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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 here...

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Alcohol Withdrawal DRG cew 434

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

Do You Have a Drinking Problem

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.

Alcohol Abuse and Fetal Alcohol Syndrome FAS

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.

Ethnicity And Alcoholism

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.

National Institute on Alcohol Abuse and Alcoholism NIAAA

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.

Avascular Necrosis in Chronic Alcoholism

Osteonecrosis The Right Femoral Head

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.

Medical Complications Of Alcoholism Gastrointestinal Tract and Pancreas

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...

Addictionsubstance abuse

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.

Electrolyte Abnormalities Sodium

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.

Epidemiology of Spinal Cord Injury Incidence

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.

Risk Factors and Cancer

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.

Genetic Considerations

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...

The Dangers of Alcohol and Other Drugs

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...

Gender Ethnicracial And Life Span Consideration

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.

Primary Nursing Diagnosis

Upon assessment of a pattern of heavy drinking, the patient is often placed on prophylactic benzodiazepines. These medications are particularly important if the patient develops early Although sedation should prevent withdrawal, if withdrawal occurs patients will often require intravenous hydration, with fluid requirements ranging from 4 to 10 L in the first 24 hours. Hypoglycemia is common, and often a 5 dextrose solution in 0.90 or 0.45 saline will be used. Monitor and replace electrolytes as necessary because people with alcohol dependence often have low calcium, magnesium, phosphorous, and potassium.

Safety and Your Health

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...

Discharge And Home Healthcare Guidelines

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.

Alcoholrelated Dementia

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...

Antihypertensive Agents

Minoxidil, oral General Statement The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure classifies BP for adults aged 18 and over as follows Optimal as < 120 < 80 mm Hg, Normal as < 130 < 85 mm Hg, High Normal as 130-139 85-89 mm Hg, Stage 1 Hypertension as 140-159 90-99 mm Hg, Stage 2 Hypertension as 160-179 100-109 mm Hg, and Stage 3 Hypertension as 180 or greater 110 or greater mm Hg. Drug therapy is recommended depending on the BP and whether certain risk factors (e.g., smoking, dyslipidemia, diabetes, age, gender, target organ damage, clinical CV disease) are present. Life-style modification is an important component of treating hypertension, including weight reduction, reduction of sodium intake, regular exercise, cessation of smoking, and moderate alcohol intake.

Cultural and Social Change

The low rates of alcoholism among Asian peoples, who presumably find the reaction aversive and hence drink little although rates are increasing across much of Asia (Ohmori, Koyama, et al., 1986). 2. The high rates of alcoholism among certain Native American groups, who presumably must drink through their flushing reaction to experience other alcohol effects. In addition to religion as a preventive measure, religion has also served as a therapy for psychoactive substance abuse. Native Americans and Latin Americans, plagued with high rates of alcoholism, have joined fundamentalist Christian sects as a means of garnering social support while resisting peer pressures to drink (Mariz, 1991). Many Native Americans have joined the Native American Church, in which peyote is a sacramental substance but alcohol is proscribed (Albaugh & Anderson, 1974).

Serotonin transporter polymorphisms

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.

Patterns of Psychoactive Substance

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 APAP Poisoning

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.

Social And Selfhelp Movements

Abstinence-oriented social movements first appeared among organized religions (Johnson & Westermeyer, 2000). Certain South Asian sects, arising from early Persian religions and Hinduism, abstained from alcohol over two millennia ago. Buddhist clergy were forbidden to drink alcoholic beverages, and pious Buddhist laity were urged to refrain from drinking, or at least to drink moderately. Early on, Moslems were urged not to drink tradition has it that Mohammed himself established abstinence for his followers. Abstinence-oriented Christian sects evolved in England and then in Central Europe at about the time of the gin epidemic. Religiomania has long served as a cure for dipsomania and narcotomania. Opium addicts in Asia have gone to Buddhist monasteries in the hope that worship, meditation, or clerical asceticism would cure them, which it sometimes did (Westermeyer, 1982). Many Latin Americans and Native Americans with high rates of alcoholism have abandoned Catholicism and...

