Online Alcohol Therapy

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. More here...

Alcohol Free Forever Overview


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Uncomplicated Alcohol Withdrawal

This is the most frequent and benign type, usually occurring some 12-48 hours after alcohol intake is reduced, although it can develop as early as 6 hours after drinking has stopped. The essential features are a coarse tremor of the hands, tongue, and eyelids, together with at least one of the following If symptoms are mild, it is safe to recommend simple observation, but significant tremor and agitation will usually require sedation. The drugs of choice are long-acting benzodiazepines, which will not only treat alcohol withdrawal symptoms but will also prevent later complications (178). The starting dosages depend on the severity of the withdrawal, but 20 mg of chlordiazep-oxide, or 10 mg of diazepam, both given four times a day, will generally be appropriate (179). Usually the benzodiazepines should not be started until such time as the blood alcohol level has reached zero (180). However, detained persons with marked alcohol dependence may develop withdrawal symptoms before this...

Alcohol Withdrawal Delirium

The essential diagnostic feature of this disorder is a delirium that develops after recent cessation of or reduction in alcohol consumption. Traditionally referred to as delirium tremens, this withdrawal state typically begins 72-96 hours after the last drink, so it is uncommon within the normal span of detention in police custody. The delirium is characterized by impaired attention and memory, disorganized thinking, disorientation, reduced level of consciousness, perceptual disturbances, and agitation. Vivid, and often terrifying, hallucinations may occur. Usually these are visual, but other sensory modalities (e.g., auditory or tactile) may be involved. The disorder usually coexists with other features of alcohol withdrawal, for example, autonomic hyperac-tivity, which is usually severe. Alcohol withdrawal delirium is a medical emergency with a mortality rate of approx 5 . Once diagnosed, the detained person with delirium requires urgent hospitalization.

Complications of Alcohol Withdrawal

Several complications of alcohol withdrawal have been recognized, any one of which may be encountered when alcoholics are detained in police custody (176). Seizures are typically single and generalized. They usually occur between 6 and 48 hours after the last drink and although in themselves are not life threatening, their importance lies in the fact that about one-third of those with seizures will go on to develop alcohol withdrawal delirium. This is an infrequent disorder that tends to occur at about the age of 40 years in those who have been drinking heavily for more than 10 years. The essential features are vivid and persistent hallucinations, which develop shortly (usually within 48 hours) after cessation of alcohol intake. The hallucinations may be auditory or visual, and their content is usually unpleasant and disturbing. The disorder may last several weeks or months and is quite different from the fleeting hallucinations observed in other forms of alcohol withdrawal. The...

Heavy Alcohol Consumption

For most adults, occasional moderate alcohol drinking (one to two drinks per day) is not harmful, and may have health benefits. Moderate alcohol drinking can increase the HDL-cholesterol level in the blood, decrease risk of blood clots, and reduce risk of heart attack.1 However, regular heavy drinking (more than three to four drinks per day) is a health hazard. (A drink is considered a 180-ml glass of wine, 360-ml glass of beer, or 30-45 ml of spirits.) Heavy drinking increases risk of high blood pressure, stroke, liver disease, im mune weakness, and cancer.2,3 Moreover, about one in ten people who drink alcohol become physically addicted.


The acute and chronic toxicity profile of cannabis is described in Chapter 10 of this volume. Liver damage is not a prominent feature and it has been suggested that alcoholics might be encouraged to shift their dependence from alcohol to cannabis on grounds of increased safety, in a parallel with the substitution of methadone for heroin in addiction with the latter. There are no reports of individual cannabinoids being investigated in this respect. In spite of early reports of success in weaning alcoholics from their primary addiction (Mikuriya, 1970 Scher, 1971), subsequent findings are far from encouraging. Rosenberg et al. (1978) reported a trial in which 56 alcoholics were given disulfiram or cannabis, alone or in combination, in an attempt to wean them from alcohol. Cannabis proved ineffective at reducing alcohol consumption. Cannabis and alcohol are commonly used and abused together and surveys have shown that it is the most prevalent drug combination among adolescents and young...

