Alcoholism: Clinical and Experimental Research

Fetal alcohol spectrum disorders (FASD) constitute a wide range of developmental, cognitive, and behavioral impairments caused by prenatal alcohol exposure (PAE). Although neuronal and vascular consequences of PAE have been studied, how alcohol affects the cerebrovasculature within the framework of the neurovascular unit (NVU) across development remains poorly understood. At minimum, the NVU comprises neurons, astrocyte endfeet, and endothelial cells (ECs), which coordinate to maintain brain homeostasis. Here, we used the NanoString Digital Spatial Profiling platform to characterize spatial transcriptomic data from neurons, astrocytes, and ECs from PAE and saccharin (SAC) control cortices at embryonic day 18 (E18) and postnatal day 28 (P28). Differentially expressed genes were then used for Ingenuity Pathway Analysis (IPA) to identify altered biological pathways and perform comparison analyses across developmental time points, while CellChat was used to infer cell cell communication networks. We uncovered thousands of differentially expressed genes and numerous altered pathways and biological processes in PAE cortices across development. Both IPA and CellChat analyses implicated dysregulation of vascular and extracellular matrix (ECM) remodeling, cell adhesion, and neuroinflammatory signaling. CellChat further predicted the loss of several key bidirectional relationships and altered ligand-receptor interactions among neurovascular cell types at E18 and P28. Overall, these findings identify PAE associated alterations in neurovascular gene expression and intercellular signaling across development, providing potential mechanisms by which PAE may disrupt neurodevelopment.

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.

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.

Background Alcohol-associated injury is a leading cause of emergency department (ED) utilization in the United States and a clinically important driver of preventable morbidity across the adult lifespan. Prior surveillance research has characterized how the rate and severity of alcohol-associated injury vary by patient age, but whether the seasonal timing of injury risk is equally predictable across age groups (a question directly relevant to the timing of clinical screening intensification and public health intervention) has not been formally tested. Methods We conducted a retrospective surveillance analysis of 45,876 alcohol-associated ED visits among adults aged 18 years and older, identified from the National Electronic Injury Surveillance System (NEISS), 2019-2025 (weighted national estimate: 2,092,319 visits), using the structured Alcohol_Involved indicator introduced into NEISS case abstraction in 2019. Patients were stratified by sex and five age groups (18-24, 25-34, 35-49, 50-64, and [&ge;]65 years). Single-harmonic cosinor (Poisson) regression was used to estimate the seasonal peak day of injury risk (acrophase) for each stratum. To assess reliability, we performed leave-one-year-out jackknife resampling (seven iterations per group), case-resampling bootstrap confidence intervals (1,000 iterations), and likelihood-ratio tests of seasonal-phase interactions. Results Peak injury timing differed significantly across age groups (X^2 [8] = 2356.2, p < .0001). Adults aged 25-64 years showed a highly reproducible early-to-mid-July peak, with jackknife estimates shifting [&le;]14 days when any single study year was excluded. Adults aged [&ge;]65 years showed significant seasonal variation annually (all p < .0001, amplitude comparable to younger groups) but a pooled peak estimate that shifted by up to 100 days across jackknife iterations. Sex-stratified analyses revealed that this instability was driven entirely by females aged [&ge;]65 years (jackknife range: 332 days, peak consistently in late October through early January) rather than males aged [&ge;]65 (jackknife range: 31 days, peak consistently in early August). Hospital admission rates increased monotonically with age from 9.0% (18-24 years) to 31.8% ([&ge;]65 years). Conclusions Alcohol-associated injury follows a reproducible, calendar-stable summer seasonal pattern in adults aged 25-64 years. Among adults [&ge;]65 years, the previously reported temporal instability is concentrated in the female subgroup, whose seasonal injury risk does not converge on a fixed calendar window. These findings suggest that fixed-calendar prevention and screening strategies are well suited to working-age adults and older men, but older women may require a year-round, individually tailored approach. Keywords: Alcohol-related injury; Emergency department; Seasonality; Age factors; Sex differences; Injury surveillance; Cosinor analysis; Older adults

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.

