Quit Drinking Alcohol

Alcohol Free Forever

This powerful guide walks you step-by-step through exactly what you need to do to free yourself from your alcohol addiction without going through AA meetings or expensive sessions. There are three main types of relaxation techniques you can practice when you feel upset and stressed. If you practice regularly, they will become part of your lifestyle and you may find yourself habitually more relaxed as a result. Part 2 will exercise Neuro Linguistic Programming to release thoughts and a technique of progressive muscle relaxation also negative situations. Because of the mind body connection, exercises to relax the body will also flow through the mind. Much of the stress we feel is because of our resistance to certain feelings or emotions. Alcohol Free Forever is a lifesaver ebook. This guide was extremely eye-opening and the daily emails make it extremely easy to quit and to establish a routine that did not involve alcohol. Read more...

Alcohol Free Forever Overview


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Validity of Alcohol Intake

Reporting bias by high-intake or low-intake consumers could, to some extent, explain the apparent lower mortality among light to moderate drinkers. In the type of studies included in this review,- with an emphasis on prospective population studies, one obvious source of bias is misclassification of subjects according to their self-reported alcohol intake. Studies of the validity of self-reported total alcohol intake have mainly concentrated on validating total alcohol intake in suspected alcoholics, whereas intake validity among low-intake consumers in the general population is poorly studied. No reference of alcohol intake (sales reports, collateral information, biological markers, etc.) has been identified. Some biochemical markers of alcohol intake have been suggested, such as 7-glutamyl transferase, high-density lipoprotein, and carbohydrate-deficient transferrin, the latter being one of the most promising. However, in a study from Copenhagen, it was shown that...

Effects of Alcohol Consumption on the Diet

Alcohol is consumed by about two-thirds of adult Americans, and the estimated per capita annual consumption of alcohol exceeds 2 gallons for each US citizen over age 14 years. In the US, young adults between 18 and 25 years of age consume more alcohol than any other age group, and the preferred beverages are wine, beer, and spirits in that order. Men and teenage boys consume about 3 times more alcohol than teenage girls and adult women. Among alcohol consumers, most are moderate drinkers, while about 10 are heavy drinkers at risk of addiction and organ damage. Moderate drinking can be defined as no more than 2 drinks per day for men or 1 drink per day for women, where 1 drink is equivalent to 12-15 g of alcohol. Heavy drinking is defined as consuming more than 5 drinks on any given day per week in men or 4 drinks on any given day per week for women. Chronic alcoholics are addicts who typically consume excessive amounts of alcohol on a daily basis. Binge drinkers are chronic alcoholics...

The risks of Excessive Alcohol Consumption

Unlike other abused drugs, chronic alcohol in excess affects many different organ systems, which include the liver, pancreas, heart, and brain (Table 1). Excessive chronic alcohol use also increases the risk of certain cancers. While these risks are apparent among the 7 of US citizens over aged 14 who abuse alcohol, their prevalence is generally no less in countries such as France, Italy, and Spain where drinking wine with meals is considered part of the culture. The organ damage from chronic alcoholism may impact on processes of nutrient assimilation and metabolism, as is the case with chronic liver and pancreatic disease, or may be modulated in large part by nutrient deficiencies, as with thiamine and brain function. This section will consider specific effects of alcohol abuse on certain organs as a

Is Alcoholism a Disease

Beliefs about the cause or causes of alcoholism and the nature of drinking problems exert an important influence on public perceptions, institutional responses, and treatment and prevention, and shape the framework that guides ethical inquiry and response. The disease concept of alcoholism, first articulated by Elvin M. Jellinek in the 1940s, was actively promoted by a loose coalition of reformers, service providers, and recovering alcoholics. Since then, it has become the official view of the American medical profession and the World Health Organization (WHO), and has gained wide acceptance among the public at large in the United States and many other Western countries. Proponents of the disease concept argue that alcoholism, like diabetes, essential hypertension, and coronary artery disease, is a biologically based disease precipitated by environmental factors and manifested in an irreversible pattern of compulsive, pathological drinking behavior in individuals who are...

Maternal Alcohol Consumption

Several laboratories have investigated the effects of sustained maternal alcohol consumption on the offspring's metabolic health. Alcohol consumption during pregnancy can lead to abnormal fetal development and a subsequent reduction in birth weight. Increased offspring morbidity may also be linked to gestational alcohol consumption. It has been previously documented that female rats fed a gestational diet supplemented with alcohol tended to have a higher number of pups die in early postnatal life. Of those alcohol-exposed offspring that survived, the reduced rate of prenatal growth and development has been linked to abnormalities in the offspring's glucose and insulin homeosta-sis. Both glucose intolerance and insulin resistance are evident in the rat offspring exposed during in utero life to maternal alcohol. Phenotypic abnormalities, Consumption of alcohol is quite common among breast-feeding mothers as studies have shown ethanol to aid in the promotion of lactation. Establishing...

Excessive Alcohol Consumption during Pregnancy

Chronic alcohol abuse may result in a wide spectrum of secondary disturbances of the absorption and utilisation of many nutrients, including glucose, amino acids, fat, sodium, and some vitamins (especially thia-min, vitamin B12, and folate). The inhibition of folate Both alcohol and its primary metabolite, acetaldehyde, are teratogenic. Excessive alcohol consumption (> 80 g of ethanol or 10 units per day) during pregnancy can result in a child being born with a specific combination of physical and mental disabilities known as fetal alcohol syndrome (FAS). Such fetuses usually survive until birth but are growth retarded and display a characteristic range of clinical features, principally craniofa-cial abnormalities and neurological damage (Table 3). FAS is only seen in infants born to women who are excessive drinkers, but it is not an inevitable result of heavy drinking in pregnancy, and even children born to mothers who are active alcoholics may not show it. This differing...

Binge Drinking and Social Alcohol Consumption during Pregnancy

Binge drinking, generally defined as the consumption of alcohol equivalent to five or more standard drinks per occasion, may be particularly harmful because it exposes the fetus to high blood alcohol concentrations over relatively short periods of time and may be associated with repeated withdrawal episodes. Animal studies have demonstrated binge-like exposure to alcohol to be as teratogeneic as long-term exposure throughout gestation, even if the overall alcohol amount consumed by binge drinking is less than intake during more continuous drinking patterns. However, the findings of human studies have been inconsistent, possibly because of the problems of recording binge drinking during pregnancy. The question of whether moderate or occasional alcohol consumption is safe during pregnancy has been widely debated. Currently, there is little evidence that modest drinking (< 10 units per week) has any harmful effects. Although there is general agreement that women should not drink...

Programming Effects of Moderate and Binge Alcohol Consumption

Heavy, sustained consumption of alcohol by pregnant women is associated with the constellation of birth defects and symptoms known as fetal alcohol syndrome (FAS). Similarly, exposure to high concentrations of alcohol for extended periods in animal models of FAS reproduces the teratogenic effects. In contrast, far less is known regarding the more subde effects on offspring of lesser maternal ethanol ingestion. The most widely studied permanent consequence of prenatal alcohol exposure is impaired development of the nervous system, leading to changes in brain chemistry, neurobiology and behaviour. This is reflected in the mental retardation and neurological deficits associated with FAS. Because this is more accurately described as mimicking a teratogenic outcome present at birth and is considered to be the result of high and sustained exposure to alcohol in humans, it will not be specifically covered in this essay. There are numerous excellent recent...

What Is Moderate Alcohol Consumption and What Are Common Pregnancy Exposures in Humans

In humans it is generally accepted that 1-2 standard drinks (10-20 grams of ethanol) per day is not harmful and may even confer health benefits. This amount of alcohol, when consumed within a relatively short time, produces a blood alcohol concentration (BAC) in the vicinity of 0.05 in a 50 kg woman. In countries such as Australia, the UK and US, alcohol consumption rates in women of childbearing age often appear to be somewhat higher than recommended levels.46 Once women learn they have become pregnant, however, they largely decrease or cease consumption of alcohol. Nevertheless, a significant proportion of women continue to consume alcohol during pregnancy, and there are many women who, despite intentions to the contrary, consume alcohol in dangerous amounts. This is evident in a recendy published Danish study, where it was found that up to 40 of pregnant women engage in at least one episode of binge drinking (a minimum of 5 standard drinks within a short period) during the second...

