Pesquisa

Artigos no Europe PMC

Resumo do Europe PMC lido nesta página. Não é bula, diagnóstico nem orientação clínica. O PDF completo protegido por direitos não entra no BETARUBI.

• Europe PMC · 2026

  Integrated behavioral care in general hepatology increases alcohol use disorder treatment in veterans.

  Perumalswami PV, Cornwell BL, Grau PP, Meyers AC, Jayaram M, Irani S, Wongsirisakul P, Liangpunsakul S, Patel A, DePhilippis D, Liberto J, Szymanski BR, McCarth

  Background Hepatology visits present an opportunity to engage patients with alcohol-associated liver disease in care. This quality improvement pilot integrated a behavioral health provider (BHP) into the hepatology clinic at one Veterans Health Administration site and assessed its impact on alcohol use disorder (AUD) treatment. Methods and results Hepatologists across Veterans Health Administration facilities developed a workflow to refer patients with signs of unhealthy alcohol use to a BHP co-located in the hepatology clinic. Data during the first year of BHP integration (December 2022 to January 2024) were obtained through chart reviews and the Veterans Health Administration Corporate Data Warehouse. t tests and χ2 tests compared baseline characteristics and assessed the associations of referral status with receipt of evidence-based AUD treatments within 6 months of referral or index liver clinic appointment. Two hundred ninety-three patients with signs of unhealthy alcohol use were identified, representing 19.9% of all liver clinic patients engaged in care during the pilot. Of these, 86.4% had a prior mental health diagnosis, 79.2% had an AUD diagnosis, 57.7% had a positive AUDIT-C screen, 40.3% had an alcohol-associated liver disease diagnosis, and 71 patients (24% of patients with unhealthy alcohol use) were referred to the BHP. Referred patients were more likely to receive AUD psychotherapy and/or pharmacotherapy and had significantly more AUD pharmacotherapy fill days (35.2 vs. 10.3, p Conclusions Referral to a co-located BHP was associated with a higher likelihood of receiving AUD treatment and a greater amount of AUD treatment, but gaps in referral remain and need to be addressed. Integrating BHPs into general hepatology clinics may improve AUD treatment uptake, addressing an important gap in care.

• Europe PMC · 2026

  Functional magnetic response imaging predictors of alcohol use disorder treatment outcome: a systematic review.

  Elsayed M, Siroosi R, Najdzionek P, McIntyre-Wood C, Hargreaves T, Blakely A, Mote E, MacKillop J.

  Background Despite evidence-based pharmacological and behavioural interventions, alcohol use disorder (AUD) is associated with highly variable treatment outcomes. Functional magnetic resonance imaging (fMRI) may identify neural markers that predict treatment response, ultimately supporting a precision medicine approach to AUD. Objectives This systematic review synthesized evidence on fMRI predictors of treatment outcomes in individuals with AUD, evaluated methodological consistency, and identified gaps to guide biomarker development. Methods A comprehensive search of PubMed/MEDLINE, Embase, and PsycINFO combined terms related to fMRI, AUD, and treatment outcomes. Eligible studies included participants with AUD receiving pharmacological, behavioural, or neuromodulatory interventions with fMRI measures collected before or early in treatment to predict clinical outcomes. Screening and extraction were conducted in duplicate using Covidence, and study quality was assessed with the Grading of Recommendations Assessment, Development, and Evaluation framework. Results Of 342 records, 15 studies met the inclusion criteria. Most used alcohol cue reactivity tasks (k = 11), with others using resting-state fMRI (k = 2), a monetary reward task (k = 1), or an alcohol-specific Go/No-Go task (k = 1). Pharmacological treatments were most common (k = 8), followed by behavioural therapies (k = 6) and one neuromodulation trial. Across paradigms, neural activity in the ventral striatum, orbitofrontal cortex, and anterior cingulate cortex commonly predicted outcomes. Greater prefrontal engagement predicted improvement, while heightened striatal cue reactivity predicted relapse. Resting-state findings suggested reduced reward- and stress-network connectivity corresponded with better outcomes. Across studies, however, considerable heterogeneity and inconsistency were present and sample sizes tended to be small. Conclusions Evidence implicates frontostriatal and salience circuitry in predicting AUD treatment outcomes, but inconsistency and underpowered studies limit firm conclusions. Larger longitudinal studies are needed to robustly validate clinically useful biomarkers.

