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...

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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.

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...

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...

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...

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...

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...

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

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...

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...


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...

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).

Theoretical Bases

A basic premise is that readers can attain certain hoped-for goals by implementing material read (although, in some cases this may only be possible through relinquishing control over uncontrollable events). There is a built-in self-efficacy message, an expectation that readers can attain certain outcomes through reading and acting on what they read. The expectation is that readers will be able to successfully apply the instructions given in real life. For example, it is expected that parents who read a manual describing how to toilet train their child will be able to use the information to achieve this outcome or that readers of a self-help manual designed to decrease alcohol consumption will be able to use the information to decrease their drinking. That is, it is assumed that people can be their own agents of change with minimal or no counselor contact. A key step in behavior change is identifying and altering factors related to desired outcomes. Self-control or self-management...

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

Personality Differences by Gender

While there are people suffering from mental illness, data suggest that it is not gender specific, although quantitatively more women than men seem to suffer. Alcoholism is an extensive problem for both men and women. Impressions are that more men than women struggle with alcohol abuse, although alcoholism among women is increasing.

Puberty and Adolescence

Pressure from their families to conform to their family's and society's constraints upon them, while boys are given more freedom to explore the world on their own. Mothers, particularly older ones and those in rural areas, continue to want their daughters to entertain boys at home rather than to go out with them (Vajda, 1998), although most girls prefer to go out on dates. Girls generally also experience heavier family sanctions against alcohol use and as a result experience drunkenness less than their male counterparts. Nonetheless, both adolescent girls and boys do drink alcohol, so much so that by 11th grade fully 100 of the boys and 94.9 of the girls in a recent study had tried alcohol (Swaim, Nemeth, & Oetting, 1995).

Leisure Recreation and the Arts

Men tend to have more leisure time than women, in part due to women's extensive responsibilities in both the home and work place outside the home. Leisure time is spent with one's barkada, family members, or friends of both sexes. Sex segregation during leisure time is voluntary. Men tend to spend more money than women on leisure activities, including drinking alcohol, buying alcoholic beverages for their friends, and gambling. Fewer women than men drink beer or gin and become drunk, though women do drink rice wine at rituals and secular feasts. People commonly meet friends of the same sex at a sari sari, or small store, to socialize, snack, and drink soft drinks, or beer for men. While males and females listen to music broadcast on radios, adolescent girls especially enjoy radio soap operas. Women occasionally cook special sweet treats during their leisure time that they share with other family and community members.

Skin Subdural Hematoma

Putrefactive Bullae Postmortem

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.

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).

Clinical Features

Because of the phenomenon of tolerance, blood alcohol levels correlate poorly with degree of intoxication. While death from respiratory depression may occur in unhabituated individuals at concentrations of 400 to 500 mg dL, it is not uncommon for some alcoholics to appear minimally intoxicated if at all at blood concentrations as high as 400 mg dL.5 Although most states have adopted 100 or 80 mg dL as the legal definition of intoxication for the purposes of driving a motor vehicle, there is considerable evidence to suggest that impairment may be seen with levels as low as 5 mg dL, especially in unhabituated individuals.

Necrotizing Fasciitis

Necrotizing fasciitis is a feared complication. The usual cause is direct contamination of the wound with group A streptococcus or S. aureus however, mixed aerobic and anaerobic infections have been reported. Risk factors include diabetes mellitus, alcoholism, immunosuppression, and peripheral vascular disease, but necrotizing fasciitis also occurs in young, otherwise healthy individuals. Early clinical differentiation from cellulitis can be difficult. CT may show asymmetric fascial thickening, gas tracking along fascial planes, or focal fluid collections however, the actual sensitivity and specificity of CT in the diagnosis of necrotizing fasciitis has not been defined.4 Magnetic resonance imaging has been shown to be highly sensitive but not totally specific for necrotizing fasciitis and can be a useful adjunct. 5 The presence of marked systemic toxicity and pain out of proportion to local findings indicates fasciitis. In more advanced cases, there may be deep pain with patchy areas...

Type I or Familial Chylomicronemia

The recommended treatment includes a diet low in simple carbohydrates and with a fat content below 20 of total energy. The use of medium-chain triglycerides (MCT) has also been reported to be efficacious. Body weight should be maintained within the normal limits and alcohol consumption should be avoided. Other secondary causes leading to the presence of chylomicrons in the fasting state include uncontrolled diabetes mellitus, alcoholism, estrogen use, and hypothyroidism.

Change in Attitudes Beliefs and Practices Regarding Gender

Whose structurally unequal status has lessened as their capacity for independent action and their successful (but not uncontested) assertion of this degree of autonomy have increased. Some younger women characterize this change by calling themselves free agents to convey this sense of greater freedom. Despite considerable expression of nostalgia for the old days in their desert heartlands, many middle-aged and older women nonetheless seem to favor settlement life, and one reason for this may be that they are now less firmly under the control of men. Young women's refusal to marry the men to whom they have been betrothed, the refusal of widows to remarry at all, and the increasing incidence of wrong marriage among younger adults point to an erosion of traditional values and the structures of the Law. Such changes amount to a loosening of the control that mature men as a category can exert over women as a category. Mindful of the many accommodations already enforced as a result of...

TABLE 2311 Drugs that Can Cause Hypocalcemia

Hypocalcemia Causes

Hypomagnesemia Hypomagnesemia in association with hypocalcemia may be seen in alcoholism, diuretic use, epilepsy, and renal failure. Neonatal hypomagnesemia leads to low PTH secretion, decreased responsiveness of bone cells to PTH, and decreased calcium mobilization from bone.

TABLE 785 Pruritus

Numerous dietary factors have been implicated and are associated with secondary pruritus ani, although proof of cause is lacking for most of them. Those dietary factors most commonly listed include excessive consumption of caffeine-containing liquids, such as coffee, tea, or colas, and beer, although one recent study failed to demonstrate any correlation between pruritus ani and alcohol consumption. Milk, chocolate, tomatoes, and citrus fruits are other food products that allegedly contribute to pruritus ani. Likewise, certain drugs, such as colchicine and mineral oil, have been associated with pruritus ani. Ingestion of these products can result in increased liquidity and seepage of fecal material, which in itself is a probable cause of pruritus ani.

Alcoholic Ketoacidosis

Alcoholic ketoacidosis (AKA) is a wide anion-gap acidosis most often associated with acute cessation of alcohol consumption after chronic alcohol abuse. The metabolism of alcohol with little or no glucose sources results in the elevated levels of ketoacids that typically produce the metabolic acidosis present in this illness. Although usually seen in chronic alcoholics, ketoacidosis has been described in first-time drinkers who binge drink, particularly in association with volume depletion from poor oral intake and vomiting.

