If you have any doubt about your level of alcohol consumption or your ability to control it, consider these questions If you answered yes to any of these questions, you may be addicted to alcohol. If you think that you or someone you love has a drinking problem, seek help immediately. Stopping now will significantly improve your life and your health, no matter how long you have been drinking. Here is how you can get help Ask your doctor for the name of a healthcare professional who specializes in treatment for alcohol dependency. Call the employee assistance program where you work. Call nearby hospitals or a local mental health center to ask if they provide a program for alcohol addiction. Call the local chapter of AA, a support group of alcoholics who meet regularly to help each other stop drinking and stay sober. If you are concerned about the drinking of a family member or a friend, call the local chapter of Al-Anon, a support group for relatives and friends of alcoholics.
NIAAA leads the federal government's efforts to reduce the enormous health, social, and economic consequences of alcohol abuse and alcoholism. NIAAA supports intramural research facilities, promotes a variety of research efforts, and fosters the development of effective treatment and prevention through the circulation of research findings to health care providers and professionals. The institute has also expanded research on public policy issues such as alcohol taxation, alcohol consumption, warning labels, and drinking-and-driving laws to provide a scientific basis for the development and assessment of public policy.
The existence of a close cause-and-effect relationship between alcoholism and avascular os-teonecrosis has long been noted, most typically in the femoral head (Patterson et al. 1964). In a recent review Jones (2001) again emphasized the importance of alcohol-induced fatty liver as a major source of continuous or intermittent fat embolism that creates avascular necrosis. Radiographically detectable osteonecrosis was observed in the femoral head or the humeral head in all 30 chronic alcoholism patients he studied. The diagnosis was histologically confirmed in 19 patients. The mechanism was explained on the basis of endarterial occlusion created by repeated shower of fat emboli.
Secondary to vitamin deficiencies, alcoholics suffer from inflammation of the tongue (glossitis), inflammation of the mouth (stomatitis), caries, and perio-dontitis. A low-protein diet, associated with alcoholism, can lead to a zinc deficiency, which impairs the sense of taste and further curbs the appetite of the alcoholic. Parotid gland enlargement may be noted. Alcohol decreases gastric emptying and increases gastric secretion. As a result, the mucosal barrier of the gastrium is disrupted, allowing hydrogen ions to seep into the mucosa, which release histamine and may cause bleeding. Acute gastritis is characterized by vomiting (with or without hematemesis), anorexia, and epigastric pain. It remains unclear whether chronic alcohol abuse increases the risk of ulcer disease. The small intestine shows histological changes and contractual pattern changes even with adequate nutrition. Acute alcohol consumption impairs absorption of folate, vitamin B12, thiamine, and vitamin A, as well...
ithdrawal is a pattern of physiological responses to the discontinuation of a drug. Although most central nervous system (CNS) depressants produce similar responses, alcohol is the only one in which withdrawal is life threatening, with a mortality rate of about 25 . Withdrawal symptoms should be anticipated with any patient who has been drinking the alcohol equivalent of a six-pack of beer on a daily basis for a period of 6 months smaller patients who have drunk less may exhibit the same symptoms. Alcohol withdrawal involves CNS excitation, respiratory alkalosis, and low serum magnesium levels, leading to an increase in neurological excitement (Table 6). 52 Alcohol Withdrawal TABLE 6 Pathophysiology of Alcohol Withdrawal TABLE 6 Pathophysiology of Alcohol Withdrawal
Ethnic minorities made up 29 of the U.S. population in 2000. Cultural attitudes exert a powerful influence on drinking behaviors and response to treatment. It has been shown that although cultural approval may increase the accessibility of alcohol, ritualistic use of the drug by the culture may help to inhibit abuse or dependence (Westermeyer, 1986). The lower rates of drinking problems among Italian Americans, Italians, and Jews have been explained by the traditional use of wine in these groups integration of drinking into family life and, in the Jewish drinkers, the religious significance attached to alcohol. However, even ethnic groups with ritualistic use patterns do not consistently show low incidences of alcoholism or alcoholic complications. For example, the French have relatively high rates of alcoholism and cirrhosis.
Epidemiology 20 of pregnant women consume alcohol 1-2 consume 4 drinks day FAS 2-3 ounces of ethanol day (4-6 drinks day) or with frequent binge drinking. Mechanism of FAS Craniofacial dysmorpho-genesis early teratogenesis mental retardation and cortical defects occur later in gestation. FAS Intrauterine growth retardation (IUGR), microcephaly, epicanthal folds, short palpebral fissures, cleft palate, short philtrum maxillary hypoplasia, micrognathia, mental retardation.
Current approved treatments for substance abuse are directed at decreasing craving and preventing relapse. These include methadone and buprenorphine treatment for heroin addiction, and naltrexone for the treatment of alcohol abuse. Currently no drug is approved for the treatment of cocaine addiction, although several, including disulfiram and modafinil, have shown promise in randomized control trials. Notably, none of these compounds was developed for their potential to treat substance abuse. This stems in part from the persistent and ill-informed prejudice that addicts use compounds like methadone as a surrogate 'crutch.' It is clearly evident from the current statistics that substance abuse represents a major unmet medical need and a significant opportunity for future drug development.
Only 1 of magnesium is found in the extracellular space with the remaining in bone and muscle. Hypomagnesemia can result in hypermetabolic states, muscle wasting, starvation, malabsorption, fistula, primary aldosteronism, chronic alcoholism. Signs include hyperactive tendon reflexes, muscle tremors, tetany, positive Chvostek sign, delirium and convulsions. Treatment is with intravenous or oral administration of magnesium.
The incidence in different American states varies, due to a combination of differences in reporting procedures, differences in underlying population characteristics such as age, sex, ethnic groups, and educational levels and differences in geographical and interrelated social factors such as climate, degree of urbanization, driving patterns, road conditions, gun ownership, and alcohol consumption.
Alcohol and tobacco smoking are the main cause of cancers of the upper respiratory and gastrointestinal tracts. Alcohol by itself plays a role in liver cancer (cirrhosis) and possibly in a proportion of colon and breast cancer.36 Poverty is associated with increased exposure to tobacco smoke, alcoholism, poor nutrition, and certain infectious agents. Thus, poverty can act as a carcinogen, which suggests that fighting cancer also requires fighting poverty.
Susceptibility to alcohol abuse appears to run in families and is the subject of vigorous ongoing investigations to locate genes that contribute. It is probable that the effects of multiple genes and environment are involved in alcoholism. Twin studies have shown a stronger concordance between identical rather than nonidentical twins (55 or greater concordance for monozygotic twins and 28 for same sex dizygotic twins). Genetic differences in alcohol metabolism may result in higher levels of a metabolite that produces pleasure for those with a predisposition toward alcohol abuse. TEENAGERS AND YOUNG ADULTS. The use of alcohol is seen as a part of growing up for many individuals. Binge drinking is common and dangerous. The combination of alcohol and potentially risky activities, such as driving or sex, is a source of high morbidity and mortality for teens. PREGNANT WOMEN. Alcohol is a potent teratogen. Binge drinking and moderate to heavy drinking have been associated with many fetal...
Anticipate withdrawal syndrome with any intoxicated patient. Formal withdrawal assessment instruments are available to help guide the use of benzodiazepines. If the patient is a dependent drinker, an alcohol referral to social service, psychiatric consultation service, or a clinical nurse specialist is important.
Drinking alcoholic beverages is an accepted social activity. Consumed in moderate amounts, alcohol relaxes you, stimulates your appetite, and produces mild euphoria. It also loosens inhibitions, making you feel more friendly and outgoing. While moderate drinking is not detrimental to your health, excessive drinking (defined as four drinks or more per day) or binge drinking (defined as four drinks at one sitting) can eventually lead to alcoholism and other serious health problems. There is evidence that some people have an inherited predisposition toward alcoholism. The disorders produced by alcoholism are very costly in terms of human suffering and economic hardship. According to scientific research, the incidence of heart disease in men who consume a moderate amount of alcohol (two drinks a day or less) is lower than in men who do not drink. But there is not much difference between moderate drinking and heavy drinking. A typical drink is 5 ounces of wine, 1V 2 ounces of 80-proof...
