Alcohol Treatment

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. Continue reading...

Alcohol Free Forever Summary


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All the modules inside this book are very detailed and explanatory, there is nothing as comprehensive as this guide.

Alcoholism and Movement Disorders

In addition to the classic postural tremor associated with alcohol withdrawal, other movement disorders can occur in the setting of alcohol abuse and withdrawal. y 1 A rare, slow tremor of the lower extremities can also occur in alcoholics and is produced by the synchronous flexion- extension of the muscles of the hip girdle. y.1 This 3-Hz tremor is associated with alcoholic cerebellar degeneration affecting the anterior superior vermis and cerebellar hemispheres. y.61 When they are supine, patients with this form of tremor may reveal a kicking movement when the legs are elevated and the knee and hip joints are flexed 90 degrees. It can be best observed when Transient parkinsonism may rarely appear in the setting of alcohol abuse or withdrawal in patients with no liver dysfunction. 107 , This typically occurs a few days after alcohol cessation and is characterized by bradykinesia, stooped posture, and a coarse resting tremor in the hands. Cogwheel rigidity of the limbs can also be...

Studies of chronic alcohol abusers during detoxification

Blood specimens were collected from alcohol abusers n 32 admitted to the National Alcohol Inpatient Unit at the Royal Bethlum Hospital, Beckenham Kent, UK. Ethical permission for these studies was given by the Bethlum & Maudesley NHS Health Trust Ethical Committee. All patients fulfilled ICD-10 DSM IV criteria for alcohol dependence. A blood specimen was taken at the time of the planned admission for the assay of alcohol levels, biochemical parameters as well as haematological indices. Heparinised blood specimens were taken both at the time of admission and 7 days after detoxification for the analysis of taurine and plasma amino acids. Information on both the maximal daily dose and total dose of chlordiazepoxide administered during the alcohol detoxification stage was also collected. In approximately one third of these patients, n 10, acamprosate, 666 mg x 3 x day was administered during this detoxification period. In these patients the levels of acamprosate in the plasma after 7...

Antabuse Disulfiram And Other Antialcoholism Drugs

Antabuse (disulfiram), a drug used as a supplementary therapy for alcoholism, was originally used in the manufacture of rubber. When the chemical got into the air in one factory and settled on the workers' skin, many developed dermatitis (Schwartz & Tulipan, 1933). If they inhaled the disulfiram, they discovered that they could no longer tolerate alcohol. Beginning in the 1940s, therapists tried using the drug as a therapy for alcoholism, on the theory that alcoholics would learn to avoid alcohol because of its now unpleasant aftereffects. converted to acetate. Symptoms of acetaldehyde accumulation include flushing of the face, increased heart rate, nausea and vomiting, headache, abdominal pain, and labored breathing. People using Antabuse are advised to take a 200 to 500 mg pill daily and warned that drinking alcohol within a day or two after taking a pill can cause severe illness. They need to avoid even using shampoos containing alcohol, because of the danger of skin rashes....

Alcohol Consumption

It is well known that consumption of alcohol is associated with increased risk for essential hypertension, even though light drinking has been shown to be associated with reduced risk for coronary heart disease (Thun et al., 1997). In general, the most recent data suggest that the relation between alcohol consumption and blood pressure is a linear one, with increased alcohol consumption associated with increases in blood pressure (Puddey et al., 1997), although some earlier reports positing a J-shaped relation have been cited, in which slight increases in incidence of high blood pressure occur with total abstinence (Shaper, Wannamethee, and Whincup, 1988). Reductions in alcohol intake are typically associated with reductions in blood pressure within a week or two (Puddey et al., 1997). Given that alcohol consumption is associated with higher blood pressures, what is the relation between alcohol consumption and acute physiological responses to environmental stress There is evidence...

Disorders of the Back

Is the most expensive cause of work-related disability.8 Risk factors for the development of low back pain include heavy lifting and twisting, bodily vibration, obesity, and poor conditioning however, low back pain is common even among patients without these risk factors.1 In cases of more severe back pain, occupational exposures are much more significant, including repetitive heavy lifting, pulling, or pushing, and exposures to industrial and vehicular vibrations. If even temporary work loss occurs, additional important risk factors include job dissatisfaction, supervisor ratings, and job environment (i.e., boring, repetitive tasks).1 Factors associated with recurrence of low back pain include traumatic origin of first attack, sciatic pain, radiographic changes, alcohol abuse, specific job situations, and psychosocial stigmata.

Affective Disorder Syndromes

Major depression has a lifetime prevalence of about 15 percent and is about 15 times as common as bipolar disorder (manic-depressive disorder). Major depression is about twice as common in women as in men in all countries and cultures and does not vary in occurrence among different races. It may occur at any age, but the majority of cases occur in adulthood. Studies suggest a genetic predisposition because there is an increased incidence of major depression and alcoholism in relatives of patients with this mood disorder. The diagnosis of depression is often overlooked, especially in patients with chronic neurological disease. The Diagnostic and Statistical Manual, 4th edition (DSM-IV) criteria for this diagnosis requires either that the patient have a depressed mood or that the patient have a sustained loss of interest and pleasure. Some depressed patients have a depressed affect or become withdrawn or irritable but do not admit to or complain of feelings of sadness. Almost all,...

Host Risk Factors For Severity Of Illness

Host factors related to underlying diseases and enhanced oxidative stress also appear to determine severity of rickettsioses. Patients with diabetes mellitus have an increased risk of a fatal outcome with Mediterranean spotted fever. Anecdotal descriptions suggest that alcohol abuse and cardiovascular disease may be risk factors for severity of rickettsial illness.

Alcohol And Depression

Although there is considerable epidemiological and neurobiological evidence linking alcohol use and depression, the exact nature of this relationship has yet to be elucidated and may vary between patients. In their review of the substance abuse and depression literature, Swendsen and Merikangas (11) proposed that multiple causal factors and mechanisms probably underlie the association of alcoholism and depression. Neurobiological similarities have been postulated as one of these mechanisms. For example, monoamine, cholinergic, and other neurotransmitter systems have been implicated in both disorders (12,13). The relationship between depression and both acute alcohol-related states (such as intoxication and withdrawal) and chronic use problems (such as abuse, protracted withdrawal, and chemical dependence) has been studied. All of these alcohol-related conditions have been shown to be associated with dysphoric mood states, but the mechanism of mood depression is not well understood and...

Genetic Family Studies

There is an increased rate of somatization disorder in first-degree female relatives of patients with somatization disorder, indicating familial aggregation of the disorder (Guze and Cloninger 1986). Family studies have linked somatization disorder to antisocial personality disorder (Cloninger et al. 1975 Coryell 1980) first-degree male relatives of patients with somatization disorder have elevated rates of both antisocial personality and alcoholism. Cloninger et al. (1975) used an alternative method to assess the association between antisocial personality disorder and somati-zation disorder by examining first-degree relatives of male felons. This study found an increased rate of somatization disorder in female relatives. The investigators suggested that sociopathy and somatization may have a common etiology. Further strengthening these findings, a study of adopted children whose biologic parents had antisocial behaviors revealed a higher-than-expected rate of hysteria or other...

Interaction Transactional Theories and Research

Although some theoretical perspectives have focused on stress as a stimulus and others have focused on stress as a response, most modern conceptualizations of stress can be considered interactive or transac-tional in nature. Transactional theories incorporate the importance of both stressors and stress responses in explaining the linkage between stress and illness or disease. Additionally, transactional theories of stress suggest that stress responses can serve as new stressors that elicit more intense stress responses. For example, if an individual responds to interpersonal conflict (a stressor) by drinking alcohol and smoking cigarettes (an acute behavioral stress response), these behavioral responses may become new stressors that warrant additional stress responses. Thus transactional theories of stress incorporate components of stress stimuli and responses that operate upon one another in a cyclic fash

Associated Neurological Findings

Attention to ataxia, apraxia for orolingual movements, oculomotor abnormalities, coordination problems, gait disturbances, tremor, bradykinesia, and rigidity is critical, since alterations in the ability to smell are present in some patients with Huntington's chorea and multiple sclerosis, and in approximately 90 percent of patients with early-stage Parkinson's disease. In Korsakoff's syndrome, ataxia of the trunk but not of the limbs is frequently present, as are signs of acute alcohol withdrawal (e.g., tremor, delirium, and tachycardia).