Fatty Acid Ethyl Esters As Markers Of Ethanol Intake

Because of the long half-life of FAEEs in adipose tissue, it was suggested that FAEE in adipose tissue could be a laboratory marker for previous alcohol intake, particularly for forensic applications where adipose tissue samples can be readily obtained. In postmortem samples from four chronically intoxicated subjects whose blood ethanol levels were zero, it was demonstrated that prior ethanol ingestion could be established by the presence of FAEEs in the adipose tissue (Laposata, 1989). In this report, a separate series of experiments determined the half-life of FAEEs to be 16.6 h in the adipose tissue of rabbits that received 10 ethanol in their drinking water for 10 mo.

Major Depression And Tissue Composition Studies

Symptoms (Ellis et al., 1977 Fehily et al., 1981), unfortunately these studies lacked diagnostic specificity, did not control for alcoholism or smoking, and did not specify the use of psychotrophic medications. Following those initial reports, eight studies have reported that lower concentrations of n-3 fatty acids in plasma or red blood cells (RBCs) predicted depressive symptoms (Adams et al., 1996 Maes et al., 1996 Peet et al., 1998 Edwards et al., 1998a Edwards et al., 1998b Peet et al., 1999 Maes et al., 1999 Hibbeln et al., 2000). Adams et al. (1996) were the first to report that lower measures of DHA in the phospholipids of red blood cells (r 0.80, p < 0.01) and a greater aracidonic acid (AA) to EPA ratio (r 0.73, p < 0.01) predicted more severe depressive symptoms. Edwards et al. (1998) carefully controlled common confounding factors that would alter omega-3 status among depressed subjects by controlling for both alcohol consumption and cigarette smoking while also...

Human Data On Omega3 Fatty Acids And Neurotransmitter Metabolites

Correlational data from human studies are consistent with the proposition that omega-3 status is related to cerebrospinal fluid (CSF) neurotransmitter metabolite concentrations. We observed that plasma concentrations of DHA and AA predicted CSF 5-HIAA and CSF homovanillic acid concentrations in 234 subjects (Hibbeln, 1998a Hibbeln et al., 1998b). In healthy control subjects and late-onset alcoholics, higher concentrations of plasma DHA predicted higher concentrations of CSF 5-HIAA. It is remarkable that this correlational relationship was found between a cerebrospinal fluid measure of a neu-rotransmitter metabolite and a plasma level of a fatty acid. We have also replicated this finding among 104 adult rhesus monkeys. Higher concentrations of the omega-3 fatty acids DHA and EPA in plasma predicted higher concentrations of CSF 5-HIAA (Hibbeln, et al., unpublished data). Among these animals, higher EPA and DHA plasma concentrations also predicted more functional dominance behaviors....

Comments For The Design Of Future Studies Tissue Concentration Studies

Comparisons of tissue concentrations between controls and patients groups may be useful for exploratory analyses, but the groups should be controlled for confounding influences on fatty acid metabolism and catabolism and care should be take in the interpretation of the results. Comparison studies are of little value without careful diagnostic assessment and patient characterization. Consideration should also be given to the observation that improvement of depressive symptoms among subjects with other diagnoses may confound other outcome measures such as improvements in psychosis or cognition. Typically, comparison studies of the tissue composition of the fatty acids only determine if there is a difference between the groups at single point in time. Thus, it may be difficult to make interpretations concerning differences in basal metabolism or causal relationships. A series of critical questions must be addressed. Does this measure reflect differences in dietary intake Does the measure...

Recent Trends and Practical Implications

In the 1970s, anthropologists increasingly turned from descriptive ethnographic work to more applied or practical studies in many fields, and this was especially true with respect to alcohol. Sources of funding also increased markedly in fields of public health and social welfare, while simultaneously decreasing for non-problem-oriented ethnography. Anthropologists have increasingly been employed by institutions that emphasize the costs rather than an impartial view of drinking, so that more recent anthropological writings on the subject have similarly tended to emphasize the abuse rather than use of alcohol, various kinds of risks and harm of alcohol consumption, the prevention or lessening of such problems, and treatment to help problem drinkers.

Epidemiology and Public Policies

Many individuals abstain and even so-called moderate drinkers generally consume very little. It should not be surprising that most control measures cut drinking among non-abusers while hardly affecting those who engage in heavy drinking. It is a concern that so little has been achieved in the way of reducing harm or preventing problems.

Nutrient and Drug Interactions

In Europe, 83 of 'apparently healthy' people in the previously mentioned SENECA study use an average of two types of drugs, with antihypertensives (33 ), analgesics (31 ), diuretics (24 ), sleeping pills (18 ), and psychotropic drugs (17 ) taken most often. Many drugs taken by the elderly can interfere with nutritional status. The possible effects include suppression or stimulation of appetite and impaired nutrient absorption and metabolism. For example, lisdiuretics can have adverse effects on calcium metabolism, salicylates can increase the need for vitamin C, and some types of antihypertensives act as antagonists of vitamin B6. Negative consequences of laxatives, often taken by the elderly, include interference with nutrient absorption. Dietary interventions may help to reduce the intake of drugs. There is evidence that moderate sodium restriction prevents or delays the development of hypertension. Also, limiting alcohol intake provides protection...

Courtship and Marriage

In contemporary times the institution of marriage is still considered a stronghold of the Sakha family and cultural life. For example, Sakha continue to refer to an age-old word pairing yal-kuus, literally family strength, meaning that a person does not realize their full strength until they marry. A man is only a half and a woman is only a half. A whole is realized through the marriage of a man and a woman. However, the past 10 years have been a period of rapid change for rural Sakha households, resulting in a 5 drop in village populations due to migration to urban areas for employment and both a decline in marriages and a rise in divorces, all correlated with the increasingly downward-spiraling economy and the overall rise in alcoholism, unemployment, and crime. As a result, it is not uncommon to find that 15 of households in rural Sakha villages are headed by a single mother with one or more children. Most of these households rely on extended kin in their village to help with the...

Husband Wife Relationship

Some Sakha have extramarital affairs and can decide between themselves whether to separate or forgive. In contemporary times many (mostly males) argue for procreation with multiple women because the Sakha population has been decreasing the last decade and their efforts would help offset this decline. Historically, children out of wedlock were referred to as oruk oghoto, referring to the thick branches of the evergreen trees under which the child was conceived. There are also many Sakha women today who desire children but not a husband, owing to the high levels of alcoholism and

Recovery Curves And Treatment

The most effective treatment approach to most mild head injuries focuses on enhancing the natural recovery curve. Unlike more severe brain injury, significant medical intervention, cognitive rehabilitation, and physical therapy are rarely indicated. Interventions that focus on the previously mentioned individual risk factors will allow the individual to take advantage of natural recovery. Specific suggestions include increasing rest and reducing stress levels, reducing or eliminating alcohol consumption, treating depression with supportive psychotherapy and medications where warranted, assessing and treating pain and sleep disturbance, and educating the patient, family, and significant others regarding the typical mild head injury symptoms and natural recovery course. Early in the intervention process, it is important for everyone involved to have appropriate reassurances and positive expectations but an appreciation for the possible development of symptoms and an understanding that...