Overuse and abuse of alcohol are seen in all age groups and in females and males. More and more teens are identified as alcohol-dependent and should have their drug or alcohol usage assessed on admission to the hospital or clinic. Binge drinking (more than five drinks at one time for males and four for females) is a growing problem among college students. Approximately 70 of people who are alcohol dependent are males, but women are more likely to hide their problem. Of growing concern is the number of elderly who are abusing alcohol as a way to deal with their grief, loneliness, and depression. Ethnicity and race have no known effects on alcohol withdrawal.
You may not often think about the effect safety has on your health, but accidental injury, motor vehicle collisions, fires, violent crime, and firearms constitute major causes of death and disability in the United States. Working in your home and community to prevent accidental and violent injury is an important but often neglected responsibility. Safety issues arise in countless places, from the dead battery in the smoke detector to the seat belt left unbuckled in the car. Drinking alcohol greatly increases your risk of injury. For example, men have a much higher risk of accidental drowning than do women, and alcohol is implicated in about 40 percent of such incidents. Drinking alcohol also heightens the risk of accidents from motor vehicle collisions, including those involving motorcycles, all-terrain vehicles, and bicycles. Never drink alcohol and drive. Alcohol affects your judgment and timing. Always appoint a nondrinking designated driver if you know you will be drinking. Follow...
Following an alcohol withdrawal experience, the patient may be able to accept that he or she has a problem with alcohol abuse. Discharge plans may include behavior modification programs, sometimes in conjunction with disulfiram (Antabuse) or participation in AA. Families must also be involved in the treatment planning to gain an understanding of the part that family dynamics play in people who are alcohol dependent.
The existence of alcohol-related dementia is complicated by the various syndromes described in individuals who abuse alcohol, as well as other possible comorbidities contributing to cognitive dysfunction in these individuals (vitamin B12 deficiency, subdural hematomas and head injuries, cerebrovascular disease, etc.). Knowledge about whether alcohol abuse may be a risk factor for other dementias is also sparse. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), classification relies on alcohol use to identify alcohol-related dementia, a process that may be subjective or based on limited information. Oslin et al. propose diagnostic criteria following the model used in the National Institute of Neurological and Communicative Diseases and Stroke Alzheimer's Disease and Related Disorders Association (NINCDS ADRDA) criteria for Alzheimer's disease (AD). It also uses cutoffs for heavy drinking of 28 drinks per week for women and 35 for men. As the authors...
Reduced binding of imipramine and paroxetine to brain and platelet SERTs in patients with depression and suicide victims indicates that altered SERT function might contribute to aberrant behaviors. Two polymorphic regions have been identified in the SERT promoter and implicated in anxiety, mood disorders, alcohol abuse, and in various neuropsychiatric disorders.21 Thus, studies are emerging to support the notion that impaired regulation might contribute to human disease conditions such as those seen in human variants of the SERT coding region.
Socially sanctioned, episodic psychoactive substance use may involve heavy use, with marked intoxication or drunkenness (Bunzel, 1940). In a low-technology environment, this pattern may cause few problems, although psychotomimetic drugs such as cannabis can cause toxic psychosis (Chopra & Smith, 1974). In a high-technology environment, with modern methods of transportation and industrial machinery, intoxication even at mild traditional levels may be life threatening (Stull, 1972). Binge-type alcohol problems include delirium tremens, fights, sexually transmitted disease, and falls.
Chronic Because APAP is a phenacetin metabolite, renal papillary necrosis and nephrotic syndrome are possible chronic analgesic nephropathy. In addition, patients at risk of increased NAPQI production as a result of CYP40 enzyme induction (from INH, rifampin, most anti-convulsants, ethanol) or reduced glu-tathione stores (alcoholism, HIV AIDS, malnutrition, starvation) are at increased risk of hepatotoxicity from APAP.
Difficulty concentrating, increased appetite and weight gain). For most individuals, these symptoms peak within a few days of quitting and dissipate within 1 or 2 weeks. (4) The physician can help the patient identify high-risk or dangerous situations. These are events, internal states, or activities that increase the risk of smoking or relapse due to their past association with smoking (e.g. negative emotional states, being around other smokers, drinking alcohol). These situations should be avoided early on, if possible. (5) The physician can help the patient select cognitive and behavioural coping skills to use when she experiences an urge (or craving ) for cigarettes. Examples of cognitive coping skills are reminding him herself reasons for quitting telling him herself that urge will pass and repeating the phrase, Smoking is not an option. Behavioural coping skills include leaving the situation, engaging in some distracting activity, taking deep breaths, and seeking social support.
The overlap of the two types of disorders causes confusion among lay people as well as professionals. For example, cancer can cause severe depression, but it should be a ''mental disorder only if the physical illness has caused a dysfunction of the internal psychological mechanisms that control emotional behavior. If that is the case, then the individual has both a physical and mental disorder. The reverse can also occur. A mental disorder, such as alcohol abuse, can cause a physical disorder (i.e., liver damage). Physical and mental disorders can occur together or separately, but it is important to understand that they are different conditions. The relationship of the two conditions has instigated the growth and development of behavioral medicine and health psychology.
These are features (see Table 55) that caution against, but do not firmly exclude, a diagnosis of frontotemporal lobar degeneration (FTLD). A history of alcohol abuse raises the possibility of an alcohol-related basis for a frontal lobe syndrome. However, excessive alcohol intake may also occur in patients with frontotemporal dementia (FTD) as a secondary manifestation of social disinhibition or hyperoral tendencies. The presence of vascular risk factors, such as hypertension, ought to alert investigators to a possible vascular etiology. Nevertheless, such risk factors are common in the general population and may be present coincidentally in some patients with FTLD, particularly in those of more advanced age.
But the prototypic reaction is the oxidation of ethanol to acetaldehyde, during which they transfer the pro-R hydrogen from NADH to substrate. Globally, these enzymes constitute part of the medium-chain dehydrogenase reductase superfamily.70 In humans, five classes (classes I-V) of ADHs are known members of different classes share less than 70 amino-acid sequence identity within a species.71 Three genes found within the human class 1 enzymes - ADH1, ADH2, and ADH3 are expressed in most adult tissue, with the exception of brain, kidney, and placenta. The absence of ADH1 enzymes, the most efficient ethanol-metabolizing enzymes among the ADH family, in the placenta and brain argues against a substantial contribution of this enzyme in local ethanol developmental central nervous system toxicity. On the other hand, polymorphisms in the human ADH2 gene have been associated with alcoholism.72
Diseases of the urogenital and digestive organs caused 13 of the sudden and unexpected deaths in 1937.59 Nowadays, such cases are uncommon, with possibly the most common entity a massive hematemesis due to esophageal varices complicating cirrhosis of the liver. Occasionally, one will see a death following a duodenal ulcer eroding into a major blood vessel with massive GI hemorrhage. There are occasional deaths caused by peritonitis from a perforated duodenal ulcer or an acute peritonitis. These latter deaths are more common in alcoholics and psychotic patients on heavy doses of antip-sychotic medications that could mask the symptoms of these conditions and the patients' awareness of their illness.
The landmark HIV Cost and Services Utilization Study (HCSUS) found that a large, nationally representative probability sample of adults receiving medical care for HIV in the United States in early 1996 (N 2,864 2,017 men, 847 women) reported major depression (36 ), anxiety disorder (16 ), and drug dependence (12 ) (Bing et al., 2001 Galvan et al., 2002), as well as heavy drinking at a rate (8 ) almost twice that found in the general population and high rates of drug use (50 ). The HCSUS study remains the most comprehensive view we have of the prevalence of psychiatric disorders among people living with HIV AIDS, though the study was not designed as a diagnostic assessment of psychiatric disorders among people with HIV AIDS and so rates of psychosis, bipolar disorder, alcohol abuse or dependence, and substance abuse, among others, were not obtained. Disorders of alcohol and other drug (AOD) abuse are differentiated from dependence in the Diagnostic and Statistical Manual of Mental...