Alcohol Dependence

Alcohol abuse and dependence is a major risk factor for serious health, social, and economic problems (167). Early identification of those who are dependent on alcohol increases the possibility of successful treatment, and However, obtaining accurate and reliable information about a person's drinking habits can be extremely difficult because heavy drinkers tend to underestimate or deliberately lie about their alcohol consumption (170). Use of the Alcohol Use Disorders Identification Test identifies persons whose alcohol consumption has become harmful or hazardous to health (171) self-report questionnaires, such as the Michigan Alcohol Screening Test (172,173) and CAGE (174,175) may help to identify those with alcohol dependency and should prevent the doctor falling into the trap of assuming that alcohol abuse is synonymous with alcohol dependence (Appendix 5). DSM-IV (165) distinguishes between these two diagnostic categories. The main features differentiating alcohol dependence from...

Alcohol Withdrawal

Many alcoholics develop symptoms of withdrawal when in custody. Their acquired tolerance to and physical dependence on alcohol is a manifestation of compensatory neuropsychological changes that offset the drug's CNS depressant effects. When alcohol intake is abruptly stopped on incarceration, the compensatory changes give rise to signs and symptoms of withdrawal (176). The severity of the symptoms depends mainly on the amount and duration of alcohol intake, although other factors, such as concurrent withdrawal from other drugs, like benzodiazepines, may contribute to the clinical picture (177). Alcohol withdrawal may present as a mild picture of uncomplicated alcohol withdrawal or as the more severe syndrome of alcohol withdrawal delirium (DSM-IV criteria).

Use in Prevention and Therapy

Taurine protects the body from damage by toxic compounds in the environment and diet. Taurine binds to, detoxifies, and enhances excretion of chemicals, pesticides, and other toxins.1 Taurine helps prevent liver damage from chronic, heavy alcohol consumption.

Synopsis Of The Novel

All throughout the human life span Controllers decide what is best for the common good, but from time to time things go wrong. The Alpha-Plus psychologist Bernard, a loner mocked for his Gamma-like appearance, is different. During his embryonic stage, the Controllers put too much alcohol in his blood-surrogate. Bernard and another misfit, the poet Helmholtz, become friends. Bernard attends the quasi-religious Solidarity Service where the president is the minister, the T is the cross, and everyone else leaves feeling reperfected. Unlike Len-ina, the woman Bernard likes, he refuses to join in the orgy. Lenina has been conditioned with the feelings and desires of her lower class and cannot understand Bernard's nasty desire to express his individuality. They plan to vacation on a New Mexico Indian Reservation, an outpost not worth civilizing. Long ago the Director had taken a pneumatic Beta-Minus woman there who was lost and did not return with him. Bernard fears being banned for his...

Clinical Presentation

Dyspnea 011 exertion is the most sensitive symptom for the diagnosis of CHF, but its specificity is much lower. Other symptoms, which are common but less sensitive for the diagnosis, include dyspnea at rest, anxiety, orthopnea, paroxysmal nocturnal dyspnea, and cough productive of pink, frothy sputum. Nonspecific symptoms sometimes reported are weakness, lightheadedness, abdominal pain, malaise, wheezing, and nausea. Patients may have a medical history of hypertension, coronary artery disease, or other heart diseases (cardiomyopathy, valvular disease). Histories of cigarette smoking and alcohol abuse may also be found.

Micronutrient Metabolism

Deficiencies of water-soluble vitamins, including vitamin C, and the B complex compounds, are particularly common in cirrhotic patients with active alcoholism. Similarly, low plasma concentration of fat-soluble vitamins (A, E, D, and K) may occur in patients with cirrhosis of any aetiology 72 . Abnormalities in vitamin activation, conversion, release, and transport by carrier molecules all result from hepatocellular injury. Low serum levels of some trace elements, such as zinc and selenium, have also been detected in cirrhotic patients 73 . In most patients with liver cirrhosis, while micronutrient deficiencies are clinically silent, the biological antioxidant effects of micronutrients are notably impaired.

Polymorphic structure of cannabinoid receptor genes

And association of the marker with schizophrenia indicating that CBX Cnr gene is not a gene of major aetiological effect for schizophrenia but might be a susceptibility locus in certain individuals with schizophrenia, particularly those whose symptoms are apparently precipitated or exacerbated by cannabis use (Dawson, 1995). Comings et al. (1997), hypothesized that genetic variants of CBX Cnr gene might be associated with susceptibility to alcohol or drug dependence and analyzed the triplet repeat marker in the CBX Cnr gene. They found a significant association of the CBj Cnr gene with a number of different types of drug dependence (cocaine, amphetamine, cannabis), and intravenous drug use but no significant association with variables related to alcohol abuse dependence in non-Hispanic Caucasians. In addition, this group also reported that a significant association of the triplet repeat marker in the CBX Cnr gene alleles with the P300 event related potential that has been implicated...

