Alcohol

Alcohol use disorders are heritable, and large-scale genome-wide association studies have recently identified novel genetic loci that are correlated with alcohol consumption and problematic alcohol use. One such gene is Slc39a8, which encodes the ion transporter ZIP8, responsible for cellular import of zinc and other metals. Slc39a8 is highly pleiotropic, and a common missense variant has been associated with decreased problematic alcohol use. Here, we used Slc39a8 heterozygous (HET) knockout mice and their wild type (WT) littermates to characterize the effects of reduced gene function on two models of voluntary alcohol consumption (drinking in the dark and intermittent access two-bottle choice), and anxiety- and depression-like behavior. We found that HET mice consumed less alcohol than WT in the intermittent access two-bottle choice procedure. No evidence was found for genotypic differences in baseline locomotor activity, anxiety-like, or depression-like behavior in the open field and forced swim tests. Slc39a8 mRNA expression and alcohol metabolism experiments confirmed decreased brain expression of Slc39a8 in HET mice and unchanged alcohol metabolism. Basal and post-alcohol measurement of zinc levels showed that HET mice after ethanol exposure had lower zinc concentrations in the liver and higher concentrations in blood than WT animals. Analysis of the spatial distribution of multiple trace metals in the brains of naive Slc39a8 HET and WT mice using Laser Ablation Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS) showed region-specific genotypic differences in levels of zinc and iron. These results provide evidence for a direct role of Slc39a8 in ethanol consummatory behavior that does not appear to be due to metabolism, affective state, or locomotor activity. Moreover, we confirm that this animal model shows tissue- and brain region-specific alterations in zinc levels, highlighting potential mechanisms for future study.

Understanding the neurobiological systems that regulate alcohol cue-induced craving is of utmost importance for the development of novel intervention strategies for alcohol use disorders (AUDs). However, although a human experimenter is required to conduct alcohol self-administration studies in the lab, the cues associated with the experimenter are seldom if ever factored into the experimental design. Thus, although we have learned much to date about alcohol cue-induced behavior and neurobiology, and in particular about discrete cues presented many times throughout a single daily alcohol self-administration session, we know relatively little about how responses to alcohol availability cues might predict subsequent alcohol consumption. For the current experiment, mice were exposed daily to auditory cues that preceded 2 hours of alcohol or water access using drinking-in-the-dark (DID) methods. An additional control group experienced cues but were not otherwise manipulated. Importantly, cues were initiated remotely from outside the animal facility, avoiding the experimenter being the first cue predicting ethanol availability. Head direction, location in the home cage, and movement velocity were the primary variables on interest. Surprisingly, during the cue period, there were no significant differences between groups in any of these measures, despite meaningful alterations over days. However, we observed many significant correlations between behaviors and drinking variables. First, we observed significant positive associations between ambulatory velocity during cues and subsequent total alcohol (R2=0.14; p<0.0001) and total water (R2=0.12; p=0.0002) consumption, but only in females. We also observed a significant positive relationship (R2=0.25; p<0.0001) between the amount of time oriented toward the sipper port during the auditory cues and the average rate of subsequent alcohol consumption (i.e. front-loading), but only in females. In males, head direction was found to be positively associated with subsequent total water consumption (R2=-0.21; p<0.0001), but not alcohol (R2=-0.01; p=0.2267). We also observed a significant negative relationship (R2=-0.15; p<0.0001) between proximity to the sipper during the cue period and subsequent total 2-hour alcohol intake in males. Although these associations were modest in strength, they suggest potential sex-specific behavioral predictors of alcohol consumption that are regulated by different neural dynamics.

Despite growing evidence that neuroimmune dysfunction contributes to Alcohol Use Disorder (AUD) pathology, the underlying neuroinflammatory mechanisms that may promote alcohol consumption are not as clear. We recently report that specific knockdown of interferon regulatory factor 7 (IRF7) in the anterior insula (aIC) mitigates escalation in ethanol self-administration in rats. In addition, we find pro-inflammatory activation of microglia contributes to other AUD-related behavioral impairments. Here, we sought to determine if pro-inflammatory activation of microglia from ethanol contributes to elevations in IRF7 and ethanol self-administration in rats. Male Wistar rats were trained under our ethanol self-administration paradigm (15% v/v; FR2 vs inactive lever) followed by 1-4 cycles of chronic intermittent ethanol exposure (CIE). To inhibit microglia, rats were treated with minocycline (30mg/kg, i.p.) before and after each ethanol vapor session. Escalation in self-administration and biochemical markers were assessed 72 hours into abstinence. We found CIE increased ethanol self-administration, which was positively correlated with aIC IRF7 levels. Minocycline treatment blunted IRF7 expression and alleviated ethanol self-administration following CIE. These data suggest a role for microglia in driving both IRF7 levels and escalation in ethanol self-administration in early abstinence.

