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The question of how alcohol alters mood states and why this may end up becoming an addiction has puzzled alcohol researchers for decades. In this volume, a group of highly distinguished experts and leaders in alcohol addiction research presents our current state of knowledge and remaining research challenges, as well as interesting viewpoints on future research directions aimed to stimulate communication and convergence between clinical and preclinical researchers, and to renew interest in the vibrant field of alcohol addiction research among a broad scientifically minded audience. Five Current Topics are discussed in this volume: Neurobiological mechanisms of alcoholism, Genetics, Clinical phenotypes and their preclinical models, Brain imaging, and Translational approaches for treatment development, both pharmacological and non-pharmacological. These areas have in our opinion substantially brought alcohol research forward and influenced our thinking about how to reach our common paramount goal, namely to offer effective treatment solutions for an extensive group of patients with largely unmet medical needs.

<b><i>Introduction:</i></b> Preclinical studies have shown that calcium seems to be the active component of the anti-craving drug acamprosate (Ca²⁺ bis-acetyl-homotaurinate). Clinical effects in humans have also indicated an association between increased calcium plasma concentration due to acamprosate treatment and better outcome relating to time to relapse and cumulative abstinence. In contrast, low calcium concentration in alcohol-dependent patients was related with craving for alcohol. The main goal of the trial was to investigate whether an oral calcium administration is able to affect craving, withdrawal, and relapse risk in alcohol-dependent patients. <b><i>Methods:</i></b> We conducted a single-blind, randomized, monocentric, controlled clinical two-arm trial in alcohol-dependent patients (Clinical Trials Registration: DRKS00011293). A total of 55 alcohol-dependent subjects received calcium carbonate (800 mg + 5 μg vitamin D) versus sodium bicarbonate (1,000 mg) daily during the 14 days of inpatient alcohol-withdrawal treatment. <b><i>Results:</i></b> Based on an intention-to-treat protocol, withdrawal intensity (assessed with CIWA-Ar) in the calcium carbonate group attenuated faster than in the sodium bicarbonate subgroup. Alcohol craving (assessed with OCDS) in the calcium carbonate subgroup was also significantly reduced versus the sodium bicarbonate subgroup. <b><i>Conclusion:</i></b> Our data support earlier findings and show that treatment with calcium carbonate during alcohol withdrawal reduces symptoms of alcohol withdrawal as well as alcohol craving in a controlled clinical pilot study. Mode of actions will need to be determined to allow the further development of pharmacological interventions beyond Ca²⁺ bis-acetyl-homotaurinate.

[EN] Already moderate alcohol consumption has detrimental long-term effects on brain function. However, how alcohol produces its potent addictive effects despite being a weak reinforcer is a poorly understood conundrum that likely hampers the development of successful interventions to limit heavy drinking. In this translational study, we demonstrate widespread increased mean diffusivity in the brain gray matter of chronically drinking humans and rats. These alterations appear soon after drinking initiation in rats, persist into early abstinence in both species, and are associated with a robust decrease in extracellular space tortuosity explained by a microglial reaction. Mathematical modeling of the diffusivity changes unveils an increased spatial reach of extrasynaptically released transmitters like dopamine that may contribute to alcohol's progressively enhanced addictive potency ; This work was supported by the European Union's Horizon 2020 research and innovation program (668863-SyBil-AA) and the ERA-NET NEURON program (FKZ 01EW1112-TRANSALC and PIM2010ERN-00679), as well as the Spanish State Research Agency through the Severo Ochoa Program for Centres of Excellence in R&D (SEV-2017-0723), the Deutsche Forschungsgemeinschaft (center grant TRR265-B08), and the Czech Science Foundation (GACR; grant no. 16-10214S to L.V.). S.C. and D.M. further acknowledge financial support from the Ministerio de Economia y Competitividad (MINECO) and FEDER funds under grant nos. BFU2015-64380-C2-1-R, BFU2015-64380-C2-2-R, and PGC2018-101055-B-I00 and the Generalitat Valenciana through the Prometeo Program (PROMETEO/2019/015). S.C. also acknowledges support of the Ministerio de Sanidad, Servicios Sociales e Igualdad (#2017I065). E.S. acknowledges financial support from the Slovak Research and Development Agency (APVV-17-0642). S.D.S. is supported by a NARSAD Young Investigator Grant (grant no. 25104), by the European Research Council through a Marie Sklodowska-Curie Individual Fellowship (grant no. 749506), and by the ...

Abstract
Craving for alcohol is an important diagnostic criterion in alcohol use disorder (AUD) and an established predictor of future relapse. The 5-item Penn Alcohol Craving Scale (PACS) is one of the most widely used questionnaires to quantify craving and has been translated into different languages. It is assumed that the PACS constitutes one factor, although theoretical considerations suggest an additional second factor. We conducted stability and factor analyses (principal component and confirmatory factor analyses) of the German PACS (PACS-G) in samples of patients with AUD from the following three German study sites: Erlangen, N = 188 (mean age: 47.1 years, 43.5% female); Mannheim, N = 440 (45.5 years, 28.6% female); Hannover, N = 107 (48.1 years, 48.6% female). In our samples, the 2-factor solution of the PACS-G version is more stable than the internationally assumed 1-factor solution. The resulting two PACS-G subscores 'difficulty to resist' (items 4 and 5) and 'thoughts about alcohol' (items 1, 2, and 3) have an internal consistency (Cronbach's alpha) of 0.80 ≤ α ≤ 0.90, m = 0.86 and 0.86 ≤ α ≤ 0.91, m = 0.89 with an overlap of R2 = 62%. We found good convergent validity assessed via the Craving Automatized Scale-Alcohol and the Obsessive-Compulsive Drinking Scale, but also correlations with depression and anxiety assessed via the Beck's Depression and Anxiety Inventories. This study is the first to provide evidence for a 2-factor solution ('difficulty to resist' and 'thoughts about alcohol') underlying the PACS-G version.

AbstractAimsThe estimated effect of sodium oxybate (SMO) in the treatment of alcohol dependence is heterogeneous. Population severity and treatment duration have been identified as potential effect modifiers. Population severity distinguishes heavy drinking patients with &lt;14 days of abstinence before treatment initiation (high-severity population) from other patients (mild-severity population). Treatment duration reflects the planned treatment duration. This study aimed to systematically investigate the effect of these potential effect moderators on SMO efficacy in alcohol-dependent patients.MethodsNetwork meta-regression allows for testing potential effect modifiers. It was selected to investigate the effect of the above factors on SMO efficacy defined as continuous abstinence (abstinence rate) and the percentage of days abstinent (PDA). Randomized controlled trials for alcohol dependence with at least one SMO group conducted in high-severity and mild-severity populations were assigned to a high-severity and mild-severity group of studies, respectively.ResultsEight studies (1082 patients) were retained: four in the high-severity group and four in the mild-severity group. The high-severity group was associated with larger SMO effect sizes than the mild-severity group: abstinence rate risk ratio (RR) 3.16, P = 0.004; PDA +26.9%, P &lt; 0.001. For PDA, longer treatment duration was associated with larger SMO effect size: +11.3% per extra month, P &lt; 0.001. In the high-severity group, SMO showed benefit: abstinence rate RR 2.91, P = 0.03; PDA +16.9%, P &lt; 0.001. In the mild-severity group, SMO showed benefit only in PDA for longer treatment duration: +23.9%, P &lt; 0.001.ConclusionsIn the retained studies with alcohol-dependent patients, high-severity population and longer treatment duration were associated with larger SMO effect sizes.