Definition Prevalence And Stability Of Controlled Drinking

The term controlled drinking is used to describe non-abstinence outcomes that is, moderate or non-problem drinking by persons who have abused or have been dependent on alcohol. Definitions of controlled drinking typically include some limit on the quantity of alcohol consumed per day for example, consumption of no more than 3 to 5 standard drinks per day (1 standard drink 0.5 ounce of ethanol). Similarly, the British Department of Health recommends that men limit their consumption to no more than 4 units per day and that women limit their consumption to no more than 3 units per day (1 unit 8 grams of ethanol). In addition to limits on quantity consumed per day, some definitions of controlled drinking prescribe limits on the number of drinking days per week and limits on the speed with which one Controlled drinking is also typically defined by the reduction or absence of harmful drinking-related consequences. These include drinking-related health problems (e.g., significantly elevated...

Acceptance of Controlled Drinking

As noted earlier, controlled drinking training is controversial in some countries and its application may be limited by institutional treatment philosophy and setting. For example, abstinence is the predominant outcome goal prescribed for alcoholics and problem drinkers in American alcoholism treatment programs. A survey of American alcohol treatment agencies found that controlled drinking was considered unacceptable for clients in almost every responding residential program (including inpatient detoxification and rehabilitation services as well as halfway houses). However, almost one-half of the responding outpatient programs reported moderate drinking as appropriate for a minority of their clientele (e.g., drunk driving offenders). Canadian alcohol treatment programs typically report somewhat more acceptance of controlled drinking than their geographic neighbor. A nationwide survey employing a random sample of Canadian alcohol treatment services found that about 40 of responding...

The Role of Alcoholics Anonymous

Despite the widespread acceptance of the disease concept, the leading approach to overcoming alcoholism in the United States is, ironically, not a medical treatment but a self-help program based on principles of moral and spiritual renewal. Founded in 1935 by Bill Wilson, an alcoholic stockbroker, Alcoholics Anonymous (AA) borrowed many of its ideas from an evangelical Christian movement known as the Oxford Group. Though it embraces the disease concept as part of its holistic view of alcoholism as a threefold illness (physical, mental, and spiritual), AA's primary emphasis is on achieving sobriety through a process of moral-spiritual renewal as set forth in the Twelve Steps. Central to AA's approach is the alcoholic's decision to abstain from alcohol one day at a time. Believing alcoholism to be a disease that may be arrested but never cured, AA views recovery as a lifelong process requiring constant vigilance and regular attendance at meetings where members share their experience,...

Electrical Aversion in the Treatment of Alcoholism

As compared with its use in homosexuality, empirical studies of electrical aversive therapy for alcoholism were limited in number and methodological adequacy. A probable contributing factor was the report by Garcia and Koelling in 1966 that in animals aversions to tastes were much more easily established to malaise produced by ionizing radiation than to electrical shock, whereas the reverse was true for aversions to visual and auditory stimuli. In his 1977 review pointing out the lack of randomized controlled studies evaluating electrical aversion in treatment of alcoholism, Lovibond recommended that to develop aversive control of excessive drinking, illness and malaise may be a more appropriate stimulus than electric shock. However, Smith, Frawley, and Polissar in 1997 reported a slightly superior abstinence at 6 and 12 months in patients treated for alcoholism with electrical as compared to chemical aversion.

Seizures in the Alcohol Abuser

Seizures and alcohol are associated through missed doses of medication sleep deprivation as an epileptogenic trigger propensity for head injury toxic coingestions electrolyte abnormalities alcohol withdrawal seizures and alcohol-related seizures. Alcohol-related seizures are precipitated by alcohol intake. The alcohol withdrawal syndrome involves a spectrum of symptoms that follow reduction or cessation of alcohol. Minor symptoms of alcohol withdrawal, which can begin within 24 h of cessation of drinking, include tremulousness, nausea, anxiety, tachycardia, hypertension, and insomnia. When autonomic hyperactivity becomes more pronounced, disorientation, visual hallucinations, paranoid ideation, or delirium may occur, in the symptom complex of delirium tremens. Classic alcohol withdrawal seizures usually occur within 6 to 48h after reduction or cessation of alcohol, but may occur up to 1 week later. The seizures are generalized, and the interval EEG is usually normal. There may be...

Twin Studies of Alcoholism

That risk-related behaviors are evident early in life, remain stable into adolescence, and are associated with a family history of alcoholism suggests that those behaviors are, at least in part, of genetic origin. To establish that, researchers must use genetically informative study designs. One approach is to study child or adolescent twins and their parents. Several such studies, which specifically assess the initiation of alcohol use and the transition to alcohol abuse, are being conducted throughout the world. We illustrate with two ongoing studies from Finland. The ratings include multidimensional scales (i.e., scales that rate various characteristics) of behaviors associated with increased alcoholism risk. Two years later, at age fourteen, the twins were followed up, and, while most reported abstinence, about one-third were then using alcohol.

Longterm Outlook For Alcoholics

Alcoholic patients should be referred for counseling when possible. A fifth or more may achieve permanent abstinence with the aid of Alcoholics Anonymous or other self-help groups. Unfortunately, the rate of recidivism is related to socioeconomic status and availability of family and social support systems. Thus, while 60 percent of middle-class alcoholics remain ethanol free for at least 1 year after completing a rehabilitation program, the outlook is considerably bleaker for those who are less advantaged.


What are the benefits and problems that attend the use of alcoholic beverages In what ways may drinking cause harm Is the use of alcohol hazardous for all individuals or only for some Who is at risk Should an intoxicated person be held accountable for his or her actions while under the influence How is excessive drinking like or unlike other self-injurious appetitive behaviors such as overeating, smoking, or other substance abuse Should society limit or control the use of alcohol, and should it warn consumers of potential risks associated with drinking Is alcoholism a disease, primarily a medical rather than a moral problem Opinion remains divided on many of these issues, reflecting the diversity of beliefs, practices, and emotions surrounding the use of beverage alcohol in various cultures. Historical and cross-cultural investigations indicate that prevailing cultural beliefs about alcohol and alcohol problems play an important role in determining moral attitudes. Research continues...

Alcoholism in Humans

Again, alcohol use and abuse provide an illustration. Alcoholism is a major social and medical problem in the United States and in most of the world. It is estimated that 10 percent of men and 4 percent of women in the United States experience alcohol dependency, at a cost of billions of dollars and 100,000 lives annually. Because use of alcohol is typically part of social interactions, familial (and possibly genetic) factors would be expected to contribute to variation in drinking. But where shall we begin its study Perhaps with diagnosed alcoholism Most adults in our society use alcohol, yet only a fraction of them ever experience clinical symptoms of alcoholism. Perhaps we should begin much earlier, studying the decision to begin drinking Obviously, one cannot become alcoholic without initiating drinking and then drinking large quantities regularly and with high frequency. Or perhaps much earlier yet, for behavioral predictors of alcoholism can be identified years before alcohol is...

General Metabolism Of Alcohol

Aldehyde dehydrogenase (ALDH) also exists widely in humans. Cytoplasmic ALDH is the same in all people, whereas the mitochondrial ALDH does differ among people, with that found in Asians being less active than the form found in whites. But it is probable that mitochondrial ALDH is not nearly as important in oxidizing acetaldehyde as is cytoplasmic ALDH. Because very little acetaldehyde is found circulating in the blood even after high alcohol intake, it is assumed that the rate-limiting step in alcohol metabolism is the first step its dehydrogenation to acetaldehyde.

Absorption Of Alcohol

Effects of gender and chronic alcohol abuse on blood ethanol concentrations. Ethanol was administered orally (solid lines) or intravenously (dashed lines) in a dose of 0.3 g body weight. The shaded area represents the difference between the curves for the two routes of administration (the first-pass metabolism).

Consumption of Alcohol

In the NDNS, alcohol was consumed by 10 of 1114 year olds and 37-46 of 15-18 year olds with older boys most likely to drink alcohol. Other European surveys have found higher proportions (6090 in 14-18-year-old males), while US surveys have found similar proportions to the UK. The average contribution of alcohol to energy intakes in the NDNS was just over 1 , with higher contributions reported by Danish and Irish studies (around 2-5 energy). Excess alcohol intake can increase micro-nutrient requirements but few younger adolescents fall into this category. However, binge drinking in the 15-18-year-old age group is a concern. One US study found that 20 of adolescents could be classed as problem drinkers, while 7 could be classed as alcoholics. Regular moderate consumption of alcohol can contribute to obesity since the energy provided by alcoholic drinks rarely displaces energy from other food sources. This is likely to increase overall daily energy intakes and could lead to a positive...