Alcohol misuse is a leading cause of preventable death worldwide. Chronic alcohol is associated with disrupted circadian rhythms, yet molecular mechanisms linking circadian rhythm dysregulation and alcohol consumption are poorly understood. Current FDA-approved treatments for alcohol use disorder (AUD) do not target molecular rhythms or sleep-wake cycles. Mammalian circadian rhythms are regulated by transcription-translation feedback loops that regulate expression of 'clock genes' (e.g., Arntl encoding for BMAL1). Both human and rodent studies demonstrate associations between clock gene variants and changes in reward-seeking behavior. Evidence suggests astrocytes, non-neuronal brain cells with cell-autonomous rhythms, may regulate both circadian rhythms and reward. In the nucleus accumbens (NAc), a region responsible for modulating alcohol- and reward-related behavior, over 43% of the astrocyte transcriptome is expressed rhythmically. However, no studies to date have investigated roles of NAc astrocyte rhythmicity in regulating alcohol drinking. We used AAV8-Gfap-Cre to functionally ablate molecular rhythms in NAc astrocytes of BMAL1 floxed mice. Two-bottle choice (2BC), drinking-in-the-light (DIL), and drinking-in-the-dark (DID) assessed alcohol drinking. Behavioral assays included locomotor response to novelty, sucrose preference, and social interaction. Disrupting molecular clock function in NAc astrocytes increased binge-like drinking during both DIL and DID paradigms (d = 1.44), but not with any other drinking paradigm or behavior. This study carves out a unique role for astrocytes in controlling the temporal organization of reward circuitry and susceptibility to binge-drinking. Future studies will investigate clock-controlled astrocyte mechanisms, such as glutamate uptake and ATP release, that may underlie binge-like drinking behavior.

Chronic ethanol consumption produces long-lasting effects on the brain that contribute to persistent behavioral changes. This has been modeled in animals using the chronic intermittent ethanol (CIE) paradigm, which induces escalation of consumption and alterations in affective and cognitive behavior. While this model has been well characterized in male subjects, the effects of CIE in females and long-term effects that persist beyond the acute withdrawal remain relatively underexplored. Here, female C57BL/6J mice were exposed to four weeks of chronic intermittent ethanol (CIE) vapor to induce dependence. Following CIE, mice were evaluated for physiological tolerance to ethanol and alterations in anxiety-like behaviors and memory processing. Using the ethanol responsivity battery (ERB) assay to assess physiological tolerance, we found blunted responsiveness to the intoxicating effects of ethanol in the CIE-exposed females, indicating heightened ethanol tolerance that persists beyond the acute withdrawal phase. A cohort underwent behavioral testing following CIE to characterize changes in anxiety-like behavior, exploration, and memory across abstinence. In early abstinence (<5 days post-CIE), CIE-exposed females showed increased exploratory behavior compared with Air controls. After one week of abstinence, CIE-exposed females displayed impaired object recognition memory. CIE-exposed females also showed increased anxiety-like behavior at protracted abstinence time points, exhibiting hyponeophagia in the novelty-suppressed feeding test at 2 weeks post-CIE. In addition, following cued fear conditioning, we found reduced extinction recall at 4 weeks post-CIE. Together, this work indicates that chronic alcohol exposure leads to increased alcohol tolerance and distinct, persistent alterations in memory and anxiety-like behavior in female mice.