The extent to which addiction fuels IDU is the most obvious link between psychiatric disorders and HIV transmission. Kral et al. (1998) estimated an overall HIV infection rate among U.S. IDUs of 13 , with wide geographic variability between cities in the East (where rates exceed 40 ) and in the Midwest and West (where rates generally are under 5 ). Yet many studies of this population did not obtain AOD use disorder diagnoses, so summarizing across studies to generalize rates of HIV infection for specific diagnostic groups is methodologically problematic. People discharged from general hospitals who had documented AOD use disorders were twice as likely to be HIV infected as those without AOD use disorders (Stoskopf et al., 2001). Studies of people admitted to treatment for primary alcohol abuse or dependence reported HIV infection rates of 5 to 10.3 (Avins et al., 1994 Mahler et al., 1994 Woods et al., 2000), and these rates are 10 to 20 times higher than those among the general...
Genital olfactory disturbances manifest themselves as partial anosmia ( olfactory blindness ). The perceived intensity of a persistent odor decreases or disappears with time (olfactory adaptation). External factors such as an arid environment, cold, or cigarette smoke impair the ability to smell diseases affecting the na-sopharyngeal cavity impair both smell and taste. Odors and emotions are closely linked and can influence each other. The perception of smell may be qualitatively changed (parosmia) because of autonomic (hunger, stress) and hormonal changes (pregnancy) or disturbances such as ozena, depression, traumatic lesions, or nasopharyngeal empyema. Olfactory hallucinations can be caused by mediobasal and temporal tumors (focal epilepsy), drug or alcohol withdrawal, and psychiatric illnesses such as schizophrenia or depression.
Recognize alcoholism and develop a treatment plan for it before, and subsequent to, institution of cancer treatment. It would be appropriate at this juncture to include new parameters in the staging system for HNC whose importance has been realized in recent years, such as the impact of positive retropharyngeal nodes and the patient's alcohol consumption status,16' 17 both of which can impact on survival outcomes to a much greater extent than variations in current treatment. 7. Increase attention to the multifactorial consequences of smoking32 and alcoholism in the HNC patient population.65,66 This factor has been poorly quantified in the existing retrospective HNC cancer treatment literature. However, new evidence of the seminal importance of the patient's alcohol status on cancer survival16,17 (a 40 to 50 difference much larger than any we can currently attribute to variations in cancer treatment), and the fact that reversing a patient's alcoholism can have a positive impact on...
The five substances routinely tested for include marijuana, cocaine, amphetamines, opiates, and PCP. Other drugs, such as alcohol, may be added to the panel if suspected by the employer from objective evidence (i.e., slurred speech, alcohol on the breath). Keeping with the Rule of Fives, there are five situations in which drug testing is conducted (1) preemployment, (2) random, (3) postaccident, (4) probable cause, and (5) return to work follow-up. The employer may request testing for additional substances in the case of postaccident, reasonable suspicion, and return-to-work situations. In order to undergo this additional testing, the employee must be notified via an official Employee Drug Policy document. Recognizing the high prevalence of alcohol abuse, ethanol testing was mandated in a 1994 amendment. There are separate regulations for alcohol testing, including not requiring MRO participation. The program is designed always to give the employee the benefit of the doubt, and the...
Hispanic persons, than in other populations. Alcohol dependence and alcoholic liver disease are more common in minority groups, particularly among Native Americans. Primary biliary cirrhosis is more common in Northern Europeans and is less common in populations of African descent.
The iron lung (Drinker respirator) makes use of negative-pressure respiration ( A2). The patient's body is enclosed from the neck down in a metal tank. To achieve inhalation, pressure in the tank is decreased to a level below ambient pressure and, thus, below alveolar pressure. This pressure difference causes the chest to expand (inspiratory phase), and the cessation of negative pressure in the tankal-lows the patient to breathe out (expiratory phase). This type of respirator is used to ventilate patients who require long-term mechanical ventilation due to paralytic diseases, such as polio.
The assumption that alcoholism and personality traits are linked in some fashion has a long history. Earlier editions of the DSM (DSM-I and DSM-II) classified alcoholism along with personality disorders. By 1980, with publication of DSM-III, substance use disorders (including alcoholism) were understood as entities independent of the personality disorders. Generally, antisocial personality disorder (APD) is the most prevalent personality disorder associated with alcoholism when samples from public treatment centers are studied, and borderline personality disorder (BPD) is the most common disorder in studies from private treatment facilities. In a private psychiatric hospital sample, 57 of substance-abusing patients met DSM-III-R criteria for a personality disorder with BPD being the most commonly occurring personality disorder (Nace, Davis, & Gaspari, 1991). Personality disorder occurs more commonly in alcoholics than in the general population. A prospective long-term study of a...
Certain forms of repetitive behavior may influence the present coloration of the teeth, and the likelihood that an improved appearance can be maintained. The dentist must know if the patient is an active drinker of tea, coffee, or colas. These beverages cause a readily correctable form of staining, but they may compromise the maintenance of a whitened smile. Smoking (cigarettes, pipes) and chewing tobacco are much more invasive. The stains follow the microfissures of the tooth structure internally, and may be very difficult to eliminate.
It is well established that alcoholic heart muscle disease is a complication of long-term alcoholism and not malnutrition or other possible causes of dilated cardiomyopathy. In a dose-dependent fashion, left ventricular systolic function declines, implicating alcohol in at least 30 of all dilated cardiomyopathies (Lee & Regan, 2002). The contractility of heart muscle is decreased through Transient hypertension is noted in nearly 50 of alcoholics undergoing detoxification and is related to quantity of drinking and severity of other withdrawal symptoms. Epidemiological studies have demonstrated that alcohol elevates blood pressure independently of age, body weight, or cigarette smoking (Klatsky, Friedman, & Armstrong, 1986). A 10-year follow-up study found even moderate intake of alcohol (60 grams day) is associated with increased risk of ischemic and hemorrhagic stroke. Mechanisms involved include alcohol-induced hypertension, coagulation disorders, atrial fibrillation, and reduction...
TB is epidemic among high-risk populations of Asian, African, and Eastern European immigrants Native Americans and Inuits alcoholics prisoners homeless refugees intravenous drug users (IVDUs), and HIV AIDS patients. Approximately 2 billion people worldwide are infected with TB, with 10 million new cases per year, and 1 million deaths per year. Isonicotinyl hydrazide (INH) or isoniazid is among the most common causes of drug-induced seizures in the United States. INH toxic risk factors rapid acetylators of INH the elderly or malnourished alcoholics patients with preexisting liver disease synergistic drug toxicity INH and concomitant rifampin or pyr-azinamide antituberculosis treatment.
The development of osteoporosis in middle-age men is uncommon except in male alcoholics, where decreased bone mass has been documented (Turner, 2000). In women, improvement in bone mass has been shown with moderate alcohol use, especially in postmenopausal women (Laitinen et al., 1993).
Pathophysiological Endocrinopathy (Addi-son's disease, Sheehan's syndrome) neoplasms (insulinomas, multiple endocrine adenomatosis MEA type I) liver disease (alcoholism, cirrhosis) chronic renal failure (CRF) and hemodialy-sis miscellaneous (AIDS, autoimmune diseases, pregnancy).