Microsomal Ethanol Oxidizing System

Chronic administration of ethanol with nutritionally adequate diets increases clearance of ethanol from the blood. In 1968, the MEOS was identified. The MEOS has a higher Km for ethanol (8-10mmol l) than ADH (0.2-2.0 mmol l) so at low BEC, ADH is more important. However, unlike the other pathways, MEOS is highly inducible by chronic alcohol consumption. The key enzyme of the MEOS is cytochrome P4502E1 (CYP2E1). Chronic alcohol use is associated with a 4- to 10-fold increase of CYP2E1 due to increases in mRNA levels and rate of translation.

Effects of Alcohol on the Central Nervous System

Dopamine is involved in the rewarding aspects of alcohol consumption. 'Enjoyable' activities such as eating or use of other recreational drugs also release dopamine in the nucleus accumbens of the brain. Serotonin is also involved in the in reward processes and may be important in encouraging alcohol use.

Cbt In The Treatment Spectrum

Though one of the most widely researched treatments for numerous Axis II and other Axis I disorders, CBT is not currently the most widely used in the treatment of SUDs, particularly alcohol. Fuller and Hiller-Sturmhofel (1999) reported that the 12-step programs, such as Alcoholics Anonymous, are most commonly used to treat alcoholism, with CBT a distant second, and pharmacological treatments such as disulfiram (Antabuse), acamprosate (Campral), and naltrexone (Revia) an even more distant third. In the field of substance abuse treatment, CBT is more commonly used in relapse prevention, and in academic and VA hospitals (Longabaugh & Morgenstern, 1999).

Neuroendocrine Effects of Alcohol

Alcohol activates the sympathetic nervous system, increasing circulating catecholamines from the adrenal medulla. Hypothalamic-pituitary stimulation results in increased circulating cortisol from the adrenal cortex and can, rarely, cause a pseudo-Cushing's syndrome with typical moon-shaped face, truncal obesity, and muscle weakness. Alcoholics with pseudo-Cushing's show many of the biochemical features of Cushing's syndrome, including failure to suppress cortisol with a 48-h low-dose dexamethasone suppression test. However, they may be distinguished by an insulin stress test. In pseudo-Cushing's, the cortisol rises in response to insulin-induced hypoglycemia, but in true Cushing's there is no response to hypoglycemia. Ethanol affects hypothalamic osmoreceptors, reducing vasopressin release. This increases salt and water excretion from the kidney, causing polyuria. Significant dehydration may result particularly with consumption of spirits containing high concentrations of ethanol and...

Alcohol and Nutrition

The nutritional status of alcoholics is often impaired. Some of the pathophysiological changes seen in alcoholics are direct consequences of malnutrition. However, in the 1960s, Charles Lieber demonstrated that many alcohol-induced pathologies, including alcoholic hepatitis, cirrhosis, and myopathy, are reproducible in animals fed a nutritionally adequate diet. Consequently, the concept that all alcohol-induced pathologies are due to nutritional deficiencies is outdated and incorrect. Myopathy is a direct consequence of alcohol or acetaldehyde on muscle and is not necessarily associated with malnutrition. Assessment of nutritional status in chronic alcoholics using anthropometric measures (e.g., limb circumference and muscle mass) may be misleading in the presence of myopathy.

Effects of Alcohol on the Cardiovascular System

The beneficial, cardioprotective effects of alcohol consumption have been broadcast widely. This observation is based on population studies of mortality due to ischemic heart disease, case-control studies, and animal experiments. However, there is no evidence from randomised controlled trials. The apparent protective effect of alcohol may therefore result from a confounding factor. Furthermore, on the population level, the burden of alcohol-induced morbidity and mortality far outweighs any possible cardiovascular benefit.

Effects of Alcohol on Liver Function

Central to the effects of ethanol is the liver, in which 60-90 of ethanol metabolism occurs. Ethanol displaces many of the substrates usually metabolized in the liver. Metabolism of ethanol by ADH in the liver generates reducing equivalents. ALDH also generates NADH with conversion of acetaldehyde to acetate. The NADH NAD+ ratio is increased, with a corresponding increase in the lactate pyruvate ratio. If lactic acidosis combines with a 3-hydroxy-butyrate predominant ketoacidosis, the blood pH can fall to 7.1 and hypoglycemia may occur. Severe ketoacidosis and hypoglycemia can cause permanent brain damage. However, in general the prognosis of alcohol-induced acidosis is good. Lactic acid also reduces the renal capacity for urate excretion. Hyperuricemia is exacerbated by alcohol-induced ketosis and acetate-mediated purine generation. Hyperuricemia explains, at least in part, the clinical observation that alcohol misuse can precipitate gout. Continued alcohol consumption may lead to...

Wernickes Encephalopathy

Neuropathologists have recognized for many years that chronic heavy ethanol intake can result in a syndrome first described by Wernicke in 1881, in which neurodegenerative changes occur in the thalamus, periaqueductal region, and floor of the fourth ventricle. Individuals with Wernicke's encephalopathy typically manifest a triad of clinical symptoms consisting of ocular abnormalities, ataxia, and a disturbance in consciousness varying from mild confusion to a profound comatose state. Whether a direct action of ethanol in the brain contributes to this neuropatholo-gical syndrome is unclear. A very similar syndrome is known to occur in individuals who have severe nutritional deficiencies, especially thiamine deficiency, and the Wernicke pattern and type of brain damage can be induced in experimental animals by rendering them severely thiamine deficient. Chronic alcoholics are typically deficient in thiamine because they tend to substitute ethanol for other more nutritional sources of...

Alcohol and Mortality Amount of Alcohol

Several large prospective population studies from many countries have described the impact of alcohol intake on mortality as J-shaped, indicating both the beneficial effect of a light to moderate alcohol intake and a detrimental effect of a high alcohol intake (Figure 1). Some have explained the J shape as an artefact due to misclassification or confounding. Prevailing beliefs among these researchers is that abstainers comprise a mix of former heavy drinkers, underreporting drinkers, ill people who have stopped drinking, and people with an especially unhealthy lifestyle apart from abstaining. However, most researchers attribute the 'J' to a combination of beneficial and harmful effects of ethanol. This is based on findings from population studies of alcohol-related morbidity and cause-specific mortality that show a decreased relative risk of coronary heart disease, and an increased risk of certain cancers and cirrhosis, with increased alcohol intake. Further evidence derives from...

Alcoholic Deterioration

Progressive ataxia, degeneration of cerebellar Purkinje neurons, cerebral atrophy, and mild to severe dementia have been described by many authors as findings typically associated with chronic heavy alcohol use. In one study, loss of Purkinje neurons from the cerebellar vermis correlated with long-term daily ingestion of moderate doses of ethanol, but in other studies a definite correlation could not be established between either cerebrocortical or cerebellar atrophy and the long-term pattern or amount of ethanol intake. Dementia syndromes of mild to moderate degree have been described in chronic alcoholics, with stabilization or improvement occurring if ethanol ingestion is discontinued. Thus, there is suggestive evidence that ethanol can have deleterious effects on the adult brain which may be separate and distinct from the Wernicke and Korsakoff syndromes, but it remains to be determined whether or how ethanol directly contributes to these brain damage syndromes.

Benefits Coronary Heart Disease

A large number of investigators have studied the relation between alcohol intake and coronary heart disease. Studies indicate that the descending leg of the curve is mainly attributable to death from coronary heart disease, as mentioned previously. The lowest risk seems to be among subjects reporting an Alcohol consumption, drinks day Figure 1 Relative risk of death from all causes according to total alcohol intake. Relative risk is set at 1.00 among nondrinkers (0 drinks week). (Reproduced with permission from Boffetta P and Garfinkel L (1990) Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study. Epidemiology 1 342-348.) Alcohol consumption, drinks day Figure 1 Relative risk of death from all causes according to total alcohol intake. Relative risk is set at 1.00 among nondrinkers (0 drinks week). (Reproduced with permission from Boffetta P and Garfinkel L (1990) Alcohol drinking and mortality among men enrolled in an American Cancer...

Risks Large Number of Somatic Diseases

At the other end of the range of intake, the ascending leg has been explained by the increased risk of cirrhosis and development of certain types of cancers with a high alcohol intake. The mechanisms by which alcohol induces cirrhosis have been intensively studied but sparsely enlightened. It is well documented that women, most likely due to smaller size and different distribution of body fat and water, are at higher risk of developing cirrhosis than men, but other risk factors for alcoholic cirrhosis are not well established (Figure 2). Alcohol consumption, drinks wk Figure 2 Relative risk of alcohol-induced cirrhosis according to sex and alcohol intake. Relative risk is set at 1.00 among nondrinkers (< 1 drink week). (Reproduced with permission from Becker U et al. (1996) Prediction of risk of liver disease in relation to alcohol intake, sex and age A prospective population study. Hepatology 23 1025-1029.) Alcohol consumption, drinks wk Figure 2 Relative risk of alcohol-induced...