A body of research suggests that autistic individuals are less likely to drink alcohol than neurotypicals. However, emerging studies support a link between autism and alcohol use. This complex relationship is also reflected in studies that have examined the genetic overlap between the two traits. However, it is unclear whether there is a direct causal relationship between them. To explore this, we applied a combination of polygenic score and Mendelian randomisation analyses using publicly available genome-wide summary statistics and phenotypic measures of autism and alcohol consumption from UK Biobank. LD score regression analyses did not provide evidence of a genetic correlation between genetic liability for autism and drinks consumed per week (rg=-0.08; CI95%=-0.19, 0.03). Further, findings from polygenic score analyses did not support an association between genetic liability for autism and overall monthly alcohol intake. Univariable Mendelian randomisation analyses showed little evidence for a total effect of autism, attention deficit hyperactivity disorder (ADHD) or depression on overall monthly alcohol consumption. Multivariable Mendelian randomisation analyses also showed little evidence of a direct effect of autism on drinks per week when controlling for ADHD and depression. It is plausible that genetic liability for autism does not directly increase the amount of alcohol consumed but instead operates via commonly co-occurring difficulties in the autistic community. However, our findings may be due to methodological shortcomings, including weak instruments biasing effects towards to the null. Consequently, results should be interpreted with caution and further research conducted to address these issues.

Gradients across socioeconomic status (SES) exist across most health conditions. While there has been significant attention devoted to the relationship between SES and physical and mental health, less research has examined how these relate to substance use disorders (SUD). In the current study, we use data from the prospective study within the Collaborative Study on the Genetics of Alcoholism (COGA) to explore the relationship between SES (in early life and adulthood) with multiple substance use disorders (alcohol, tobacco, cannabis, opioid, cocaine, and other substances). We find that early life SES (parental education and income) are associated with lower odds of lifetime diagnoses and lower severity for tobacco (TUD) and cannabis (CUD) use disorders. Associations with TUD remain after adjusting for demographic and familial risk, but associations with CUD were null after including familial risk factors. In participants aged 25+, adult education was associated with lower odds of diagnosis and severity for each of the SUD considered, conditional on early life SES, adult income, sociodemographic characteristics, and familial risk for SUD. Exploratory analyses of changes in SES revealed that those who were upwardly or downwardly mobile were at the lowest or greatest risk for more severe SUD across multiple substances, respectively. Our results demonstrate the relevance of both early life and adult SES in SUD risk. Early life conditions seem particularly relevant for specific substances while greater adult education was associated with reduced risk across all forms of SUDs.

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.

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.

Background: Alcohol and cannabinoids are frequently used during pregnancy, however their combined effects on offspring outcomes are currently under-investigated. In this study, co-exposure was compared to single-drug and drug-free exposures for influences on adult alcohol-seeking and cannabinoid system proteomics. Methods: Pregnant C57BL/6J mice received ethanol vapor (ALC), CP-55,940 (0.75 mg/kg; CB), both (ALC+CB), or neither on gestational days 12-15. Beginning on Postnatal Day 200, male and female offspring underwent home-cage ethanol drinking (N=108) and operant self-administration, progressive-ratio, extinction, and reinstatement testing (N=96). CNR1 and CNRIP1 protein abundance was quantified in the medial prefrontal cortex (mPFC) and dorsomedial striatum (N=57) and compared to within-subject drinking behaviors. Results: Prenatal CB exposure increased cumulative home-cage ethanol intake, primarily in males. At 40% ethanol under progressive-ratio schedules, ALC+CB males consumed more than all other male groups, whereas all exposed female groups consumed more than controls. ALC+CB males also showed greater extinction responding than all other male groups and greater reinstatement intake relative to baseline than CON and ALC males. ALC+CB increased mPFC CNR1 in males relative to all other groups, whereas CB and ALC+CB reduced mPFC CNR1 in females. Higher mPFC CNR1 was associated with fixed-ratio and 40% progressive-ratio intake, extinction, and reinstatement exclusively in males. Conclusions: Prenatal co-exposure produced a persistent male phenotype of enhanced ethanol seeking that was distinct from either exposure alone and accompanied by elevated mPFC CNR1. This behavioral and molecular convergence justifies future investigations manipulating corticostriatal cannabinoid signaling to attenuate exposure-induced ethanol consumption in late adulthood.