• Europe PMC · 2026

  The Predictive Value of Tenascin-C, Neopterin and Pro-Inflammatory Cytokines (IFN-γ, TNF-α, IL-6) in Alcohol Use Disorder Treatment Response.

  Akpinar G, Sener G, Altunkiliç EF, Yazgec E, Ozturk AB, Basan NM, Ozsemerci HA.

  The underlying neurobiological mechanisms of chronic alcohol consumption, particularly neuroinflammation and immune system dysregulation, have been extensively studied in recent years. In this process, the identification of objective biomarkers that can predict treatment response and enable personalized medicine approaches is of critical importance. This study aimed to evaluate the potential predictive value of tenascin-C (TNC), an extracellular matrix protein, neopterin, a marker of cellular immune activation and pro-inflammatory cytokines interferon-gamma (IFN-γ), tumour necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), during the treatment process for alcohol use disorder (AUD). This prospective observational cohort study included 30 patients admitted to an AUD treatment centre and 31 healthy controls. Serum TNC, IL-6, TNF-α and IFN-γ levels were measured using the ELISA method. Clinical outcomes were assessed using the SCL-90-R and API-K scales. Serum samples were collected from patients at admission and on the 7th day of detoxification treatment. Baseline serum TNC levels in the alcohol group (131.78 ± 50.92 ng/mL) were significantly higher than in the healthy control group (63.92 ± 23.85 ng/mL). In the alcohol group, TNC (p = 0.007) and AST (p = 0.025) levels decreased significantly, while vitamin B12 (p = 0.002) and platelet count (p = 0.012) increased. No significant difference was observed in neopterin and cytokine levels (TNF-α, IL-6 and IFN-γ) between baseline and follow-up measurements. Clinical assessments showed significant improvements in depression (p = 0.041), anxiety (p = 0.014) and total symptom scores (p = 0.026) on the SCL-90-R scale. ROC analysis showed that a reduction of 28.22% or more in TNC predicted clinical improvement with an overall accuracy rate of 73.33%.

• Europe PMC · 2026

  A double-blind randomized clinical trial of zonisamide and contingency management for alcohol use disorder treatment (ZARRA) protocol.

  Palombo P, Schmidt A, Akana N, Ryan R, Hovland S, Stark BC, Rodin N, Chaytor N, McDonell M, Burduli E, Layton M, Roll JM, Smith C, Miguel AC, McPherson S.

  Background Alcohol Use Disorder (AUD) has a significant negative impact on health and is associated with high morbidity and mortality rates. Despite the availability of pharmacological treatments, abstinence rates remain low, highlighting the need for novel therapeutic approaches. This study aims to evaluate the efficacy of combining Contingency Management (CM) with Zonisamide in promoting alcohol abstinence and reductions in alcohol use among individuals seeking AUD treatment. Additionally, this study will collect data on the Addiction Neuroclinical Assessment ANA framework to identify potential mediators or moderators of treatment outcomes. Methods This is a randomized, double-blind, controlled trial involving individuals diagnosed with AUD seeking treatment. Following a two-week induction period, eligible participants will be randomly assigned in equal proportions to one of two 12-week treatment conditions: CM + Zonisamide (experimental condition) or CM + Placebo (control condition). The primary outcome is biochemically verified alcohol abstinence assessed using repeated urine ethyl glucuronide (EtG) testing across the 12-week randomized treatment phase. Both groups will receive incentives for submitting alcohol samples during the first two weeks (induction phase). From weeks three to six, incentives will be contingent on providing alcohol-negative samples. Finally, from weeks seven to fourteen, incentives will be based on medication adherence. Follow-up assessments will be conducted at one, six- and twelve-months post-treatment. Conclusions If effective, this treatment could provide significant advancements in AUD treatment by offering a novel, integrated approach to reduce alcohol use. Furthermore, the findings may contribute to a deeper understanding of how ANA-based responses influence treatment outcomes, facilitating the development of more personalized AUD treatment approaches.

• Europe PMC · 2026

  Predictors of Engagement and Impact on Alcohol-Related Hospital Utilization with Primary Care-Based Alcohol Use Disorder Treatment Clinic.

