MHGP) survey

PurposeNo lifetime utilization of mental health treatment (NUMT) is an indicator of the treatment gap among people in need of treatment. Until now, the overall prevalence and predictors of NUMT have never been explored in France.MethodsIn a 39,617-respondent survey, participants were assessed for NUMT, i.e., no lifetime psychotherapy, psychopharmacotherapy, or psychiatric hospitalization. Mental disorders were investigated using the Mini International Neuropsychiatric Interview (MINI 5.0.0). MINI diagnoses were grouped into five categories: mood disorders (MDs); anxiety disorders (ADs); alcohol use disorders (AUDs); substance use disorders (SUDs); and psychotic disorders (PDs). Using multivariable logistic regression models, we explored the factors associated with NUMT among the MINI-positive respondents. The odds ratio and 95% confidence interval were calculated for each factor.ResultsIn total, 12,818 (32.4%) respondents were MINI-positive, 46.5% of them reported NUMT (35.6% for MDs, 39.7% for PDs, 42.8% for ADs, 56.0% for AUDs, and 56.7% for SUDs). NUMT was positively associated with being male [OR 1.75 (1.59–1.91)] and practising religion [OR 1.13 (1.02–1.25)] and negatively associated with ageing [per 10-year increase: OR 0.88 (0.85–0.91)], being single [OR 0.74 (0.66–0.84)], being a French native [OR 0.67 (0.60–0.75)], and experiencing MDs [OR 0.39 (0.36–0.43)], ADs [OR 0.47 (0.43–0.52)], AUDs [OR 0.83 (0.73–0.96)], SUDs [OR 0.77 (0.65–0.91)], or PDs [OR 0.50 (0.43–0.59)].ConclusionsIn France, NUMT rates were the highest for AUDs and SUDs. Additionally, suffering from MDs or ADs increased the lifetime treatment utilization for people having any other mental disorder. This finding emphasizes the need to better screen AUDs and SUDs among people treated for MDs or ADs.

Thirty- Versus Ten-day Diazepam Treatment for Alcohol Detoxification and a Comparison of Drinking Patterns, Craving, and Anxiety for up to 12 Weeks: A “proof-of-concept” Open-label Randomized Controlled Trial

Purpose The aim of this study was to evaluate whether a prolonged detoxification treatment could decrease the relapse rate at 3 months after alcohol cessation in alcohol-dependent individuals through decreasing the levels of postdetoxification craving and anxiety. Methods Twenty-six adult patients with alcohol dependence (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) who began an outpatient alcohol cessation program with an initial drinking goal of abstinence were enrolled in a 3-month, parallel, randomized (1:1 ratio), controlled, open-label, pilot trial. Participants were randomized to receive a detoxification treatment of diazepam with a duration of 30 (n = 12) or 10 days (n = 14). All participants received BRENDA-based psychotherapy during follow-up. Results No significant between-group difference in relapse to any drinking was found at 3 months (P = 0.20). However, relapse to any heavy drinking at 3 months and regular drinking or heavy drinking during follow-up were significantly lower in the 30-day diazepam group (P = 0.009, P = 0.049, and P = 0.004, respectively). These differences were corroborated by significant differences in the alcohol-specific biological marker carbohydrate deficient transferrin at 3 months. Participants in the 30-day diazepam group also displayed significantly lower scores for alcohol craving (P = 0.007), self-reported anxiety (P = 0.024), and clinician-assessed anxiety (P = 0.002) throughout the follow-up. No serious adverse event was reported during the study. Conclusion This study provides an evidence-based rationale for a double-blind, randomized, placebo-controlled trial to confirm the efficacy of such a procedure on short-term and mid-/long-term drinking outcomes after alcohol cessation in alcohol-dependent individuals.