Age and Risk Factor Profile

A few studies have indicated that subjects already at high risk of coronary disease experience a greater beneficial effect of drinking alcohol moderately conversely, only in those with a high risk level is coronary heart disease prevented. Hence, the large Nurses Health Study found that the J-shaped relation was significant only in women older than 50 years of age, whereas younger women who had a light alcohol intake did not differ from abstainers with regard to mortality. Fuchs et al. found that women at high risk for coronary heart disease (due to risk factors such as older age, diabetes, family history of coronary heart disease, high cholesterol, and hypertension) who had a light alcohol intake were at a lower risk of death than women who were at the same risk level but did not drink alcohol. In a study by the American Cancer Society, the finding by Fuchs et al. was confirmed among men,

Alcoholic Liver Disease

In the abdominal cavity, and the syndrome of hepatic encephalopathy, which is due to inadequate hepatic detoxification of substances in the visceral blood that is shunted around the liver. The risk of developing alcoholic cirrhosis is dependent upon the amount of alcohol exposure independent of the presence or absence of malnutrition. For example, a study of well-nourished German male executives found that the incidence of alcoholic cirrhosis was directly related to the daily amount and duration of alcohol consumption, such that daily ingestion of 160 g alcohol, equivalent to that found in a pint of whisky, over a 15-year period predicted a 50 risk of cirrhosis on liver biopsy. Other worldwide demographic data indicate that mortality rates from cirrhosis of the liver can be related to national per capita alcohol intake. These studies have defined the threshold risk for eventual development of alcoholic cirrhosis as 6 drinks per day for men, and about half that for women.

Pancreatitis and Pancreatic Insufficiency

Pancreatitis occurs less frequently than liver disease in chronic alcoholics, and is characterized by severe attacks of abdominal pain due to pancreatic inflammation, while pancreatic insufficiency is due to the eventual destruction of pancreatic cells that secrete digestive enzymes and insulin. This destructive process is associated with progressive scarring of the pancreas together with distortion and partial blockage of the pancreatic ducts, which promote recurrent episodes of acute inflammatory pancreatitis. Since the pancreas is the site of production of proteases and lipases for protein and lipid digestion, destruction of more than 90 of the pancreas results in significant malabsorption of these major dietary constituents, as well as diabetes secondary to reduced insulin secretion. Consequently, patients with pancreatic insufficiency exhibit severe loss of body fat and muscle protein. Since the absorption of fat-soluble vitamins is dependent upon pancreatic lipase for...

Pyridoxine Deficiency

Pyridoxine (vitamin B6) is required for transamination reactions, including the elimination of homo-cysteine. Pyridoxine deficiency in chronic alcoholism is caused by poor diet, whereas displacement of pyridoxal phosphate from circulating albumin by the alcohol metabolite acetaldehyde increases its urinary excretion. Low serum levels of pyridoxal phosphate are common in chronic alcoholics, and pyridoxine deficiency is manifest by peripheral neuropathy and sideroblastic anemia. In alcoholic hepatitis, the serum level of alanine transaminase (ALT) is disproportionately low compared to aspartate

What Exactly is Health

A second criticism of the dichotomy hinges on the fact that both disease and illness are located in the individual or experienced at an individual level. The term illness does refer to an individual's social relations, but generally it does so only insofar as these were the cause of the illness (e.g., when an offended party places a hex) or as the illness leaves the individual unable to fulfill social or role obligations. However, some scholars would link suffering more palpably to the social order by examining how macro-social forces, processes, and events (such as capitalist trade arrangements) can culminate in public health problems (such as HIV AIDS, tuberculosis, alcoholism, pesticide-induced anomalous pregnancy outcomes) and poorly functioning health systems (see Baer, Singer, & Johnson, 1986 Waitzkin, 2000).

Treatment of Folate Deficiency

If the deficiency is nutritional it is usually treated in the first instance with dietary supplements. In the past, daily supplements of 5.0mgday_1 have been used but more recent evidence suggests that such high levels would only be appropriate for the immediate treatment of an overt deficiency. More long-term treatment would recommend dietary changes to improve folate intake. In practice, to achieve effective changes is very difficult so the recommendation might be to improve intake through foods fortified with the synthetic form of the vitamin, namely folic acid, or the use of supplements of folic acid. In both of these instances the aim is to achieve a maximum increased intake via folic acid of 400 mgday-1. Long-term ingestion of larger amounts are not recommended because of their ability to mask the diagnosis of vitamin B12 deficiencies (discussed above). Other causes of folate deficiency are treated by removing the cause, e.g., alcohol abuse.

TABLE 234 Etiology of Syndrome of Inappropriate Antidiuretic Hormone SIADH

COMPLICATIONS OF THERAPY Complications with the treatment of acute hyponatremia, especially when there is no underlying CNS, hepatic, or renal disorder, are uncommon and occur in fewer than 2 percent of patients. In chronic hyponatremia, brain edema is usually not severe, and little evidence exists that chronic hyponatremia itself causes brain damage. Nevertheless, these patients appear to be at greater risk for brain injury (CPM) during the correction process. The injury reportedly occurs after the hyponatremia has been corrected and progresses in a predictable manner. These neurologic changes are believed to be due to correction of the serum Na+ at a rate faster than the brain can adapt to the higher osmolality. In patients with chronic hyponatremia, other factors contributing to the CPM may include alcoholism, malnutrition, toxins, and metabolic imbalance.

Risk Factors and Characteristics

Likely than the comparison group of caregivers to have mental, emotional, and or alcohol problems and to be dependent on the victims. Conversely, the abused elders were less functionally dependent than the control group in carrying out their activities of daily living. The families in which abuse occurred also tended to have fewer outside contacts and were less satisfied with them than were their nonabuse counterparts. Similar results have been reported by other researchers (Phillips, 1988 Bristowe and Collins Anetzberger Lachs et al., 1997). A comparison of 328 cases by abuse type revealed three distinct profiles (Wolf et al.). Perpetrators of physical psychological abuse were more likely than perpetrators of neglect to have a history of mental illness and alcohol abuse, and to be dependent on the victim for financial resources. The victims were apt to be in poor emotional health but relatively independent in the activities of daily living. In contrast, those cases involving neglect...

Imaging methods their application to psychopharmacology

In addition to epilepsy, reduced GABA has been recorded in patients with unipolar depression, following alcohol withdrawal and in hepatic encephalopathy. The finding that the concentration of GABA is reduced in depression is unexpected as there is no evidence that the disorder is associated with an increased cortical excitability. One possibility is that the reduction in GABA is a reflection of a decreased availability in its excitatory amino acid precursor glutamate.

Addiction and dependence

Addiction has wide-ranging consequences. In 1998 over 500,000 full-time college students were unintentionally injured under the influence of alcohol and over 600,000 were hit or assaulted by another student who had been drinking (Hingson, et al.). Over 1,400 students died from unintentional alcohol injuries (Hingson, et al.), 42 percent of adolescents admitted to a trauma center tested positive for drugs or alcohol and 72 percent of adolescents who were victims of gunshot wounds tested positive for substance use (Madan, et al.). Young persons are not the only ones affected by drug and alcohol abuse. For example, almost half of patients over 65 years old who were treated at trauma centers tested positive for alcohol (Zautcke et al.). As can be seen from the above data, drug and alcohol abuse puts an extreme burden on the healthcare system. Over the past eighteen years, persons admitted to level I Drug and alcohol abuse and dependence cut across all geographic, ethnic, and social...

Circumstances Leading to Deficiency

Disease, sudden infant death syndrome, renal dialysis, gastrointestinal diseases, and alcoholism. Studies of biotin status during pregnancy and of biotin supplementation during pregnancy provide evidence that a marginal degree of biotin deficiency develops in at least one-third of women during normal pregnancy. Although the degree of biotin deficiency is not severe enough to produce overt manifestations of biotin deficiency, the deficiency is sufficiently severe to produce metabolic derangements. A similar marginal degree of biotin deficiency causes high rates of fetal malformations in some mammals. Moreover, data from a multivitamin supplementation study provide significant albeit indirect evidence that the marginal degree of biotin deficiency that occurs spontaneously in normal human gestation is teratogenic.