Environmental Factors

Inefficient or limited support network. Patients may come to see the therapist as their principal support person. The patient may experience few people in the world as accepting, understanding, caring, and thoughtful as the therapist. Patients may then place all of their eggs in the therapist's basket. One of the goals of therapy with all patients is to help them build a broader, more useful, more accepting, more available, more generous, and more appropriate support network. Sometimes this can be done through the use of recognized support groups, such as Alcoholics Anonymous, parenting groups, or disability-oriented groups.

Determination of the Cause of Death

A 49-year-old chronic schizophrenic male became acutely agitated and extremely violent. His past history included alcohol abuse and cigarette smoking, and his medications included clozapine. There was no other significant medical history. He was restrained in the prone position by four carers and held in this position for a period of 15 minutes, all the while demonstrating persistent, strenuous resistance. His forehead was noted to contact the floor firmly several times prior to and during the restraint. He was noted to suddenly go limp and was found to be in cardiorespiratory arrest. Resuscitation attempts were made by the carers and ambulance staff, but he was declared dead at the scene.

Putative Mechanisms Involving Folate Metabolism That May Explain The Above Disorders

Chromosome breakage and DNA methylation are both thought to be factors in the development of certain cancers. Those with an etiology linked to C677T MTHFR include colon cancer (9,121) and acute lymphoblastic leukemia (11). As mentioned earlier, other cancers have also been associated with folate status. These include premalignant cervical cancer (7) and squamous metaplasia of the bronchial epithelium (8). The most recent work on folate and the development of cancer suggests low levels of the vitamin are a risk for breast cancer when associated with high alcohol intake (10), with

An Individual Case Approach To Assessment And Treatment

At present, there is no clear consensus as to what causes sex offending. However, a concept on which most cognitive-behavioral researchers agree is that multiple factors are likely to conglomerate and form a general vulnerability to commit a sex offense. As such, all vulnerability factors that have been empirically identified need to be assessed for each individual. This would include, but not be limited to, the following assessment methods structured interviews cognitive-behavioral self-report measures of affect (e.g., depression, anxiety, anger) measures of coping and social skills assessment of motivation information concerning static historic factors criminal records role-play measure of social competency, problem-solving, and empathy skills phallometric and other assessment of deviant interests measures of drug and alcohol abuse and behavioral descriptions from collateral sources. An individual case approach to assessment and treatment can highlight what particular vulnerability...

Animal Models of Alcohol Exposure

Binge exposure also forms the basis of one model of fetal alcohol exposure in animals. One of the most widely used doses is 5 g of alcohol per kg body weight in rats or mice, delivered by oral gavage. Because of the increased metabolic rate in rodents, the maximum BACs achieved are far less than would occur if the same dose were administered to humans. A regression based on maximum BACs in pregnant rats fed alcohol at various doses suggests that maximum BAC 0.05 X dose (g kg). Thus 5 g alcohol per kg body weight produces a maximum BAC in the order of 0.25 West has suggested in other work that, by virtue of the concentrations reached and time of exposure, binge exposure may be the most relevant model for human alcohol consumption and effects on the fetus.9

Applications And Exclusions

The patient should be a willing participant in the process of exposure therapy, with complete control over the nature and timing of any exposure exercises. Exposure may be traumatizing if it is forced on an unwilling patient. Exposure should be used only if the patient is able to tolerate some degree of distress, and is sufficiently motivated to overcome his or her fears. Patients should be told about the side effects of exposure treatment (e.g., transient increases in irritability), so that they can make an informed choice about whether or not to participate in treatment. The therapist needs to consider the patient's other problems before initiating a course of exposure. If a patient had social phobia and alcohol abuse, then one would need to consider whether the distress caused by exposure therapy would cause an increase in alcohol abuse. If this is likely, then the alcohol problem would need to be treated first.

Domestic Violence Outcomes

Two studies with male alcoholics found nearly identical results, indicating that male-to-female violence was significantly reduced in the first and second year after BCT and that it was nearly eliminated with abstinence. For example, in the year before BCT, 60 of alcoholic patients had been violent toward their female partner, five times the comparison sample rate of 12 . In the year after BCT, violence decreased significantly to 24 of the alcoholic sample but remained higher than the comparison group. Among remitted alcoholics after BCT, violence prevalence of 12 was identical to the comparison sample and less than half the rate among relapsed patients (30 ).

Nerve Cells And Memory

Information acquired at a certain time and place in the past. In this manner, it has been established that damage to the medial parts of the temporal lobes, especially the hippocampus, greatly impairs the acquisition of new episodic memories. Patients with acquired damage to the hippocampal formation invariably suffer impairment of episodic memory, only the degree of damage changes. This means that they have difficulty remembering events during their daily life. Bilateral hippocampal damage may also affect the ability to acquire new memories. Episodic memory also appears to rely on the prefrontal cortex, which seems to provide temporal information on episodic memories. Patients with damage to the prefrontal cortex may have severe difficulty in remembering when and even where recent events occurred. Frontal lobe damage also often produces what is known as source amnesia, which means that patients readily acquire new facts but fail to recollect where or when they learned them. Damage to...

The Cognitive Revolution

The Cognitive Revolution

The principle task in cognitive therapy (CT) is to help clients systematically determine ways of challenging these thoughts, usually by evidence gathering and self-monitoring. Since the time that Beck and his colleagues described this method for treating depression, it has been extended to anxiety disorders, substance abuse, personality disorders, obsessive-compulsive disorder, eating disorders, and delusions. Beck's approach has shown a great deal of promise in alleviating emotional distress, as well as shedding light on the interaction between therapy and medication. Specifically, it has been shown in numerous trials that cognitive therapy alone is at least as effective as antidepressant medication for depression, while also showing greater maintenance of gains following medication discontinuation. This has since become an important experimental design for use in determining the relative contribution of CBT and medication for a number of other psychological conditions such as...

Phenytoin And Fosphenytoin Toxicity

It is estimated that over 2 million Americans suffer from epilepsy, and as many as 10 percent of the population may suffer at least one seizure in their lifetime. Phenytoin is a primary anticonvulsant for all types of epilepsy except absence. It is useful in the treatment of status epilepticus in conjunction with other more rapidly acting anticonvulsants.1 Phenytoin has been used prophylactically in a variety of settings (head trauma, alcohol withdrawal, and drug overdose) but has so far only proven useful in the setting of head trauma.