Deficiency Of Thiamin

Thiamin deficiency occurs among individuals who consume inadequate intakes of thiamin. It is more common in developing and undeveloped countries, and in the regions where rice is the staple food item.144 Also, breastfed infants of low socio-economic families,46 alcoholics,3647 and total parental nutrition patients may present with thiamin deficiency.48,49

Wernicke Korsakoff Syndrome

Wernicke-Korsakoff syndrome, or Wernicke's encephalopathy, the acute thiamin-deficient disease that occurs most often in Western developed countries, is linked to alcoholism.39,56 Patients with alcoholism, HIV-AIDS and malabsorption disorders are at a greater risk of acquiring Wernicke-Korsakoff syndrome. However, patients with alcoholism will likely develop Wernicke's encephal-opathy more often than the others for several reasons, including insufficient diet intake of thiamin,57 increased metabolic demands of thiamin due to increased alcohol consumption and the fact that alcoholism induces malabsorption of thiamin and consequently inhibits thiamin-dependent enzymes.39,58 Wernicke-Korsakoff syndrome symptoms are similar to those of wet beriberi, being characterized by defects in motor, sensory and cognitive systems.36 59 Moreover, with progression of Wernicke-Korsakoff syndrome, psychosis may develop, with coma occurring in severe cases.

Alcohol Induced Persisting Amnesiic Disorder Korsakoffs Syndrome

Amnesia, especially anterograde amnesia, or memory loss for recent events, is an intriguing but serious disorder. When amnesia occurs as a consequence of long-term alcoholism, it is referred to as alcoholic Korsakoff's syndrome. Patients with Korsakoff's syndrome are permanently unable to remember new information for more than a few seconds. However, memories that were formed prior to the onset of alcohol-related brain damage are relatively well preserved. Because new events are forgotten a few seconds after they occur, virtually nothing new is learned, and the patient with Korsakoff's syndrome lives in the past. Although anterograde amnesia is the most obvious presenting symptom in Korsakoff patients, these individuals have other cognitive impairments as well. Like patients with bilateral prefrontal cortical lesions, Korsakoff patients are abnormally sensitive to distractions (proactive interference). This sensitivity may be due to alcoholism-related prefrontal dysfunction, which...

Substanceinduced Psychotic Disorders That Must Be Excluded Prior To Diagnosing Schizophrenia

Transient hallucinations and delusions have been reported to occur in alcohol abuse and dependence. Victor and Hope (26) found that, in a series of 76 patients with a diagnosis of alcohol dependence, 15 patients had onset of hallucinations while still drinking. In the 51 patients for whom the time of the last drink could be determined, 32 (60 ) had onset of hallucinations within 12 to 48 hours of the last drink. In the 75 patients for whom the duration of hallucinations could be determined, 64 (85 ) had a duration of hallucinations of 6 days or less. Only eight of 75 (11 ) had a duration of hallucinations of 6 weeks. In a family study of persons with a diagnosis of alcohol abuse dependence, Schuckit and Winokur (27) found no increase in the incidence of schizophrenia in the relatives of the patients with alcohol abuse dependence with hallucinosis. These patients were also no more likely than other patients with alcohol abuse dependence to have a history of schizophrenia. Based on...

Other actions and sideeffects

5 Restless legs syndrome and periodic limb movements in sleep. The effect of alcohol has not been studied in detail, but while the sedative effect of acute alcohol intake may prevent arousals from periodic limb movements, chronic alcohol ingestion appears to worsen this condition. This may be due to nutritional deficiencies, particularly iron, or to the development of an alcoholic peripheral neuropathy, or to more direct effects of alcohol on the neurological systems responsible for leg movements during sleep. 6 NREM sleep motor abnormalities. These disorders, including sleep walking, are commonly triggered by acute alcohol consumption, probably because of enhancement of stages 3 and 4 NREM sleep or because of an abnormality in the mode of arousal from them.

Chronology Of Bipolar Disorder And Sud Comorbidity

Age of onset of their bipolar disorder (28 years) than did nonalcoholic bipolar patients (23 years). Winokur et al. (30) observed that the alcoholic bipolar patient does not differ from the nonalcoholic bipolar patient in clinical course. In fact, they found that the patients in whom alcoholism preceded the bipolar illness were less likely to relapse than patients whose bipolar illness preceded the alcoholism. Feinman and Dunner (32), in a retrospective chart review of 188 bipolar patients, also did not find that SUD preceded bipolar disorder. They found that the complicated group compared to the two other groups had the earliest age of onset of symptoms at 13.3 years. In addition, compared to the other two groups they had the highest percentage of suicide attempts. More recently, Strakowski and colleagues (31), examining the associations of antecedent drug and alcohol abuse with the age of onset of bipolar disorder, studied a sample of 59 patients presenting with their first episode...

Course Of Bipolar Disorder With

Who had bipolar disorder with associated alcoholism had an increased likelihood of rapid cycling and a slower time to recovery from affective episodes. They found that 13 of 67 patients with mixed mania or rapid-cycling disorder (both forms of bipolar illness are less likely to respond to treatment) had concurrent alcohol use disorder, and that these patients recovered more slowly than those with pure mania or pure depression. Tohen et al. (46), in a 4-year prospective follow-up study of 75 patients who recovered from an index manic episode, reported that a history of alcoholism was a predictor of poor outcome for the bipolar disorder. They found that the presence of SUDs was strongly associated with a shorter time to relapse and poor psychosocial outcome. In addition, in a sample of firstepisode patients (9), the median time to recovery was shorter for persons without drug abuse than those with comorbid drug abuse (43 days vs. 55 days, respectively p 0.045). The presence of comorbid...

Wine Alcohol and the Heart

Physicians have generally been reluctant to say anything about the health benefits of alcohol. After all, doctors treat patients suffering the effects of alcohol misuse from drunk driving to spousal abuse to cirrhosis of the liver. They are naturally worried that the public will interpret the message a little alcohol is good for your health as an excuse to drink more heavily. Yet there is now a huge amount of scientific data showing that the moderate consumption of alcohol is a powerful preventative factor in heart disease. Likewise, increasing evidence suggests that balanced information on the effects of alcohol consumption may not always lead to increased abuse. What is the basis for the claim that moderate alcohol consumption may have health benefits

Far Distal Peripheral Lesions

Isolated lesions of either the glossopharyngeal or vagus nerves are unusual. As noted earlier, glossopharyngeal nerve abnormalities may be clinically undetectable unless adjacent structures are also involved. Perhaps the most common vagus nerve lesion is that involving the recurrent laryngeal nerve, resulting in ipsilateral vocal cord paresis and hoarseness of voice. The left nerve has a longer course, with its looped recurrence in the chest rather than in the neck, as on the right. The nerve passes around the aorta before returning rostrally to the larynx. The left recurrent laryngeal nerve may be compromised by an expanding aortic arch aneurysm or other intrathoracic processes, such as enlargement of the left atrium of the heart, pulmonary neoplasm, or mediastinal adenopathy. Both right and left superior or recurrent laryngeal nerves may be injured during the course of neck surgery such as thyroidectomy. Vocal cord paralysis has been described with vagal neuropathy attributed to...

Systemic Lupus Erythematosus

Vitamin B12 deficiency can present with psychosis, dementia, mood disorder, and personality changes. Neuropsychiatric impairment is estimated to occur in about 40 of these patients, with about 16 having overt symptoms of psychosis (7). Delusions of persecution, uncharacteristic aggression, mood instability, and delirium are some of the commonly reported symptoms. This condition can also be commonly seen in alcoholics (21). Megaloblastic anemia is a common feature of this condition and can aid in the diagnosis. However, there are also case reports of neuropsychiatric symptoms secondary to vitamin B12 in the absence of megaloblastic anemia (22).

How Does Alcohol Reduce the Risk of Heart Disease

New studies are beginning to show that moderate to light alcohol consumption (one drink a day, six days a week) may have a protective effect on the heart. This explains why some wine-consuming European countries experience relatively lower rates of coronary artery disease despite high-fat diets.

HT in Addictive Behaviors

In view of these contradictory actions on dopaminergic reward pathways, it is not surprising that the part played by 5-HT in addictive behaviors is uncertain. However, there is some evidence for decreased serotonergic activity in alcoholics,51 bulimics52 and possibly in opiate and CNS stimulant abusers, although this may be related to depression. It has been suggested that 5-HT deficiency may underlie drug-seeking behavior,51 that it is involved in craving53 and that brain serotonergic activity contributes to satiety47,52 and modulates the reinforcing effect or 'high' produced by other drugs of addiction.54 Trials with drugs that increase serotonergic activity, especially SSRIs, are described below, but it should be noted that these constitute only one of several pharmacological approaches to the treatment of drug addiction. It may be that the combined use of other drugs such as naltrexone, acamprosate,55 clonidine, lofexidine and others56 is more effective in some cases.

Will Drinking Make One Live Longer

It depends on how much alcohol is consumed. We know that heavy alcohol consumption or inappropriate alcohol use is very harmful to the individual doing the drinking, those around him or her, and society. But are moderate and responsible drinkers likely to live longer than they would if they did not drink alcoholic beverages The bottom line for epidemiologists is total mortality. We know that, in most prospective studies, the consumption of one or two drinks a day lowers the death rate. We recently had a report from a very large survey (almost fifty thousand people) done by the American Cancer Society on the risk of dying according to alcohol consumption. Total mortality decreased by 21 percent for men and women who reported that they averaged one or two drinks per day compared with that of nondrinkers.