Epidural use causes analgesia at presynaptic and postjunctional al-pha-2-adrenergic receptors in the spinal cord due to prevention of pain signal transmission to the brain. tv2, distribution, epidural 19 min elimination 22 hr. Uses Oral, Transdermal Mild to moderate hypertension. A diuretic or other antihypertensive drugs, or both, are often used concomitantly. Non-FDA Approved Uses Alcohol withdrawal, atrial fibrillation, attention deficit hyperactivity disorder, constitutional growth delay in children, cyclosporine-associated nephro-toxicity, diabetic diarrhea, Gilles de la Tourette's syndrome, hyperhidrosis, hypertensive emergencies, mania, menopausal flushing, opiate detoxification, diagnosis of pheochromocy-toma, postherpetic neuralgia, psychosis in schizophrenia, reduce allergen-induced inflammatory reactions in extrinsic asthma, restless leg syndrome, facilitate smoking cessation, ulcerative colitis.
In an attempt to document hyperarousal in patients suffering from insomnia, functional neuroimaging methods, assessing regional cerebral glucose metabolism were used 38 . Evidently, subjectively disturbed sleep was associated with greater brain metabolism. Thus, it is possible that the inability to fall asleep is related to a failure of arousal mechanisms to decline in activity from waking to sleep states. This may be an explanation why there is an association between chronic insomnia and alcohol dependence 39 . Perhaps some individuals with hyperarousal and failure in their mechanisms to control it, try self-treatment methods through alcohol consumption.
Phobia), however, the common nonshared environmental factor contributed a greater share of the liability variance than the common genetic factor. Using the same Virginia-based twin sample, Kendler et al. (1995) examined the causes of comorbid-ity among panic disorder, phobias, GAD, major depression, alcoholism, and bulimia nervosa in women. They reported that the genetic influences responsible for the overlap between major depression and GAD in female twins appeared to be distinct from the genetic influences responsible for the overlap between panic disorder and phobias. Based on the finding of more than one shared genetic factor, the authors speculated that the anxiety disorders may be etiologically heterogeneous. Although provocative, this hypothesis seems hard to reconcile with the earlier findings by this group on common genetic influences on depression and phobias (Kendler et al., 1993c).
It was a terrible production I had to put up with that. Then I went to the cast party. Well, it was a great group. I could see that the younger people and the older people had a lot in common. They really shared this interest in the theater. And there was no question that the younger people would not drink the beer at all. It was like at our house, when I have people over and the older people drink alcohol and it's just understood that the younger people don't.
A small number of victims have been chronically disabled by the earthquake. They are suffering from head injuries and spinal cord injuries, and some have developed paraplegia. Pseudodementia has been suspected among a sizable number of elderly victims. Heavy drinking caused alcoholic hepatitis in some victims. A high-risk group for chronic stress disorders is elderly males who lost their family members. However, large-scale epidemiologic studies have yet to be completed for the victims of the earthquake.
The lifetime prevalence of alcohol dependence in the United States is in the range of 14.1 (Kessler et al., 1997), while binge alcohol use and heavy alcohol use within the past month have been reported as 22.8 and 6.9 , respectively (SAMSHA, 2005). Even higher rates are seen among gay men, regardless of their serostatus (Ferrando et al., 1998 Stall et al., 2001). Alcohol is rapidly absorbed from the duodenum with blood alcohol concentrations of 100-200 mg , causing impaired motor function and judgment concentrations of200-400 mg lead to stupor and coma. Alcohol activates GABA receptors, inhibits NMDA receptors, and has additional effects on 5-HT3, nico-tinic, and opioid receptors. It is metabolized by alcohol dehyrogenase at a constant rate of 100 mg kg hour. Medical complications of alcohol dependence are listed in Table 8.3. Problems such as anemia, peripheral neuropathy, and dementia are of particular concern in HIV patients, who are already predisposed to these complications. More...
A temple carving depicting the San Pedro cactus has been found at an archaeological site in northern Peru and is more than three thousand years old. The cactus is also an important artistic motif throughout later periods, demonstrating continuous use from the distant past up to the present. Folk uses are not restricted to shamanistic vision quests, and San Pedro cactus is also deemed to be effective in the treatment of fever, hepatitis, and alcoholism.
After medical stabilization and detoxification, the goals of treatment should include maintenance of abstinence when possible and rapid treatment of relapse. Substance abuse treatment is usually provided on an outpatient basis, though treatment communities afford a higher level of care for those with a more severe and refractory SUD. Adjunctive anticraving agents may be used by HIV-positive patients with severe addictive disorders to aid in abstinence. Disulfu-ram, acamprosate, and naltrexone have all been used to curb alcohol craving. Methadone maintenance therapy has been shown to be effective in managing abstinence from opiates, and recently buprenorphine has been approved for the office management of opiate dependence.
Alcohol consumption has been shown to significantly increase the blood serum level of abacavir by competing for alcohol dehydrogenase (McDowell et al., 2000) however, with chronic use, alcohol can induce CYP 3A4 and may decrease levels of some antiretrovirals (Caballeria, 2003). Ritonavir, and possibly other protease inhibitors, can inhibit the metabolism of alprazolam, which can lead to oversedation and respiratory depression if this drug is being abused. Inhaled marijuana has been shown to decrease the bioavailability of indinavir and nelfinavir, although the precise mechanism is unknown (Kosel et al., 2002).
Other Drugs Analgesics may be ordered for bone pain. Monitor the effectiveness of the pain medications. Avoid administering antacids that contain aluminum. If the patient develops alcohol withdrawal, the treatment of choice is the benzodiazepine class of medications. as possible. If the patient develops signs of alcohol withdrawal (restlessness, insomnia, thirst, and tremors progressing to fever, hallucinations, and combative and irrational behavior), notify the physician and decrease stimulation as much as possible. Place the patient in a quiet, darkened room with a cool temperature. Provide frequent sips of water and fruit juices, but avoid fluids with caffeine. Place the patient in a room where she or he can be monitored frequently to decrease the risk of injury.
Major depression is one of the most common mood disorders in HIV-seropositive individuals, and it was the earliest reported mood disturbance of HIV. Rates of depression in HIV have varied widely across studies due to differing sample populations, which are difficult to compare as they share little else in common other than their HIV serostatus. The landmark HIV Cost and Services Utilization Study (HCSUS) identified high rates of drug use (50 ), major depression (36 ), anxiety disorder (16 ), and heavy drinking (12 ) among a large representative sample of adults receiving care for HIV in early 1996 (Bing et al., 2001 Galvan et al., 2002). The HCSUS study remains the most well-designed and comprehensive study of the prevalence of psychiatric disorders in an HIV-infected population, although other studies provide snapshots of the high rates of comorbid psychiatric disease in this population (Winiarski et al., 2005). Depression is the most common reason for psychiatric referral among...
The Health and Daily Living Form (HDLF) is a structured assessment for patient and community groups that assesses health related factors such as alcohol consumption, drinking problems, and depression. It is a structured assessment procedure that can be administered either as an interview or as a questionnaire, and can be used with both patient and community groups.
Depression (of various types) can impair sleep, though paradoxically sleep deprivation can ameliorate depression. Depressed persons typically complain of early morning awakening, nocturnal restlessness, and difficulty in starting the day. Sleep disturbances are also common in patients suffering from psychosis, mania, anxiety disorders, alcoholism, and drug abuse.
Cancer of the larynx is more common in men than in women (5 1 ratio) because, heretofore, men have been more likely to smoke cigarettes and drink alcohol, but the incidence in women is rising as more women also smoke and drink. Cancer of the larynx occurs most frequently between the ages of 50 and 70. Women are more likely to get laryngeal cancer between the ages of 50 and 60 and men between the ages of 60 and 70. Laryngeal cancer is 50 more common in African Americans than in whites. HISTORY. Be aware as you interview the patient that hoarseness, shortness of breath, and pain may occur as the patient speaks. Obtain a thorough history of risk factors alcohol or tobacco usage, voice abuse, frequent laryngitis, and family history of laryngeal cancer. Obtain detailed information about the patient's alcohol intake ask about drinks per day, days of abstinence, and patterns of drinking. Ask the patient how many packs of cigarettes he or she has smoked per day for how many years.