Background: Observational studies frequently report a J- or U- shaped association between alcohol use and anxiety and depression, with moderate drinkers appearing to have lower risk than abstainers. However, this pattern may be driven in part by confounding due to health-related selection into abstinence or low-risk drinking (sick-quitter bias), whereby individuals reduce or stop drinking in response to declining health that is independently associated with worse mental health outcomes. We aimed to evaluate whether this association reflects a causal effect or residual confounding driven by sick-quitter bias. Methods: We analyzed data from 4,673 participants in the CHASING COVID Cohort, a U.S. longitudinal study with repeated measures from September 2021 through December 2023. Alcohol use was assessed at five timepoints using the AUDIT-C and categorized as abstinent, low-risk, moderate-risk, or high/severe-risk. Using a target trial emulation framework, we estimated the effects of sustained alcohol use strategies on anxiety and depression symptom severity (GAD-7 and PHQ-8) at follow-up. Artificial censoring and stabilized inverse probability weighting were applied to account for time-varying confounding and loss to follow-up. To assess the role of sick-quitter bias, we compared the abstinent versus moderate-risk contrast across strata of health status at time zero. Results: In the full sample, a J-shaped pattern was observed, with moderate-risk drinkers having the lowest predicted symptom scores. The abstinent versus moderate-risk symptom score contrast was 1.38 for depression (PHQ-8: 95% CI: 0.65, 2.14), and 0.95 for anxiety (GAD-7: 95% CI 0.24, 1.65). Among participants without underlying conditions or poor self-rated health, this pattern attenuated, with contrasts near zero for both outcomes. In contrast, the J-shaped pattern was amplified among participants with poorer baseline health, with abstinent versus moderate-risk contrasts of 3.31 for depression (95% CI: 2.14, 4.32) and 2.83 for anxiety (95% CI: 1.61, 3.86). High-risk drinking was consistently associated with higher symptom scores across all analyses. Conclusions: The J-shaped pattern between alcohol use and anxiety and depression symptoms observed in the full cohort was attenuated among participants without poorer baseline health, consistent with sick-quitter bias. Findings underscore the importance of addressing confounding due to declining health in observational alcohol research and caution against interpreting moderate drinking as beneficial for symptoms of anxiety and depression.

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.

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.

Addiction is a complex and heritable trait which progresses through several developmental stages, each of which is presumably influenced by multiple partially overlapping genetic factors. Cocaine initially produces rewarding effects, followed by aversive effects including anxiety, craving, anhedonia, and withdrawal. These aversive effects have been suggested to contribute to the etiology of cocaine use disorders (CUD), as repeated exposure is thought to desensitize the rewarding effects and sensitize the aversive effects through a process involving both aberrant reward-based learning and aberrant avoidance-based learning. We examined the genetic basis of aversion learning using both food-based and cocaine-based behavioral assays in outbred Heterogenous Stock (HS) rats. A total of 1,074 HS rats (35.3% male) underwent runway operant cocaine-seeking, food-based progressive ratio and punishment testing, and locomotion testing. These phenotypes were significantly heritable (with h2 estimates as high as 0.307) and identified significant (p < 0.05) genetic loci related to avoidance-based learning including from the punishment task on Chromosomes 2, 3, 5, and 6, and the cocaine-operant runway latency task on Chromosome X. 172 positional candidate genes were identified from significant and suggestive loci, including Cdh10, Cdh12, Cdh18 which have previously been associated with smoking initiation from human GWAS, Adcy3, Cfap206, and Drc1 which are associated with primary neuronal cilia, as well as SNPs associated with novelty-related and social interaction phenotypes in independent samples of HS rats. Our results suggest that these aversion learning phenotypes are themselves complex heritable traits influenced by multiple genetic loci, which may pleiotropically affect other aspects of addiction biology.

In the KARE trial, 96 adults with severe alcohol use disorder, abstinent following detoxification, were randomised in a 2x2 factorial design to 3 weekly infusions of ketamine (0.8 mg/kg) or saline, each combined with mindfulness-based psychological support (PS) or alcohol psychoeducation (PE). We re-expressed the trial data on endpoints acceptable to regulators and compared the most and least intensive arms. Across pooled weeks 17-24, ketamine plus PS gave 78.5% versus 57.8% days abstinent (difference, 20.7 percentage points; P = .032); adjusted for baseline, the difference at weeks 21-24 was 26.9 percentage points (P = .011). At weeks 21-24, 50.0% versus 26.1% had no heavy drinking days (P = .127). Relative reductions in heavy drinking days were 55% in KARE, against 25%, -17%, 46% and 35% reported for naltrexone, exenatide, semaglutide and pemvidutide. These post hoc differences, measured 4 to 6 months after a 4 week course ended, are of magnitude similar to agents requiring continuous administration.

