As is true of all studies, it is important to keep the findings in perspective. The original sample was limited to non– alcohol-dependent European American and White Hispanic male college students or nonacademic staff, and additional studies are needed to demonstrate if the current results generalize to women and to other samples. Also, although the SDPS began with a relatively large population for such intense every-5-year evaluations, the current analyses focused on outcomes for men who developed AUDs, which, despite the greater than 90% 35-year overall follow-up, produced a modest 156 subjects. Furthermore, the analyses were dependent on the existing baseline data gathered four decades ago that included information from multiple domains but offered a limited number of specific variables in each category. In addition, although data from additional informants were used for evaluations at ages 30, 35, 40, and 45, financial restrictions contributed to the decision to gather data only from probands at the two most recent assessments, with a potential for under reporting of heavy drinking and alcohol problems. Finally, it is important to remember that Table 4 presents four separate binary regression analyses, and although Bonferroni corrections for multiple testing would still be significant for the R2 values and for specific predictors with p values less than .01, predictors in Table 4 with p values less than .05 are more tenuous. In summary, these data described the age 50–55 outcomes for 156 higher educated and accomplished men who developed an AUD during the prior 30 years. For most, their AUDs were persistent and severe, despite which their accomplishments did not fit the public stereotype of the “average alcoholic.” Their achievements and public persona in their 50s underscore the importance of clinicians screening all patients for possible AUDs,cannabis grow system including those with high levels of life achievements. The robust predictions of alcohol problems from their LR in this and other studies offer potential promise in instituting earlier intervention programs based on tailored feedback about their vulnerability .
With the legalization of “medical” marijuana and recreational cannabis use in some states of the U.S , the high rates and earlier onset of cannabis use , the increasing potency of cannabis , the recreational use of highly potent synthetic cannabinoids , and the high rates of emergency department visits related to cannabis there is a need to understand the basic mechanisms underlying the behavioral effects of cannabinoids such as delta- 9-tetrahydrocanabinol , the primary psychoactive constituent in cannabis. Δ 9 -THC, via activation of brain cannabinoid 1 receptors , induces a range of acute alterations in perceptual, emotional, and cognitive functions that are relevant to psychotic states and psychotic disorders such as schizophrenia . Neural oscillations in the gamma -band are thought to play a key role in the operation of these functions by participating in sensory registration and integration, associative learning, and conscious awareness among other processes . Therefore, it is expected that alterations in these processes will be associated with abnormalities in γ-band oscillations. Consistent with this view, a number of studies in schizophrenia patients have confirmed the existence of an association between functional and γ-band abnormalities as measured by electroencephalography . This raises the intriguing possibility that some of the acute psychosis-relevant functional abnormalities induced by Δ9 -THC may be associated with γ-band alterations . paradigm , which is associated with some of the characteristic abnormalities of the disorder . In view of this, we selected the ASSR paradigm to study the relationship between the acute 9 -THC-induced alterations in γ-band oscillations and psychosis relevant effects. This study was part of a larger project that aimed to assess the dose-related effects of 9 -THC on several electrophysiological indices of information processing relevant to psychosis and to determine the relationship between the electrophysiological and behavioral effects of 9 -THC. In this study we examined the acute, dose-related effects of intravenous 9 -THC on the ASSR in a number of frequency bands, and the relationship between these effects and the psychosis-relevant effects induced by 9 -THC. We hypothesized that 9 -THC would specifically reduce the γ-band ASSR, and that γ-band ASSRs measures would be inversely correlated with the psychosis-relevant effects of 9 -THC.
This randomized, double-blind, placebo-controlled, counterbalanced, cross-over study was conducted at the Neurobiological Studies Unit . Subjects were recruited by advertisements and by word of mouth, and were paid for their participation. The study was approved by the institutional review boards of the VACHS and Yale University School of Medicine and was carried out in accordance with the Helsinki Declaration of 1975. Subjects were informed about the potential for adverse effects of Δ9 -THC including psychosis, anxiety, panic and abuse liability. For assessment of ASSRs, subjects sat in an acoustically shielded booth in front of a computer monitor with eyes open, while passively listening to click trains presented through Etymotic insert ER-1 earphones . Stimuli consisted of standard, unattended auditory click trains from a three-stimulus oddball task as reported previously . The auditory click trains were presented at 3 different frequencies . Each block contained 150 trials of a single frequency presented for 500ms each . Each trial lasted 1250ms, and each block lasted 4 minutes. Across subjects, the order of blocks was counterbalanced and the order of conditions was randomized. A detailed account of EEG methods is provided in the supplementary text 1. Continuous EEG data were band-pass filtered , line noise was removed using a multi-tapering technique , muscle artifacts were removed using a blind source separation algorithm, and eye movement and blink artifacts were removed with an adaptive filter algorithm . Data were segmented in 1200ms epochs time locked to stimulus onset, with a 300ms pre-stimulus baseline. A ±95 μV voltage criterion was used to reject bad epochs. EEG data from three midline electrodes were used for ASSR analyses, given that the ASSR is typically maximal at the midline electrodes . All analyses were done in Matlab using either custom-made scripts or the EEGLAB toolbox‟ scripts and plugins . Demographic and cannabis use data are listed in table 1. Of 56 subjects who were initially consented for the study, 10 failed the screening process and 8 chose not to initiate the study. Of the remaining 38 subjects, 30 completed all three test days of which 5 had to be dropped due to technical difficulties during EEG acquisition. There were no obvious differences between dropouts and completers . Of the remaining 25 subjects, 2 were dropped during the EEG preprocessing due to artifactual contamination , and 3 were categorized as outliers and dropped during the statistical inspection of the EEG measures. Thus, EEG data from 20 subjects who completed all test days were used for statistical analyses. The inspection of the behavioral measures of these 20 subjects, revealed 1 outlier for the PANSS general and total scores during the 0.015mg/kg condition. This data point was excluded from the regression analyses . Alcohol and drug use among women of childbearing age represents an increasing burden to society and healthcare providers across the United States. Substance use during pregnancy is associated with increased rates of obstetric University of North Dakota School of Medicine and Health Sciences, North Dakota Fetal Alcohol Syndrome Center, Department of Pediatrics, Grand Forks, North Dakota complications, fewer prenatal visits, and poor perinatal outcomes.Fetal alcohol spectrum disorder , a serious consequence of prenatal alcohol exposure, is the leading preventable cause of birth defects and neurodevelopmental disability in the U.S.