Patients with a recent history of alcohol abuse should receive postoperative thiamine, folate, and vitamin B12 supplementation. For patients who continue to drink actively up to the time of operation, aggressive delirium tremens prophylaxis should be initiated. We typically administer benzodiazepines, either as a standing dose or as needed, depending on the patient's preoperative level of alcohol consumption.
Most patients with head and neck cancer have squamous cell carcinoma arising from mucosal surfaces of the head and neck. Most of these patients are more than 40 years of age with a 4 or 5 to 1 male female ratio. The vast majority of these patients relate a history of tobacco use, usually cigarette smoking, and many have a history of alcohol abuse. A patient presenting with a mass in the neck that is nontender and enlarging and who matches the above profile, should be regarded as having cancer until proven otherwise. An orderly stepwise approach should be taken in evaluating these patients. Most physicians treating these patients agree that open biopsy of the neck mass should be delayed until later stages of evaluation.
Alcohol dehydrogenase (E.C. 1.1.1) (ADH)32 toxifies ethanol to acetaldehyde, which is then (predominantly) detoxified by an aldehyde dehydrogenase (E.C. 1.2.1) to acetic acid. The second step, the aldehyde dehydrogenase-mediated oxidation to acetic acid, is inhibited by disulfiram (Antabus), which is used in the treatment of alcohol addiction. After alcohol consumption disulfiram leads to the accumulation of the toxic acetaldehyde. The resulting toxicity provokes headache and nausea, which is intended to keep the alcoholic from further alcohol consumption. Many other aldehydes, such as the a,b-unsaturated aldehydes (lipid peroxidation products), are also markedly toxic. Thus, aldehyde dehydrogenase predominantly leads to detoxification. However, as is the case with all adequately investigated drug-metabolizing enzymes, aldehyde dehydrogenase plays a dual role with respect to toxification detoxification, the nature of which depends on the substrate in question. Methanol is metabolized...
Mallory-Weiss syndrome, first described in people with alcohol dependence, is now recognized across the life span but is most common in men over the age of 40. In women, hyperemesis gravidarum, which in the first trimester of pregnancy causes persistent nausea and vomiting. There are no known ethnic or racial considerations.
Patients with profound emotional disturbances and instability (e.g., alcoholism, drug abuse, depression) and those involved with compensation and litigation should undergo a thorough psychiatric evaluation. Even if they are found to have a genuine neurosurgical problem, the psychosocial problem should be dealt with first, as additional low back surgery would otherwise fail again. After exclusion of the psychosocial group of patients, a smaller group of patients with back and or leg pain due to mechanical instability or scar tissue remains only those patients with mechanical instability will benefit from additional surgery.
Depending on the trigger of the anemia, the monocyte, lymphocyte, or plasma cell counts are often moderately increased, and megakaryocyte counts are occasionally slightly elevated. The important indicator is iron staining of the bone marrow. The iron pull of the RES leads to intensive iron storage in macrophages, while the red cell precursors are almost iron-free. However, combinations do exist, when a pre-existing iron deficiency means that the iron depositories are empty even in an infectious or toxic process. Moreover, not every secondary anemia is hypochromic. Where there is concomitant alcoholism or vitamin deficiency, secondary anemia may be normochromic or hyperchromic.
Central pontine myelinolysis (CPM) is a demyelinating disorder of the central basis pontis that was first described in malnourished alcoholics by Adams.4 Patients with CPM have a sudden change in mental status, flaccid quadriparesis with hypereflexia, pseudobulbar palsy, and an extensor plantar response unless coma obscures these signs. CPM is associated with the rapid correction or overcorrection of hyponatremia5 and the symptoms appear a few days (ave. 6 days) after overcorrection with a serum sodium rise of at least 20 mmol L. Grossly, victims have a discolored, finely granular demyelinated zone in the central basis pontis with sparing of the tegmentum, ventral pons, and corticospinal tracts (Figure 2.4.1 ).6 Extrapontine myelinolysis has become more recognized.7 The demyelinated area varies from a few millimeters to the entire basis pontis and may be triangular, diamond, or butterfly-shaped. Microscopically, there is demyelination with relative preservation of axon cylinders and...
Alcohol and drug use are well-known risk factors for sexual assault, especially among adolescents (Gidycz, Hanson, & Layman, 1995 Koss & Dinero, 1989 Greene, Navarro, & Gidycz, 1995 Muelenhard & Linton, 1987). In addition, drug and alcohol abuse are highly prevalent among individuals with childhood sexual abuse (Browne & Finkelhor, 1986 Polusny & Follette, 1995). Recent data suggest that alcohol consumption is a risk factor for sexual assault as well as a consequence of childhood abuse. However, it seems that although alcohol consumption is a consequence of childhood sexual abuse, it becomes an independent and additional risk factor for later assault. In a study of navy recruits, Merrill et al. (1999) found that childhood sexual abuse, alcohol problems, and number of sexual partners were distinct and independent predictors of adult rape. Similarly, Messman-Moore and Long (2002) found that childhood sexual abuse, alcohol-related diagnoses, and substance-related diagnoses each predicted...
More recently, other Eastern European studies have investigated the mental health impact of the disaster. Rahu et al. 16 reported that suicide was the leading cause of death among Estonian clean-up workers. However, methods of registration of causes of death among the heavily monitored clean-up workers group differed substantially from those used in the general population, thereby making comparison with the general population risky. Another report suggested that there was an increase in the rates of schizophrenia and dementia in clean-up workers 17 , but this finding has not been verified. More likely, selection bias, non-blind evaluations, confounding variables (especially alcoholism), and other methodological factors explain these implausible findings.
Depression is the most common psychiatric disorder and as such is common among individuals with HIV AIDS. A meta-analysis of studies reported active depression in 9.4 of individuals with HIV AIDS compared with 5.2 in HIV-negative individuals (Ciesla and Roberts, 2001). Individuals with depression are predisposed to greater HIV AIDS risk for several reasons. Higher HIV risk may result from a sense of hopelessness about the future. Additionally, persons with depression may seek to alleviate their symptoms with alcohol and other drugs. Alcohol abuse and dependence are prevalent among persons with depression. For patients with depression, alcohol use is a major source of HIV risk, as patients under the influence of alcohol are more likely to engage in risky sexual behaviors and IVDU because of decreased inhibition (McKinnon et al., 2002). Lack of memory and attention may distract depressed individuals from self-care and risk reduction behaviors. It can also keep patients from being...
There is a strong association between invasive V. vulnificus infections and underlying medical conditions. Underlying predisposing conditions include chronic cirrhosis, hepatitis, thalassemia major and haemachromatosis and there is often a history of alcohol abuse. Less commonly, V. vulnificus infections occur where there are underlying malignancies, gastric disease, including inflammatory bowel disease and achlorhydria, steroid dependency and immunodeficiency. Males are markedly more susceptible than females and account for over 80 of infections (Oliver, 1989).
Treat chronic pancreatitis with alcohol abstinence oral pancreatic enzyme replacement and fatsoluble vitamin supplements
Mallory-Weiss tears are superficial esophageal erosions that may cause a GI bleed. They usually are seen with vomiting and retching (alcoholics and bulimies). Diagnosis and treatment are done endoscopically (sclerose any bleeding vessels). Boerhavc's tears are full-thickness esophageal ruptures if not iatrogenic (from endoscopy), they are usually due to vomiting or retching (alcoholics and bulimics). Diagnose with endoscopy or barium enema, and treat with immediate surgical repair and drainage.