Psychiatric Disorders Related To Trauma And Disaster

Perhaps the best predictors of both the probability and the frequency of post-disaster psychiatric illness are the severity of the traumatic stressor and the degree of exposure. Shore et al. 21,22 found that psychiatric outcome was related to the intensity of disaster exposure following the Mount St. Helens volcanic eruption. They documented higher rates of postdisaster psychiatric illnesses, including PTSD, generalized anxiety disorder, and depression, in those who lived closer to the volcano. Additional evidence for the association of psychiatric illness and severity of the traumatic stressor is seen in the study of war trauma. Higher rates of PTSD, depression and alcohol abuse were significantly related to greater exposure

Trends In Treatment And Prevention

One of these methods was the substitution of one drug for another. For example, laudanum (combined alcohol and opiates) was once prescribed for alcoholism. Morphine, and later heroin, was recommended for opium addiction during the mid-1800s. This approach is not extinct, as exemplified by the frequent recommendation in the 1970s that alcoholics substitute cannabis smoking for alcohol. Currently, methadone is used for chronic opiate addicts who have failed attempts at drug-free treatment. Despite aversive selection factors, methadone maintenance patients tend to do well as long as they comply with treatment. The so-called Minnesota Model of treatment developed from several sources a state hospital program (at Wilmar) and a later private program (at Hazelden), supplemented by the first day program for alcoholism (at the Minneapolis Veterans Administration Hospital). The characteristics of this model have varied over time as treatment has evolved and changed, and definitions still differ...

Preparation for Quitting

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.

Defining Abnormal Behavior

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.

Transient Global Amnesia

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.

Alcohol dehydrogenases

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

Urogenital and Gastrointestinal Tracts

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.

Rates Of Psychiatric Disorders Among People Living With Hiv Infection

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...

Rates Of Hiv Infection Among People With Substance Use Disorders

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...

Olfactory Disturbances Dysosmia

Cirrhosis And Cerebral Edema

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.

Recommendations to Enhance QOL of HNC Patients

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...

Testing Programs in Occupational Settings

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...

Gender Ethnicracial And Life Span Considerations

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.

Personality Disorders

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...

Reliability and Validity of Clinical Diagnosis

In a study of more than 200 adults at risk of AIDS, multiple diagnoses of personality disorder were recorded for most individuals with any DSM-III-R Axis II diagnosis. Almost half of the subjects with a diagnosis in one personality cluster also had a concurrent diagnosis in another cluster (Jacobsberg, Francis, & Perry, 1995). A study of the comorbidity of alcoholism and personality disorders in a clinical population of 366 patients also obtained comparable findings. There was extensive overlap between Axis I disorders and personality disorders, as well as among personality disorders themselves (Morgenstern, Langenbucher, Lubouvie, & Miller, 1997). In another study of 118 gay men conducted to investigate the stability of personality disorder, it was reported that diagnoses of personality disorders had low stability over a 2-year period (Johnson et al., 1997). A study of seventy-eight adult outpatients with attention deficit hyperactive disorder evaluated by standard tests showed...

Pharmacology Of Alcohol

The principal route of metabolism of alcohol is through the ADH pathway, which eliminates approximately one drink (13 g of alcohol) per hour. The major product is the toxic substance acetaldehyde. Acetaldehyde is further broken down to acetic acid via the enzyme aldehyde dehydrogenase (ALDH), and subsequently goes through the citric acid cycle to become carbon dioxide and water. Both ADH and ALDH possess several distinct isoenzymes that may reflect a genetic predisposition to alcoholism. Another pathway for oxidation, the microsomal ethanol-oxidizing system (MEOS), is induced by chronic ingestion of alcohol. An increase in the activity of the MEOS pathway can increase the rate of elimination by 50-70 . The MEOS may be responsible for the increased metabolic tolerance seen in chronic alcoholics for other hypnotic sedative drugs, as well as for alcohol. One action of ethanol is the disruption of the phospholipid molecular chain in the nerve cell membrane. The result is an increased...