The Social Epidemiology of Illness

Although the link between social class and the prevalence of illness is not disputed, the reasons for it are. A number of explanations have been advanced to account for this relationship, including lack of access to healthcare resources lifestyle (there is an inverse relationship between obesity, as well as tobacco and alcohol consumption, and social class) and increased exposure to economic and social stress. Work has been indicted as a causal factor in the relationship between social class and heart disease (Siegrist, et al. Marmot and Theorell). Lower-class jobs provide less autonomy, more constraint, and less opportunity for expression than middle-class occupations. In addition, the causal direction of the link between class and illness has been questioned, with some analysts suggesting that since the less well are unable to compete in the economic system, they have their class standing lowered as a result. This is known as the downward drift hypothesis. There is some evidence to...

Broadening Perspectives on the Consequences of Drug

Acknowledgment that drug use may have different impacts under different cultural circumstances, regardless of the drug being consumed, provided an important perspective on the impact of drugs in different cultural settings. Heath (1958) and Carter (1977) concluded that problems related to alcohol consumption may have markedly different frequencies in cultural settings that restricted drinking to ritual contexts. Wilbert (1990) and Lowie (1919) made the same point about tobacco in traditional Native American cultural environments. On the other hand, in circumstances of poverty and marginaliza-tion, Singer (1986) made a convincing case for expecting increases in alcohol-related problems among Puerto Rican immigrants to the northeastern United States. Problems related to fully commercialized tobacco use, the most ruinous drug in terms of impact on the public health, have also drawn the attention of anthropologists attempting to find strategies for preventing the onset of addiction to...

Comorbidity and Nutrition in Tuberculosis Patients

TB often occurs in association with other diseases or conditions that have nutritional implications. HIV infection is a strong risk factor for the progression of primary or latent infection with M. tuberculosis to active TB disease. Tuberculin skin test (TST)-positive, HIV-infected people develop active TB at the rate of 7-10 per year. TST-positive individuals without HIV infection develop active TB at the rate of 5-10 over their lifetime. HIV infection, of course, has profound implications for nutritional status and nutrient requirements. Diabetes mellitus also increases the risk of progressive primary or reactivation TB. Nutrition is a central consideration in the pathogenesis and management of diabetes mellitus. TB is more frequent in alcoholic individuals. Alcoholism is associated with profound alterations in nutrition that affect production of red blood cells, intermediary metabolism, and mucous epithelial tissue such as the lining of the gastrointestinal system. These include...

Nutritional Issues with Antituberculosis Drug Toxicity

In the absence of vitamin B6 supplements, approximately 2 of patients treated with 5 mg kg will develop peripheral neuritis, increasing up to 20 at higher doses or in high-risk patients such as diabetics or alcoholics. Daily administration of 25 mg of vitamin B6 prevents peripheral neuritis and nearly all nervous system side effects of isonia-zid. A similar situation exists for the second-line anti-TB drug, D-cycloserine, which has useful antibiotic properties but inhibits a wide range of pyri-doxal phosphate-requiring enzymes. Cycloserine is used only for patients with drug-resistant TB, but in such patients doses of 200-300 mg of vitamin B6 have been recommended.

Substance Induced Disorders

WITHDRAWAL Withdrawal can follow cessation or reduction in use of a substance of abuse. The category signifies a syndrome characteristic of withdrawal from that particular drug, when the clinical syndrome does not satisfy the criteria for delirium or another organic brain syndrome. For example, mild forms of alcohol withdrawal would be classified here, but if the patient is confused, hallucinating, and agitated, a diagnosis of alcohol withdrawal delirium is indicated. The diagnosis is made by identification of the withdrawal syndrome along with evidence of recent use of the substance in a pattern sufficient to produce withdrawal when the amount ingested is decreased. Specific withdrawal patterns depend on the agent customarily used. Alcohol withdrawal, for instance, includes up to four stages autonomic hyperactivity (6 to 8 h after cessation of drinking) hallucinations (24 h after withdrawal) major motor seizures (1 to 2 days) and global confusion (3 to 5 days after last use of...

Physical Examination

A physical examination should be conducted on every patient. Vital signs are a simple physical screening test of patients with altered behavior. Abnormal vital signs, when observed, must not automatically be dismissed as secondary to anxiety or stress. Bradycardia can be seen in patients with hypothyroidism, Stokes-Adams syndrome, or elevated intracranial pressure. Tachycardia may be apparent in patients suffering from hyperthyroidism, infection, heart failure, pulmonary embolus, or alcohol withdrawal. Fever is often associated with extreme hyperthyroidism or thyroid storm, vasculitis, alcohol withdrawal, sedative-hypnotic withdrawal, meningitis, or various inflammatory processes. Hypothermia is observed in sepsis, dermal disease, hypoendocrine status, CNS dysfunction, and intoxication. Hypotension may be an indicator of shock, Addison's disease, hypothyroidism, or medication side effects. Hypertension may be associated with hypertensive encephalopathy or stimulant abuse. Tachypnea is...

Effectiveness of Brief Intervention

That ED intervention represented a paradigm shift from the legacy of prohibition, the Harrison narcotics laws, and their underlying perspective of substance abuse as a moral weakness requiring criminal sanctions for individuals with substance abuse problems and penalties for physicians who tried to intervene. Shortly before the Chafetz study was published, the American Medical Association recognized alcoholism as a disease for the first time and encouraged physicians to care for patients with this problem as they would other sick individuals. Many models for brief intervention have now been tested. A review of 32 controlled trials of brief counseling, primarily in the alcohol field, found that not only was brief counseling more effective than no treatment, but it compared favorably with more traditional treatments in 11 of 13 randomized trials. 15 The elements common to these trials were feedback, responsibility, advice, menu or choice, empathy, and self-efficacy (FRAMES). A World...

Chapter References

Cherpital CJ Screening for alcohol problems in the emergency department. Ann Emerg Med 26 158, 1995. 14. Chavetz ME, Blane HT, Abrams HS, et al Establishing treatment relations with alcoholics. J Nerv Ment Dis 134 395, 1962. 15. Bien TH, Miller WR, Tonigan JS Brief interventions for alcohol problems A review. Br J Addict 83 315, 1993. 16. WHO Brief Intervention Study Group A cross-national trial of brief interventions with heavy drinkers. Am J Public Health 86 948, 1996. 19. National Institute of Alcohol Abuse and Alcoholism The Physician's Guide to Helping Patients with Alcohol Problems. Washington, US Department of Health and Human Services, Public Health Service, National Institutes of Health publication 95-3769, 1995. 21. Steinweg DL, Worth H Alcoholism The keys to the CAGE. Am J Med 94 520, 1993.

Social And Environmental Etiologic Factors

Risk factors for abuse also reside in the characteristics of the abuser. In one study,3 elderly abuse victims and a nonabused control group were compared to explore the relationship of caretaker stress to caretaker psychopathology. The authors found that abuse is associated more with personality problems of the caretaker than with stress. Earlier studies substantiated financial dependency of the caretaker as a major risk factor. A more recent study concluded that in general abusers are heavily dependent individuals. That study included family caretakers who were disabled, cognitively impaired, or mentally ill. Other studies have uncovered substantial psychological impairment on the part of the abusers, as well as higher rates of alcoholism, arrest, and other deviant behavior. These deviant characteristics and behaviors appear to be related to the abusers' dependence on elderly relatives for financial assistance, housing, social support, and other help.