One must also understand that sometimes the classification of manner of death is based on tradition. Thus, if two people are kidding around with a gun and one individual points the gun at another and pulls the trigger, in some localities, this is classified as an accident, in others, as a homicide. An individual walking down the street is hit by an automobile the driver stops. This is an accident. If the driver continues on his way, in a number of jurisdictions, this is classified as a homicide. If one drinks too much alcohol and dies of acute alcohol intoxication, this is an accident. If one drinks too much alcohol every day for 15 years and develops cirrhosis of the liver and chronic liver failure due to the alcohol, then the manner of death is classified as natural.
Significance Argyll Robertson pupil is traditionally ascribed to injury to the central parasympathetic pathway in the periaqueductal area. It is a classical sign of meningovascular syphilis (e.g., neurosyphilis, tabes, and general paresis). It is also occasionally seen in epidemic brain stem encephalitis, alcoholism, pinealomas, and advanced diabetes.
Repeated violent vomiting can produce lacerations of the esophagus, even perforations, at its lower end, where it meets the stomach. These lacerations are usually single in number, longitudinal, and on the lateral or posterior wall. They can range from superficial, involving only the mucosa, to complete lacerations of the wall with perforation. Lacerations of the esophagus in this area are most frequently seen in alcoholics, following prolonged bouts of violent and excessive vomiting (Mallory-Weiss Syndrome). Normally, in vomiting, the pyloric sphincter contracts and the lower and upper esophageal sphincters relax prior to contracture of the gastric musculature. It is postulated that, during violent spasmodic vomiting, if the upper esoph-ageal sphincter fails to relax, the powerful contractions of the gastric musculature, aided by abdominal wall contractions, will propel the gastric contents into the esophagus. There is sufficient violence to cause a rapid rise in intraesophageal...
Nutrition is of great importance in alcoholic liver disease, to the extent that some authors regard ethanol itself as nonhepatotoxic, and that the liver disease associated with chronic ethanol intake is caused purely by inadequate nutrition, in both animal models and human disease.20,21 Most authors now, however, regard ethanol as hepatotoxic and that the degree of hepatotoxicity is modified by nutritional factors.4,22 Not surprisingly for a disease associated with free-radical production, dietary antioxidant intake is of great importance in alcoholic liver disease. Particular interest has been shown in a possible relationship between vitamin E status and alcoholic liver disease. However a-tocopherol status of alcoholics has been variably reported as increased, decreased, or unchanged compared to controls (e.g., 23-25 , 26-28 ). These differences may be due to the degree of liver damage in the studied groups and or whether a-tocopherol levels are normalized to plasma lipid levels....
It is well established that excessive alcohol intake, usually in combination with thiamine deficiency, can cause brain damage. One well-known type of brain damage is the Wernicke-Korsakoff syndrome, in which profound short-term memory impairment occurs. Unlike dementia, this is not a progressive condition but it is irreversible, leaving the sufferer severely impaired even when alcohol consumption ceases. More controversially, alcohol has long been regarded as a cause of dementia, although precise brain pathology has not been established. Epidemiological studies have not demonstrated that alcohol is a risk factor for dementia. Indeed, as demonstrated in the Rotterdam Study, light to moderate drinking (one to three drinks per day) was significantly associated with a lower risk of any dementia, and vascular dementia in particular, in individuals aged 55 years or older. The effect seemed to be unchanged by the source of alcohol.8 However, some studies have suggested that red wine may have...
Lesions of the radial nerve occur most commonly in this region. The lesions are usually due to displaced fractures of the humeral shaft after inebriated sleep, during which the arm is allowed to hang off the bed or bench ( Saturday night palsy ), during general anesthesia, or from callus formation due to an old humeral fracture. There may be a familial history, or underlying diseases such as alcoholism, lead and arsenic poisoning, diabetes mellitus, polyarteritis nodosa, serum sickness, or advanced Parkinsonism.
Similarily, clinical data suggest an additive effect of ethanol and chronic viral hepatitis, the combination of which enhances oxidative cell damage and leads to a more severe liver disease.56 In patients with hepatitis C and hepatocellular carcinoma, a high alcohol intake was related to increased tumor growth.17 Chronic exposition to alcohol alters cell organelle membranes, especially in the endoplasmic reticulum, which may be of relevance for the development of neoplasia.15 In addition, ethanol induces liver enzymes which may be of importance in metabolism of carcinogenic compounds, and ethanol could therefore modulate one or more steps of the carcinogenic process.18
In patients with alcohol dependence or substance dependence (Caetano & Weisner, 1995), the majority of whom use substances simultaneously (Staines, Magura, Foote, Deluca, &Kosanke, 2001). Longitudinal studies in community samples are able to discriminate between simultaneous and concurrent polydrug use, but a differential impact upon subsequent health outcomes including psychological distress, physical symptoms, and services utilization has not been identified (Earleywine & Newcomb, 1997).
Alcohol Consumption Excessive alcohol consumption results in a depletion of liver vitamin A stores (Leo and Lieber, 1985). Depletion is partly due to the reduced consumption of foods. Furthermore, mobilization of vitamin A out of the liver may be increased with excessive alcohol consumption (Lieber and Leo, 1986). Because alcohol intake has been shown to enhance the toxicity of vitamin A (Leo and Lieber, 1999) (see Tolerable Upper Intake Levels ), individuals who consume alcohol may be distinctly susceptible to the adverse effects of vitamin A and any increased intake to meet one's needs should be in the context of maintaining health.
INTRODUCTION Necrotizing fasciitis is an uncommon and severe invasive soft tissue infection characterized by cutaneous gangrene, suppurative fasciitis, and vascular thrombosis. The disease is usually preceded by penetrating trauma in patients that have systemic problems, most commonly diabetes, alcoholism, and immunosupression, but may occur after blepharoplasty or other eyelid surgery. Necrotizing fasciitis represents a synergistic polymicrobial soft tissue infection with the release of endogenous cytokines and bacterial toxins. The disease is most frequently attributed to group A Streptococcus and Staphylococcus aureus. The mortality rate overall is 34 , and for those cases with periorbital involvement it is 12.5 . Death usually results from a fulminant course that may lead to septic shock, respiratory distress syndrome, and renal failure. The average age at time of infection is 57 years, but it may be seen in all age groups.
When considered in community samples, the presence of an SUD diagnosis elevates lifetime risks of additional SUD diagnoses (Regier et al., 1990). This is true with most classes of abused drugs. For example, the risk for a nonalcohol SUD is elevated among both males and females with alcohol dependence. In the National Comorbidity Survey (NCS), more than 40 of individuals with a DSM-III-R alcohol dependence had, excluding nicotine dependence, co-occurring drug abuse or dependence (Kessler et al., 1997). Between 13 and 18 of those with alcohol abuse will also have a co-occurring lifetime drug use disorder (NCS Kessler et al., 1997). Lifetime drug use disorder was also present in 21.5 of subjects (odds ratio OR 7.1) with an alcohol use disorder identified in the Epidemiologic Catchment Area survey (ECA Regier et al., 1990). In addition, among individuals with a nonalcohol substance use disorder in the ECA study, 47.3 also had a lifetime alcohol use disorder. Excluding nicotine
In community samples, 28.6 of individuals with a current alcohol use disorder have at least one personality disorder, and 47.7 of those with a current drug use disorder have at least one personality disorder (Grant et al., 2004). Furthermore, of individuals with at least one personality disorder, 16.4 had a current alcohol use disorder and 6.5 had a current drug use disorder. Personality disorders are associated with poorer treatment outcome for patients with alcohol dependence and those with drug dependence (Helzer & Pryzbeck, 1988 Rounsaville, Dolinsky, Babor, & Meyer, 1987). In various treatment settings, patients with SUDs screened with standard instruments meet criteria for personality disorders, with 57-73 having at least one personality disorder diagnosis, and 35-50 having at least two personality disorder diagnoses (Kleinman et al., 1990 Kranzler, Satel, & Apter, 1994 Marlowe et al., 1995 Rounsaville et al., 1998 Skinstad & Swain, 2001). Personality disorder diagnoses are...