Binge alcohol drinking is a public health concern that can dramatically increase the risk for development of alcohol use disorder (AUD). Continued alcohol drinking in the face of negative consequences is another key feature of AUD. A better understanding of the neural circuitry that regulates these behaviors could provide insight as to novel treatments for AUD. Serotonin is a neurotransmitter that has been implicated in alcohol consumption in both human studies and animal models. The orbitofrontal cortex (OFC) is a brain region that both receives serotonergic input from the dorsal raphe and has been implicated in AUD. However, how volitional alcohol consumption impacts serotonin signaling within the OFC and how this contributes to alcohol related behaviors is unknown. Here, we show that a history of alcohol consumption alters the ability of 5-HT to hyperpolarize OFC pyramidal neurons in mice and monkeys. Consistent with this, a history of binge alcohol consumption decreases the expression of the 5-HT1A but not 5-HT2A receptor in the OFC from mice. Next, we show that deletion of the 5-HT1A receptor from the OFC increased alcohol intake and preference in male, but not female mice. Finally, we found that 5-HT1A receptor deletion led to increased quinine-adulterated alcohol intake, a measure of aversion-resistant drinking, in both male and female mice. Altogether, we identified serotonin signaling in the OFC as key target for modulation of binge and compulsive alcohol consumption.

N-methyl-D-aspartate receptor (NMDAR) neurotransmission plays a central role in the neurophysiological and behavioral adaptations produced by chronic alcohol (EtOH) exposure and withdrawal. Although alcohol-induced changes in canonical NMDAR subtypes have been extensively studied, the mechanisms by which prolonged alcohol exposure remodels NMDAR function remain incompletely understood. To investigate the impact of chronic voluntary alcohol consumption on glutamatergic signaling, adult C57BL/6J mice were exposed to 20% EtOH using the intermittent two-bottle choice (I2BC) approach for 8 weeks and NMDAR function was examined in ventral tegmental area (VTA) dopamine (DA) neurons using whole-cell electrophysiology. Chronic EtOH exposure reduced NMDA-evoked currents, an effect that became more pronounced during withdrawal. Withdrawal also reduced NMDAR outward current rectification, indicating that chronic alcohol exposure altered the biophysical properties of NMDAR-mediated signaling. These unexpected observations led us to investigate the contribution of GluN3A-containing NMDARs. Pharmacological analyses revealed a significant increase in the proportion of VTA DA neurons expressing functional GluN3A-containing receptors following chronic EtOH exposure, with all tested neurons expressing these receptors during withdrawal. Glycine activation directly depolarized VTA DA neurons and increased action potential firing, demonstrating that the recruited receptors function as excitatory NMDARs. Moreover, the alcohol-induced changes in NMDAR currents, receptor pharmacology, and glycine responsiveness were absent in GluN3A null mice. Together, these findings identify functional recruitment of GluN3A-containing NMDARs as a previously unrecognized neuroadaptation through which chronic alcohol remodels glutamatergic signaling in the adult VTA.

The lateral habenula (LHb) encodes aversive states and negative affect, positioning it as a candidate region for the negative reinforcement that drives alcohol withdrawal. However, little is known about how chronic ethanol exposure affects LHb neuronal function and glial biology during withdrawal. Here, we used chronic intermittent ethanol (CIE) vapor exposure, a well-established model of alcohol dependence that reliably produces somatic and affective signs of withdrawal, to examine LHb physiology and astrocytic markers during acute withdrawal in male and female rats. Whole-cell and cell-attached recordings revealed that withdrawal reduced evoked and spontaneous firing in LHb neurons, with rebound firing following a crossover pattern between males and females. Despite these excitability changes, the overall distribution of firing phenotypes was unchanged, suggesting a shift in gain rather than a reorganization of cell types. Immunofluorescence revealed increased Sox9+ and GFAP labeling in the LHb during withdrawal at the same time point when electrophysiology experiments uncovered impaired astrocytic regulation of glutamate clearance. Together, these findings reveal that withdrawal from chronic ethanol exposure produces neuronal and glial adaptations in the LHb, pointing to impaired glutamate regulation as a candidate mechanism relevant to the negative affective state of alcohol withdrawal. These findings position the LHb as a potential node linking astrocyte-neuron dynamics to withdrawal symptoms and relapse vulnerability in alcohol use disorder.