Approach To Hypertension

Essential hypertension Also known as idiopathic or primary hypertension. It has no known cause, yet it comprises approximately 95 of all cases of hypertension. Lifestyle modification A cornerstone in the treatment of hypertension, consisting of regular aerobic activity, weight loss, decreased salt intake, and increased intake of fruit and vegetables, while decreasing the amount of total fat. especially saturated fat, in the diet. Alcohol consumption should be moderated, no more than two glasses of wine per day for men and one glass per day for women. Prehypertension Blood pressures 120-139 80-89 mmHg Stage I hypertension Blood pressures 140-159 90-99 mmHg Stage II hypertension Blood pressures > 160 100 mmHg Secondary hypertension Elevated arterial blood pressure with a known underlying cause, such as renal artery stenosis or primary aldosteronism. Prevalence is approximately 5-6 of all cases of hypertension.

Mechanisms of Malnutrition in Chronic Pancreatitis

Chronic Pancreatitis Mechanism

Other factors may contribute to malnutrition in patients with chronic pancreatitis. Increased resting energy expenditure, small-bowel bacterial overgrowth, severe alcoholism, and poor control of associated diabetes may have a role. Hebuterne et al. reported that the measured REE was significantly higher than the predicted energy expenditure in underweight patients with chronic pancreatitis but not in control groups 85 . Therefore, weight loss accompanied by hypermetabolism should be taken into consideration in patients with chronic pancreatitis. Small-bowel bacterial overgrowth deconjugates bile salt, impairing micelle formation. Almost 40 of patients with chronic pancreatitis have co-existent small-bowel The absorption of fat-soluble vitamins (A, E, and K) is usually preserved 84, 88, 89 in patients with chronic pancreatitis, and, although vitamin D is not significantly reduced, osteopaenia and osteoporosis are much more common than previously thought 90 . Deficiencies of...

Structure Of Biguanides

Nateglinide Sar

With metformin, with incidence estimated at 0.01 to 0.08 per 1000 patient-years. With met-therapy, lactic acidosis most often occurs in patients with renal insufficiency, problems with alcohol abuse, or liver and cardiopulmonary disease (3, 118, 119). Metformin is removed from the system almost ex-elusively by renal elimination of the unchanged drug. Thus, poor renal function may lead to accumulation. Hypoglycemia is rare with metformin monotherapy.

Implication for the medical use of marijuana

The use of cannabis for both recreational and medicinal purposes dates back to thousands of years. In recent times, there has been an increase in calls for marijuana to be legalized for medicinal use in AIDS, cancer, multiple sclerosis and other medical conditions where patients might benefit from the biological effects of cannabis. Synthetic cannabinoids such as dronabinol, marinol and nabilone already have an established use as antiemetics in nausea and vomiting associated with cancer chemotherapy. The reported beneficial effects in cancer and AIDS patients might reflect improved weight gain, owing to the well-documented anti-emetic and appetite stimulating effects of cannabinoids. This might be a major advantage for cancer patients undergoing rigorous chemotherapy, or advanced AIDS patients. Interestingly, although cannabis is widely used as a recreational drug in humans, only a few studies revealed an appetitive potential of cannabinoids in animals. However, evidence for the...

Iga And Head And Neck Cancer

Henle et al. 48, 49 found that 93 of sera from patients with nasopharyngeal carcinoma were positive for IgA antibodies to EBV viral capsid antigen (VCA) and 73 to D component of the Early Antigen (EA) complex. Veltri et al. 50 also studied the cellular and humoral immune status of patients with head and neck cancer and found that total complement, a-1 acid glycoprotein (AGP), circulating immune complexes (CIC) and IgA levels were significantly elevated, pre-treatment, in these patients. The AGP and CIC declined to nearly normal levels after treatment, but the IgA levels remained elevated. They also studied cell-mediated immunity (CMI) in these patients using both polyclonal activators and specific antigens and found significant depression of CMI both pre- and post-treatment. Similarly, Hollyfield et al. 51 studied salivary IgA levels in alcoholics and head and neck cancer patients and found significantly higher levels of IgA in the cancer patients.