Much of the evidence for the heritability of the general and specific vulnerability for SUD is taken from studies of familial aggregation. Bierut and colleagues (1998) compared siblings of probands with alcohol dependence and those of a control group for the presence of lifetime SUDs. Siblings of alcoholic probands were not only more likely to have a lifetime alcohol use disorder, but they also had an increased risk of cannabis, cocaine, and nicotine dependence. Fifty percent of the alcohol-dependent siblings of alcohol-dependent probands had an additional diagnosis of cannabis and or cocaine dependence. What is compelling with respect to understanding the risk for multiple substance dependence is that the siblings of cannabis-dependent probands had an increased risk of cannabis dependence, siblings of cocaine-dependent probands had an increased risk for cocaine dependence, and siblings of habitual smokers were at higher risk for nicotine dependence (Bierut et al., 1998). In another...
As compared with non-polysubstance-using drug abusers, those with multiple SUDs demonstrate the greatest degree of chronic neuropsychological impairment and recover the least function with long-term abstinence (Beatty et al., 1997 Medina, Shear, Schafer, Armstrong, & Dyer, 2003). This may be due in part to the increased cumulative exposure of the brain to drugs and alcohol Multiple substance users tend to use as much of a particular substance (e.g., alcohol or cocaine) as those who use only alcohol or cocaine (Selby & Azrin, 1998). Selby and Azrin (1998) conducted a comprehensive neuropsychological battery with 355 prison inmates classified by DSM-IV criteria into four groups those with alcohol use disorders, cocaine use disorders, multiple SUDs, and no history of SUD. The multiple SUDs and the alcohol groups demonstrated significant impairment on most measures compared to the cocaine or no-drug groups, but the multiple SUDs group performed worse than the cocaine alone, alcohol alone...
From early embryonic stages of life, genetic influences operate in the context of specific environments. These environments place selective pressures on the embryo and influence development. The most obvious examples for humans come from studies of environmental hazards such as drug use or alcohol consumption during pregnancy. Embryonic exposure to high levels of these substances can lead to mental retardation (Johnson and Leff, 1999). As we will see later in this chapter, embryonic exposure to sex-specific steroids can alter both physical and neural aspects of sexual maturation. In bird embryos, a brief exposure to a mother's call can imprint a preference for that call upon hatching. After hatching, song birds learn to produce the father's song, and vocalization centers in
An additional consideration is that not all patients are similar in terms of insight regarding their SUD, nor are they similarly ready to address it. Thus, patients who are undecided whether or not to address their substance use may do better in a group focused on resolving that issue, as opposed to a group in which all participants are actively engaged in treatment and making lifestyle changes to support sobriety. We know of no studies, however, that have tested this idea empirically. It is possible, for example, that having a mix of patient severity levels in one group allows patients the opportunity to learn from those further along in their recovery. This is a central principle of Alcoholics Anonymous (AA), and appears to have strong anecdotal support. Treatments that focus on particular dual diagnoses (e.g., bipolar SUD patients) also have not been directly compared to more general thematic groups (e.g., dual diagnosis groups that are more general, encompassing a wide variety of...
Lysergic Acid Diethylamide (LSD) is an indolealkylamine discovered by Albert Hoffman of Sandoz Laboratories in 1943.1 It may be synthesized from lysergic acid and diethylamine. Lysergic acid, a naturally occurring ergot alkaloid, is present in grain parasitized by the fungus Claviceps purpurea. A closely related alkaloid, lysergic acid amide, is present in morning glory seeds and the Hawaiian baby wood rose.1 In the 1950s, LSD was used as an aid in the treatment of alcoholism, opioid addiction, pyschoneurosis, and sexual disorders, but currently it is classified under Schedule I of the federal Controlled Substances Act with no accepted medical use in the U.S. It is available illicitly as a powder, tablet, or gelatin capsule, or impregnated in sugar cubes, gelatin squares, blotter paper, or postage stamps.
In non-SPMI populations, integrated treatment models have also been developed for other patient subpopulations with psychiatric disorders and SUDs such as bipolar disorder (Weiss et al., 2000), personality disorders (Ball, 1998 Linehan et al., 2002), and anxiety disorders such as PTSD (Brady, Dansky, Back, Foa, & Carroll, 2001 Najavits, Weiss, Shaw, & Muenz, 1998), obsessive-compulsive disorder (Fals-Stewart &Schafer, 1992), and social phobia (Randall, Thomas, & Thevos, 2001). With the exception of social phobia, for which integrated CBT for social phobia and alcohol use disorders has yielded worse anxiety and drinking outcomes compared to group CBT geared toward alcohol relapse prevention alone (Randall et al., 2001), preliminary evidence suggests that these new treatments are generating some positive results.
Despite the fact that self-help groups are both free of charge and geographically accessible (Kurtz, 1997), many dually diagnosed patients do not attend these meetings (Noordsy, Schwab, Fox, & Drake, 1996). Some clinicians may be reluctant to recommend self-help groups to dually diagnosed patients because of concerns that self-help group members might express negative attitudes toward psychotropic medication (Humphreys, 1997). However, recent research indicates that, while this sometimes occurs (Noordsy et al., 1996), it is not prevalent (Meissen, Powell, Wituk, Girrens, & Arteaga, 1999). Moreover, official AA literature states that psychiatric medication, when legitimately prescribed, is appropriate (Alcoholics Anonymous, 1984). When educating patients about the interaction between psychiatric symptoms, drug and alcohol use, and medications, clinicians should inform patients that while some self-help group members may criticize the use of medications, this contradicts official AA...
During the past decade, the literature regarding when to prescribe pharmacotherapy for dually diagnosed patients has changed considerably. Previous consensus in the field reflected reluctance to prescribe psychotropic medications in these populations. However, this consensus was based on earlier, methodologically flawed studies. For example, older studies examining the use of antidepressants in alcoholics often did not use standardized methods to assess the depressed population, had inadequate dosing or duration of antidepressants, and sometimes measured mood or drinking outcomes, but not both (Ciraulo & Jaffe, 1981). More recent studies have demonstrated that phar-macotherapy can improve outcomes for the psychiatric disorder and sometimes for the SUD as well (Greenfield et al., 1998 Schubiner et al., 2002). Still, it is important also to incorporate psychosocial treatments directed at improving substance use outcomes when treating dually diagnosed patients. The literature on...
Data on liver abnormalities in humans were used to derive a UL. Bccausc clcar toxicity has been demonstrated in numerous studies at doses above 15,000 jig day, only data involving doses less than 30,000 jig day of vitamin A were included in Table 4-9. Data were thoroughly evaluated for other potential causcs of liver abnormalities. The following criteria for selecting the data sets were used (1) data must show grossly elevated liver vitamin A levels or hypertrophy of Ito cclls, (2) no alcoholism, (3) no concomitant liver hepatitis, and (4) no hcpatotoxic drug use. While hepatitis A and B status arc known in most eases, testing for hepatitis C did not begin until the early 1990s and is unknown in most eases. Therefore, hepatitis C was not used as a criterion for exclusion. these studies fail to provide information on other predisposing or confounding factors such as alcohol intake, drugs and medications used, and history of viral hepatitis infection.
To the strong anticholinergic effects. tV2 10 hr. Metabolized in the liver to both active and inactive metabolites. Uses Acute and chronic schizophrenia moderate to marked depression with anxiety sleep disturbances. In children Treatment of hyperactiv-ity in clients and those with retarded and behavior problems. Geriatric clients with organic brain syndrome. Alcohol withdrawal. Intractable pain.