The Alcoholabusing Patient

Effects of Alcohol on Health Injured Etha.noHntpxicat.ed Patients Hypothermia and Ethanol .Intoxication Ethanol withdrawal Elderly Patients and. Alcohol Women and Alcohol Long-Term Outlookfor. Alcoholics Chapter. References Alcoholism is a ubiquitous medical and social problem that crosses social and economic boundaries. Ethanol dependence, defined as regular use resulting in Although alcoholism by itself is not a medical emergency, alcohol abuse and dependence are common threads in the presentation of many conditions in the emergency department. Such presentations include trauma, infections, acute alcohol intoxication and withdrawal, hepatitis, and pancreatitis. Alcohol is often used with other drugs, including cocaine, benzodiazepines, and marijuana. Emergency physicians should recognize alcoholism as both a contributor to a patient's presenting problems and as an underlying problem requiring care itself. Alcoholism is a primary, chronic disease with genetic, psychosocial, and...

TABLE 2991 Some Adverse Health Effects Associated with Ethanol Abuse and Dependence

Per month and one drink per day had a lower mortality rate than did those who drank either more or less. 5 This is the basis for the U-shaped curve of mortality in relation to alcohol consumption, with mortality greatest at the lowest and highest levels of consumption and lowest in the middle, at moderate levels of consumption Decreased mortality rates may result from diminished coronary risk among users of ethanol, apparently mediated through increased blood high-density lipoprotein levels. While this effect persists at higher levels of ethanol use, the other deleterious effects of excessive chronic use outweigh the benefits. 5

Injured Ethanolintoxicated Patients

Traffic fatalities 1977 to 1993 all versus those associated with use of alcohol. (From Campbell KE, Zobeck TS, Bertolucci D Trends in Alcohol-Related Fatal Traffic Crashes, United States 1977-1993. Rockville, MD, National Institute on Alcohol Abuse and Alcoholism, 1995.) It is uncertain whether ethanol intoxication itself worsens the prognosis of injured patients. A study of over a million motor-vehicle accidents that attempted to control for safety-belt use, vehicle deformation, vehicle speed, and other factors found that drivers who drank were more likely to suffer a serious injury or death, 8 but other studies have found no difference in outcome for intoxicated injured patients.9 Recent observations suggest that chronic alcoholism but not acute alcohol intoxication adversely affects the prognosis of injured patients.10 These findings most likely reflect the comorbidity of underlying organ system dysfunction.

Elderly Patients And Alcohol

Fewer older people drink regularly, and intake among older drinkers is less than among younger people. Nevertheless, alcohol is still a significant problem among the elderly, and alcohol-related problems are by far the most common drug-related problem in this age group. Moreover, since many physicians are even less likely to consider the possibility of alcohol abuse or alcoholism in older than in younger patients, the diagnosis is often missed. Even so, the prevalence of alcohol-related hospitalizations during a recent year for people over 65 years of age was 54.7 per 10,000 population for men and 14.8 per 10,000 for women. 1 Alcohol plays a significant role in motor-vehicle collisions and other trauma involving the elderly and has a greater impact on the health of the elderly than on that of younger persons. Mortality and morbidity rates due to all types of trauma are higher for older patients. 15

Secondary Causes of Headache

SUBDURAL HEMATOMA A history of remote trauma in a patient with a headache should raise suspicion of a subacute or chronic subdural hematoma. A low threshold for initiating investigations is appropriate for high-risk patients, including patients on anticoagulants, chronic alcoholics, and the elderly, in whom there may be no clear history of trauma.4

Chemicals as Emetogenic Stimuli

Periodic Nausea

Finger down the throat has a similar effect, irritating the mechanoreceptors in the pharynx.) The alkaloid ipecacuanha has well-known emetic effects and acts by stimulating chemoreceptors in the area postrema. It has also been used in subemetic doses in some paracetamol tablets to prevent self-poisoning a person taking an excessive number of tablets would finally receive an emetic dose of ipecacuanha, which would expel the paracetamol from the stomach. A different use was found for disulfiram in the treatment of alcoholism. If taken with alcohol, it leads to an accumulation of acetaldehyde, which induces nausea and sickness. It was used as an aversion therapy for drug abuse apomorphine was used as an alternative treatment. With these exceptions, drug-induced emesis is unwanted but occurs with many different types of medical treatments. It can vary from a transient effect of little consequence to a persistent and chronic effect to severely reduce the quality of life.

The Medicalization Critique

This position was influenced by the publications of Szasz (1961) and Laing (1960) in connection with psychiatry where they insisted that the social determinants of irrational behavior were being neglected in favor of an approach dominated by a biologically deterministic medical model. Zola (1972), Conrad, and others argued in turn that alcoholism, homosexuality, hyperactivity, and other behaviors were increasingly being biologized and labeled as diseases. While in theory this move from badness to sickness no longer made patients morally culpable for their condition, it nevertheless permitted medical professionals to make judgments about the labeling and care of such patients that inevitably had profound moral repercussions.

Confirmation Paradox See Null Hypothesis

Methods for resolving conflicts of interest A theoretical an-alysis. Journal of Social Issues, 28, 133-154. Toomey, M. (1972). Conflict theory approach to decision-making applied to alcoholics. Journal of Personality and Social Psychology, 24, 199-206. Deutsch, M. (1973). The resolution of conflict Constructive and destructive processes. New Haven, CT Yale University Press. Epstein, S. (1982). Conflict and stress. In L.

TABLE 2021 Potential Etiologies of Hypoglycemia in Adults

Approximately 50 percent of patients treated for hypoglycemia in an urban ED were acutely intoxicated with ethanol or were chronic alcohol abusers. 4 Alcohol inhibits hepatic gluconeogenesis, which becomes problematic when a patient has not eaten for a prolonged period and the glycogen stores have been depleted by glycogenolysis. A 12-h fast is often sufficient for severely malnourished alcoholics to become hypoglycemic. Hypoglycemia has also been produced in healthy adults by infusing 75 g of alcohol after a 36-h fast. Rapid bedside serum glucose determinations should be performed on all patients with any mental status abnormality or evidence of alcohol use.