Food addiction (FA) has been proposed as a phenotype sharing features with substance use disorders. Despite increasing recognition of food addiction as a behavioral phenotype with features overlapping substance use disorders, little is known about its prevalence or clinical significance among individuals with alcohol use disorder (AUD). Objective: To examine the prevalence of FA and to evaluate demographic, psychological, and alcohol-related correlates in individuals with AUD. Design, Setting, and Participants: This cross-sectional analysis included 743 adults with AUD who were either treatment seeking (Tx) (n = 534) for AUD and were enrolled in an inpatient program at the National Institutes of Health Clinical Center or not treatment-seeking (non Tx) (n = 209). Main Outcomes and Measures: FA symptoms were assessed using the Yale Food Addiction Scale, with >=2 symptoms categorized as FA in this report. Multivariable logistic regression models adjusted for age, education, and income were conducted separately within each cohort. Results: Among 743 adults with AUD, 238 (32.1%) met criteria for FA symptoms, with similar prevalence among Tx (32.6%) and nonTx (30.6%) participants despite marked differences in clinical characteristics. Across both cohorts, FA was independently associated with higher body mass index, greater psychological distress, and greater alcohol dependence severity. Childhood trauma and poorer sleep quality were additionally associated with FA among treatment-seeking participants, whereas alcohol-related measures differed according to treatment status. Conclusions and Relevance: FA was common among adults with AUD and was associated with greater psychological, behavioral, and metabolic burden regardless of treatment-seeking status. These findings suggest that FA identifies a clinically meaningful subgroup of individuals with AUD who may benefit from more comprehensive assessment and integrated treatment approaches.

Astrocytes play an important role in neuronal health. A critical function of astrocytes is to clear excess extracellular glutamate and prevent excitotoxicity. STAT3 is a transcription factor that promotes astrocyte development and astrocyte reactivity in neurodegenerative diseases and following central nervous system injury. To determine the innate molecular and behavioral functions of adult astrocyte-expressed STAT3 in a non-pathological state, we created conditional Stat3 astrocyte knockout mice (Stat3 aKO) using Stat3flox and the tamoxifen-activated Cre line, Aldh1l1-Cre/ERT2. We measured transcript levels of Gfap, a known STAT3 target gene, and glutamate transporter genes in the medial prefrontal cortex (PFC) of Stat3 aKO. Gfap, Slc1a2 and Slc17a8 transcripts were decreased in the PFC of Stat3 aKO of both sexes. GLT-1 protein, encoded by Slc1a2, was also reduced in the PFC of male Stat3 aKO. We recorded spontaneous excitatory post-synaptic currents (sEPSCs) in male Stat3 aKO and control prelimbic pyramidal neurons and found increased sEPSC amplitude, consistent with a hyper-glutamatergic state due to impaired glutamate clearance. To determine the behavioral consequences of STAT3 depletion in astrocytes, Stat3 aKO were tested for locomotor activity, anxiety-like behavior and binge ethanol consumption, behaviors linked to dysregulation of glutamate homeostasis. Stat3 aKO mice did not differ in locomotor activity or anxiety-like behavior; however, male Stat3 aKO mice consumed significantly less ethanol than controls. These results indicate that STAT3 in adult astrocytes is crucial for maintaining glutamate transporter levels in the adult brain and that astrocytic STAT3 promotes ethanol consumption in male mice. Main pointsO_LIGfap, Slc1a2 and Slc17a8 expression are lower in the cortex of Stat3 astrocyte knockout mice (Stat3 aKO) C_LIO_LIGLT-1 protein is decreased and glutamate neurotransmission is elevated in the cortex of male Stat3 aKO C_LIO_LIMale Stat3 aKO consume less ethanol C_LI

Background: Pavlovian-to-instrumental transfer (PIT) paradigms assess how environmental cues influence instrumental behaviour. Our previous research linked PIT to alcohol use disorder (AUD) and high-risk drinking using monetary rewards during learning. To better capture alcohol-related cue effects, we developed a PIT paradigm delivering trial-by-trial alcohol and juice rewards alongside monetary rewards, to examine alcohol-specific and general PIT effects in parallel. Methods: Seventy-five participants with AUD and ninety-five controls completed the task during functional magnetic resonance imaging. Alcohol-specific PIT was defined as increased alcohol choices during presentation of alcohol-associated versus juice-associated cues. General PIT was defined as increased response vigor during gain- versus loss-associated cues. Behavioural and neural associations with AUD status and AUDIT scores from baseline through one-year follow-up were examined. Results: Participants with AUD showed stronger alcohol-specific PIT effect than controls. Alcohol-specific PIT was positively associated with baseline AUDIT scores and with AUDIT scores across the one-year follow-up. Alcohol cues elicited stronger anterior insula responses, and region-of-interest analysis showed greater left amygdala responses to alcohol versus juice cues in AUD compared with controls. In contrast, general PIT showed a negative association with AUDIT but no association with AUD status. In the general PIT, no AUD-related neural differences were observed. Conclusions: These findings suggest that alcohol-specific PIT captures a clinically meaningful mechanism of cue-driven alcohol seeking that is distinct from generalized motivational transfer, supporting its potential utility as a mechanistic marker in AUD.