Alcohol withdrawal) Antivert, 7 Apresoline, 12 ARA-C, 10 dihydroergotamine, 17 dihydrotachysterol, 20 Dilantin, 4 Dilaudid, 2 diltiazem, 11 dimenhydrinate, 7 Dimetapp, 8 diphenhydramine, 8 diphenoxylateand atropine, 14 Diphenylhydantoin 14 disopyramide, 11 dipyridamole, 11 disulfiram, 15 (used in alcohol withdrawal) Ditropan, 16
Although pharmacotherapies aimed specifically at decreasing alcohol or drug use (e.g., naltrexone, disulfiram) can be efficacious in improving SUD outcomes in non-dually-diagnosed populations, the literature on the use of these medications in dually diagnosed populations is quite thin. Concerns that disulfiram may cause or exacerbate psychosis (Mueser, Noordsy, Fox, & Wolfe, 2003) have contributed to a reluctance to prescribe it in patients with SPMI (Kingsbury & Salzman, 1990). While there have been no controlled studies of disulfiram in populations with alcohol dependence and SPMI, there have been a few published case reports (Brenner, Karper, & Krystal, 1994) and case series (Kofoed, Kania, Walsh, & Atkinson, 1986 Mueser et al., 2003) describing its tolerability and potential benefit for improving alcohol outcomes and hospital-ization rates for those who remain in treatment. Additionally, there is preliminary evidence that naltrexone may improve drinking outcomes in patients with...
Long-term therapy with benzodiazepines despite alcohol dependence disorder. Am J Addict, J (4), 288-293. Aharonovich, E., Nguyen, H. T., & Nunes, E. V. (2001). Anger and depressive states among treatment-seeking drug abusers Testing the psychopharmacological specificity hypothesis. Am J Addict, J0(4), 327-334. Albanese, M. J., Bartel, R. L., Bruno, R. F., Morgenbesser, M. W., & Schatzberg, A. F. (1994). Comparison of measures used to determine substance abuse in an inpatient psychiatric population. Am J Psychiatry, J5J (7), 1077-1078. Alcoholics Anonymous. (1984). The AA member Medications and other drugs Brochure . New York Alcoholics Anonymous World Services. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC Author. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC Author. Ball, S. A. (1998). Manualized treatment...
A review of the literature revealed that individuals with high alcohol intake, pre-existing liver disease, hyperlipidemia, or severe protein malnutrition may be distinctly susceptible to the adverse effects of excess preformed vitamin A intake (Ellis ct al., 1986 Hathcock ct al., 1990 Leo and Licber, 1999). These individuals may not be protected by the UL for vitamin A for the general population.
Autopsy findings may vary from obvious signs of drug abuse to a negative autopsy. Chronic intravenous drug abusers have easily recognizable needle tracks while chronic alcoholics may have cirrhosis of the liver and bleeding abnormalities. Drugs as a cause of death should be suspected in a negative autopsy in which there is no
However, in Britain, oral cancer incidence in men has steadily declined while cigarette and alcohol consumption has increased. There is a closer relationship with pipe smoking. The high incidence of oral cancer in India is possibly related to different types and forms of tobacco usage. HPV 16 and related strains have been implicated, possibly by triggering mutation of the p53 gene. Squamous cell carcinoma usually develops after age 50 and the incidence increases with age.
Cirrhosis of the liver is one of the most well-known adverse effects of chronic alcohol abuse. The cholesterol-lowering, life-prolonging statin drugs must be monitored routinely for hepatotoxicity and rhabdomyolosis. A Google search on the terms statins, hepatotoxicity, and review produced over 22,000 hits indicating this is a very active field of interest.
In sequential treatment, the more acute condition is treated first, followed by the less acute co-occurring disorder. The same staff may treat both disorders, or the less acute disorder may be treated after transfer to a different program or facility. For example, a manic patient with a cocaine use disorder needs mood stabilization before initiating substance abuse treatment. Conversely, a patient with major depression and alcohol withdrawal delirium is not in a position to discuss treatment adherence to antidepressant medication. Instead, this issue is best addressed when the patient is more stable. Although sequential treatment has the advantage of providing an increased level of attention to the more acute disorder, a typical disadvantage of this model is that patients are often
F., Hofmann, M., DelBoca, F. K., Hesselbrock, V., Meyer, R. E, Dolinsky, Z. S., & Rounsaville, B. (1992). Types of alcoholics I. Evidence for an empirically derived typology based on indicators of vulnerability and severity. Arch Gen Psychiatry, 49, 599-608. Beatty, W. W., Blanco, C. R., Hames, K. A., &Nixon, S. J. (1997). Spatial cognition in alcoholics Influence of concurrent abuse of other drugs. Drug Alcohol Depend, 44, Bondi, M. W., Drake, A. I., & Grant, I. (1998). Verbal learning and memory in alcohol abusers and polysubstance abusers with concurrent alcohol abuse. J Int Neuropsy-chol Soc, 4, 319-328. Brook, D. W., Brook, J. S., Zhang, C., Cohen, P., & Whiteman, M. (2002). Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders. Arch Gen Psychiatry, 59, 1039-1044. Caetano, R., & Weisner, C. (1995). The association between DSM-III-R alcohol dependence, psychological distress and drug use. Addiction, 90, 351-359. Cloninger, C....
If the creative act brings satisfaction and fulfillment, why do creative people often have affective disorders such as depression In addition to having a high prevalence of affective disorders, creative people, especially writers, composer-musicians, and fine artists, have a very high rate of substance abuse, such as alcoholism (Post, 1994, 1996). As I mentioned in the chapter on neurotransmitters (chapter 8), although creative people often go through many trials and tribulations to accomplish creative endeavors, creativity itself probably does not induce affective disorders, but rather the people who are creative probably have some of the anatomic, physiological, or neurotransmitter abnormalities that the midbrain to the nucleus accumbens, and this nucleus is a portion of the ventral striatum, which I describe in more detail later. The ventral striatum and its connections to the limbic system (e.g., amygdala) have been posited to be critical for alcohol addiction. Tupala and...
Modern treatment approaches have their origins in methods developed by Benjamin Rush, a physician from the Revolutionary War era, who is often credited as the father of American psychiatry. Rush developed a categorization of drinkers and alcoholics. He further prescribed treatment that consisted of a period of asylum from responsibilities and from access to alcohol, to take place in a family-like setting, in a milieu of respect, consideration, and social support. As Rush's concepts were extrapolated to the growing American society, large state-supported institutions were developed although some smaller, private asylums or sanitoria for alcoholics have persisted up to the current time (Johnson & Westermeyer, 2000). Medical treatments can interact constructively with cultural factors. For example, taking disulfiram can serve as an excuse for Native American alcoholics to resist peer pressures to drink (Savard, 1968). Ethnic similarity between patients and staff appears to be more...
The sedatives and the hypnotics, especially the benzodiazepines, are widely used in medical practice in the treatment of anxiety, insomnia, epilepsy, and for several other indications (Baldessarini, 2001). The combination of abuse by alcoholics and drug addicts, and the withdrawal symptoms on discontinuation leads to the view that these are addictive drugs (DuPont, 2000 Juergens & Cowley, 2003). The pharmacology and the epidemiology of sedatives and hypnotics are reviewed in this chapter, which focuses on the needs of the clinician.
Data further support a relationship between behavioral and drug addictions For example, high rates of PG and SUDs have been reported during adolescence and young adulthood (Chambers & Potenza, 2003) the telescoping phenomenon (reflecting the rapid rate of progression from initial to problematic behavioral engagement in women as compared with men) initially described for alcoholism has been applied to PG (Potenza et al., 2001) and similar typologies to those defining groups with alcoholism have been proposed for PG (Lesieur, 2000 Potenza, Steinberg, McLaughlin, Rounsaville, & O'Malley, 2000). Emerging biological data, such as those identifying common genetic contributions to alcohol use and gambling disorders (Slutske et al., 2000) and common brain activity changes underlying gambling urges and cocaine cravings (Potenza et al., 2002), provide further support for a shared relationship between PG and SUDs. between gambling and alcohol use disorders (Cunningham-Williams, Cottier, Compton,...
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