The Potential Clinical Utility of Transdermal Alcohol Monitoring Data to Estimate the Number of Alcoholic Drinks Consumed.

OBJECTIVES: Transdermal alcohol monitoring is used extensively in forensic settings to identify whether individuals have violated court-ordered mandates to abstain from drinking. Despite widespread use in that setting, comparatively few studies have explored the clinical utility of transdermal alcohol monitoring. Furthermore, of the few studies conducted, most have relied on the forensically established conservative criteria to identify whether or not a drinking episode has occurred. Here, we explore how transdermal alcohol monitoring data can be used to estimate more clinically meaningful parameters relevant to clinical treatment programs. METHODS: We developed a procedure to use transdermal data to objectively estimate the number of standardized drinks an individual has consumed. Participants included 46 men and women who consumed 1 to 5 beers within 2 hours in the laboratory on separate days while wearing devices to monitor transdermal alcohol concentrations (TAC). RESULTS: A mathematical model was derived to estimate the number of standardized alcohol drinks consumed, which included a number of variables (time-to-peak TAC, area under the TAC curve, and sex). The model was then validated by applying it to data from a separate study. Our results indicate that transdermal alcohol devices can be used to estimate the number of standard drinks consumed. CONCLUSIONS: Objective methods characterizing both the level of intoxication achieved and the number of drinks consumed, such as transdermal alcohol monitoring, could be useful in both research and treatment settings.

Accounting for sex-related differences in the estimation of breath alcohol concentrations using transdermal alcohol monitoring.

RATIONALE: Previously, we reported methods to estimate peak breath alcohol concentrations (BrAC) from transdermal alcohol concentrations (TAC) under conditions where alcohol consumption was controlled to produce similar BrAC levels in both sexes. OBJECTIVE: This study characterized differences in the relationship between BrAC and TAC as a function of sex and developed a model to predict peak BrAC that accounts for known sex differences in peak BrAC. METHODS: TAC and BrAC were monitored during the consumption of a varying number of beers on different days. Both men (n=11) and women (n=10) consumed one, two, three, four, and five beers at the same rate in a 2-h period. Sex and sex-related variables were considered for inclusion in a multilevel model to develop an equation to estimate peak BrAC levels from TAC. RESULTS: While peak BrAC levels were significantly higher in women than men, sex differences were not significant in observed TAC levels. This lack of correspondence was evidenced by significant sex differences in the relationship between peak TAC and peak BrAC. The best model to estimate peak BrAC accounted for sex-related differences by including peak TAC, time-to-peak TAC, and sex. This model was further validated using previously collected data. CONCLUSIONS: The relationship between peak TAC and actual peak BrAC differs between men and women, and these differences can be accounted for in a statistical model to better estimate peak BrAC. Further studies are required to extend these estimates of peak BrAC to the outpatient environment where naturalistic drinking occurs.

Do variable rates of alcohol drinking alter the ability to use transdermal alcohol monitors to estimate peak breath alcohol and total number of drinks?

BACKGROUND: Transdermal alcohol monitoring is a noninvasive method that continuously gathers transdermal alcohol concentrations (TAC) in real time; thus, its use is becoming increasingly more common in alcohol research. In previous studies, we developed models that use TAC data to estimate peak breath alcohol concentration (BrAC) and standard units consumed when the rate of consumption was tightly controlled. METHODS: Twenty-two healthy participants aged 21 to 52 who reported consuming alcohol on 1 to 4 days per week were recruited from the community. The final study sample included 11 men and 8 women. Both TAC and BrAC were monitored while each participant drank 1, 2, 3, 4, and 5 beers in the laboratory on 5 separate days. In contrast to previous studies, a self-paced alcohol administration procedure was used. RESULTS: While there was considerable variation in the times it took to consume each beer, key TAC parameters were not affected by pace of drinking. TAC data were then used in combination with the previously derived equations and estimated peak BrAC and standard units of alcohol consumed. CONCLUSIONS: Transdermal alcohol monitoring can be used to reliably estimate peak BrAC and standard number of units consumed regardless of the rate of consumption, further demonstrating its usefulness in clinical research.

Use of continuous transdermal alcohol monitoring during a contingency management procedure to reduce excessive alcohol use.

BACKGROUND: Research on contingency management to treat excessive alcohol use is limited due to feasibility issues with monitoring adherence. This study examined the effectiveness of using transdermal alcohol monitoring as a continuous measure of alcohol use to implement financial contingencies to reduce heavy drinking. METHODS: Twenty-six male and female drinkers (from 21 to 39 years old) were recruited from the community. Participants were randomly assigned to one of the two treatment sequences. Sequence 1 received 4 weeks of no financial contingency (i.e., $0) drinking followed by 4 weeks each of $25 and then $50 contingency management; Sequence 2 received 4 weeks of $25 contingency management followed by 4 weeks each of no contingency (i.e., $0) and then $50 contingency management. During the $25 and $50 contingency management conditions, participants were paid each week when the Secure Continuous Remote Alcohol Monitor (SCRAM-II™) identified no heavy drinking days. RESULTS: Participants in both contingency management conditions had fewer drinking episodes and reduced frequencies of heavy drinking compared to the $0 condition. Participants randomized to Sequence 2 (receiving $25 contingency before the $0 condition) exhibited less frequent drinking and less heavy drinking in the $0 condition compared to participants from Sequence 1. CONCLUSIONS: Transdermal alcohol monitoring can be used to implement contingency management programs to reduce excessive alcohol consumption.

How the gastroenterology nurse and provider can implement prescriptive exercise.

Exercise is Medicine is a global health initiative of the American College of Sports Medicine. Their goal is to improve the health of every patient through prescriptive exercise, which is a goal-oriented plan for any patient to increase physical exercise. The gastrointestinal nurse works in various settings with a variety of patients who have numerous chief complaints that can be helped by prescriptive exercise. Resources the patient, nurse, and provider can use to help patients reach their exercise goals are discussed. The amount of time required for these activities is minimal and can be accomplished by the gastrointestinal nurse and provider in 15-20 seconds during a normal office visit.

Acquisition of Rater Agreement for the Stressful Life Events Schedule.

Stress has been linked to a broad range of psychopathology including alcohol and drug dependence. Recent advances in our understanding of how stress interacts with biological systems involved in addiction has generated even greater interest in stress assessment among addiction researchers. The Stressful Life Events Schedule (SLES) capitalizes on the strengths and avoids the pitfalls of self-report checklist and interview-based stress assessments. Because the SLES depends on consensus ratings of a research team, this study examined rater agreement of stressful event ratings across the first year using the SLES. Individual ratings of stressful events were compared between two experienced and three new raters. Ratings were analyzed for life events generated from interviews of 70 adolescent psychiatric inpatients and 62 healthy adolescents. Inexperienced raters, with backgrounds in addiction research, reliably rated stressful events and rater agreement improved over a year's time. Recommendations for successfully adopting the SLES for consensus rating are discussed.

Advanced transfection with Lipofectamine 2000 reagent: primary neurons, siRNA, and high-throughput applications.

Lipofectamine 2000 is a cationic liposome based reagent that provides high transfection efficiency and high levels of transgene expression in a range of mammalian cell types in vitro using a simple protocol. Optimum transfection efficiency and subsequent cell viability depend on a number of experimental variables such as cell density, liposome and DNA concentrations, liposome-DNA complexing time, and the presence or absence of media components such as antibiotics and serum. The importance of these factors in Lipofectamine 2000 mediated transfection will be discussed together with some specific applications: transfection of primary neurons, high throughput transfection, and delivery of small interfering RNAs.