Alcohol use disorder (AUD) disrupts the gut-liver-brain axis, yet mechanistically grounded and therapeutically actionable targets within this network remain poorly defined. To identify microbial modulators of alcohol-induced tissue pathology, longitudinal advanced diffusion MRI and fecal 16S rRNA profiling were integrated across Marchigian Sardinian alcohol-preferring rats evaluated at baseline, after four weeks of voluntary alcohol intake, and following six weeks of abstinence. Machine learning, specifically random forest models combining neuroimaging and microbiota data, improved phase classification and identified Akkermansia as the microbial feature most strongly associated with alcohol-related white matter microstructural abnormalities. Alcohol exposure induced widespread white matter alterations alongside gut dysbiosis characterized by reduced microbial diversity. To evaluate functional relevance, Akkermansia muciniphila was administered during the abstinence phase. Supplementation with A. muciniphila restored intestinal mucus, reduced liver injury markers, and elevated myelin basic protein levels within affected white matter regions. Collectively, these findings highlight Akkermansia as a critical modulator of alcohol-induced gut-liver-brain pathology and provide experimental support for a causal contribution of specific gut bacteria to persistent white matter damage in AUD. More broadly, this work establishes a robust multimodal framework for microbiome-based target discovery with clear translational relevance for disorders characterized by dysfunction along the gut-liver-brain axis. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSAlcohol use disorder (AUD) is associated with gut dysbiosis, impaired intestinal barrier function, liver injury, and persistent white matter abnormalities. Previous studies in patients and animal models have linked alcohol exposure to reduced microbial diversity, altered gut permeability, and white matter microstructural damage, particularly during abstinence. Other work has shown that microbiota-derived interventions can ameliorate peripheral consequences of alcohol exposure, especially in the gut and liver. However, the specific microbial features linked to alcohol-induced brain pathology remain poorly defined, and no prior study has integrated longitudinal microbiota and neuroimaging data to identify candidate microbial modulators of alcohol-related white matter damage and then functionally test them in vivo across the gut-liver-brain axis. Added value of this studyWe developed a multimodal framework that integrates longitudinal advanced diffusion MRI with fecal microbiota profiling and machine learning in alcohol-preferring rats. This approach identified Akkermansia as the microbial feature most strongly associated with alcohol-induced white matter abnormalities. Guided by this result, we administered Akkermansia muciniphila during abstinence and observed coordinated beneficial effects across multiple organs, including restoration of intestinal mucus, reduction of liver injury markers, and recovery of myelin basic protein in affected white matter regions. To our knowledge, this is the first study to combine longitudinal microbiota-MRI integration with experimental validation of a microbiota-based intervention that mitigates alcohol-induced pathology across the gut-liver-brain axis while restoring central white matter integrity. Implications of all the available evidenceOur findings support a mechanistic contribution of specific gut bacteria to persistent alcohol-induced tissue damage and identify Akkermansia as a candidate modulator of gut-liver-brain axis dysfunction in AUD. More broadly, this study establishes a generalizable strategy for integrating microbiota and neuroimaging data to discover biologically meaningful and therapeutically actionable targets in complex disorders involving coordinated peripheral and central pathology.

Background: Deficits in inhibitory control are considered a central feature of alcohol use disorder (AUD), yet behavioral and neuroimaging findings have been inconsistent. One potential explanation is the marked heterogeneity of AUD, which encompasses multiple symptom dimensions that may differ in their underlying neurocognitive mechanisms. In this study, we investigated whether behavioral and neural markers of inhibitory control are associated with specific DSM-5 AUD symptom domains. Methods: A total of 589 participants (432 with non-treatment seeking AUD, 157 controls) completed a Stop-Signal Task (SST) during fMRI. Associations between DSM-5 symptom domains (impaired control over alcohol use, risky use, social problems, physical dependence) and SST performance, inhibition-related brain activation, and alcohol consumption were examined. Real-life drinking behavior was additionally assessed over 12 months using ecological momentary assessment (EMA). Results: Greater impaired control symptom severity was associated with poorer performance on go trials and diminished post-error slowing during SST. At the neural level, higher impaired control symptom severity was associated with reduced activation across fronto-insular, parietal, cingulate, supplementary motor, and cerebellar regions. In contrast, other symptom domains showed little to no associations with inhibition-related behavioral or neural measures. Higher impaired control symptom severity was associated with greater alcohol consumption across questionnaire-based and EMA-based assessments. Conclusions: In this large cohort, altered behavioral performance and recruitment of inhibition-related brain regions in the SST was selectively linked to impaired control symptoms. These findings highlight the importance of symptom-based approaches for understanding heterogeneity in addiction and may inform the development of more targeted interventions.

