Presentation on theme: "Prevalence of Alcohol Use Disorders"— Presentation transcript:
1 Prevalence of Alcohol Use Disorders 1st Round Reprint VersionPrevalence of Alcohol Use DisordersNIAAA – National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)Any Alcohol Use Disorder17.6 million (8.5%)Purpose:To provide current data on the prevalence of alcohol use disorders in the United StatesKey Points:The 12-month ( ) prevalences of alcohol use disorders were determined by DSM-IV criteria of abuse and dependence through NIAAA diagnostic interviews (Alcohol Use Disorder and Associated Disabilities Interview Schedule [AUDADIS-IV]) of 43,093 respondentsCurrently, approximately 17.6 million adults (8.5%) in the United States meet the medical criteria for a diagnosis of an alcohol use disorderIn the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) among adults in , it was estimated that9.7 million persons (4.7%) were alcohol abusers7.9 million persons (3.8%) were alcohol dependentSource: Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders:results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004; 61:Alcohol Abuse9.7 million (4.7%)Alcohol Dependence7.9 million (3.8%)NIAAA= National Institute on Alcohol Abuse and AlcoholismGrant BF, et al. Arch Gen Psychiatry. 2004;61:
2 Epidemiology of Use and Abstention PercentThis is a graph of past-year alcohol use and abstention as assessed by the first wave of NESARC. A age related decrease in alcohol use can be seen, with a particularly large drop late in life (after age 64).
3 Epidemiology of Heavy Use Women: > 1 drink / day Men: > 2 drinks / dayPercentThis is a graph of past year heavy drinking as assessed by the first wave of NESARC. Heavy drinking was defined as greater than one drink per day for women and greater than two drinks per day for men. Again, a strong, age-related decrease in heavy drinking is apparent.
4 12-mo. Prevalence of DSM-IV AUD Diagnoses This is a graph of past year AUDs as assessed by the first wave of NESARC. The dark portion of the bars represents alcohol dependence and the light portion of the bars represents alcohol abuse. Once again, there is a strong age-related decline in alcohol pathology. Especially notable is that fact that, for both men and women, alcohol dependence is twice as prevalent among year olds as among any other age group.MenWomen
5 Medications Approved in the US for Treatment of Alcohol Dependence Disulfiram (Antabuse): 1949Naltrexone (ReVia): 1994Acamprosate (Campral): 2004Long-Acting Naltrexone (Vivitrol): 2006
6 Naltrexone Non-specific opioid receptor antagonist Dose dependent binding to m, d and k opioid receptorsFDA approved as adjunctive pharmacotherapy for the treatment of alcoholism
10 Clinical trials Naltrexone has been shown to Increase percentage of days abstinent from alcoholReduce number of drinks/drinking dayIncrease time to relapseDecrease craving for alcohol
11 Naltrexone (Revia) in the Treatment of Alcohol Dependence 1st Round Reprint VersionNaltrexone (Revia) in the Treatment of Alcohol Dependence1.00.90.80.70.6Cumulative Proportion with No Relapse0.50.40.3Naltrexone (N=35)Placebo (N=35)0.20.10.0SLIDE 41: Cumulative Relapse RateRelapse rates presented as a survival analysis indicate asubstantial difference between the placebo and naltrexonetreated groups56123456789101112Number of Weeks Receiving MedicationVolpicelli et al., Arch Gen Psychiatry, 1992
12 Effect of Long-Acting Naltrexone on Maintenance of Abstinence 1st Round Reprint VersionEffect of Long-Acting Naltrexone on Maintenance of AbstinenceSubjects with 4-day lead-in abstinence10090807060Percent without Relapse504030p < 0.025201012354678109111213151416171820192122232524262728302931WeeksPlacebo (n = 28)Vivitrex (n = 28)
15 Cochrane review (Srisurapanont and Jarusuraisin 2002) NTX treatment can decrease the chance of alcohol relapse for 36% as compared to placebo treatment. In addition, the treatment is likely to reduce the chance of returning to drinking for 13%.Short-term treatment of NTX for alcoholism gives a meaningful benefit in preventing a relapse.Small to Modest efficacy!
16 Identifying predictors of robust treatment response to naltrexone could improve clinical practice
17 Potential predictors of naltrexone response Family history of alcoholismMonterosso et al., 2001; Rubio et al., 2005OPRM1 m opioid receptor gene polymorphismsOslin et al., 2003Age of onset of alcohol abuseRubio et al., 2005Antisocial traits and heavier drinkersRohsenow et al., 2007Higher level of alcohol cravingVolpicelli et al., 1995Consistent drinking patternsGueorguieva et al 2007
18 Laboratory modelsHuman clinical laboratory paradigms can be used to model a variety of behaviors in controlled conditions.Careful experimental manipulations to understand the mechanisms underlying a behavior.Can be used to evaluate medication signals following a shorter treatment period
19 Laboratory models-Alcohol In the field of alcohol research, controlled human laboratory studies have been used to studydifferent populations of drinkers(e.g., social drinkers, dependent drinkers, women, high-risk individuals),different types of cues(e.g., stress, social drinking, solitary drinking, peer influences),different types and schedules of alcohol(e.g., beer, wine, hard liquor, IV alcohol; fixed doses, scheduled administration, ad-lib drinking).
20 Laboratory models to study alcohol-naltrexone interactions Human laboratory-based paradigms have been used to evaluate naltrexone’s effects inSocial drinkerse.g. Swift et al 1994, King et al 1997Non-treatment seeking alcohol dependent drinkerse.g. Anton et al 2004; Drobes et al 2004, Krishnan-Sarin et al 2007, O’Malley et al 2002Importantly, effects observed in laboratory studies similar to those seen in clinical trials
21 Alcohol Self-Administration Model (O’Malley, Krishnan-Sarin et al Day 0Day 6Day 7Choice Block #15:00 pmChoice Block #26:00 pm7 pm4 pmOutpatientTreatmentAlcohol ReactivitycravingAd-Lib Period4 drinks per choice period (.015 g/dl)$12 tab per choice periodNaltrexonepretreatmentMET Intervention DischargePriming Drink(.03 g/dl)