Adaptive Nonresponding Theory See Sleep Theories Of

A psychomo-tor stimulant theory of addiction. PsychologicalReview, 94, 469-492. Leonard, K. E., & Blane, H. T. (1999). Psychological theories of drinking and alcoholism. New York Guilford Press. Robinson, T. E., & Berridge, K. C. (2003).

Bacillus species and diseases

That the etiological agent of anthrax is a Bacillus species, namely B. anthracis, was mentioned at the outset. The pathogenic potential of ASB other than B. anthracis has become increasingly recognized in the past three decades with a proliferation of reports implicating Bacillus species, particularly B. cereus, in distinct emetic and diarrheal types of food poisoning and in infections of immunocompromised or otherwise debilitated hosts (e.g. alcoholics, diabetics), in mixed or secondary infections or occasionally in primary infections in otherwise healthy humans or animals.

Can Substance Misuse Trigger a Premature Onset of the Prepsychotic Prodromal Stage

In the ABC Schizophrenia Study, the lifetime prevalence of alcohol abuse until age at first admission was 24 for the first-episode sample and 12 for matched controls from the same population 119,136,137 , and that of drug abuse 14 for patients and 7 for controls. Studies on the topic almost invariably show a preponderance of men in substance abuse. We found a cumulative prevalence (until first admission) of any type of substance abuse of 39 for men and 22 for women. Cannabis was the most frequently abused substance (88 ), followed by alcohol (58 ). In this study, 35 of the patients with drug abuse and 18 of those with alcohol abuse started with the abuse behaviour in the same month as the onset of schizophrenia occurred. In this small group, precipitation of illness onset by substance abuse cannot be excluded, especially since these patients were significantly younger (8 years) at illness onset than non-abusing patients. In contrast, we could not support in our study the...

Theoretical Bases

For example, shock during alcohol sipping could be avoided or escaped by spitting out the alcohol. The aversion relief component of the treatment of alcoholics utilizes a desirable response (e.g., spitting out alcohol) as a potential positive reinforcing stimulus, deriving its positive quality from its contiguity with escape.

Traumatic Stress and Posttraumatic Stress Disorder

Although traumatic stress appears to be immuno-suppressive in the majority of trauma victims, findings concerning immune system activity in victims who meet criteria for PTSD are more mixed. Despite equivocal findings, research suggests that war veterans with PTSD may exhibit greater immune activity than similarly exposed veterans who do not meet PTSD criteria. However, these findings must be interpreted cautiously due to several characteristics of the patient sample. For instance, the length of time that has passed between the traumatic event and sampling for immune measures in these studies is often great. PTSD patients in these studies have typically suffered from chronic PTSD, often presenting with symptoms for more than 20 years. This chronicity of symptomatology is unusual and may account for some of the findings. These patients also often suffer from comorbid drug and alcohol abuse, making conclusions regarding immune alterations in PTSD difficult.

Mechanisms Of Stressrelated Immune Alterations

Use of alcohol also increases during periods of stress, and results of studies examining the immuno-logical effects of chronic alcoholism suggest that immune activity is suppressed while individuals are using alcohol but recovers within months after participants stop drinking. These results must be interpreted cautiously because alcoholism is associated with many other factors that may affect immunity (poor diet, less exercise, etc.). Recent research suggests that minimal intake (one or two drinks per day) may provide some protection against certain chronic diseases. However, chronic and moderate acute alcohol use can increase susceptibility to bacterial and viral infections, although the effects of alcohol on immunity appear to be differentially affected by alcohol dose, extent of alcohol use, and time since use.

Addiction as a Modern Governing Image

The concept of addiction as an affliction of habituated drug users first arose in its modern form for alcohol as heavy drinking lost its banalized status in the United States and some other countries under the influence of the temperance movement of the nineteenth century (Levine Valverde). Habitual drunkenness had been viewed since the Middle Ages as a subclass of gluttony now abstinence from alcohol was singled out as a separate virtue and an important sign of the key virtue in a democracy of autonomous citizens self-control. Along with other mental disorders, chronic inebriety, as alcohol addiction usually was termed, was reinterpreted as a disease suitable for medical intervention, although without losing all of its negative moral loading. In nineteenth-century formulations addictiveness was seen as an inherent property of alcohol no matter who used it, and that perception justified efforts to prohibit its sale. By the late nineteenth century such addiction concepts were being...

Forensic Pathologic and Medicolegal Problems Arising in the Postmortem Elucidation of Infection Related Deaths

Attention must be given to the exceptional constellation of fatalities that often are subject to postmortem investigations in forensic autopsy practice. Special environmental conditions (e.g., low hygienic standards, low socioeconomic settings, indolent persons) accompany a great number of outpatient deaths. Representative groups of such fatalities are addicts (e.g., intravenous drug abusers, alcoholics), old, immobilized, and neglected persons, foreigners from countries with low hygienic standards, and members of social fringe groups (e.g., homeless people).

The Origins of an Integrated Approach in Anthropology and Epidemiology

Epidemiologists interested in history commonly trace the origins of their discipline back 2400 years to Hippocratic texts, particularly, Airs, Waters, Places, which emphasized environmental factors (seasons, winds, water, position, and soil) in disease causation. But Hippocrates also discussed diseases as attributes of populations, and he emphasized the eti-ologic significance of the mode of life of a town's populace whether they are heavy drinkers, taking lunch, and inactive or athletic, industrious, eating much and drinking little (Hippocrates 1957 73). Thus an interest in what today might be called behavioral or social causes of disease predates the terms themselves and certainly comes long before the scientific disciplines organized to investigate them.

Children and Adolescents 2151 Suicides

Various studies have noted that psychiatric disorders, including drug and alcohol abuse, history of suicide threats and attempts, antisocial behavior, and disturbed family structure were common (70,106,107). A note was left in up to one-third of cases. Deaths usually occur at home (106). Most deaths are unwitnessed by adults, but other children can be present in some cases (103).

Case presentation 3

A 74-year-old retired schoolteacher presents with an infection in his left forefoot. He gives a history of type 2 diabetes mellitus of 8 years' duration, which has required insulin for control of blood sugar for the last 4 years. He is a non(never)-smoker, with a daily alcohol intake of 4-5 units. His family doctor reports that his blood sugar control has deteriorated over the last year, and that he had an episode a week previously that may have been a transient ischemic attack.

Past and Personal History

History of alcohol consumption, substance abuse and exposure to various toxins should be elicited and documented. Whether consumption of large amount of alcohol, especially adulterated alcohol, is a risk factor for epilepsy is not certain.19 But in a study in Togo,15 attributed epilepsy to alcohol consumption in 8 of the 237 patients studied. The tropical world is the major region for the production and distribution of narcotics. In the developing world psychotropic drug consumption is on the rise. Over indulgence of substance abuse can provoke epileptic seizures.30 Benzene hexachloride, a pesticide used in India, has been associated with seizures.31 Consumption of certain fruits can result in fatal convulsive encephalopathy, this is more often described during famine. In Burkina Faso and other African countries epidemics of fatal convulsive encephalopathy in children have been reported following consumption of unripe ackee fruit (Blighia sapida).32,33 The traditional healers provoke...

Complex Behaviors Complex Causes

Thus, for use and abuse of alcohol, we know that the importance of genetic and environmental effects changes with sequencing in the use and abuse of alcohol, from abstinence or initiation to frequency of regular consumption, to problems associated with consumption, and ultimately, to diagnosed alcoholism and end-organ damage from the cumulative effects of alcohol. Similar stories could be told for many other behaviors of interest. Thus, for the major psychopathologies, from depression and schizophrenia in adults to attention deficit disorder in children or eating disorders in adolescents, genetic influences are invariably part of the story but never the whole story.

Puberty and Adolescence

In adolescence (badanegootyoon) boys have more freedom than girls. A girl's freedom of movement, already limited in childhood, is further restricted in adolescence. Teenage girls are expected to come home directly after school and to keep their parents informed of their whereabouts at all times. If a girl has older brothers, she is expected to obey them as she obeys her parents and to respect their opinions. Meanwhile, a boy regardless of age, is expected to protect his sisters and to guard their honor, which often means fighting with other boys. During adolescence, boys begin to smoke cigarettes and drink alcohol. Since there is no enforced legal drinking age, boys spend a great deal of time drinking with friends in caf s and bars. Increasingly, girls are also beginning to spend time in caf s and bars either with their boyfriends or with a group of girlfriends. However, girls generally frequent bars and caf s where parents, neighbors, or relatives will not see them and, unlike boys,...