The Physiological Differences of Addiction

The biology of dependence is also linked to the addict's moral and ethical flaws because of its role in producing and maintaining the repetition, circularity, and habitual action that are regarded as characteristic of the addict's mode of existence. The fear of withdrawal and the need to maintain the fragile homeostasis of the physically dependent body is regarded as locking the addict into a rigid pattern of behavior. The contrast between the socially influenced fluidity of normal consumptive behavior and the inflexible routine of addiction is highlighted by psychiatrists Griffith Edwards and Milton Gross in their classic description of the alcohol dependence syndrome. They observe that

Functional Analytic Clinical Case Modeling

FIGURE 2 A functional analytic clinical case model (FACCM) of a Vietnam war veteran's drinking behavior and hypervigilance. Note. Using the example of the war veteran provided in the article, an FACCM can show both respondent and operant conditioning at work. An original causal variable, the combat experience, is paired with a variety of innocuous stimuli (smells, sounds, etc.) that will later remind the veteran of his combat experiences through respondent conditioning and generalization. The trauma of the combat experience leads to intrusive thoughts and recollections long after the veteran returns from the combat theater. Both environmental cues and the intrusive thoughts and recollections have the potential to elicit sympathetic nervous system activation (e.g., increased heart rate, respiration). Sympathetic nervous system activation can also reciprocally elicit intrusive thoughts and recollections (e.g., an increase in heart rate through exercise can trigger a combat memory). The...

Bernard E Bulwer MD MSc and Scott D Solomon MD

Enzyme inhibitor, furosemide, and digoxin. Investigations revealed no clear cause of his cardiomyopathy, but he admitted a 20-yr history of excess alcohol intake. An echocardiogram done at that time reported an ejection fraction of less than 20 . Cardiac catheterization was normal except for a 30 stenosis of the midleft anterior descending artery.

Major Clinical Syndromes Of Aggression

And sleep terrors, which arise out of non-REM sleep. Nocturnal seizures must also be excluded. The evaluation in suspected cases includes a thorough history of sleep complaints from patient and bed partner, neurological and psychiatric examination, overnight polysomnographic study, and MRI. REM sleep behavior disorder has been associated with a variety of neurological conditions, including Parkinsonism, dementia, stroke, multiple sclerosis, and alcohol withdrawal. However, more than 50 of cases are idiopathic. Pontine tegmental lesions, which might be expected from animal studies, are rare, possibly because pontine injury frequently produces devastating motor and arousal deficits that preclude expression of the disorder. Approximately 90 of patients exhibit sustained improvement when treated with clonazopam.

Differential Diagnosis

Gallstone pain can be very similar to that of renal colic and should generally be considered in all patients with any right upper quadrant abdominal tenderness. Unlike the symptoms of renal colic, biliary colic symptoms are often associated with oral intake, last for several hours before remitting, and include vomiting. Pancreatitis is suggested by left upper quadrant or midepigastric pain, especially in the presence of risk factors (e.g., alcohol consumption or cholelithiasis). A perforated peptic ulcer may present with severe pain in the midepigastrum or either upper quadrant. However, these patients have marked tenderness on examination and develop peritoneal signs over time. Appendicitis shares the unilateral presentation with renal colic, but the subacute prodrome usually excludes urolithiasis. Ventral hernias should also be considered in the differential diagnosis and sought on physical examination. Diverticulitis usually causes pain in lower quadrants, more commonly the left,...

Medical Clearance For Detoxification

Inquire about past history of hospitalization for delirium tremens, alcohol-related seizures, hepatitis, and pancreatitis screen for severity of alcohol withdrawal signs and symptoms review past medical illness and medications and rule out underlying medical conditions related to substance abuse.

Diagnosis of Megaloblastic Anemia

Frequently, an FBC would also form part of an outpatient work-up or might be ordered by a GP through an associated hospital or laboratory. Where the hemoglobin level is below the reference value with respect to sex and age indicating anemia, the mean corpuscular volume (MCV) is assessed. This parameter essentially gives a mean of the size of red blood cells in the circulation. Mega-loblastic anemia usually results in larger than normal red cells in the circulation and thus a raised MCV however, sometimes quite advanced stages of megaloblastic anemia can be accompanied by a normal and, infrequently, even below normal MCV. This can arise because of the concomitant presence of iron deficiency. A raised MCV accompanying the anemia seen in the FBC (macrocytic anemia) moves the diagnosis to being one of megaloblastic anemia, although other causes of macrocytosis such as hypothyroidism or excess alcohol consumption may need to be considered also. Conventionally, the next step is...

Winnie Eng and Richard G Heimberg

Alcohol Use Disorders CBT has also been applied to the treatment of alcohol problems. Alcohol use is viewed as a learned behavior that can be modified once a clear understanding is reached of the antecedents and consequences of its use. Several successful treatments have been developed with roots in CBT. Behavior self-control training (BSCT) is a treatment aimed at teaching clients self-regulation strategies. Although the goal of BSCT can be abstinence, the more common goal is moderation. Focus is placed on engaging in self-monitoring as a means of understanding motives underlying drinking, learning ways to cut back on drinking, and developing more adaptive coping skills with which to replace drinking. BSCT has been shown to be more effective than no treatment and at least as effective as treatments aimed at complete abstinence. William R. Miller and his colleagues also found that BSCT had good long-term efficacy for individuals with moderate drinking problems. As mentioned...

Middle Age and Old Age

Retirement and or having grown children mark old age in Hungary. As of the late 1990s, 19 of the Hungarian population was over 60 years of age (15.8 of the total male population and 21.8 of the total female population) (Foldesi, 1998). While there are many reasons for the difference between men and women, a few contributing factors are that many more men than women in this age group smoke cigarettes, drink alcohol regularly, and remain unwilling to change their traditional diet for a healthier one. At the same time, only 1 more of the men in this age group (5 vs. 4 of women) have remained physically active into their old age, which might have

Enantiomers their importance in psychopharmacology Introduction

In addition to metabolic interactions, consideration should be given to drug-protein binding interactions, although there is little clinical evidence to suggest that such interactions are of any consequence with the SSRIs. It must be stressed that many liver enzymes are non-specific for their substrates and that most drugs are metabolized by multiple pathways. Good therapeutic practice demands that drug interactions should be considered carefully, particularly in subpopulations of depressed patients such as the elderly or those with hepatic dysfunction or a history of alcoholism.

Contents In Fruits And Vegetables And Its Products

Epicatechin by dry weight as well as other flavonoids and their glycosides (26). Thearubigins, highly colored catechin oxidation products and their gallate are of major significance in determining the quality and flavor of tea. Black tea as consumed by humans contains about 36 thearubigins, 3 theaflavins, 5 epigallocatechin gallate, and 1 gallic acid by dry weight. Due to the large amounts of these phenolic compounds in tea, heavy drinkers of tea in Japan may consume 1 g of epigallocatechin gallate per day per person. Dry whole cocoa beans contain approximately 12 to 18 phenolic compounds and the major compound is epicatechin (27). Phenolic compounds in roasted coffee beans are produced during thermal processing from carbohydrates, chlorogenic acid, and lignins. Phenolic compounds in beer that contribute to bitterness, astringency, harshness, and the formation of haze are catechin and epicatechin (approximately 40 mg L), gallocatechin (less than 15 mg L), and hydroxycoumarins and...