Chronic heavy alcohol use shifts brain metabolism from glucose toward acetate utilization. Sudden decreases in acetate following alcohol cessation in individuals with alcohol use disorder (AUD) may create an energetic imbalance that contributes to craving and withdrawal. A recent randomized study found that, compared with a standard American (SA) diet, a ketogenic diet (KD) during alcohol detoxification reduced withdrawal severity and craving and increased ketones and glutamate in the dorsal anterior cingulate cortex. These findings suggest that ketones may support metabolic adaptation during alcohol withdrawal, but the effects of altered brain metabolism on neural dynamics and alcohol cue reactivity remain unknown. Here, we used a control theoretic approach to test whether shifts in cerebral energy substrate utilization influence large-scale network dynamics through altered information flow. We analyzed fMRI cue-reactivity scans collected after one, two, and three weeks of inpatient treatment during presentation of alcohol, food, and neutral cues. Whole-brain effective connectivity was estimated using Shannon transfer entropy applied to whole brain atlas-aligned fMRI time series. Assuming neural activity flow along effective connections, we identified distinct shifts in the state-transition landscape in participants receiving the KD compared with the SA diet. Increases in serum {beta}-hydroxybutyrate (BHB) were associated with changes in state-transition landscape organization, which were in turn associated with reduced cue-induced alcohol craving. These findings link metabolic adaptation to large-scale neural dynamics and clinically relevant behavior and suggest that cerebral energy substrate availability may shape behavior by altering the organization of large-scale neural dynamics.

BackgroundCircadian disruption is strongly associated with alcohol use disorder (AUD), but insight into the underlying brain-region and sex-specific mechanisms is limited. The function of the circadian clock gene Bmal1 within the striatum has been linked to alcohol drinking, yet its role within functionally distinct striatal subregions has not been systematically examined. MethodsWe deleted Bmal1 in medium spiny neurons of the dorsomedial striatum (DMS) or dorsolateral striatum (DLS). Male and female mice were tested for anxiety-like behavior, depressive-like behavior, and motor coordination. Voluntary alcohol intake was measured with an intermittent two-bottle choice paradigm, followed by sucrose preference and quinine-adulterated alcohol tests. To assess hormonal contributions, a subset of female mice underwent ovariectomy before behavioral testing. ResultsDeletion of Bmal1 in the DLS did not alter alcohol intake, alcohol preference, or quinine-adulterated alcohol intake in either sex. In contrast, DMS Bmal1 deletion significantly reduced alcohol consumption and alcohol preference in female mice, with no effect in males. These effects were not accompanied by changes in depressive-like behavior or motor coordination and were not explained by generalized reward changes, as sucrose preference was unaffected. Ovariectomy eliminated the effect of DMS Bmal1 deletion on alcohol intake, indicating dependence on ovarian hormones. ConclusionsThe DMS is a critical site at which Bmal1 regulates alcohol consumption in a sex-specific manner. These findings support an interaction between local circadian mechanisms and ovarian hormones in controlling alcohol drinking and highlight a potential target for sex-specific therapeutics in AUD.