It often reoccurs within sibships and themortality among birth mothers of children diagnosed with an FASD is increased by nearly 39-fold.Recent data demonstrate that 11.9% of non-pregnant women and 5.3% of pregnant women age 15-44 reported illicit drug use in November, 2016.1 Alcohol use at levels meeting criteria for binge or heavy drinking was reported by 23.7% of non-pregnant women and 2.8% of pregnant women.1 According to the National Institute on Drug Abuse, of the more than 130 million visits to emergency departments in 2009, 2.1 million were for drug abuse.From 2004 to 2009 ED visits for non-medical use of drugs increased 98% , with 32% of patients reporting concurrent alcohol use.7 In 2005 the National Alcohol Survey found that 24% of individuals presenting to the ED reported high-risk drinking behaviors.Approximately 50% of pregnancies in the U.S. are unplanned, with fetal first trimester exposure rates of 56% for all women and 78.9% for women with recent alcohol dependence.While the majority of women cease or reduce alcohol consumption during pregnancy, in the U.S. alone every year around 80,000 women report drinking during all three trimesters.11Women meeting criteria for a substance use disorder used ED services 57% more frequently than women who did not have a substance use disorder and were hospitalized 67 % more frequently.Given the high prevalence of substance use in the patient population most using ED services, this setting presents a unique opportunity to screen a high-risk population for substance use. However,marijuana grow system limited data exist to examine the nuances of the screening process in the ED for substance use. In this study, we compared rates of screening for substance use among pregnant and non-pregnant women seeking care at an ED facility. The project was approved by the Altru Health System Institutional Review Board and the University of North Dakota Institutional Review Board. We captured all ED records of women from a single community hospital for the years 2010 to 2016 . A woman was considered pregnant if her pregnancy status was recorded as “pregnant.” All other women were classified as not pregnant. Demographic data included age in years, race/ethnicity , marital status , and body mass index .We created a dependent binary variable based on whether the woman was tested for alcohol or drugs during her ED visit or not tested. We examined the electronic medical record and the lab record for any test for substance use that was ordered or completed by the lab. Testing modalities included blood, urine, hair, or breathalyzer readings. We included testing for amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, opioids, and alcohol. The 399 unique chief complaint ICD-9 codes were then further grouped into 20 categories . The last department used by the woman was categorized as ED, urgent care, or other . Their dispositions were combined into two groups, internal or external .We compared the association between pregnancy status and drug/alcohol testing using the chi-square statistic with relative risk and 95% confidence intervals . This association was assessed for the demographic covariates. The risk of drug/alcohol testing for pregnant woman relative to non-pregnant women was produced for levels of other variables using relative risk and 95% CIs. We tested interactions between pregnancy status and the demographic variables using the Breslow-Day test for homogeneity in odds ratios. Logistic regression was then used to test for interactions between pregnancy status and demographics or ED visit characteristics. We used SAS version 9.4 for analyses.
Our study found that pregnant women presenting to the ED were 75% less likely to be tested for substance use than non-pregnant women. Even among the most-tested presenting complaints for all women ,pregnant women were still 37%-54% less likely to be tested. These data may suggest a relatively lower index of suspicion for substance use among pregnant women seeking care in the ED. This difference by pregnancy status was present even for women with similar presenting complaints and demographics in the ED. While no prophylactic treatment exists at this time, early screening and counseling is the best practice to support women in decreasing the risk of the serious consequences associated with prenatal substance exposure.12 Identification of prenatal alcohol exposure is of particular importance as the long-term implications of alcohol exposure for the fetus have shown significant consequences in comparison to other substance exposures.3,13-15 With fetal first-trimester alcohol exposure rates of 56% for all women and 78.9% for women with recent alcohol dependence,10 the ED presents a unique opportunity to address a population of women with a greater than average incidence of alcohol and drug use. The opportunity to provide education and intervention at this stage is especially compelling among women of low socioeconomic status who are seen in the ED more frequently than in primary practice.16 Women who received treatment based on positive drug/alcohol screening results have been shown to subsequently have fewer future ED visits, injuries and hospitalization.