Alcohol Animal Studies

Several SSRIs including zimelidine, norzimelidine and fluoxetine have been shown to decrease alcohol consumption in alcohol-trained rats in a free-choice environment.57-59 This effect could occur without significant effects on body weight, total fluid intake or intake of sucrose solution.58 Drugs with major effects on noradrenaline reuptake (amitriptyline, desipramine, doxepin) did not affect alcohol consumption.57 Similarly, in rats specially bred for alcohol preference, fluoxetine inhibited intragastric self-administration of alcohol. Treatment with the 5-HT precursor, 5-hydroxytryptophan,51,60,61 and with 5-HT-releasing agents such as d-fenfluramine51 likewise reduced alcohol consumption. The magnitude of these effects varied between different studies but, with SSRIs, was generally of the order of 40-50 reduction, both in alcohol preference over water and in total alcohol consumption.51 In all these investigations the effects of SSRIs were immediate, occurring on the first day of...

Substance Abuse and Personality Disorders in the General Population

A high degree of co-occurrence between personality disorders and substance abuse is seen in the general population, particularly with regard to antisocial personality disorder (ASPD) and alcoholism. In the Epidemiologic Catchment Area survey, the co-occurrence of alcoholism with other psychiatric conditions was examined among five community samples of approximately 20,000 people (4). Psychiatric disorders studied included the Axis I disorders of mania, schizophrenia, somatization, anorexia, affective disorders, and anxiety disorders and the Axis II disorder ASPD. Of all the psychiatric diagnoses investigated, the highest comorbidity rate observed was between alcoholism and ASPD. In the general population, male alcoholics were four times more likely to have a diagnosis of ASPD than nonalcoholics, and female alcoholics were 12 times more likely to be diagnosed with ASPD then nonalcoholic females. In 1997, Kessler and colleagues (5) examined the lifetime co-occurrence of alcohol use...

Substance Abuse and Personality Disorders Among Treatment Populations

In an inpatient substance abuse treatment population, Nace and colleagues (9) found that 57 of substance abusers had an Axis II personality disorder. ASPD was the most frequently diagnosed personality disorder in this sample. When a sample of cocaine-dependent inpatients was studied, 70 of patients met criteria for at least one personality disorder (10). Comorbidity rates were highest for borderline personality disorder (BPD) (34 ), followed by ASPD (28 ) and narcissistic personality disorder (28 ). In outpatient substance abuse patients, the prevalence rate of personality disorders was at least 60 in alcoholics (13,14) and 48 in cocaine addicts (15). Some studies have attempted to deal with the problem of overlapping criteria when making personality disorder diagnoses by employing diagnostic rules that exclude behaviors that occur in combination with substance use. Even when such conservative assessment methods are employed, however, high rates of these particular personality...

Impact Of Personality Disorders On The Course Of Substance Abuse

A multitude of studies have demonstrated that ASPD is associated with an earlier age of onset for alcohol use and dependence (7,27-29) and for cocaine use and dependence (17). Severity of drug dependence is also affected by the coexistence of a personality disorder. Alcoholics with ASPD, for example, exhibit a higher alcohol symptom count and longer duration of alcoholism (4). A distinct pattern of alcohol use characterized by compulsive use, drinking to manage moods and enhance functioning, and pervasive use of alcohol in one's life is seen among alcoholics with personality disorders as compared with those without personality disorders (9). BPD was the largest personality disorder group represented in this study hence, this particular pattern of alcohol use may pertain more to BPD than other personality disorders. Polydrug use, another indicator of severity, is also more likely among substance abusers with a personality disturbance. For example, alcohol-dependent patients with BPD...

Historical Background

Suggested adverse effects of maternal drinking appeared in seventeenth-century England, and several observers reported that mothers who drank heavily during the early eighteenth-century gin epidemic had children who were small, sickly, and mentally slow. In the nineteenth-century, reports linked stillbirth, infant mortality, and mental retardation to maternal drinking during pregnancy. However, claims of ancient descriptions of damaging effects of maternal alcohol consumption appear to be erroneous (Abel, 1984).

Incidence and Risk Factors

Full FAS apparently occurs only with heavy maternal drinking, and incidence and degree of FAE ARND increases with amount of prenatal maternal alcohol consumption (e.g., Abel, 1998). Animal experiments confirm that the damage is from prenatal alcohol and not secondary to another factor (e.g., Abel, 1998 Sampson et al., 1997). Although some (e.g., Abel, 1998) claim that prenatal alcohol exposure has a threshold effect, considerable research suggests that many effects show a continuous dose-response relationship (e.g., Sampson et al., 1997). Indeed, alcohol-exposed children without characteristic FAS features show significant deficits in IQ relative to normal children (Matt-son & Riley, 1998). FAS occurs much more commonly in offspring of mothers of lower socioeconomic status (SES) even after equating alcohol intake in different SES women (Abel & Hannigan, 1995). Binge drinking is a particularly high risk factor other factors include minority ethnic status, smoking, maternal age,...

Effects of Axis II Diagnosis on Treatment Outcome

The common assumption that personality disorders have a negative impact on treatment outcome has been supported in the literature, although not consistently. Multiple studies have demonstrated that alcoholics and opiate addicts with an additional diagnosis of a personality disorder are more likely to have a negative response to substance abuse treatment (13,33,36,37). Axis II diagnoses from Cluster B (ASPD, BPD, histrionic personality disorder), in particular, have been identified as risk factors that predict the poorest overall treatment response (16). Additionally, substance abusers with personality disorders are more likely to drop out of treatment prematurely those with ASPD have the highest attrition rates (16). The negative outcomes associated with ASPD have been emphasized in several studies (31,32). The work of Longabaugh and colleagues (39) suggests that pessimistic generalizations of negative outcomes for ASPD substance abusers may be due to a failure to account for the...

Multiple sleep latency tests MSLTs

These should be carried out after a period of withdrawal from drugs such as amphetamines and anticat-aplectic agents, which may affect the results. MSLTs are not suitable for children under the age of around 6 years. They show a short sleep latency with a mean of less than 5 min in 80 of narcoleptics. Sleep-onset REM sleep in two or more of the four or five MSLTs is present in over 75 of narcoleptics, but may also be seen in depression, REM sleep deprivation due to sleep restriction or fragmentation due, for instance, to obstructive sleep apnoeas, and in REM suppressant drug and alcohol withdrawal.

Problems Associated with Excessive Gambling

Problem gamblers are more likely to suffer from depression or alcohol problems. They report greater rates of psychological distress and more use of psychiatric treatment. Problem gamblers often experience serious relationship difficulties. Spouses and family members must cope with the consequences of the gambler's behavior, including absence from the home, distrust of the gambler, and stress over family finances. Among problem gamblers, divorce rates are higher than the national average.

Treatment of Problem Gambling

It is likely that future treatment strategies for problem gambling will build on contemporary models that have been developed in the alcohol treatment field or models that are specific to problem gambling. For example, brief, motivationally based treatment programs, which have received empirical support as effective alternatives to traditional abstinence-based interventions for alcohol problems, are now being adapted and tested to help problem gamblers.

Confounding and Causation

In multiple regression, it might arise that as well as being associated with the response, two predictor variables are associated with each other. If this happens, the coefficient for one of the variables can be distorted by the absence of the other variable in the model, and vice versa. Statisticians and epidemiologists call this confounding, and it typically occurs when two predictors that are strongly related, such as smoking and alcohol consumption, are both of interest in a model. At its worst, confounding can lead to completely spurious results. For example, high water consumption is associated with low blood pressure. Water consumption is higher in people who exercise frequently, and people who exercise frequently have lower blood pressure, while water consumption, after taking into account exercise frequency, has little or no effect on blood pressure. We say that the relationship between water consumption and blood pressure is confounded by exercise level.

Imaging of Other Neurotransmitter Systems

Similarly, a SPECT investigation also found decreased binding of 123I iomazenil to GABAa receptors in the anterior cingulate gyrus, frontal lobe, and cerebellum of alcoholic patients. However, based on these findings alone it is not possible to discern whether the described reduction in GABAa receptors represents a preexisting susceptibility factor or the result of chronic alcohol abuse. Gilman S, Adams KM, Johnson-Greene D, et al. (1996). Effects of disulfiram on positron emission tomography and neuropsychological studies in severe chronic alcoholism. Alcohol Clin Exp Res 20 1456-1461.

Relationships with Substance Use Disorders

The Pittsburgh Adolescent Alcohol Research Center (PAARC) is a longitudinal study which compares adolescents with alcohol abuse or dependence with community control adolescents. In a comparison of adolescents with alcohol dependence and community controls from PAARC (34) (Table 2), those with alcohol dependence had increased odds over community controls for CD (adjusted odds ratio 7.1) and ODD (adjusted odds ratio 2.0). The association between CD and adolescent SUD was stronger than for any other comorbid mental disorder, a finding consistent with other studies.