Dosedependent Hepatotoxicity

Chronic alcohol abusers. (alcoholism, diabetes mellitus, natural products continues to grow steadily, it is remarkable that dose-dependent hepatotoxicity is reported so rarely. The reasons for this are not entirely clear. Perhaps many instances are unrecognized, with episodic rises in serum liver enzymes being wrongly ascribed to fluctuations in the activity of the underlying chronic hepatitis, or to alcohol use. Doubtless, an important reason is that, for most drugs, the doses commonly used are relatively low, and the therapeutic indices are high. As discussed above, in many instances in which toxicity is mediated by a toxic metabolite, the presence of liver disease may decrease the rate or extent of formation of the metabolite, and actually exert a protective effect. Then, too, most authorities advise all patients with chronic liver disease not to drink alcohol (or to drink only occasionally, and not more than one drink per day). This decreases the induction of CYP2E and minimizes...

Lipoatrophy Associated with Multiple Symmetric Lipomatosis Launois Bensaude Syndrome or Madelung Collar

Multiple Lipomatosis Pictures

In a series of 69 patients, the male to female ratio was 7 1. MSL appears in adulthood (range 29-65 years), has a slowly progressive course, and is an autosomal dominant inherited disorder that primarily affects adipose tissue. Previous observations suggested lipomatous cells as brown-adipose-tissue-derived cells 46, 47 . Almost all patients have a high alcohol intake, usually red wine, suggesting a specific role for ethanol or

Vitamin B1 or Thiamine

The active form of thiamine, thiamine pyrophosphate, is a coenzyme involved in energy metabolism reactions the requirement for thiamine is therefore related to energy expenditure 56 . Patients at risk for vitamin B1 deficiency include alcoholics, those on chronic peritoneal dialysis, those re-fed after starvation, and thiamine-deplet-ed persons who are given glucose 64 . The RDA of vitamin B1 is 1.1 mg per day for women over 50 years and 1.2 mg per day for men over 50 years (Table 3) 54 . Patients at high risk, such as alcoholics, may benefit from supplementation 54 . Excessive amounts of ingested thiamine are rapidly cleared by the kidneys. No evidence exists of thiamine toxicity by oral administration 50 .

Serum Creatinine and Blood Urea Nitrogen Concentration

Hand, alcoholism, liver disease, or a low dietary protein intake will lower BUN concentrations in the absence of changes in glomerular filtration. The usual BUN Cr ratio is 10 1. Higher values indicate volume depletion, and lower values suggest volume expansion, liver dysfunction, or malnutrition. Urea clearance usually underestimates GFR and may be one half or less than that measured by creatinine or inulin techniques. However, in advanced renal failure (< 15 mL min) the lower urea clearance (due to increased reabsorption) and the higher creatinine clearance (due to increased secretion) cancel each other so that the average of both is very close to the GFR measured with inulin.

Orienting and Defensive Reflexes

Hypac Hormonal Axis

In an open-field test, RHAs are more active and exploratory, whereas RLAs are more inhibited and fearful. RHAs are more aggressive in response to shock. RHAs are more ready to drink alcohol and have a high tolerance for barbiturates. Female RHAs are not good mothers, spending little time in their nests with their young pups. RLA females are more nurturing mothers. RHAs drink alcohol (in solution), RLAs abstain

Quantitative sensory testing

The limitations of QST are also clear. No matter what the instrument or procedure used, QST is only a semiobjective measure, affected by the subject's attention, motivation and cooperation, as well as by anthropometric variables such as age, sex, body mass and history of smoking and alcohol consumption (Gerr & Letz 1994 Gelber et al. 1995). Expectancy and subject bias are additional factors that can exert a powerful influence on QST findings (Dyck et al. 1998). Further, QST is sensitive to changes in structure or function along the entire neuroaxis from nerve to cortex it is not a specific measure of peripheral nerve function (Arezzo 2003).

Patient Selection

The initial selection of patients for therapy is an important determinant of the outcome of treatment. In a typical cohort of patients diagnosed with hepatitis C, approx one-third of patients are not candidates of therapy. Typically, in this third of patients are included those who are still actively using intravenous (iv) drugs, patients who are abusing alcohol, patients with concomitant serious medical illnesses, patients with advanced liver disease, and patients who decline therapy. In this latter group, both patient and physician bias can influence the choice of therapy. Patients may decline therapy because they believe it is not effective, or because they are worried about the side effects profile of treatment. Physicians are often influenced by their perception of the patient's individual commitment to a long course of treatment, and are frequently worried about the effect of therapy on the patient's quality of life. Recently, the authors evaluated 175 consecutive patients...

Dietary Recommendations

In general, alcohol should be restricted to moderate levels given its myocardial depressant properties. High doses of alcohol intake predispose the patient to arrhythmias, particularly atrial fibrillation, and hypertension and may lead to important alterations in fluid balance. The prognosis in alcohol-induced cardiomyopathy is poor if consumption continues, and abstinence should be advised. Abstinence can result in substantial clinical benefit and improvement in left ventricular function.