Alcohol Induced Persisting Dementia

This disorder develops in approximately 9 of alcoholics (Evert & Oscar-Berman, 1995) and consists of memory impairment combined with aphasia, apraxia, agnosia, and impairment in executive functions, such as planning, organizing, sequencing, and abstracting. These deficits are not part of a delirium and persist beyond intoxication and withdrawal. The dementia is caused by the direct effects of alcohol, as well as by vitamin deficiencies. Models of cognitive impairment in alcoholics include premature aging, which means that alcohol accelerates the aging process, and or that vulnerability to alcohol-induced brain damage is magnified in people over the age of 50 the right-hemisphere model, which is derived from the evidence that nonverbal skills (reading maps, block design tests, etc.) are more profoundly impaired in alcoholics than left-hemisphere tasks (language functions) and the diffuse brain dysfunction model, which proposes that chronic alcoholism leads to widespread brain damage...

Alcohol Induced Sexual Dysfunction

Alcohol consumption has been found to have a negative relationship to physiological arousal in women. Although women state that they felt more aroused, the physical responses tend to be depressed when alcohol is consumed. Inhibition of ovulation, decrease in gonadal mass, and infertility may follow chronic heavy alcohol use. In males, erectile dysfunction may occur transiently with alcohol use, especially at blood alcohol levels above 50 mg 100 ml. Decreased libido, erectile dysfunction, and gonadal atrophy are reported in chronic alcoholics (Adler, 1992). Chronic male alcoholics, even without liver dysfunction, commonly demonstrate primary hypogonadism, as evidenced by decreased sperm count and motility, and altered sperm morphology. Increases in luteinizing hormone and a decrease in the free androgen index were reported in noncirrhotic males and related to lifetime quantity of ethanol intake (Villalta et al., 1977). However, a controlled study of abstinent alcohol males selected for...

Cardiovascular System

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 (< 23 grams day) significantly increased the risk for hypertension in men, independent of age and body mass index. The risk of hypertension was increased for women, but not significantly, when...

TB and Isoniazid INH Epidemiology

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.

Musculoskeletal System

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).

Etiologies of Hypoglycemia

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).

[KLOHnihdeen Pregnancy Category C

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.

Diagnosis of insomnia

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.

Differential Diagnosis

Smokers with psychiatric illness such as schizophrenia, alcoholism, and depression also have an extremely difficult time quitting smoking (Glassman, 1993 American Psychiatric Association, 1996), and for smokers who succeed in quitting, negative affect and stress play a major role in smoking relapse (Shiffman, 1986).

Multivariate Behavior Genetic Studies of Mood and Anxiety Disorder Symptoms

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).

Negotiating Childrens Autonomy

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.

Longterm Health Consequences

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.

Alcohol and Sedatives

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...

San Pedro cactus Echinopsis spp Cactaceae

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.

Treatment And Management Of Substance Use Disorders

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.

Drugdrug Interactions

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).

Pharmacologic Highlights

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.

Disorders of the Stomach and the Duodenum

Almost everyone has experienced indigestion (also known as an upset stomach or dyspepsia). This painful, burning sensation in the upper abdomen is often accompanied by nausea, bloating, belching, and sometimes vomiting. Indigestion is usually a symptom of a digestive disorder, such as an ulcer. However, some people have persistent indigestion that has no identifiable cause this is called functional indigestion or nonulcer indigestion. Smoking, drinking too much alcohol, taking certain medications, or being exhausted or stressed can cause or worsen indigestion. Avoid drinking alcohol, coffee, or tea.

Disorders of the Gallbladder the Pancreas and the Liver

In acute pancreatitis, the pancreas suddenly becomes inflamed and then returns to normal. Most people experience only one attack, but the condition can recur. Acute pancreatitis usually is caused by alcohol abuse or by gallstones. An attack usually lasts about 48 hours and begins with severe pain in the upper abdomen. The pain may appear suddenly and be severe, or it may worsen gradually, especially after eating. The abdomen may be swollen and tender. The pain is often accompanied by nausea, vomiting, fever, and a rapid heart rate. Chronic pancreatitis is more common in men than in women and usually develops after many years of alcohol abuse. Symptoms are usually the same as those of acute pancreatitis, but the attacks become more frequent as the disease progresses. People with chronic pancreatitis experience pain, weight loss (due to malabsorption of nutrients), and diabetes (due to insufficient production of insulin by the pancreas). Blood tests and other procedures such as...