Predisposing Factors for Heat Illness

Certain segments of the population are at greater risk for dehydration and subsequent heat illness than others (Table 5). The predisposing factors for dehydration and heat illness in these populations are obesity (extra exertion, heat production, and sweating are required to move a larger mass), insufficient heat acclimation (associated with reduced sweating and evaporative cooling and increased cardiovascular and renal stress), socioeconomic barriers to cooling methods (fans, air conditioners, etc.), pyrexial illness (fever), drug and alcohol abuse (interferes with fluid balance and thermoregulation), physical work in environments that contribute to dehydration (heat sweating cold respiratory water loss and diuresis altitude respiratory water loss and

Projects Integrating Anthropology and Epidemiology

Before thinking about the new issues facing anthropologists and epidemiologists at the beginning of the twenty-first century, it is important to recall the contemporary themes that already have received decades of attention. For example, the interdisciplinary exchanges between these fields four and five decades ago were based partly on the movement of epidemiologists from home to foreign terrain. Anthropology became more relevant and necessary when epidemiologists started working more often in cultural contexts they did not understand. This theme is still relevant today, although the uncharted terrain now includes a mixture of foreign territories and domestic communities. As epidemiologists have become increasingly involved in the design and implementation of intervention trials attempting to change human behaviors such as unsafe sex, smoking, and high alcohol consumption, their need and desire to understand communities and human behaviors has grown correspondingly (Smedley and Syme...

Clinical Features

Ihe hallmark of chronic pancreatitis is abdominal pain, but in about 10 percent of cases the disease may be painless. 21 As in acute pancreatitis, pain is usually mid-epigastric and may radiate to the back, although abdominal tenderness is often less prominent. 2 Nausea and vomiting may be present. In the early stages of chronic pancreatitis, discrete attacks of pain (formerly called relapsing pancreatitis) occur, lasting days to weeks. 17 Pain is frequently worse after alcohol ingestion or a fatty meal. As the disease progresses, pain-free periods become less frequent and often disappear completely. 2 In distinction to acute pancreatitis, patients with chronic pancreatitis appear chronically ill and may have signs and symptoms of pancreatic insufficiency, including weight loss, steatorrhea, clubbing, and polyuria. Stigmata of chronic liver disease may be present if the etiology is alcohol abuse.

Choice And Definition Of Problems To Be Studied

Prostitutes in general (CDC, 1987 Cohen et al Rosser, 1994) and African-American women as prostitutes in particular. Several studies have also revealed that practitioners recognize and report at higher rates crack-cocaine abuse in African-American women and alcohol abuse in American Indian women, compared to white women seeking prenatal care. An American Civil Liberties Union study revealed that in forty-seven out of fifty-three cases brought against women for drug use during pregnancy in which the race of the woman was identifiable, 80 percent were brought against women of color (Pattrow, p. 2).

Courtship and Marriage

Some sculptors inspired by spirits may never marry it may be said that they are actually married to an invisible spirit wife who jealously prevents them from marrying a human. Depending on the severity of their infirmity, those with significant physical or mental impairments, or who are alcoholics, may not marry.

Aetiologyrisk factors

The aetiology of seborrhoeic dermatitis is not clear. Several factors, such as sebaceous output, androgenic hormones, mycological infection and neurological disturbances can have a major effect on the development of the condition. In particular, qualitative and quantitative abnormalities in the composition of sebum have been suggested but not clearly defined. The non-pathogenic fungus Malassezia furfur (Pityrosporum ovale and P. orbiculare) may play a role3 but the mechanism has not been established.4 Increased keratinocyte and sebocyte turnover has been reported in association with altered keratinisation. Systemic lipid metabolism and antioxidants may play a role in modulation of the disease onset and the inflammatory reaction. A few studies have linked the onset or relapses with psychological situations, alcohol intake, psychotropic drugs and a deficiency of micronutrients (lithium, zinc, magnesium, biotin).

Timothy J OFarrell and William Fals Stewart

Keywords alcoholism, drug abuse, couples therapy, behavioral contracts, communication skills training Although alcoholism and drug abuse have been historically viewed as individual problems best treated on an individual basis, there has been a growing recognition over the last three decades that couple and family relationship factors often play a crucial role in the maintenance of substance misuse. The relationship between substance abuse and couple relationship problems is not unidirectional, with one consistently causing the other, but rather each can serve as a precursor to the other, creating a vicious cycle from which couples that include a partner who abuses drugs or alcohol often have difficulty escaping. * Preparation of this article was supported by grants to the first author from the National Institute on Alcohol Abuse and Alcoholism (K02AA0234) and to the second author from the National Institute on Drug Abuse (R01DA14402)), and by the Department of Veterans Affairs. A...

Assumptions about Defining and Measuring Variables

I have described two different levels of categorization of variables in the last few paragraphs. Person, place, and time represent very large groupings of variables, whereas concepts such as religion, altitude, or season are more specific. But another aspect of measurement is also significant, namely, the specific question or measure used to collect information about a given variable called the operationalization of that variable. Consider, for example, how to measure the impact of religion on health status. Let's imagine a hypothetical experiment to assess the effects of religiosity on health. We might want to compare the health of people who pray with those who do not or the health of people who are prayed for with those who are not. (For a wonderful example of a test of this theory, see an 1872 paper by the statistician Francis Galton titled A statistical inquiry into the efficacy of prayer.) The investigator in this case would want to measure the frequency and duration of prayer....

Serotonin and drugs of abuse

The role of 5-HT in the control of alcohol intake has received considerable attention following the discovery that 5-HT reuptake inhibitors reduce alcohol intake in alcohol dependent rats. Similar effects have been found for intracerebroventricularly administered 5-HT or its precursor 5-HTP. Regarding the type of 5-HT receptor involved, there is experimental evidence that the 5-HT1A partial agonists buspirone and gepirone are effective. Differences were found between the effects of the 5-HT3 antagonist ondansetron and the 5-HT2A 5-HT2c antagonist ritanserin. Thus the 5-HT3 antagonist ondansetron reduces alcohol intake without affecting the alcohol preference of rats, while ritanserin reduces both the alcohol preference and intake. This suggests that, at least in rats, different populations of 5-HT receptors may be involved in alcohol intake and preference.

Social Cost Outcomes and Benefitto Cost Ratio

Three BCT studies (two in alcoholism and one in drug abuse) have examined social costs for substance abuse-related health care, criminal justice system use for substance-related crimes, and income from illegal sources and public assistance. The average social costs per case decreased substantially in the 1-2 years after as compared to the year before BCT, with cost savings averaging 5000- 6500 per case. Reduced social costs after BCT saved more than 5 times the cost of delivering BCT, producing a benefit-to-cost ratio greater than 5 1. Thus, for every dollar spent in delivering BCT, 5.00 in social costs is saved. In addition, BCT was more cost-effective when compared with individual treatment for drug abuse and when compared with interactional couples therapy for alcoholism.

Stroke Risk Factors

Homocysteinemia, obesity, alcohol intake, and sedentary lifestyle. In addition, there are numerous predisposing factors, or stroke etiologies, including genetically inherited hematologic conditions (e.g., sickle cell disease and protein C deficiency), vascular malformation, connective tissue diseases, vasculitis, substance abuse, trauma with arterial dissection, and patent foramen ovale (Table II).

Contraindications For

A few contraindications for BCT should be considered. The first is current psychosis for either the alcoholic patient or the family member. The second is an acute risk of severe family violence with a potential for serious injury or death. Cases with less severe forms of family violence can be treated successfully in BCT. In such cases, conflict containment is an explicit goal of the therapy from the outset, and you will need to take specific steps to avoid violence (for more details see O'Farrell & Murphy, 2002). Third, couples for which there is a court-issued restraining order for the spouses not to have contact with each other should not be seen together in therapy until the restraining order is lifted or modified to allow contact in counseling. Finally, if the spouse also has a current alcohol or drug problem, BCT may not be effective. In the past, we have often taken the stance that if both members of a couple have a substance use problem, then we will not treat them together...

Description Of Treatment

Biblical behavior modification, composed as it is of both theoretical and practical components from behaviorism, social learning, and cognitive science, offers a wide variety of treatments that can be especially appealing to Christians. Christians might desire, for example, to show less anger in their reactions to certain events, get rid of a slight agoraphobia in order to spend more time with fellow Christians, control a problem with alcoholism, or learn to think of others in a less critical way. In this desire to live a more Christian life (i.e., live up to their beliefs), Christians seek help in a variety of ways in order to change or control certain behaviors. They pray or study their Bible, talk to friends or family members, or seek counseling from a minister or a counselor therapist (who may or may not be a Christian).