Psychological disturbances

2 Irritability and mood disturbance including anxiety and depression. Anxiety and depression are present in more than 50 of those with chronic insomnia and may be either a cause or a result of the insomnia. A vicious cycle of insomnia and worsening anxiety and depression often develops. If insomnia persists despite treatment of depression or alcoholism or following cessation of antipsychotic drugs and schizophrenia, it is more likely that the underlying psychiatric disorder will relapse.

The actuarial survival statistics have in general been estimated from published graphs and may not be entirely precise

Data because postshunt survival has been shown by some investigators to be lower among patients with alcoholic liver disease. Furthermore, the effect of continued alcoholism on survival was not assessed in any investigation. Only one study (BILG) categorized patients with regard to the severity of their liver disease before randomization, and a single study (LA) excluded patients with active liver cell necrosis, which is known to increase the risk of a portacaval shunt. Finally, among all four studies, almost one third of the medical control patients ultimately required a portacaval shunt. This fact presents a statistical enigma in determining the value of shunt surgery.

Gender Similarities and Differences

Two studies that examined gender-related aspects of BDD found that the clinical features of the disorder appear to be similar in men and women. One of these studies (N 188) found, however, that women were more likely than men to focus on their hips and weight, camouflage with makeup and pick their skin, and have comorbid bulimia nervosa (Phillips and Diaz 1997). In addition, the study found that men were more likely to be unmarried be preoccupied with body build, genitals, and hair thinning use a hat for camouflage and have alcohol abuse or dependence. In the other study (N 58), women were more likely to focus on their breasts and legs, check mirrors and camouflage, and have bulimia, panic disorder, and generalized anxiety disorder men were more likely to focus on their genitals, height, and excessive body hair, and have bipolar disorder (Perugi et al. 1997a).

Prevention Of Sideeffects

It is possible to prevent the peripheral neuropathy caused by isoniazid. This neuropathy usually shows as a burning sensation of the feet. It occurs more commonly in HIV-positive individuals and in people who drink alcohol. These patients should receive preventive treatment with pyridoxine 10 mg daily. Ideally, where possible, pyridoxine 10 mg daily should routinely accompany isoniazid.

Characteristics of the study population

From the overall cohort of 418 children, 209 were breast-fed and 209 were formula-fed during infancy. A total of 207 subjects were living in Rotterdam, and 21 1 in Groningen. In Groningen, the educational level achievedby both the mothers and their partners was higher than in Rotterdam, as was the maternal alcohol consumption during pregnancy. Duration of gestation, based on reported last menstrual period, was also significantly different, but the difference was considered to be too small to have any biological significance. Mean birth weight was slightly higher in Groningen (3.56 0.44vs. 3.47 0.44kg). Baseline characteristics ofthe study group as a whole and that ofthe breast and formula feeding group at birth are given in Tables 1 and2. Alcohol consumption during pregnancy*

Suicidal thoughts after acute stroke

Our first investigation of patients with suicidal thoughts evaluated 301 patients with acute stroke in whom we had systematically asked them about the existence of suicidal thoughts or plans (Kishi et al. 1996a). Using the present state examination (PSE), a total of 20 patients (6.6 ) reported that they had deliberately considered suicide and that these death wishes were not simply passive death wishes or fleeting thoughts (Fig. 19.1). Background comparisons of the 20 patients who had suicidal intentions and the 281 patients without suicidal intentions are shown in Table 19.1. The suicidal patients were significantly younger than non-suicidal patients (p 0.03). In addition, the patients with suicidal thoughts had a greater frequency of alcohol abuse than non-suicidal patients (p 0.03). The suicidal patients also had a Psychiatric disorder (excluding alcohol abuse) Alcohol abuse Prior psychiatric disorder (excluding alcohol abuse) Alcohol abuse age, prior stroke, and alcohol abuse were...

Benefit of Alcohol in Cardiovascular Disease

Leger (6) looked at a number of different factors with the potential to influence risk of cardiovascular disease. The most significant finding was a strong negative association between deaths due to cardiovascular disease and alcohol consumption St. Leger and his coauthors felt that this effect was attributable entirely to the drinking of wine. Kozararevic et al. (7), in a cohort of 11,121 men, found that alcohol consumption was inversely related to risk of death from coronary artery disease, but increased the risk of trauma and stroke in Yugoslav men aged 35-62. Their 1980 study used a complex system of estimating alcohol intake, as they were trying to equalize a number of kinds of beverages with different alcohol contents. Briefly, they found that the death rate due to heart disease among those who consumed two or more drinks per day was about half that of infrequent drinkers (less than once per week). Most recent studies have continued to support the hypothesis that...

Prevention and Treatment

Nonpharmacological therapy for prevention and treatment of osteoporosis includes adequate dietary intake of calcium and vitamin D, weight-bearing exercise, fall precautions, no smoking, and avoidance of excessive alcohol intake. These steps should be started early in life and continued through menopause because BMD peaks at about age 35 and then begins to decline with accelerated bone loss after menopause.

Explanatory Frameworks and Risk Factors

Several explanatory frameworks have been developed to describe the causes of partner abuse. Feminist accounts identify partner abuse as a product of a patriarchal (maledominated) society. Violence in the home is viewed as one of many expressions of gender-based power inequality in society (Yllo, 1993). Psychological accounts identify partner abuse, particularly severe partner abuse, as a manifestation of the interaction between individual personality traits or personality disorders and other risk factors such as marital dissatisfaction (O'Leary, 1993). Sociological accounts identify position in the social structure as an important causal factor in partner abuse. Substantial research linking variables associated with position in the social structure, such as poverty, age, and race, to partner abuse provides support for this explanatory framework (Gelles, 1993). Numerous other social, psychological, and biological factors, such as anger, depression, witnessing violence as a child,...

See also Peer Group Therapy Peer Influences

Rigorous honesty about personal responsibility for actions done, admission of past wrongs to a member of the group or the group itself, readiness to give up old ways of behaving, the making of amends to people who have been harmed, the turning over of one's will and life to the care of some higher power, and assistance to others as a means of helping the member stay sober. Peer group therapy is also practiced in groups such as Synanon, Daytop, and other communities set up to free people of drug use and to provide continuous living support thereafter. They are structured around an environment of deep love and concern but have a highly confrontative atmosphere with a constant demand for rigorous honesty in every aspect of the ex-addicts' daily lives. Communal living and constant confrontation seem to be required for addicts, whereas alcoholics do not find this necessary.

Clinical features

Nocturnal epilepsy may be difficult to distinguish from other movement disorders during sleep, but the episodes are more stereotyped. Innate patterns of motor behaviour may emerge, such as uttering non-intelligible noises, walking and grasping movements. The pattern depends on the site of the epileptic focus and the regions to which it spreads. Tonic posturing early in the episode is characteristic of epilepsy, and nocturnal choking in children is often due to epilepsy rather than gastro-oesophageal reflux. Seizures may be precipitated by sleep deprivation, stress and alcohol withdrawal.

Other things that can reduce the risk of infection with HIV or other STDs are Do not share needles or works

The safest thing a person can do is to not inject (non-prescription) drugs. For people who do continue to inject drugs, use a new, sterile needle from a reliable source each time. HIV and other viruses can be spread whenever needles are contaminated with blood - even small quantities of blood which may not be visible to the naked eye. This is true of all needles - including needles used for steroids, tattooing or body piercing. If sterile needles cannot be used, disinfect needles and syringes before and after each use. Stay sober Use of drugs or alcohol can affect sexual behavior because of reduced inhibitions and clouded judgment. Stay in control - stay sober.

Comorbid Neurobiology

Although it would appear logical that schizophrenics with substance abuse or dependence have significantly more neuropathology than schizophrenics without, this has been difficult to show objectively. Sullivan and coworkers (9) studied the distinguishing neuropatholog-ical features of alcoholics and schizophrenics with MRI. They reported that the schizophrenic group had tissue volume deficits selective to cortical gray matter, whereas the alcoholic group had tissue volume deficits in gray matter and white matter, and concluded that distinct pathophysiological processes were underlying the structural abnormalities seen in alcoholism and schizophrenia. In accordance with this, Scheller-Gilkey and coworkers (10) hypothesized that schizophrenics with substance use disorder have more structural brain pathology than schizophrenics without however, their investigation found no significant differences in MRI scans between substance-abusing (61.2 had abused alcohol) and non-substance-abusing...

Lifestyle Interventions

As observed in Chapter 6, alcohol consumption represents a unique lifestyle factor that appears to exhibit differential effects on risk for hypertension and magnitude of cardiovascular response to stress. Although incidence of essential hypertension increases with chronic alcohol use, its acute effects are to attenuate blood pressure responses to stress. Despite its unique characteristics, alcohol restriction has been examined as an intervention strategy for lowering blood pressure. In a meta-analytic review of 15 randomized controlled trials examining pro grams to reduce alcohol consumption, Xin et al. (2001) reported that reductions in alcohol consumption were associated with diminished blood pressures. SBP was reduced by an average of 3.3 mm Hg and DBP was reduced by an average of 2 mm Hg in these studies. In contrast, in a recent controlled trial, Cushman et al. (1998) reported no impact on blood pressure with moderate alcohol restriction however, participants in this study were...