High Anion Gap Metabolic Acidosis

The ingested toxins may be organic acids themselves, such as salicylic acid, or have acidic metabolites, such as formic acid from methanol. Renal failure leads to an inability to excrete organic acids as well as inorganic acids such as phosphates (often without an anion gap). Alcoholic ketoacidosis develops in chronic alcoholics who are malnourished and have depleted glycogen stores, and is often seen in the setting of binge drinking, which may shift the ratio of the reduced form of nicotinamide adenine dinucleotide (NADH) to nicotinamide adenine dinucleotide (NAD), inhibiting gluconeogenesis. They develop an anion gap metabolic acidosis as a result of ketoacidosis and lactic acidosis. They present with the same symptoms of acidosis as do DKA patients, for example, abdominal pain, nausea, and vomiting, but with low. normal, or slightly elevated glucose levels (in contrast to DKA. in which the glucose level usually is markedly elevated). Treatment is...

Metabolism of Alcohol

Once absorbed, alcohol is eliminated at a fairly constant rate, with 90 being metabolized in the liver and the remainder excreted unchanged in urine, breath, and sweat. The rate of elimination in moderate drinkers may vary between 10 and 20 mg 100 mL blood h, with a mean of 15 mg 100 mL blood h. Chronic alcoholics undergoing detoxification have elimination rates of 19 mg 100 mL blood h or even higher (17). This increased rate of alcohol burnoff is believed to be a consequence of increased activity of hepatic microsomal enzymes (P450IIE).

Diagnostic and Statistical Manual of Mental DisordersIV

(7) Continued substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., continued cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer is made worse by alcohol consumption)

Coping by limiting activity

We have found that CFS patients who limit activity and stress also tend to restrict their dietary and alcohol intake. Each patient seems to develop his or her own beliefs around which foods should be avoided and the self-help literature is inundated with such narratives

Intracranial Hemorrhages

In subdural hematoma (SDH), the hematoma forms between the inner surface of the dura and the arachnoid, generally in the fronto-parietal regions, but it may cover the entire hemisphere. It results from tearing of the veins at the point where they enter the superior sagittal sinus (bridging veins). Here, unsupported by the brain parenchyma, they are prone to tearing by motions of the brain that occur in blows to the head, falls, and traffic accidents. SDH is a common finding in physically abused children (shaken baby syndrome). Importantly, it can result from minor injuries and, in about 20 of cases, no clinical evidence of injury exists. Alcoholism, hematologic disorders, anticoagulant therapy, ventricular shunting, and old age predispose to SDH.

High Risk Offender Scheme

A special program in England, Wales, and Scotland was introduced in 1983, and the criteria widened in 1990 to cover drivers who were convicted of having a blood alcohol concentration (BAC) in excess of 200 mg 100 mL of blood, or refusing to provide an evidential specimen, or two offenses involving BACs in excess of 80 mg 100 mL of blood within a 10-yr period. This group accounts for approx 30-40 of drunk drivers in Britain. To regain their licenses at the end of a period of disqualification, the drivers must undergo a medical examination (including blood tests to discover biochemical evidence of excessive alcohol consumption) to demonstrate with reasonable certainty that they are not alcohol abusers (3). Similar statues apply in the United States. In California, drivers with a BAC higher than 200 mg 100 mL, in addition to whatever other sanctions are imposed, are required to attend a 6-months educational program (22). In the United States, penalties for drunk driving may be enhanced...

Helplessness and Depression

Seligman (1975) argued that the research on learned helplessness provides a model for clinical depression. For example, there is evidence that helplessness is involved in the relationship between alcohol dependence and depression (Sitharthan, Hough, Sitharthan, & Kavanagh, 2001). More generally, thousands of people each year are diagnosed as depressive. These individuals show insomnia, report feeling tired, often say that life is not worth living, have difficulty performing routine tasks, and may be suicidal. Clinical depression is severe, long lasting, and is not easily traced to a recent environmental experience.