How common is anaphylaxis

A French study28 supports Bock's findings from Colorado. This multi-centre study investigated the presentation rate of food-induced anaphylactic shock to 46 emergency departments, 29 dermatology units and 19 internal medicine departments. In 794 reported cases of anaphylaxis, food was implicated in 81 cases (10 ). Unusually, only 19 patients (23.4 ) had known food allergy. The presence of the causative allergen in 'hidden form' contributed to 25 cases (31 ) of food-related anaphylaxis. An enhancing factor, such as alcohol consumption or exercise,29 was present in 221 cases (27.8 ).

Molecular epidemiology

Confounding is the effect of a third variable that influences the exposure-disease relationship under study and is very important in epidemiology. The confounder variable is associated with the exposure being studied and is an independent risk factor for the health outcome under analysis. A cohort study on the relation between alcohol intake and risk of lung cancer might find a relative risk. However, people who consume alcohol often smoke (a confounding variable). Smoking is a known risk factor for lung cancer. Confounding variables usually have a stronger effect than the exposure under study. To find the correct relative risk of alcohol on lung cancer, either the study population has to be restricted to nonsmokers or else smokers and nonsmokers have to be separated. Therefore, a corrected estimate of the relative risk can be obtained by calculating a weighted average of the stratum-specific relative risks for smokers and nonsmokers, which usually involves statistical procedures to...

Impact Of Fish Analysis In Different Research Areas

A small number of studies have addressed the possible effects of lifestyle factors such as smoking, air pollution, and caffeine and alcohol consumption on sperm aneuploidy frequencies. Robbins et al. 22 found a significant association between caffeine and alcohol consumption and increased disomy frequencies for some chromosomes. No significant association was noted for smoking. Two studies found a significant association between smoking and aneuploidy for some chromo-somes, 23,24 but it is difficult to rule out combined lifestyle factors because smokers also consume more caffeine and alcohol than nonsmokers. Our laboratory studied over 600,000 sperm cells from heavy smokers, light smokers, and nonsmokers (all nondrinkers of alcohol) and found a significant increase of disomy only for chromosome 13, but not for chromosome 21, X, or Y. 25,26 Perreault et al. 26 studied seasonal air pollution and found an association between high levels of air pollution and YY disomy in nonsmoking men....

Definitions and Clinical Aspects

The Mallory-Weiss syndrome is characterized by bleeding from a mucosal laceration in the distal esophagus. The cause is a sudden rise in intraabdominal pressure, which may occur with forceful vomiting (especially in alcoholics), vigorous coughing, asthma attacks, or during pregnancy.

Personality Differences by Gender

Many psychological problems are gender specific. While boys and men tend to suffer from aggression-related problems, women are more apt to experience depression. Substance abuse and alcoholism are also gender specific. While men form the majority of heavy drinkers and alcoholics, women form the majority of psychiatric drug abusers. While male alcoholics attract public attention because they usually behave noisily and aggressively,

Leadership in Public Arenas

Physical disadvantages, such as their generally lower tolerance of alcohol. Alcohol consumption still seems to be a very important social lubricant in the traditional German political party and public administration net-works a tradition that goes back at least to the early modern age. This makes it understandable that the proportion of women in politics is highest in the relatively new Green Party. This party had a high share of female membership from the very beginning and the average age of party members is low.

The Moral Differences of Addiction

As a number of critics have outlined, the notion of a disease characterized by loss of control relies on a presumption and expectation of personal self-control that is historically and culturally specific (Room 1985). Harry Levine has argued that the understanding of alcoholism as a disease of the will emerged in early nineteenth-century America because of the rise of bourgeois society in which social stability and individual success depended on self-discipline The idea of addiction 'made sense' not only to drunkards, who came to understand themselves as individuals with overwhelming desires they could not control, but also to great numbers of middle-class people who were struggling to keep their desires in check desires that at times seemed 'irresistible' (Levine 1978 165). Almost two centuries later, the addict is still the threatening shadow of the rational self-regulating citizen. He or she is also disturbing because of his or her proximity to the modern experience of ourselves as...

Genetic Engineering and Society

Other risks exist in the uses of biotechnology. From the late nineteenth century until World War II, a school of thought called eugenics suggested that the methods of genetics should be turned to improving the human gene pool. This idea led to forced sterilization first, of various criminal populations, and eventually, of alcoholics and epileptics. The

Change in Attitudes Beliefs and Practices Regarding Gender

These days, especially near the one large village in Hadza country, women are becoming much more promiscuous. They sometimes become quasi-prostitutes, sleeping with non-Hadza men in exchange for money or gifts. Near the village, men are drinking alcohol more and more. This results in more wife-beating, even wife-killing occasionally. Some men go into the village with their wives and let them sleep with village men in exchange for free alcohol. This promiscuity is bound to result in increasing rates of sexually transmitted diseases and death from AIDS.

The History of Circumcision

The practice of routine neonatal circumcision has been debated within the U.S. medical profession for over a century. Circumcision was initially advocated in the Victorian era as a measure that would reduce masturbation. Medical benefits from the procedure were first widely proposed in 1891 by P. C. Remondino, who claimed that circumcision prevented or cured a host of diseases, including alcoholism, epilepsy, asthma, and renal disease (Wallerstein). More scientific studies of the potential medical benefits of circumcision began to appear in the professional literature in the 1930s. Urologists observed an association between penile cancer and an intact foreskin (Schoen, 1992). During World War II, American troops stationed in the Pacific and in desert climates had problems with irritation and infection of the penis because of sand and the inability to maintain adequate hygiene. The military response was to circumcise many of the affected soldiers. However, the Japanese did not use...

TABLE 1383 Case Definition of Streptococcal Toxic Shock Syndrome

STSS associated with GAS invasive infections, in contrast to previous reports of GAS bacteremia, most commonly affects individuals between the ages of 20 and 50 without predisposing illnesses.10 There is regional variability in populations at risk for developing STSS and necrotizing fasciitis from GAS infections. Extremes of age, diabetes, alcoholism, drug abuse, and immunodeficiency appear to be risk factors for GAS invasive infections. 1 ,12

Leisure Recreation and the Arts

Both adult men's and women's friendships are largely instrumental rather than emotional in Hungary (Toth, 1993), men's even more than women's (Albert & David, 1998). Hungarian men also spend more time in the company of friends and colleagues than women do and they go out more often (Albert & David, 1998). Male leisure activities include home crafts and building, attending sporting events, watching television, and listening to music, and for some younger men, surfing the internet and other computer activities (Wolf, 2000). In addition, heavy drinking is also considered a socially acceptable male activity. Nearly 22 of men in the late 1990s drank alcohol every day the figure for women was only 2.9 (Pongracz & Toth, 1999).

Dietary Management

The relationship between gout and gluttony (overindulgence of food and alcohol) dates back to ancient times. In the fifth- century bc, Hippocrates attributed gout to dietary excesses of food and wine he advised dietary restriction and reduction of alcohol consumption. Historically, the dietary management of gout has focused on two goals (i) reducing the amount

Skin Subdural Hematoma

Septic Microemboli

The proof of the portal of entry of the pathogenic organism often is difficult to establish because clostridial gas gangrene also may develop in the absence of trauma in individuals with underlying immunocompromise, malignancies, pancreatitis, cholecystitis, liver cirrhosis, diabetes mellitus, radiation colitis, or alcohol abuse.

Recommended Inclusion and Exclusion Criteria

Before treatment begins, a clinical interview is conducted that includes demographic information, current life situation, family history, history of traumatic experiences, current psychological adjustment, health status, alcohol and drug use, and severity of PTSD symptoms. Individuals who have been victims of childhood trauma, and who continue to experience recurring intrusive recollections (e.g., recurring flashbacks, repetitive nightmares) of their trauma(s) are likely to be good candidates for IRRT. Before proceeding with IRRT, however, it is important to review the following recommended exclusion criteria (1) a diagnosis of schizophrenia, acute psychosis, or dissociative identity disorder (especially if the patient is dissociative during imagery sessions) (2) active involvement in substance or alcohol abuse

Case Illustration

Michelle had been shy for as long as she could recall. During her adolescent years she was overweight and suffered from bad acne, which bought her ridicule and rejection from schoolmates. As a result of a series of particularly disturbing episodes of teasing during grades 10 through 12, she became increasingly anxious in social settings, including talking in groups and having one-to-one conversations, particularly with members of the opposite sex. Michelle also developed intense fear of eating in public after an episode in which she vomited during lunchtime in the school cafeteria. This appeared to have been the result of influenza combined with the effects of high anxiety.