  Pulsifer BH, Lom J, Aleuy L, Miller LS, Klein R.

  Background Primary care-based alcohol use disorder (AUD) treatment models may improve engagement with AUD treatment, yet predictors of engagement and impact of these approaches on hospital utilization are unclear. Objective To characterize patients referred to a primary care-based AUD clinic (AUDC), identify predictors of engagement, and assess associations between engagement and alcohol-related hospital utilization. Design Retrospective cohort study of adults referred to the AUDC at a large public hospital using electronic health record data (2022-2025). Participants Adults (≥ 18 years) referred to the AUDC, classified as attendees (attended ≥ 1 AUDC visit) or non-attendees. Main measures Differences between attendees and non-attendees in characteristics using t-test/chi square and alcohol-related ED visits or hospitalizations 6, 12, and 18 months after referral using multivariate regression. Key results Of 463 patients, 253 were attendees (54.6%). Attendees were more often referred by primary care providers (PCPs) than non-PCPs (57% vs. 35%, p Conclusions Primary care-based AUDC engagement was associated with reduced alcohol-related hospital utilization short- and intermediate-term but not long-term. Existing relationship with primary care was a notable predictor of AUDC engagement, providing insights into who benefits from this model.

• Europe PMC · 2026

  Family-supervised disulfiram as a culturally grounded model for alcohol use disorder treatment in Sri Lanka: a pilot randomised controlled trial

  Rajasuriya M, Chulasiri P, Ratnayake P, Plevin D.

  Objectives To evaluate the effectiveness and cultural feasibility of family-supervised disulfiram as a first-line treatment for alcohol use disorder (AUD) in Sri Lanka, and to compare its clinical outcomes with standard therapy delivered at a tertiary psychiatric unit. Design Single-blind Randomized Controlled Trial known as ETAT-RCT (Efficacy of Two Alcohol Treatments) was conducted under routine clinical setup with three parallel groups: family-supervised disulfiram, locally developed psychosocial intervention, and routine treatment. Allocation was independently concealed; assessors were blinded. Analyses followed an intention-to-treat approach using repeated-measures ANOVA (group x time). This paper reports the disulfiram (test) versus routine treatment (control) comparison; the psychosocial intervention will be reported separately. Setting University Psychiatry Unit, National Hospital of Sri Lanka, Colombo (UPU, NHSLC). Participants Patients aged ≥14 years with AUD presenting to the unit were recruited consecutively without inducements. Planned allocation ratio was 1:1:1 with 31 participants per arm; key exclusions were lifetime psychotic disorder and current contraindication to disulfiram. Randomisation Participants were randomised into each treatment arm using an independent concealed paper-based allocation system. Intervention (1) family-supervised disulfiram, with psychoeducation/support only - DT arm, (2) a locally developed denormalization focused psychosocial programme - PT arm, and (3) standard therapy (motivational/cognitive/behavioural input; naltrexone permitted; no disulfiram/denormalisation) - ST arm. Outcome measures Primary outcome was Alcohol Use Disorders Identification Test (AUDIT) score at 12 months. Key secondary outcomes were past 30 day alcohol use via Timeline Follow-Back (TLFB); alcohol biomarkers [ALT (alanine aminotransferase), γ-GT (gamma-glutamyl transferase), MCV (mean corpuscular volume)]; locally developed measures of addiction-relevant cognitive, affective, behavioural factors [AARSU (Attitude Assessment Related to Substance Use), BARSU (Behaviour Assessment Related to Substance Use)]; and Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Outcomes were assessed at baseline, 6, and 12 months. Results Participants in DT (n=33) and ST (n=38) were comparable at baseline. Both groups showed clinically and statistically significant improvement in AUDIT scores over 12 months (DT: F=39.90, p 0.05). In moderator analyses, improvement in AUDIT was not moderated by baseline motivation (F=0.20, p=0.89) but was moderated by baseline AUD severity (F=7.70, p=0.007). No serious adverse events were attributed to disulfiram. Adherence to supervised dosing was generally high during periods of supervision but intermittent overall. Conclusions In this pilot RCT, family-supervised disulfiram achieved 12-month outcomes comparable to standard therapy in a tertiary Sri Lankan setting. Improvements were independent of baseline motivation and varied by baseline AUD severity. These findings may support family-supervised disulfiram as a culturally feasible first-line option in Sri Lanka; larger, adequately powered multicentre trials are warranted to confirm effectiveness and scalability. Trial registration S LCTR/2014/021 Strengths and limitations of this study This pragmatic randomised controlled trial demonstrates an improved real world applicability and validity as it was conducted in an unmodified public-sector psychiatric setting. Strong generalisability of the study with similar health systems due to broad eligibility criteria of patients warranted the inclusion of regular and general patient cohort with alcohol use disorders, strengthening generalisability within similar health systems. Interventions were carried out without additional staff or patient monitoring reflecting routine clinical practice. Comprehensive assessment beyond abstinence alone with multidimensional outcomes su