Wernicke Korsakoff Syndrome Is Exacerbated by a Defect in Transketolase

An enzyme having an affinity for its coenzyme TPP that is one-tenth that of the normal enzyme. Although moderate deficiencies in the vitamin thiamine have little effect on individuals with an unmutated transketolase gene, in those with the altered gene, thiamine deficiency drops the level of TPP below that needed to saturate the enzyme. The lowering of transketolase activity slows the whole pentose phosphate pathway, and the result is the Wernicke-Korsakoff syndrome severe memory loss, mental confusion, and partial paralysis. The syndrome is more common among alcoholics than in the general population chronic alcohol consumption interferes with the intestinal absorption of some vitamins, including thiamine.

Treatment Of Hypertension

Vascular Function Arteries

The goals of treatment are to reduce BP and the risk of cardiovascular events, but to minimize adverse effects and facilitate patient compliance. Treatment can be divided into nonpharmacological and pharmacological 11 . Both forms of therapy rely heavily on patient education and good communication between doctor and patient. Nonpharmacological measures have the advantages of minimal cost and lack of side-effects, although compliance is not necessarily better. Current generally agreed-upon recommendations are 11 (i) appropriate weight loss (ii) no tobacco and limited alcohol consumption (iii) regular moderate exercise (iv) modest sodium restriction (no added salt) (v) diet low in animal fat and high in vegetable fiber. More controversial advice includes dietary potassium, calcium and fish oil supplementation, and reduced stress and caffeine intake. If these recommendations are followed, a significant number of patients with mild hypertension can avoid drug therapy. Even if drug...

Differential Diagnosis And Comorbidity

One prospective study 43 followed males who met, at the baseline assessment, criteria for mania+ADHD (n 15), ADHD without mania (n 65) or no psychiatric diagnosis (n 17). These subjects were re-evaluated 6 years later. There were no group differences in the prevalence of Axis I or Axis II disorders, with the exception of alcohol abuse, which was higher in controls. Manic symptoms persisted in only one mania+ ADHD subject, while three (5 ) of the ADHD subjects had new onset of manic symptoms. There were no clear cases of bipolar disorder. Levels of service utilization or criminal behaviour did not differentiate the groups. However, global functioning was significantly lower at follow-up in the mania+ADHD group compared with controls. Although a pilot study in scope, the findings cast doubt on a link between manic symptoms associated with ADHD in childhood and follow-up bipolar disorder.

Historical Notes A Early Beginnings

The 1989 Peniston and Kulkosky research combined conventional treatment and relaxation and temperature biofeedback with NF in treating 10 male alcoholics and compared the results to those of a conventional treatment only control group. The finding of much better and more enduring results with the experimental group aroused strong interest in the potential of NF for treating this notoriously treatment-resistant group. During the 1990s, there was what some describe as an explosion of interest in NF that continues today. A few highlights will be mentioned briefly in the next few paragraphs.

Neurochemistry Of Aggression

Recently, genetic studies have provided further evidence of an important role of serotonin in aggression regulation. A polymorphism in the gene for tryptophan hydroxylase, the rate-limiting enzyme in the biosynthesis of serotonin, has been associated with suicidal behavior in impulsive alcoholic criminals and in individuals with major depression. Amino acid substitutions in the 5-HT7 receptor gene have been reported among alcoholics with violent behavior. In humans, numerous studies support an important link between circulating androgens and aggressive behavior. Elevated testosterone levels in adolescent boys correlate with low frustration tolerance and impatience. Boys with increased testosterone are more likely to respond aggressively when provoked. Increased levels of free testosterone have been measured in the saliva of incarcerated violent criminals. Victorious collegiate wrestlers show a greater increase in their serum testosterone than do their defeated counterparts. Violent...

Empirical Studies

Several studies have evaluated the effects of covert sensitization among alcoholics, but the findings of most of these studies are difficult to interpret due to severe methodological limitations. One study provided some evidence that conditioned nausea could be produced in a number of alcoholics receiving covert sensi-tization treatment. Approximately 90 of patients who remained in treatment for at least six covert sensitiza-tion sessions reacted with genuine nausea responses as evidenced by swallowing, muscular tremor, and facial grimacing and occasionally by actual vomiting, but only two-thirds of these subjects developed some degree of conditioned nausea. Conditioned nausea was defined as nausea arising as a direct consequence of the subject's focusing on pre-ingestive or ingestive concomitants of typical drinking scenes. Significant degrees of extended abstinence were observed for conditioned nausea subjects as opposed to other participants. Another well-controlled study found...

Classical Conditioning

Treatments based on classical conditioning fall into two broad categories aversion therapies, which are designed to reduce appetitive responses, and exposure therapies, which are designed to reduce aversive or unpleasant responses. Aversion therapies have been vividly portrayed in novels and films such as A Clockwork Orange. The focus is on reducing maladaptive responses that the patient might find enjoyable, such as the elimination of excessive alcohol consumption or, in the case of Little Alex, the protagonist of Clockwork Orange, the elimination of his passion for ultraviolence. Classical conditioning methods for reducing alcohol consumption include emetic treatments, where the person ingests a nausea-inducing drug and then is asked to sample his or her favorite alcoholic beverage. Over a series of trials, the person learns to associate drinking with immediate nausea. Thus, the former association between drinking and pleasure is replaced by an aversive association, thereby reducing...

Communicating about Risk Menace and Safety

Organizations (companies, lobbying groups, governments) repackage and redistribute scientific reports to serve their objectives. Reports of risk and benefit almost invariably improve the commercial or political status of some interest groups while reducing the status of others. It is no wonder, then, that the scientific and legislative battles over the dangers of alcohol abuse, for example, also are expressed as advertising battles containing images of sexy women and injunctions to drink responsibly on one side, and images of car wrecks and disfigured teenagers on the other.

Mendelian Inheritance Intelligence Testing and American Eugenics

The advent of intelligence testing in the 1900s provided a new way to quantify Galton's notion of genius. American eugenicists assessed an individual's eugenic worth by combining his intelligence quotient (IQ) with a Galtonian study of the family pedigree. Psychologist Henry Herbert God-dard published one famous study, The Kallikak Family, in 1912. Goddard traced two family lines that originated with a common male ancestor, whom he called Martin Kallikak (from the Greek words for beautiful kalos and bad kakos ). One branch appeared healthy and eugenic, descended from Martin's marriage to a respectable woman. The second branch was composed of Defective degenerates (alcoholics, criminals, prostitutes, and particularly the mentally feebleminded) born of Martin's dalliances with a feebleminded tavern mistress. Goddard thus proved the inheritance of feeblemindedness, and its social cost.