Major Depressive Disorder

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...

Health And Daily Living Form

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.

Precision and validity

The third type of bias is confounding, one of the most important concepts in epidemiology. Confounding can be defined as the combined effect of the factor under investigation and other (confounding) factors. An illustrative example of confounding is the finding that lung cancer is associated with alcohol consumption. However, this finding is caused by the fact that smoking is associated with alcohol consumption, and lung cancer is associated with smoking. In the association between alcohol consumption and lung cancer, smoking is called the confounding factor (the confounder). A factor can only be a confounder if the occurrence of the disease as well as the exposure under investigation is associated with it. There is an essential difference between confounding and information or selection bias. If information on the confounder is collected during the study, it can be adjusted for in the statistical analyses. Sometimes, however, an unknown or not measured confounder is present. Such a...

Secondary Sleep Disorders

Secondary Sleep Disorders

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.

Description Surgical Tracheostomy for Face

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.

Prevention and Optimization

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.

Evaluation of Patient

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.

Dehydrogenases and reductases

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...

Description Surgical Stomach Esophageal

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.

Multiple Lumbar Spine Surgery Failed Back Syndromes

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.

Pharmacological treatments of OSA risk factors and morbidities

Rather than considering OSA as an isolated condition for treatment, it is also important to consider risk aggravating factors such as obesity, alcohol consumption, cigarette smoking and obstructive nasal pathologies. Furthermore, some of the important resultant morbidities of OSA such as hypertension (discussed above) and neurobehavioral dysfunction, particularly manifesting as excessive daytime sleepiness, also warrant early and direct therapeutic approaches. The roles of anti-obesity drugs, alertness-promoting drugs and other drugs are therefore discussed below.

Bone Marrow Cytology in the Diagnosis of Hypochromic Anemias

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.

Alcohol related disorders

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...

Risk Factors Related to Affect Dysregulation

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...

Mental Health Findings Population Studies

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.

Severe Mental Illness And Hiv Risk

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...

Risk factors detection methods and control procedures

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.

Psychiatric Comorbidity And Sequelae

More than one-half of all cocaine abusers meet criteria for a current psychiatric diagnosis and nearly three-fourths for a lifetime psychiatric diagnosis (Ziedonis, Rayford, Bryant, Kendall, & Rounsaville, 1994). The most common comor-bid psychiatric diagnoses among cocaine abusers include alcohol dependence, affective disorders, anxiety disorders, and antisocial personality disorder (Kleinman et al., 1990 Marlowe, Husband, Lamb, & Kirby, 1995 Mirin, Weiss, Griffin, & Michael, 1991 Rounsaville et al., 1991 Weiss, Mirin, Griffin, Gunderson, & Hufford, 1993). For most cocaine users, co-occurring psychiatric disorders (including agoraphobia, alcohol abuse, alcohol dependence, depression, posttraumatic stress disorder (PTSD), simple phobia, and social phobia) precede cocaine use (Abraham & Fava, 1999 Shaffer & Eber, 2002). The most frequent co-occurring substance use disorder is alcoholism 29 of cocaine abusers have a current alcoholism diagnosis, and 62 a lifetime...

Cause Manner and Mechanism of Death

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.

Causes of Horners Syndrome

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.

Gastrointestinal Tract

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...

Importance Of Nutrition In Alcoholic Liver Disease

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....

Prevention of dementia I

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...

Cognitive Behavioral and Nonpharmacological Treatments

Cocaine disorders have proven to be refractory to both psychological and pharmacological treatment. Consequently, considerable energy has been directed toward developing and testing the efficacy of new psychotherapeutic approaches in the treatment of cocaine use disorders. Many of these therapies have been adapted from ones originally developed to treat alcoholism. One approach that has received attention is cognitive-behavioral relapse prevention (Marlatt & Gordon, 1985). Relapse prevention strives to teach the addict how to recognize high-risk situations and deal with these using cognitive strategies that have been well rehearsed. Relapse prevention recognizes that with a chronic disorder such as addiction, relapses and remissions are expected. When a relapse occurs, more intense treatment and cognitive restructuring are necessary to help prevent a slip from escalating. Reminding patients of their prior progress, focusing on making the slip an isolated event, and maximizing the...