Objective To evaluate the association of early addiction consultation with withdrawal pharmacotherapy and complications in hospitalized patients with alcohol withdrawal. Methods Retrospective single-center cohort of adult hospitalizations with alcohol withdrawal (diagnosis code or CIWA-Ar [&ge;]10 within 24 hours) from July 2020 to January 2026. Exposure was an addiction consult service order within 24 hours of arrival, compared with no or later consultation. Primary outcomes were intensive care unit (ICU) transfer after the first 24 hours and delirium tremens or withdrawal seizure not present on admission. Process outcomes included phenobarbital and thiamine administration within 24 hours and benzodiazepine dose in the first 48 hours. Secondary outcomes included length of stay and 30-day death or return to hospital. Results Of 4,663 hospitalizations, 1,379 (29.6%) received early consultation. After adjustment, early consultation was associated with lower odds of ICU transfer (odds ratio [OR] 0.73; 95% CI 0.54-0.99) and fewer episodes of delirium tremens (risk difference -1.09 per 100; -1.45 to -0.73), with no significant difference in withdrawal seizure. Early consultation was associated with phenobarbital (OR 1.57; 1.32-1.86) and thiamine (OR 1.23; 1.07-1.41) within 24 hours, higher 48-hour lorazepam-equivalent dose (ratio of geometric means 1.44; 1.32-1.57), shorter stays (ratio 0.92; 0.88-0.97), and lower odds of 30-day death or return to hospital (OR 0.78; 0.66-0.91). Conclusions Early addiction consultation was associated with earlier, more intensive withdrawal pharmacotherapy, lower odds of ICU transfer, and fewer episodes of delirium tremens, although the complication associations were sensitive to cohort definition.

Background: Alcohol use and physical activity are common, interrelated behaviors with opposing associations to mental health, yet little is known about their joint relationship with anxiety and depression. This study evaluated whether the association between alcohol use and anxiety and/or depression symptoms differed by physical activity level in a large U.S. longitudinal cohort. Methods: Using data from 5,152 adults in the CHASING COVID Cohort (2021-2023), alcohol use was categorized as low-, moderate-, or high-risk based on repeated AUDIT-C assessments, and physical activity was classified as active versus sedentary using items adapted from the 2023 Behavioral Risk Factor Surveillance System. Moderate to severe symptoms of anxiety/depression, assessed subsequent to the exposure assessment period, was defined as a PHQ-8 or GAD-7 score [&ge;]10. Log-binomial regression estimated adjusted risk ratios (aRRs) for associations between alcohol use and anxiety/depression symptoms within strata of physical activity. Effect modification by physical activity was evaluated on the additive and multiplicative scales. Analyses were repeated among healthier participants without chronic conditions or poor self-rated health to reduce sick-quitter bias (N=3,141). Results: Most participants had low-risk or no alcohol use (70.3%), followed by moderate-risk (21.9%) and high-risk use (7.8%); 29.5% were sedentary. Sedentary participants had higher risk of moderate to severe anxiety/depression symptoms than active participants across alcohol use levels overall and in the healthier subsample. In the overall sample, active participants with high-risk alcohol use had elevated risk compared with active participants with low-risk or no alcohol use (aRR = 1.44, 95% CI: 1.15-1.80) and physical activity did not modify the association between alcohol use and anxiety/depression symptoms on either scale. Among healthier participants, risk was highest among sedentary participants with moderate-risk alcohol use compared with active participants with low-risk or no alcohol use (aRR = 1.92, 95% CI: 1.50-2.45); physical activity modified the association between moderate-risk alcohol use and moderate to severe anxiety/depression symptoms on the additive scale (RERI = 0.61, p=0.013) and multiplicative scales (ratio of aRRs = 1.49, p=0.001). Conclusions: Among healthier adults, physical activity modified the association between moderate alcohol use and symptoms of anxiety or depression on additive and multiplicative scales. Findings suggest sedentary behavior may amplify mental health vulnerability associated with moderate drinking; future studies are warranted to clarify these relationships, including those with larger numbers of high-risk drinkers.

Circadian clock genes in the striatum modulate alcohol drinking behavior in female mice, but the underlying synaptic mechanisms remain unknown. Medium spiny neurons (MSNs) of the striatum express D1- or D2-type dopamine receptors, which are differentially modulated by alcohol. Here we used whole-cell patch-clamp recordings to examine how deletion of the clock gene Bmal1 affects spontaneous excitatory postsynaptic currents (sEPSCs) in electrophysiologically identified D1 and D2 neurons of the female mouse dorsomedial striatum (DMS). Prior intermittent access to alcohol increased sEPSC amplitude in putative D1 neurons of wildtype mice without affecting sEPSC frequency, and this increase was accompanied by greater dendritic branching and complexity in biocytin-filled D1 MSNs. Bmal1 knockout had the opposite effect in D1 neurons, reducing sEPSC amplitude in both alcohol-exposed and alcohol-naive animals. In D2 neurons, alcohol produced only a non-significant trend toward increased sEPSC amplitude in wildtype mice, but a significant increase in Bmal1 knockout mice. Thus, local disruption of Bmal1 appears to block the alcohol-induced enhancement of sEPSCs in D1 neurons while unmasking a similar enhancement in D2 neurons. These findings may help explain how Bmal1 deletion in the DMS reduces alcohol consumption in female mice.