• Europe PMC · 2026

  Investigating the Effect of Secondary Cannabis Use in Treatment Discontinuation Among Individuals Undergoing Alcohol Use Disorder Treatment.

  Shikalgar S, Kane L, Khalil MZ, Noor-E-Alam M.

  Background As of 2025, medical-use cannabis is legal in 39 US states and recreational-use in 24, meaning more than half of Americans live under at least partial legalization. This shift creates new clinical considerations for individuals undergoing treatment for alcohol use disorder (AUD), particularly those who also use cannabis during treatment. Objective To examine the association between cannabis co-use and completion of AUD treatment among individuals admitted primarily for alcohol-related treatment. Methods We used the Substance Abuse and Mental Health Services Administration's Treatment Episode Data Set: Discharges (TEDS-D) from 2015 to 2021. A multivariate logistic regression model estimated the association between cannabis co-use and treatment completion among patients admitted for AUD. To test robustness, the multivariate regression was repeated on a propensity score-matched subsample. Results Cannabis co-use was associated with lower likelihood of treatment completion (odds ratio = 0.76) compared with alcohol-only patients. Treatment completion rates differed notably between alcohol-only users (74%) and those who used both alcohol and cannabis (64%). The direction and magnitude of this association remained consistent in the propensity score-matched analysis. Conclusions Cannabis co-use is linked with reduced treatment success among individuals treated for AUD. These findings highlight the added complexity posed by dual substance use and suggest a need for tailored interventions and clinical awareness in treatment settings.

• Europe PMC · 2026

  Disparities, Perceived Discrimination, and Patient-Clinician Communication in Alcohol Use Disorder Treatment: An All of Us Cohort Study

  Moon J, Espinoza JCI, Puzantian T.

  Background and Aims Alcohol use disorder (AUD) remains a major public health concern, with persistent disparities in access to evidence-based treatment. This study aimed to examine associations between perceived discrimination in healthcare settings (PDHS), patient-clinician communication (PCC), and receipt of treatment for AUD, and compared these with sociodemographic and insurance-related factors. Design Cross-sectional analysis using structural equation modeling (SEM), logistic and multinomial logistic regression, and machine learning approaches including SHapley Additive exPlanations (SHAP). Setting United States, using data from the National Institutes of Health All of Us Research Program. Participants A total of 5,287 adults with AUD (mean age 61 years; 57% men), including 71.6% non-Hispanic White, 12.2% Black, and 8.6% Hispanic participants. Insurance coverage included 52% government (Medicaid/Medicare), 37% private, and 21% military with 19% reporting more than one type. Measurements Primary outcomes were receipt of Food and Drug Administration-approved pharmacotherapy and/or psychotherapy for AUD, examined as binary and multinomial outcomes. The primary exposure was PDHS, measured using a 7-item scale (range 7-35), with higher scores indicating more frequent discrimination. PCC, assessed using a 2-item scale (range 2-8) with higher scores indicating poorer communication, was examined as a potential mediator. Models were adjusted for age group, sex at birth, race/ethnicity, insurance type (government, private, military), household income, and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores (range 0-12). Findings PDHS was associated with poorer PCC (β = 0.209, p Conclusions Access to treatment for alcohol use disorder is most strongly associated with insurance coverage, particularly military insurance. PDHS and PCC also contribute to treatment engagement, with differential effects across socioeconomic groups. These findings highlight the importance of addressing structural and interpersonal barriers to improve equitable access to evidence-based AUD treatment.