Complexity of Adaptation

Once people develop PTSD, the recurrent unbidden reliving of the trauma in visual images, emotional states, or in nightmares produces a recurrent reliving of states of terror. In contrast to the actual trauma, which had a beginning, middle, and end, the symptoms of PTSD take on a timeless character. The traumatic intrusions themselves are horrifying They interfere with getting over the past, while distracting the individual from attending to the present. The unpredictable exposure to unbidden feelings, physical experiences, images, or other imprints of the traumatic event leads to a variety of (usually maladaptive) avoidance maneuvers, ranging from avoidance of people or actions that serve as reminders to drug and alcohol abuse and emotional withdrawal from friends or activities that used to be potential sources of solace. Problems with attention and concentration keep them from being engaged with their surroundings with zest and energy. Uncomplicated activities like reading,...

Niacin and Nicotinic Acid

Pellagra continues to occur in portions of Africa and Asia, especially in populations dependent on corn as the principle source of carbohydrate. When corn is first soaked in lime water, as is done in Mexico when tortillas are prepared, niacin is liberated and deficiency occurs less commonly. In the United States, niacin deficiency is seen in alcoholics and in those taking isoniazid. There is a single case report of a patient developing nicotinic acid deficiency after valproic acid therapy. y Pregnant women are protected from niacin deficiency owing to their enhanced ability to convert tryptophan to niacin endogenously, particularly in the third trimester. Pellagra, or rough skin, affects the skin, the gastrointestinal system, and the CNS. Hence, the classic triad of the three Ds--dermatitis, diarrhea, and dementia. In industrialized countries, particularly among alcoholics, niacin deficiency may present only with encephalopathy. y y y Patients may have altered sensorium, diffuse...

Proteinenergy Malnutrition

Chronic PEM has traditionally been a disease of the Third World, particularly Africa and Asia. In industrialized countries, it is seen in young children in poverty, the elderly, alcoholics, or in children born to malnourished mothers. PEM also occurs in hospitalized elderly, particularly those suffering from sepsis, burns, or other serious illnesses that preclude a normal diet. Up to 27 percent of hospitalized elderly develop PEM during their hospital stay, with an associated increased risk of mental status changes, depression, and prolonged length of stay. 7 In patients with third-degree burns, up to 500 g of muscle may be lost in a day, and death from malnutrition may occur in 2 to 3 weeks.

Overview and Pharmacology

Alcohol is one of the most widely used psychoactive drugs, and alcoholism is characterized by the chronic, repetitive, excessive use of alcohol such that it interferes with the health, personal relationships, and livelihood of the drinker. In pharmacological terms, alcoholism is the addiction to alcohol. Although the cause of alcoholism is unknown, there clearly are genetic, environmental, and cultural factors involved. In the United States, the incidence of alcoholism cannot be determined specifically, but it is estimated that 10 percent of adult Americans are affected by alcohol abuse and dependence.

Alcoholic Dementia and Cerebral Atrophy

Some authorities have contended that chronic excess ingestion of alcohol leads to cerebral atrophy and alcoholic dementia. However, the notion that alcohol has a direct toxic effect on cerebral tissue is greatly disputed. Most cases of dementia in alcoholics can be explained on the basis of Korsakoff's disease, other nutritional deficiencies, or medical causes. This syndrome has been described only in longstanding alcohol abusers, and the essential clinical features of this putative syndrome are the combination of cognitive and behavioral deficits including impaired memory and judgment, loss of social refinements, and paranoid ideation. Symptoms and signs develop gradually and continue to progress as long as alcohol abuse continues. Patients often show other stigmata of longstanding alcohol abuse. The major diagnostic distinction is with a slowly evolving form of Korsakoff's psychosis. Other considerations when encountering an impaired intellect in alcoholics include hepatic...

Cerebellar Degeneration

Although a definite association between cerebellar degeneration and nutritional deficiency is not established in alcoholism, thiamine deficiency is suggested by the clinical and pathological resemblance to the cerebellar involvement in Wernicke's disease. Alcoholism is the chief risk factor for the development of this disorder, and males are affected more often than females. The main clinical manifestation is a disorder of gait characterized by instability and a widened base. Patients are unable to walk with one foot Because this disorder is associated with alcoholism, many patients have evidence of other complications of nutritional deficiency, particularly a polyneuropathy. In alcoholics, alternate causes of gait ataxia include Wernicke's disease, acquired hepatocerebral degeneration, and the effects of head trauma. Cerebellar syndromes featuring prominent speech or oculomotor deficits should suggest another cause for the ataxia, even in alcoholics. MRI may demonstrate atrophy of...

Marchiafava Bignami Disease

The majority of the pathological changes in this disease occur in the middle lamina of the corpus callosum. The mechanism responsible for the white matter damage and the reason for the particular vulnerability of the corpus callosum are unknown. Longstanding alcohol abuse is clearly a risk factor, but Marchiafava-Bignami disease has also been described in nonalcoholics. The rarity of this disorder when measured against the prevalence of alcoholism also suggests that other factors are involved. Originally thought to selectively affect Italians, Marchiafava-Bignami has been found in other populations as well. There is no consistent or typical clinical presentation, but manifestations usually encompass both cognitive and behavioral aspects. Many patients appear to become progressively demented, disinhibited, or aggressive. Transient neurological deficits, often focal in nature, may form part of the clinical picture. Seizures and impaired consciousness may be terminal events. Because...

Fetal Alcohol Syndrome

Because addicts often abuse several drugs, it is important to consider that an irritable, tremulous, small baby may also result from use during pregnancy of crack cocaine or other agents. There are no laboratory tests of value to support or refute the diagnosis of fetal alcohol syndrome. Maternal education regarding the toxic effects of alcohol is of paramount importance in preventing the fetal alcohol syndrome. There is no safe minimum amount of alcohol consumption that can be guaranteed not to be toxic to a fetus, so mothers-to-be are urged to abstain entirely from alcohol throughout their pregnancy. There is no direct treatment for the effects of the fetal alcohol syndrome, although proper postnatal nutrition and care will help affected babies as they do unaffected ones. Approximately one in six babies born with this syndrome die. Of the remainder, about half suffer permanent physical or mental handicaps.

Risk Factors for Development of the Disease

In some studies, a diet high in meat and fat has been associated with an increased risk for pancreatic cancer. In animal models, increased amounts of dietary unsatur-ated fats lead to pancreatic carcinogenesis. The way meats are cooked may lead to carcinogenic substances in the fat, or the fat may act to promote the effects of other carcinogens. In contrast, diets high in fruits, vegetables and fiber are associated with a decreased risk of developing pancreatic cancer. Older studies found some correlation with coffee and alcohol consumption with the risk for developing pancreatic cancer, but recent studies have not confirmed these findings.

Origins and Present Status

Alcoholics Anonymous (AA) is the oldest, largest, and best known ongoing self-help group. Founded in 1935 by Bill W. and Dr. Bob, it is organized by and for alcoholics (with offshoots Al-Anon and Al-Ateen for relatives and friends). Although described in the 1937 publication Alcoholics Anonymous, AA was little known to the general public until a 1944 Saturday Evening Post article. It now has well over a million members in 100 countries. Its 12-step program has been adopted by many other groups (e.g., Gamblers Anonymous, Overeaters Anonymous, Narcotics Anonymous, Debtors Anonymous). Other early self-help organizations are Recovery, Inc., founded in 1937 by psychiatrist Abraham Low for former patients of mental health institutions, and Synanon, founded in the 1950s by Charles Dederich for drug addicts (and, later, ex-convicts).

Squamous Cell Carcinoma

Oesophageal SCCs can be divided into two major risk groups those tumours associated with tobacco and alcohol consumption and those occurring in populations consuming a poor, generally monotonous diet that lacks green, leafy vegetables, citrus fruits, micronutrients such as zinc, riboflavin and vitamin A and other unknown factors. These circumstances render the oesophageal mucosa more susceptible to injury by various carcinogens, including mycotoxins in the Transkei, substituted hydroxyphen-anthrenes (a strongly mutagenic form of opium) in Iran, and -nitroso compounds in China. Heavy alcohol and cigarette consumption are recognized risk factors for oesophageal SCC, especially in Western populations. The increased risk with increasing alcohol consumption is exponential while the increase in risk from tobacco is linear (Tyuns et al., 1977). The strong association of oesophageal cancer with alcohol helps explain the especially high rates of oesophageal cancer in calvados-producing regions...