Background The detrimental impact of alcohol consumption on the gut microbiome is well-established. However, less is known about how alcohol exposure during pregnancy affects the maternal gut and vaginal microbiota, or how these microbial changes relate to subsequent infant diagnosis of fetal alcohol spectrum disorder (FASD). We therefore investigated associations between self-reported alcohol use during pregnancy, infant FASD diagnosis, and maternal gut and vaginal microbiota. Methods Fecal samples (n = 207) and vaginal swabs (n = 28) from pregnant participants recruited through antenatal clinics in the Western Cape Province of South Africa were profiled by 16S rRNA V1-V2 amplicon sequencing. Maternal alcohol use was assessed using Alcohol Use Disorder Identification Test (AUDIT) scores, and FASD was diagnosed in infants using revised Institute of Medicine criteria. Microbial diversity, taxonomic profiles and PICRUSt2-predicted functional pathways were analyzed using vegan, phyloseq and MaAsLin3. Results Maternal AUDIT scores were negatively associated with maternal gut microbiota richness, Shannon, and Inverse Simpson diversity (p < 0.05). Observed richness was also reduced in participants whose infants were diagnosed with FASD (p = 0.046). Gut microbiota community structure was not significantly associated with alcohol use or infant FASD diagnosis. However, taxonomic and functional analysis suggested gram-positive taxa depletion with alcohol use and FASD diagnosis, and impaired one-carbon metabolism among participants with infants diagnosed with FASD. Vaginal microbiota diversity and composition were not associated with alcohol use or infant diagnosis. Conclusions This is the first human study to investigate the maternal gut and vaginal microbiota in relation to alcohol use during pregnancy and infant FASD outcomes. Our findings suggest that alcohol use is associated with maternal gut microbiota disruption, with potential implications for FASD development in exposed infants. Further investigation of alcohol-associated maternal microbial disturbances may inform microbiota-targeted strategies to improve maternal and infant health linked to alcohol use.

BackgroundConcurrent cocaine and alcohol use is one of the most prevalent forms of polysubstance consumption and is associated with poorer clinical outcomes than cocaine use alone. However, the regional molecular adaptations induced by combined exposure remain poorly understood. Here, we used matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI-IMS) to characterize peptide/protein alterations in addiction-related brain regions following cocaine and cocaine-alcohol self-administration. MethodsYoung adult male and female Wistar rats underwent intravenous self-administration of saline, cocaine (1 mg/kg/infusion) or cocaine plus ethanol (1 mg/kg cocaine and 133 mg/kg ethanol per infusion), followed by extinction of drug-seeking behaviour. Coronal brain sections containing the anterior cingulate cortex (ACC) and ventral hippocampus (vHPC) were analysed by MALDI-IMS. Differential molecular features were identified using an exploratory statistical approach (FDR q < 0.20) and subsequently subjected to MS/MS analysis. ResultsThe ACC exhibited a substantially greater number of treatment-associated molecular alterations than the vHPC, suggesting a higher regional susceptibility to cocaine-induced molecular remodelling. Several molecular features were shared between the cocaine and cocaine-alcohol groups, indicating persistent cocaine-driven neuroadaptations. In contrast, additional signals were selectively associated with combined cocaine-alcohol exposure, while others present after cocaine alone were absent following alcohol co-exposure, supporting a modulatory effect of alcohol on specific cocaine-induced molecular responses. Overall, combined exposure generated a distinct regional molecular profile rather than simply reproducing the effects of cocaine alone. ConclusionsThis exploratory study demonstrates that MALDI-IMS enables the identification of region-specific peptide/protein alterations associated with cocaine and cocaine-alcohol exposure while preserving their spatial distribution within the brain. These findings highlight the ACC as a particularly responsive region and provide a framework for future studies aimed at validating molecular pathways involved in cocaine-alcohol polysubstance use.