Zoonotic Infections And Immunocompromised Patients

Immunocompromised patients deserve special consideration and encompass a very large group patients with congenital immunodeficiencies, diabetes mellitus, chronic renal failure, or liver failure splenectomized patients chronic alcoholics cancer patients and HIV-positive patients. Of all of these patients, those undergoing chemotherapy and those with AIDS have the greatest risk of acquiring a zoonotic infection. 7 It is estimated that 30 to 40 percent of immunocompromised patients may own pets.57 Salmonella and Campylobacter are the two most common infections acquired by immunocompromised patients from their pets,7 but the overall risk of transmission of Salmonella and Campylobacter from contact with pets is low. Additionally, Mycobacterium marinum, from aquatic pets, and Bartonella, from cats, are also commonly acquired by immunocompromised patients. Other acquired zoonotic infections that immunocompromised patients are susceptible to include

Holistic New Age and Folk Medicine

One example of such a holistically oriented healing movement is Alcoholics Anonymous (AA), and its Twelve-Step program, which has influenced many other self-regenerative therapies. Founded in the 1930s, Alcoholics Anonymous has well over one million members, with about 35,000 groups meeting weekly in over ninety countries. The principal founder of the movement, Bill Wilson, was an alcoholic who became acutely aware of his inability to overcome his addiction. A mystical experience of a great white light convinced him that a loving Presence surrounds us and is capable of healing our broken inner lives. Wilson maintained that we need only to cease relying upon our own willpower and surrender to this Higher Power. Wilson was extremely wary ofinstitutional religion, especially the moralism associated with biblical religion. From psychologists such as William James and Carl Jung, he pieced together a form of spirituality based upon opening the unconscious mind to a higher metaphysical...

Pathology Pathogenesis and Carcinogenesis

Other factors such as iodine deficiency, autoimmune thyroid disease, hyperthyroidism, sex hormone status and alcohol intake have all been implicated in the development of thyroid carcinoma, but remain unproven. Possible genetic patterns of differentiated thyroid carcinoma include patients with Gardner's syndrome (familial colonic polyposis) and Cowden's disease (familial goiter and skin hamartomas), but less than 3 of all papillary and or follicular thyroid carcinomas are truly familial.3 Cigarette smoking has not caused an increase in the incidence of thyroid carcinoma.

The Control of Drugs and Alcohol

Confidence in legal control was reinforced by the obvious decline in drug use, and alcohol consumption fell from 1.7 U.S. gallons per capita in 1910, to about 0.6 gallons between 1920 and 1930, and did not return to the 1910 level until the mid-1960s (Rorabaugh, p. 232). Anti-drug legislation became increasingly severe, even after Prohibition was repealed in 1933, including mandatory minimum sentences and, in 1956, federal enactment of the death penalty as an option in some cases of drug trafficking. The debate between law-enforcement and public-health approaches to drug and alcohol abuse is particularly sensitive to public attitudes toward the nature of the drugs themselves. In an era of drug toleration, public-health methods and medical treatment in general are advocated and practiced. The concern is not so much with a drug itself as with the bad effects that it may have on an unwise or excessive user. As the attitude turns against the use of drugs in any amount, frustration and...

Laboratory Evaluation

If the patient has unconjugated hyperbilirubinemia, the bilirubin is usually only mildly elevated and consists predominately (more than 85 percent) of the indirect fraction. Since unconjugated bilirubin is tightly bound to albumin, it does not appear in the urine. Liver aminotransferase levels will be normal, and the blood count and smear may show evidence of anemia or hemolysis. A Coombs test and hemoglobin electrophoresis may be helpful if no history of hemolytic anemia or hemoglobinopathy is known. Gilbert's syndrome is the most common cause of mild unconjugated hyperbilirubinemia. This is an inherited deficiency in bilirubin conjugation that produces no symptoms other than variable elevations of bilirubin and no adverse effects. Factors that can cause bilirubin to rise include fever, heavy physical exertion, fasting, surgery, and heavy alcohol consumption.

Delirium Dementia Amnestic and Other Cognitive Disorders

This group of syndromes is characterized by a clinically significant deficit in cognitive or memory function due to a general medical condition. There are several distinct and common causes of organic brain syndromes in which the causative factor is known for example, vascular dementia and alcohol withdrawal delirium. In these cases, the specific diagnosis is listed in DSM-IV. In other cases, the etiologic factor should be specified using the descriptor due to general medical disorder or substance for example, delirium due to hepatic encephalopathy.

Effects on Particular Organs or Organ Systems

Mechanisms that impair the release of triglycerides to the blood. Carbon tetrachloride and ethanol are among the substances that can cause this. Necrosis is caused by carbon tetrachloride, which forms free radicals in the liver, as well as by other halogenated hydrocarbons. Cirrhosis is the formation of scar tissue in the liver. It is also caused by carbon tetrachloride, although ethanol is most commonly associated with this condition. Although there is evidence to the contrary, the effect of ethanol may be related to nutritional deficiency associated with alcoholism. Cholestasis is an inflammation of the ducts carrying bile or a decrease in bile flow by other mechanisms. There are many types of liver cancer, and many chemicals are known to cause cancer in laboratory animals. The role of chemicals in human liver cancer is less clear, except for the notable case of vinyl chloride, which is known as a potent cause of angiosarcoma. Physical damage may target either the long axons by...

Challenging Unrealistic Alcohol Outcome Expectancies

Alcohol expectancies are the beliefs one holds about the positive desirable and negative undesirable outcomes of drinking. For example, some people believe that drinking alcohol will make it easier for them to meet new people that drinking helps them perform better sexually that drinking will result in difficulty thinking clearly or speaking clearly. Such beliefs result from observing the outcomes of drinking by others (both in vivo and portrayed in popular culture) and by recalling (and anticipating) effects from one's own past drinking. Beliefs about the outcomes of drinking also appear to be contextual, depending on, for example, how much one anticipates drinking and what type of alcohol one will drink. III. MODES OF CONTROLLED DRINKING TRAINING It seems reasonable to assume that family and friends serve as models for both controlled and uncontrolled drinking, and the therapist should assess whether their drinking habits will serve as a model for moderate drinking by the client....

Heritability in Humans

Most family, twin, and adoption studies have shown that addiction to alcohol has significant heritability. For example, there is an increased risk for alcoholism in the relatives of alcoholics. Depending on the study, the risk of alcoholism in siblings of alcoholics is between 1.5 and 4 times the risk for the general population. The identical twins of alcoholics (who share 100 percent of their genes) are more likely to be alcoholics than the fraternal twins of alcoholics (who share only about 50 percent). Adoption study data suggest that the risk for developing alcoholism for adopted children is influenced more by whether their biological parents were alcoholics than whether their adopted parents are alcoholics, suggesting that genes contribute to alcoholism more than environment. Similar but less extensive data has been collected for nicotine addiction. Very little genetic epidemiological data has been collected for illegal drugs. The only genes that have been conclusively shown to...

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