Risk Factors for Stroke

Cigarette smoking is a very important preventable cause of stroke, and about 30 percent of stroke patients do smoke. y Heavy cigarette smoking (more than a pack per day) carries 11 times the ischemic stroke risk and four times the SAH risk of people who do not smoke. y Smoking has an especially toxic effect on women taking oral contraceptives, in whom it carries 22 times the risk of developing stroke than occurs in nonsmoking women who use other forms of birth control. With cessation of cigarette smoking, the risk of stroke declines after 2 to 5 years. A J-shaped relationship exists between alcohol and stroke. The relative risk of stroke increases with moderate to heavy alcohol consumption and decreases with light drinking compared with nondrinkers. y Heart diseases are clearly associated with increased risk of ischemic stroke, particularly atrial fibrillation, valvular heart disease, myocardial infarction, coronary artery disease, congestive heart failure, LVH on ECG, and mitral...

Association with Alcohol and Drug Abuse

A key factor in the association between accidents and TBI is alcohol abuse, since it places individuals at greater risk for head injury than any other factor examined, including age and occupation (5). Other studies have provided additional support for the connection between alcohol intoxication and head trauma (6-13). A host of factors contribute to this association, including the physiological effect of an increased blood alcohol concentration on trauma-avoidance behaviors, psychopathology, and acute stressful life events (14,15). Drugs other than alcohol can also result in significant perceptual disturbances in association with intoxication or withdrawal states (16), thereby contributing to TBI. In DSM-IV the nosology of substance-induced perceptual problems is divided into substance intoxication with perceptual disturbances, substance withdrawal with perceptual disturbances, and substance-induced psychotic disorder with hallucinations (2). Compared to alcohol, there are fewer...

Sbp And Sbprelated Complications As Possible Risk Factors Attending Liver Transplantation

Assessment of possible contraindications to liver transplantation is also mandatory in patients who are potential candidates for this therapy. Patients with SBP can present with noninfectious contraindications to liver transplantation that may preclude the transplant procedure. Such contraindications include (a) massive peritoneal adhesions (b) complete splenic-mesenteric-portal thrombosis (c) poor short-term prognosis because of extrahepatic malignancy or AIDS or (d) other severe extrahepatic diseases, advanced hepatocellular carcinoma, active alcoholism or high hepatitis B virus (HBV) replicative status (1-6,25,26). In addition, several specific circumstances capable of influencing the result of liver transplantation in patients with SBP deserve adequate discussion.

Hepatitis C Virus HCV

HCV is a single-stranded RNA virus which shows marked genetic heterogeneity and at least six major subtypes are known, of which Ib is thought to be the most likely to lead to chronic liver disease. Whilst it is associated with only about one-sixth of all cases of hepatocellular carcinoma world-wide, this proportion is higher and rising in some areas, notably Japan and, to a lesser extent, Spain, Italy and the Middle East (Idilman et al., 1998 Bosch et al., 1999 Colombo, 1999). The infection is usually acquired in adult life via transfusion of blood and blood products or by the use of contaminated instruments and syringes by intravenous drug abusers. Perinatal and sexual transmission are unimportant. The onset of malignancy is preceded by cirrhosis in 90 of cases. The course is long, 20-40 years from infection to tumour, and patients are affected in late middle to old age. Table 3 shows that HCV is definitely associated with hepatocellular carcinoma in case-control and follow-up...

Photosensitivity dermatoses

Pityriasis Rubra Pilaris Face Treatment

This complex group of metabolic diseases causes varying skin lesions, depending somewhat on the basic metabolic fault. The most common skin lesions are xanthomas, which are characterized by yellowish plaques or nodules readily seen on the skin surface. Xanthomatous lesions are either due to primary hyperlipidemia or the secondary result of a primary disease such as alcoholism, diabetes mellitus, hypothyroidism, or, less commonly, obstructive jaundice, nephrotic syndrome, and dysproteinemia.

Pyridoxine Vitamin B6

Ihe recommended daily allowance of pyridoxine is 2 mg. It is found most abundantly in enriched breads, cereals and grains, chicken, orange and tomato juice, bananas, and avocados. Patients at risk for pyridoxine deficiency include those with general malnutrition, prisoners of war, refugees, alcoholics, infants of vitamin B 6 -deficient mothers, and patients using isoniazid and hydralazine. Surveys of hospitalized elderly patients have shown up that to 5 percent may have a vitamin B 6 deficiency. A rare autosomal recessive disorder of pyridoxine-responsive or pyridoxine-dependent neonatal seizures also exists. Pyridoxine is unique in that both the deficiency and toxic states result in a peripheral neuropathy. Deficiency affects the blood, skin, and nervous system. Ihe skin changes are indistinguishable from pellagra, probably due to the close interaction of niacin and pyridoxine. Pyridoxine improves the microcytic anemia of alcoholics as well as the anemia associated with...

Hepatic Vascular and Lymph Systems

When liver parenchymal cells are destroyed, they are replaced with fibrous tissue that eventually contracts around the blood vessels, thereby greatly impeding the flow of portal blood through the liver. This disease process is known as cirrhosis of the liver. It results most commonly from alcoholism, but it can also follow ingestion of poisons such as carbon tetrachloride, viral diseases such as infectious hepatitis, obstruction of the bile ducts, and infectious processes in the bile ducts.

Consequences of Sleep Deprivation

Impairment in simulated driving tests after modest sleep loss has been shown to be comparable to that produced by alcohol. In one study, 18.5 and 21 hours of wakefulness produced deficits of the same magnitude as 0.05 and 0.08 blood alcohol concentration, respectively (29). The combined effect of sleep restriction and alcohol is additive, reducing alertness, and impairing simulated automobile driving in healthy young men, even with low alcohol intake and safe alcohol concentrations below 0.08 blood alcohol concentration, the legal intoxication level in most states (30,31). The effects of regular sleep loss on driving are Horne JA, Reyner LA, Barrett PR. Driving impairment due to sleepiness is exacerbated by low alcohol intake. Occup Environ Med 2003 60(9) 689-692.

The Risks of Sleeping for Long Periods in the Sitting Position

Since many older people are afraid of flight in general and high altitude transoceanic flight in particular, they may take hypnotics or lounge in an inebriated state for several hours - terrified, exhausted, drugged, or all three combined. That could be responsible for (or at least contribute to) DVT or pulmonary embolism on disembarkation. Such travellers could be inexperienced in the exigencies and difficulties of long distance air transport - sitting around in stations, cars, trains, buses and hotels on the way to major international hubs, transporting heavy luggage - and are particularly likely to suffer thromboembolic consequences.6 Thus, in addition to the distance and duration of such flights, the state of the passenger should be taken into account. All elderly, exhausted, terrified travellers, who are perhaps fearfully inebriated through excessive alcohol intake and or may have used normal or unaccustomed doses of analgesics, tranquilisers, hypnotic medicaments, anti-nausea...

Genetics of Restless Legs Syndrome

Although clinical observations suggest that RLS may be associated with emotional distress, psychosocial dysfunction, and depression, several large-scale epidemiological studies (1,2,7) were undertaken to systematically identify the significant correlates with RLS. Berger et al. (7) performed a large-scale cross-section survey with face-to-face interviews and physical examinations of 4310 participants in the Study of Health in Pomerania in northeastern Germany. The overall prevalence rate of RLS was 10.6 however, it increased with age, and women were twice as often affected as men. In addition, the risk of RLS increased gradually with women with more children. Thus, these epidemiological variables were implicated as important environmental factors for RLS. The 1996 Kentucky Behavioral Risk Factor Surveillance Survey collected data on the frequency of those experiencing RLS, self-rated general and mental health status, demographic, and behavioral risk factors, by telephone interviews...

Effect Of Spirulina On Fatty Liver

Fatty liver is a common cause of chronic liver disease and refers to accumulation of excess fat in the liver. It is diagnosed that if fat exceeds 5 of the total weight of normal liver or when more than 30 of the hepatocytes in a liver lobule have lipid deposits, most of the fat that accumulates in the liver is triacylglycerols and fatty acids other forms of fat, such as cholesterol, cholesterol ester, and phospholipids, are also present. Fatty liver is often associated with alcoholic liver disease, hyperinsu-linemia, and insulin-resistance. Accordingly, it is most often observed in alcoholics, obese persons, and diabetic patients. It is also frequently caused by drugs,83 viral hepatitis,84 chemical intoxication,85 pregnancy,86 intestinal bypass surgery,87 and malnutrition.88 Histological findings reveal that fat deposits in the liver may vary in size and distribution. Hepatocytes may contain large fat droplets with an anomalously displaced nucleus (macrovesicular type) or multiple...

The Effect Of Uricemia Of Urbanization Of

There is a marked difference in the prevalence of hyperuricemia between Caucasian and various Pacific island populations. Less than 10 percent of most unselected Caucasian populations, but more than 40 percent of many Pacific populations, exceed normal upper limits. Many surveys have been conducted since the 1960s. The hyperuricemia cannot be attributed entirely to dietary changes, nor is alcohol consumption necessarily a factor. The highest prevalence of hyperuricemia has been found on the Micronesian island of Nauru. The diet there had largely become Westernized by the time these surveys were conducted. However, some groups were hyperuricemic on their traditional diets. The complexity of the uricemia - gout relationship is illustrated by the unexplained observation that although the New Zealand Maoris, Tokelauans, and Raroton-gans have the same high prevalence of hype-ruricemia, a fourfold difference exists in the prevalence of gout.