Compression within the Spiral Groove of the Humerus

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.

Distinguishing Medical And Nonmedical Use Of Benzodiazepines

Is the substance used to treat a diagnosed medical problem, such as anxiety or insomnia, or is it used to get high (or to treat the complications of nonmedical use of other drugs) Typical medical use of a benzodiazepine or other controlled substance occurs without the use of multiple nonmedical drugs, whereas nonmedical use of the benzodiazepines is usually polydrug abuse. Although alcoholics and drug addicts sometimes use the language of medicine to describe their reasons for using controlled substances nonmedically, self-administration or self-medication of an intoxicating substance outside the ordinary practice boundaries of medical care is a hallmark of drug abuse (DuPont, 1998).

Interaction Between Iron Alcohol And Hepatotropic Viruses

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

Identification Of Problems Among Longterm Benzodiazepine Users

Some critics of benzodiazepines, including Stefan Borg and Curtis Carlson of St. Goran's Hospital in Stockholm, Sweden (Allgulander, Borg, & Vikander, 1984), have expressed concerns about the possibility that benzodiazepine use may lead to alcohol problems in patients without a prior history of alcohol abuse, especially in women. The simple advice to a long-term medical user of a benzodiazepine is not to use alcohol, or to use alcohol only occasionally and never more than one or two drinks in 24 hours. Most anxious patients who do not have a prior history of addiction either do not use alcohol at all or use it only in small amounts. The Benzodiazepine Checklist helps the physician, the patient, and the patient's family identify any problems (including alcohol abuse) at early stages, thus facilitating constructive interventions.

Newer Sedative and Hypnotic Agents

In recent years, a variety of alternatives to the benzodiazepines have become available to treat both anxiety and insomnia. Buspirone (Buspar) has been shown to reduce anxiety in generalized anxiety disorders, but it does not suppress panic attacks, and is not used as a primary treatment of obsessive-compulsive disorder. Buspirone is not abused by alcoholics and drug addicts, and it does not produce withdrawal symptoms on abrupt discontinuation. Like the antidepressants, buspirone requires several weeks of daily dosing to produce antianxiety effects, which are less dramatic from patients' point of view than are the effects produced by the benzodiazepines (Sussman & Stein, 2002). The antidepressants as a class have been shown to possess antipanic and antianxiety effects opening a new range of uses for these medicines in the treatment of anxiety disorders. The selective serotonin reuptake inhibitors (SSRIs) have emerged as the first-line treatment for many anxiety disorders...

Descriptive Approaches

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).

Years1300 jig RAEday of vitamin A

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.

Necrotizing Fasciitis

Severe Necrotizing Cellulitis Picture

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.

Population Based Studies

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

Personality Correlates

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...

Genetic And Family Studies

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...

Neuropsychological Impact Of Multiple Substance Use Disorders

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...

Environmental Determinants Of Behavioral Development

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

Diagnosing Psychiatric Disorders In Patients With Substance Use Disorders

Is independent of substance use or related to intoxication or withdrawal. For example, when examining a patient who has a long history of alcohol dependence and depressive symptoms, it can be difficult to determine whether the depressive symptoms result from the direct pharmacological effects of alcohol, the many losses experienced as a result of the alcohol use, feelings of discouragement about the inability to stop drinking, or an independent mood disorder. Other etiologies, such as metabolic disturbances, head trauma, and personality disorders, must also be considered in the differential diagnosis of depressive symptoms in alcohol-dependent patients (Jaffe & Ciraulo, 1986). Given these considerations, one could ideally establish diagnostic rules to assist in determining whether a psychiatric syndrome is due to substance use or represents a separate and independent disorder. For example, some clinicians may establish a rule that a patient must be abstinent from alcohol and drugs...

Treatment Of Dually Diagnosed Patients A Heterogeneous Population

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

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.

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