Background: Alcohol consumption is a modifiable risk factor linked to anxiety and depression, yet the population-level impact of reducing alcohol use on the prevalence of anxiety and depression symptoms remains unclear. Prior studies are limited by methodological challenges including health-related selection into abstinence, time-varying confounding and reverse causation. Methods: We used data from 2,813 participants without documented underlying health conditions in a U.S. national longitudinal cohort (September 2021-December 2023) and applied the parametric g-formula within a target trial emulation framework to estimate the effect of a hypothetical intervention reducing alcohol consumption to low-risk levels on the prevalence of moderate-to-severe anxiety (GAD-7 [&ge;]10) and depression (PHQ-8 [&ge;]10) symptoms. The intervention set moderate- and high-risk drinking to low-risk at each follow-up, while leaving abstinent and low-risk drinking unchanged. Models adjusted for time-varying and baseline covariates, with uncertainty estimated using bootstrap resampling. Results: Under the natural course, the estimated prevalence of moderate-to-severe depressive symptoms was 12.67% (95% CI: 12.17, 13.23), compared to 12.77% (95% CI: 12.26, 13.29) under the intervention (risk difference: 0.10 percentage points; 95% CI: -0.22, 0.50). For anxiety symptoms, prevalence was 10.40% (95% CI: 8.89, 11.89) under the natural course and 10.25% (95% CI: 8.76, 11.98) under the intervention (risk difference: -0.15 percentage points; 95% CI: -0.68, 0.35). Conclusions: Under a hypothetical population-wide intervention reducing alcohol consumption to low-risk levels, differences in the prevalence of moderate or severe anxiety and depression symptoms were near null. These findings suggest that reducing alcohol use alone may be insufficient to meaningfully shift the population-wide burden of common mental health disorders.

Adolescent substance use is a major public health concern due to increased risk of future physical and mental health conditions. Fronto-striatal functioning - particularly regarding inhibition and reward processing - may increase vulnerability to high-risk substance use. However, it remains unclear if these neurobiological differences precede substance use or are consequences of it. The ongoing Adolescent Brain Cognitive Development (ABCD) Study follows over 10000 youth, offering an unprecedented opportunity to longitudinally examine substance use patterns throughout development. We utilized family-clustered time-varying Cox proportional hazard models to prospectively examine main and interaction effects of right Inferior Frontal Gyrus (IFG) inhibitory control and bilateral nucleus accumbens (NAc) reward response, alongside early life adversity and peer substance use as predictors of alcohol and cannabis onset in the ABCD Study. We identified a significant crossover interaction such that left NAc activity had a slight positive association with first full alcoholic drink in the context of higher right IFG activity but a negative association in the context of lower right IFG activity. However, peer alcohol and cannabis use emerged as the strongest predictors of outcomes. Alcohol onset was also more common in females, and early life adversity was associated only with cannabis onset. Findings indicate that interactions between inhibition- and reward-related brain regions may impact risk for early substance use onset, but these effects may be modest relative to socioenvironmental factors. Additionally, divergent alcohol and cannabis findings suggest that risk profiles are substance specific. Peer-focused strategies should be considered in preventive efforts.

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.

Importance: Preventing substance use disorder (SUD) is a top public health priority, but clinical practice currently lacks validated prognostic tools to identify risk before the onset of heavy use/problems. Objective: To determine whether models can predict SUD using genetic, behavioral, and environmental factors and to evaluate performance across substance types (alcohol, cannabis, tobacco), sex, and genetic similarity groups. Design: This prognostic study developed and validated a multi-domain risk model using data from four longitudinal cohorts (The National Longitudinal Study of Adolescent to Adult Health, Avon Longitudinal Study of Parents and Children, The Collaborative Study on the Genetics of Alcoholism, and FinnTwin12) with follow-up from early adolescence into young adulthood. Setting: Population-based and family-based samples from the United States, United Kingdom, and Finland. Participants: The analysis included participants with available genomic and behavioral data. The cohorts represented a spectrum of risk, ranging from nationally representative community samples to high-risk populations. Exposure(s) (for observational studies): Predictors included polygenic scores for substance use-related phenotypes and 10 established early-life behavioral and environmental risk factors. Main Outcome(s) and Measure(s): The outcomes were a diagnosis of moderate-to-severe SUD based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and positive and negative predictive value. Results: A total of 16,362 participants were included in the study (54.7% female; mean [SD] age 26.73 [3.36]). Genetic similarity group composition was 70.4% European, 16.8% African, 9.8% admixed American, 2.2% East Asian, and 0.7% South Asian. SUD prevalence was 22.0%. The integrated model achieved an AUC of 0.78 for predicting any SUD, with a sensitivity of 69% and a positive predictive value of 45%. Performance was comparable for specific substances (AUC range 0.74-0.82) and across genetic similarity groups (AUC range 0.61-0.82). The model demonstrated higher AUC in females compared with males. Conclusions and Relevance: Findings highlight the potential utility of an SUD prediction model to inform clinicians and patients about risk for developing a SUD.

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.