Action or Non Rest Tremors TabieMB

Drugs and toxins Beta agonists, dopamine agonists, amphetamines, lithium, tricyclic antidepressants, neuroleptics, theophylline, caffeine, valproic acid, alcohol withdrawal, mercury (Hatter's shakes), lead, arsenic, others with handwriting, drawing, holding a spoon, using a drinking cup, and manipulating tools. 74I The vocal cords may be affected, resulting in a wavering voice. Although ET usually occurs in isolation, it can be associated with various other neurological conditions including dystonia, parkinsonism, and certain inherited peripheral neuropathies (e.g., Charcot-Marie-Tooth disease). The differential diagnosis includes normal physiological tremor and the tremors associated with anxiety, thyrotoxicosis, and alcohol withdrawal as well as drug-induced tremors resulting from bronchodilator use, corticosteroids, various CNS stimulants, lithium, and sodium valproate. ET diminishes with rest, ethanol, beta-noradrenergic blockers (usual dose, propranolol 80 to 240 mg day),...

Communication Skills Training

Therapists of diverse theoretical positions have long realized that numerous clients with a variety of psychopatho-logical complaints are deficient in interpersonal or communication skills. Persons diagnosed as schizophrenic, neurotic, or mildly mentally retarded, as well as alcoholics, those having marital difficulties, and parents with child management problems, have all been seen as having difficulties in interpersonal communication. In the period from 1970 to 1980, three major trends led to the increased emphasis upon communication skills training as an important therapeutic and preventive tool. The first and perhaps most important trend was the disenchantment of many psychologists and other therapists with the medical model of therapeutic intervention. As Goldstein has noted in Psychological Skills Training (1981), an increasing number of therapists turned to a different set of assumptions. Basic to this new approach is the assumption that the client is suffering from a skill...

Orthostatic Hypotension

Severe supine hypertension, particularly at night, is a troublesome feature of this disorder that may be prevented by sleeping in the reverse Trendelenburg position, avoiding vasoconstrictor drugs in late afternoon, and eating a small carbohydrate-rich snack or drinking alcohol before bedtime. If needed, a short-acting vasodilator agent (e.g., nifedipine 10 mg po) may also be used at night.

Bipolar disorder following stroke

The background characteristics of bipolar and mania-only patients are shown in Table 26.1. There were no significant differences in age or in personal or family history of mood disorders. Among the bipolar patients, one had a family history of bipolar disorder and one had a family history of alcoholism. Among the 12 mania-only patients, three had a family history of mood disorder (p NS).

Severity Of Psychosocial Stressors Scale

In terms of prognosis, theorists have suggested that acute symptoms precipitated by specific stressors that are external to the disorder may have a better prognosis than symptoms whose onset is gradual and less related to stress. For example, outcome research has distinguished good-prognosis, reactive schizophrenia (with acute onset and precipitating stress) from poor-prognosis, process schizophrenia (with gradual onset and no precipitating stress). Similar dichotomies and prognoses have been noted for mood disorders and alcoholism.

Table 9 Aspects of chemoprevention at major cancer target sites3

Tobacco use (smoking, chewing) alcohol consumption, especially combined with tobacco use occupational exposure (e.g. asbestos, nickel, copper) cytochrome P-450 genetic polymorphisms (e.g. CYP1A1, GSTM2) low fruit, vegetable consumption previous oral, laryngeal, lung cancer

Methodology of Diagnostic Research

Subjects should be involved in a stable, monogamous heterosexual relationship, prepared to attempt intercourse on a regular basis, and provide written informed consent. The presence of comorbid erectile dysfunction (ED) should be evaluated using a validated instrument such as the international index of erectile function (IIEF), and patients with any degree of ED should be either excluded from the study or treated as a separate subgroup. Patients with hypoactive sexual desire or other sexual disorders, urogenital infection, major psychiatric disorders, a history of drug and alcohol abuse or contraindications to the study drug should be excluded from the study.

Nonhereditary Idiopathic Cerebellar Ataxia

Differential Diagnosis and Evaluation. The clinical phenotype of advanced IDCA-P MSA, consisting of ataxia, parkinsonism, and autonomic failure, is highly characteristic and rarely causes confusion with other disorders. In contrast, IDCA-C and incomplete or beginning forms of IDCA-P MSA must be carefully distinguished from symptomatic cerebellar ataxia. Degeneration of the cerebellar cortex in patients with chronic cerebellar ataxia may be due to alcoholism, various toxic causes (antiepileptics, cytostatic drugs, lithium, solvents, heavy metals), remote effects of malignancy (paraneoplastic cerebellar degeneration), malabsorption with vitamin E deficiency, increased body temperature (heat stroke, neuroleptic malignant syndrome, sepsis), and hypothyreosis.

Assessment Instruments For Substance Abuse Screening

Michigan Alcoholism Screening Test (MAST) or the Brief MAST 4. Alcohol Use Disorders Identification Test (AUDIT) The CAGE is a simple four-question verbal or written screen. C, A, G, and E represent symptoms of an alcohol problem (2) C difficulty Cutting back alcohol consumption A others are Annoyed at your alcohol use G Guilt over alcohol use, and E need for an alcohol Eye-opener in the morning. A score of two or more yes answers is considered a positive screen for probable alcoholism. This screen is well known, easy to use, and can be routinely used in both psychiatric and general medical settings. The AUQ consists of eight questions concerning the current desire to drink alcohol (3). Each question is scored on a six-point scale, from strongly disagree to strongly agree. The MAST is a more comprehensive self-administered questionnaire for diagnosing alcoholism (4,5). It consists of 25 simple yes or no questions. A score of 5-7 or more is indicative of alcoholism. The brief MAST,...

Vulnerability and Risk

Researchers have examined factors that increase vulnerability to victimization and risk factors for perpetrating sexual assault. Vulnerability research seeks to uncover factors that may increase the likelihood for victimization. Although the focus is on victims, identifying vulnerability factors is distinct from victim blaming. Victim blaming mistakenly assigns responsibility for victimization to victims (e.g., if a woman was drunk when she was raped, it is her fault). One of the most often replicated indicators of risk for adult rape victimization is a previous history of child sexual abuse however, the risk accounted for by this predictor is not large. Drug use, but not alcohol consumption, was found to be causally related to rape in the largest U.S. longitudinal study to date. Aside from gender and age, personal characteristics of victims are not very good predictors of victimization. Some researchers have concluded that risks for adult victimization are best understood as...

Isolated Clinic Normotension

Have found that isolated clinic normotensives were more likely to be past or current smokers than normotensives (Larkin et al., 1998a Liu et al., 1999 Selenta et al., 2000 Wing et al., 2002). Two studies have shown that isolated clinic normotensives are more likely to be men rather than women as well as persons who consume alcohol (Larkin et al., 1998a Selenta et al., 2000). Although no differences between isolated clinic normotensives and either hypertensive patients or normal blood pressure controls have emerged on measures of stress (Donner-Banzhoff et al., 1998), there is some indication that isolated clinic nor-motensives sleep less and engage in more physical activity during ambulatory monitoring periods than comparison groups (Larkin et al., 1998a). One gets the picture that daily lives of isolated clinic nor-motensive patients are packed with work and home activities and that these patients may lack adaptive coping skills to deal with the number of activities in their lives....

Acute Bacterial Meningitis

S. pneumoniae is the most common causative organism of community-acquired bacterial meningitis in the adult. Pneumonia and acute and chronic otitis media are important antecedent events. Chronic disease, specifically alcoholism, sickle cell anemia, diabetes, renal failure, cirrhosis, splenectomy, hypogammaglobulinemia, and organ transplantation are predisposing conditions for pneumococcal bacteremia and meningitis. The pneumococci are a common cause of recurrent meningitis in patients with head trauma and cerebrospinal fluid (CSF) rhinorrhea. In the older adult (50 years of age and older), S. pneumoniae is likely to cause meningitis in association with pneumonia or otitis media, and gram-negative bacilli are the likely organisms to cause meningitis in association with chronic lung disease, sinusitis, a neurosurgical procedure, or a

Does Chronic Substance Abuse Cause Personality Disorders

Personality disorders, as this was a nonsociopathic sample. Indeed, only six of the 86 men with alcohol dependence and personality disorders had ASPD, and there were no subjects with BPD in this sample. Thus, these alcoholic men with primarily interpersonally withdrawn personality disorders, rather than acting-out or impulsive personality disorders, may have experienced normal character development until they became alcohol-dependent. Whether character structure returns to premorbid levels during periods of protracted abstinence was not addressed by this data. There are several lines of evidence that suggest that the personality disturbance precedes the substance abuse. Examination of the individual characteristics that are considered risk factors for substance abuse may serve to illuminate the relationship between substance misuse and personality disorders. A growing body of evidence has identified impulsivity and conduct disturbance as risk factors for the development of a substance...