Nonunion Of The Humerus

A high percentage of humeral diaphyseal fractures heal with nonoperative treatment. Whether surgical intervention is chosen or not, union rates approach 95 (2). When nonunion does occur after nonoperative treatment, likely causes include a high level of severity of the initial injury, distraction of the fracture, soft tissue damage or interposition, transverse or short oblique fracture patterns, and or inadequate immobilization (3-6). Smoking, alcoholism, obesity, and the type of nonoperative treatment can be secondary contributory factors. In cases of nonunion following nonoperative treatment, compression or wave plating, intrame-dullary reamed nailing and external fixation have all proven to be effective treatment modalities (7-10).

Cognitive Behavior Group Therapy

The goals of intervention are behavioral, cognitive, and or emotional change. Specifically they aim at the reduction of stress and anxiety responses, depression, eliminating panic responses, reducing bulemic behavior losing weight, the resolution of phobic disorders, ameliorating agoraphobia, effective management of chronic pain, improving general social functioning, abstinence from risky sexual activity, and increasing self-control in the area of drug and alcohol abuse. (A comparable program has been described by Rose in 1998 for use with disturbed children and adolescents.) In the model proposed in this article the clients make use of the conditions of the group to enhance the clients' learning and motivation. Most CBGT models teach specific skills for coping with and resolving unique problem situations. Skills are usually developed for coping effectively with situations that trigger stress, anxiety, pain and or anger through the use of various cognitive...

Circumstances of Fire

Residential fires accounted for three-fourths of fire deaths in a North Carolina study (5). Two-thirds of the victims were male, and almost half were home alone. Many victims were either younger than 5 yr old or older than 64 yr (5). Accidents involve smoking in bed, using faulty heating equipment, cooking, and playing with fire (2,6,7). Predisposing factors for adult victims include alcoholism, senility, psychiatric disorders, and neurological disease (see Chapter 3, Subheading 3.9. Heading 4., and refs. 5 and 8). Several studies have shown that smoke detectors were either lacking or faulty in a significant number of cases (6,7,9). Although smoke detectors reduce the risk of death, one study showed their lack of efficacy in play-related fires involving children (5,6,10). This could be because of this type of fire originating away from a smoke detector (e.g., bedroom), victims hiding after the fires started, and a lack of adult supervision (6,11,12).

Outcome Research On Cbgt

CBGT has found some support in the treatment of drug and alcohol abuse. Fisher and Bentley in 1996 conducted a study looking at the effectiveness of two Eriksen, Bjornstad, and Goetestam in 1986 evaluated the efficacy of a CBGT model that used primarily social skill training procedures with patients who abused alcohol. Social skills training as part of inpatient treatment for patients with DSM III diagnosis of alcohol dependence delivered in a group format resulted in better outcomes than a traditional discussion group. Over the 1-year period after discharge, patients who had received social skills training were abstinent 77 of days, whereas control patients were abstinent 32 of days. In 1997, Vogel, Eriksen, and Bjoernelv also found support for the greater efficacy of the treatment of alcoholics in social skill groups over those in a control condition 1 year after the end of therapy.

Developmental Toxicants Which May Act Via Folate Perturbation

Alcohol is clearly a developmental toxicant in humans and animal models (reviewed in ref. 37). In humans, the fetal alcohol syndrome (126) consists of craniofacial, cardiovascular, and limb defects. Romitti et al. (89) found an association between cleft lip with without cleft palate and alcohol use, but Shaw et al. (91) did not find such an association between neural tube defects and alcohol use. Folate deficiency is associated with chronic alcohol abuse (127) however, the mechanism for the deficiency is unknown. Alcoholics tend to have poor dietary intake of folate (128). Alcohol has also been reported to decrease intestinal absorption of folate (129,130), although other studies have disputed this effect (131,132). Increased urinary excretion of folate has also been reported (133,134), although this effect does not appear to be the result of altered binding of folate by brush-border membranes in the rat kidney (135). Finally, alcohol has been reported to alter hepatic metabolism of...

Recommended Lifestyle Modifications

The established recommendations for lifestyle modification used in one arm of the PREMIER clinical trial were weight loss, increasing physical activity, reducing sodium intake, limiting alcohol consumption, and reducing total and saturated fat intake to that of an American Heart Association step 1 diet with 30 of energy from total and 10 from saturated fat. A second arm in PREMIER included essentially the same lifestyle modifications but a lower fat diet comparable to an American Heart Association step 2 diet with 25 of energy from total and 7 from saturated fat and also adherence to the DASH diet (emphasizing consumption of fruits, vegetables, and low-fat dairy products).

Nutritional Considerations

Moderation of Alcohol Intake The relationship between high consumption of alcohol (typically three or more drinks per day) and elevated blood pressure has been shown in numerous epidemiologic studies. A drink is defined as 12 oz. of beer, 5 oz. of wine, or 1.5 oz. of distilled spirits. Most evidence indicates that alcohol should be limited to two drinks per day for men and one drink per day for women. Ideally, daily alcohol consumption should be avoided. Whenever possible, alcohol, if consumed, should be done so with meals.

Chapter References

Benzodiazepines are pharmacologic agents commonly used for the treatment of anxiety, insomnia, seizures, and alcohol withdrawal. They also are used in conscious sedation as well as general anesthesia. Fourteen generic benzodiazepines are currently approved for use in the United States ( T bl 15 1).

Clinical Presentation

Patients with insufficient glutathione stores (alcoholics and AIDS patients) and patients with induced cytochrome P450 enzymatic activity (alcoholics and those taking concurrent anticonvulsant or anti-tuberculous medications) may be at greater risk for developing acetaminophen-induced hepatotoxicity following overdose. In contrast, children, because of their greater ability to metabolize acetaminophen through hepatic sulfation, may be at decreased risk for developing hepatotoxicity when compared with adults.3

Brief Overview Of Cognitive Therapy

Antirelapse techniques and belief modification. Further work is undertaken on recognition of early signs of relapse and coping techniques. For example, developing self-monitoring of symptoms, identifying characteristic prodromal features (the relapse signature), developing a list of at-risk situations (e.g., exposure to situations that activate specific personal beliefs), high-risk behaviors (e.g., increased alcohol intake), combined with a hierarchy of coping strategies for each identifying strategies for managing medication intake and obtaining advice regarding it and planning how to cope and self-manage problems after discharge from CT. Sessions also include typical CT approaches to the modification of maladaptive beliefs, which may otherwise increase vulnerability to relapse.

Outcome Studies Of Ct For Bp

Scott et al. (2001) examined the effect of 20 sessions of CT in clients with BP. Clients (n 42) were initially randomly allocated to the intervention group or to a waiting list control group, the latter group receiving CT after a 6-month delay. The randomized phase (6 months) allowed assessment of the effects of CT plus usual treatment versus usual treatment alone. Individuals from both groups who received CT were then monitored for a further 12 months post-CT. At initial assessment, 30 (n 17) of participants met criteria for a current BP episode 12 subjects also met criteria for drug and or alcohol problems or dependence, 2 met criteria for other Axis I disorders, and about 60 of the sample met criteria for personality disorder. The results of the randomized controlled phase demonstrated that, compared with subjects receiving treatment as usual, those who received additional CT experienced statistically significant

Differential Diagnosis

Intoxication with almost any CNS-active or sedative-hypnotic drug may mimic early phenytoin intoxication, especially ethanol, carbamazepine, benzodiazepines, barbiturates, and lithium. Disease states resembling phenytoin toxicity include hypoglycemia, Wernicke encephalopathy, and posterior fossa hemorrhage or tumor. Although seizures may be caused by phenytoin at toxic levels, other epileptogenic drug overdoses and seizures due to trauma and to drug and alcohol withdrawal should be considered first.

Types Of Consequences

Targeted behaviors should also be clearly defined. In the case of a child who throws temper tantrums, for example, specific targeted misbehaviors might include crying, throwing an object, hitting someone, screaming, or refusing to move. In the case of an adult with alcoholism, specific targeted misbehaviors might include missing work days, showing up unannounced at a friend's house, or driving while drunk. Each of these behaviors can be easily observed and recorded. Vague descriptions of targeted behaviors, such as aggression or lack of respect for others, should be avoided. Other criteria for targeted behaviors include feasibility and desirability. Targeted behaviors should be practical, make sense to those involved, and be within a client's value system.

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