Demographic And Clinical Correlates Of Substance Abuse In Schizophrenia

Increased in alcoholics and cannabis abusers Lower in smokers, increased dystonic reaction in cocaine abusers, increased akathisia in alcoholics No difference Rates of tardive dyskinesia have been reported to be increased (31) or decreased (42) in smokers, and increased in alcoholics (16,42) and cannabis users (43). However, smoking was observed to increase tardive dyskinesia ratings in the laboratory test setting (44). On the other hand, rates of drug-induced parkinsonism were reported to be lower in smokers (45), and not increased in cocaine abusers (46). However, cocaine use was reported as a risk factor for acute dystonic reaction in the psychiatric population treated with neuroleptics (47). Rates of akathisia have been reported to be increased in alcohol abusers (16).

Treatment of Late Life Psychopathology

Many older adults with recognized mental health problems are prescribed medications by their treating physicians in primary care settings. However, a substantial body of geropsychotherapy research over the past two decades has resulted in the development of a variety of psychological treatments for some of the most common mental health problems faced by older adults. Clinical geropsychologists provide psychotherapy or so-called talking treatments for these problems. For example, a number of theoretically and practically distinct treatments (e.g., psychodynamic or insight-oriented, cognitive-behavioral or learning-based, interpersonal therapy) have been found to be effective in the treatment of depression among healthy older adults. Psychological treatments are also available for anxiety disorders and sleep disorders such as Insomnia. There is a nascent but growing body of clinical research for older adults with Schizophrenia and older adults who engage in health-damaging substance...

Genetic and Biological Predispositions

Bipolar disorder unquestionably runs in families. Concordance rates between identical twins average 57 and between fraternal twins, 14 (Alda, 1997). The family pedigrees of bipolar probands are characterized by increased rates of bipolar disorder, unipolar disorder, and alcoholism. At least 20 of the first-degree relatives of bipolar patients have major affective disorders (Gershon, 1990). Although several gene loci have been identified, there is a particularly promising set of findings linking bipolar disorder to loci on the long arm of chromosome 18. This linkage is strongest among families of bipolar patients who are co-morbid for Panic Disorder (MacKinnon et al., 1998). There is also growing evidence that a variant in the serotonin transporter gene, which might lead to instabilities in the regulation of serotonin within the CNS, may be related to the onset of bipolar disorder (Collier et al., 1996).

Application and Techniques of Behavior Modification

Stopping is a technique in which individuals interrupt distressing thoughts by saying Stop emphatically, either aloud or covertly. Covert sensitization is a method that is used to teach a person to dislike a liked event, such as drinking alcohol, by pairing it repeatedly with an aversive event in an imagined situation.

The Primary VersusSecondary Distinction

Alternatively, the drug would appear to be the cause of panic disorder if only secondary panic is seen. Primary and secondary distinctions may also be useful in predicting long-term outcomes and determining optimal treatment. There is some evidence that anxiety symptoms may abate over time in patients with primary alcohol dependence and secondary anxiety. However, in practice, determining the temporal relationship between the disorders is often difficult, particularly if the course of both disorders is chronic and long-standing and the patient is a poor historian. In the case of alcohol, there exist empirical data to suggest that consistent temporal relationships between substance use disorders and anxiety disorders exist for some disorders or for certain individuals. A recent review on the comorbidity of alcohol abuse and anxiety disorders notes that simple panic disorder has no consistent relationship to the onset of alcohol abuse, whereas panic with agoraphobia usually...

Other Anxiety Disorders Definitions

Among adolescents with SUD, high rates of social phobia have been noted (e.g., Refs. 29, 168). In the PAARC analysis comparing adolescents with alcohol dependence to community control adolescents, anxiety disorders other than PTSD were not found to be significantly associated with alcohol dependence (34). Whether there is an association between anxiety disorders other than PTSD and SUD among adolescents remains to be definitively determined.

Beer And Breastfeeding

Abstract Traditional wisdom claims that moderate beer consumption may be beneficial for initiation of breastfeeding and enhancement of breastfeeding success. Here we review the question whether or not there-is any scientific basis for this popular belief. There are clear indications that beer can stimulate prolactin secretion which may enhance lactogenesis both in non-lactating humans and in experimental animals. The component in beer responsible for the effect on prolactin secretion is not the alcohol content but apparently a polysaccharide from barley, which explains that the effect on prolactin can also be induced by non-alcoholic beer. No systematic studies are available to evaluate the clinical effects of beer on induction of lactogenesis, and short term studies have shown a reduced breast milk intake by infants after moderate alcohol consumption of their mothers. It is conceivable that relaxing effects of both alcohol and components of hop might also have beneficial effects on...

Appraisal of Evidence for Prevention versus Aggravation of Suicide by SSRIs Comparison with Other Antidepressant Agents

A report published in 1990 implicated the SSRI fluoxetine as a cause of suicidal behavior, on the grounds that six patients treated with the drug had violent, self-destructive thoughts.66 Such behavior however may in fact have been influenced by a combination of factors, including prior history of suicide attempts concurrent treatment with several other drugs, including stimulants and a tendency to alcohol abuse among some of the patients. The balance of opinion was that the patients' suicidal ideation was more likely to have arisen from their psychological disorder than from the drug used to treat it. A meta-analysis by Beasley et al67 gave no indication that suicide was significantly more common during treatment with fluoxetine than with either TCAs or placebo. The pooled incidence of suicidal acts was 0.3 for fluoxetine, 0.2 for placebo and 0.4 for TCAs. In terms of emergence of suicidal thoughts, the pooled incidence was 1.2 for fluoxetine, 2.6 for placebo and 3.6 for TCAs....

Stance and Gait Ataxia Presence of Rombergs Sign

Damage to the anterior lobe (spinocerebellum or paleocerebellum) result in ataxia of stance and gait. Patients with this disorder develop a severe disturbance of standing and walking with relatively preserved fine coordinated movements of the upper limbs. Lesions of the spinocerebellar part of the anterior lobe are mainly observed in chronic alcoholics and lead to anteroposterior body sway with a frequency of about 3 Hz. Visual stabilization of posture is preserved and the tremor is provoked by eye closure (presence of Romberg's sign). Patients rarely fall because the body tremor is opposite in phase in head, trunk, and legs, resulting in a minimal shift of the center of gravity. Dysathria and dysmetric saccades are frequently associated cerebellar signs.

Primary Prevention Of Psychopathology

A high level of stress-causing conditions (e.g., power-lessness, unemployment, sexism, marital disruption, loss of support systems) can cause any of several patterns of emotional disruption (e.g., depression, alcoholism, anxiety, hypertension). In brief, there is a nonspecific relation between causes and consequences.

Severe Forms of Mediterranean Spotted Fever

Severe forms, including major neurological manifestations and multiorgan involvement, may occur in 5 to 6 of MSF cases (70,71). Complications and death are very rare in infancy (24,26,61). The mortality rate is usually estimated around 2.5 among diagnosed cases (1.50 in the last decade in Portugal, including 2.58 in 1997) (23,70). In Portuguese series of cases, the fatality rates were 1.2 to 10 (24,72,73). Classic risk factors for severe forms include advanced age, immunocompromised situations, chronic alcoholism, glucose-6-phosphate-dehydrogenase deficiency, prior prescription of an inappropriate antibiotic, and delay in treatment (13). In 1997 in Beja, a southern Portuguese district, the case fatality rate in hospitalized patients with MSF was 32.3 , the highest obtained there since 1994. Interestingly, when risk factors for fatal outcome were studied in 105 patients hospitalized between 1994 and 1998, the

Demographic and Historic Developmental Factors

Stress reactions have been shown to be influenced by a number of individual difference variables over which one has very little control. For example, our age, genetic constellation, developmental and medical history, and in most cases gender are variables we have no direct control over. By this time next year, we will all be one year older and still composed of the same constellation of genes that we possess today. Although we may not be able to influence these variables, many of these factors have been shown to influence the magnitude and patterning of physiological stress responses observed under conditions in which we are exposed to standard environmental stressors. For example, it has been shown that neuroendocrine and blood pressure responses to stress increase with age (Palmer, Ziegler, and Lake, 1978), males typically exhibit greater blood pressure reactions to standardized stressors than females (Allen et al., 1993 Saab, 1989), and black participants exhibit greater blood...

Benefits of Control Therapy

Control therapy has been shown to be effective in both assessment (sensitivity and specificity) and treatment (clinical outcome) with a wide range of mental disorder diagnoses and health-related concerns. Clinical areas investigated include Generalized Anxiety Disorder, panic attack, depression, borderline personality, eating disorders, and adult children of alcoholics. Control issues have also been investigated in type-A individuals with myocardial infarction, women with breast cancer, and individuals at high cardiovascular risk.

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