Universal Precautions In Pain Medicine

As we begin to gain an understanding of the prevalence of substance-use disorders within the chronic pain population, it has become clear that no one behavior is pathognomonic of addiction. With this in mind, the importance of carefully inquiring into drug and alcohol histories in all patients becomes evident. This information is vital to any clinician treating complex medical and psychological problems. Alcoholism, for example, is a disease that intrudes into many aspects of the care of affected patients seeking medical treatment. Unresponsive hypertension, intractable mood disorders, difficult interpersonal relations, and poor sleep are all part of the life of an untreated alcoholic. While the use of potent medications including opioids in such cases is likely to be more complicated than in a similar patient who is not afflicted with this disorder, the need for the treating health-care professional to explore issues related to drugs and alcohol is not because of a choice to...

Roles and pain behaviour

There is evidence that sexual abuse has a link with later pain experiences, particularly with respect to pelvic and gastro-intestinal pain. This is with relation to self-reported sexual abuse. The actual incidence of abuse is difficult to estimate and perhaps is irrelevant. Repeated studies have demonstrated this link as reviewed by Thomas (1997), who related it back to the work of Engel (1959), and by Linton (1997). Linton et al. (1996) confirmed this link, in particular with musculo-skeletal pain, and also demonstrated that with females, physical abuse increased the risk of pronounced pain by five-fold and sexual abuse increased it by four-fold (Linton 1997). Goldberg et al (1999) found significant relationships between childhood abuse and later alcoholism, drug addiction and chronic pain. They argue that from their study, childhood abuse is a wider

Evidence Based Therapy

From a behavioral and cognitive model as from systemic one. This is a particularly critical observation. By broadening the base of family therapy, Carr (2000b) and others such as Pinsof and Wynn (1995) have systematically reported a high level of success with family therapy. Carr established evidence for the efficacy of family therapy with marital and family problems, psychosexual problems, anxiety disorders, mood disorders, psychotic disorders, alcohol abuse, chronic pain management, and family management of neurologically impaired adults. In his discussion on chronic pain management, he cited two references that may not be necessarily construed as family focused. Spousal behavioral reinforcement of pain behavior and its extinction is the focus of the work that Carr cites. Again, Rivett and Street (2003) raised a fundamental question of how we should define family therapy. They noted that Roy and Frankel (1995) arrived at a less optimistic conclusion about the effectiveness of family...

Chronic illnesses in patient or family members

During the initial visit, focus the history on the woman's current state of health and on risk factors for any conditions that could adversely affect her or the developing fetus. Ask about symptoms of pregnancy such as breast tenderness, nausea or vomiting, urinary frequency, change in bowel habits, and fatigue (see table on p. 412). Review her attitude toward the pregnancy, and if she plans to continue to term. Look into her eating patterns and quality of nutrition. Does she smoke or drink alcohol What about her income and her social support network

An Initial Interview with an American Indian Client

The African American male has been said to suffer from marginalization in many ways. Franklin (1993) coined the term invisibility syndrome, referring to White culture's fear-based tendencies to treat African males as if they were invisible. African American males have a lower life expectancy than White males or than females of either race because of murder, incarceration, mental and physical disabilities, drug and alcohol abuse, and dangerous employment situations (Hines & Boyd-Franklin, 1996). This invisibility can creep into the clinical interview, either in the form of stereotyped assumptions about the male who is present in the family system, or about the absence of the male in a family system.

Micronutrients Alcohol

Alcohol can cause widespread cell damage and fat peroxidation in the liver.8 Supplements may help protect against oxidative damage. Vitamin C may help detoxify alcohol9 May help reduce damage to the liver and lessen symptoms related to alcohol withdrawal in heavy drinkers12 B vitamins are poorly absorbed and their activation is impaired by alcohol. Most heavy drinkers are deficient in many B vitamins Deficiency is very common in heavy drinkers and can produce heart and neuromuscular problems The main enzymes that detoxify alcohol are dependent on zinc, thus zinc deficiency impairs abilityto breakdown alcohol, increasing potential

Metabolic Complications

Hyperglycaemia, hypercapnia, electrolyte abnormalities, and re-feeding syndrome are metabolic complications that can occur with enteral feeding. Complications are seen more often in diabetics and in patients receiving formulas with high caloric density. In diabetics, the use of hyperosmolar formulas can lead to hyperosmolar nonketotic coma. High carbohydrate concentrations may increase respiratory quotients and increase carbon dioxide production. Re-feeding syndrome is characterised by dehydration, hypernatraemia, hyper-chloraemia, and azotaemia. Its most common cause is the use of high-protein formulas with low water intake. This syndrome is seen among severely malnourished patients, such as alcoholics, when potassium and phosphorus requirements are high because of the intracellular shift that occurs when nutrients are replenished.

Guidelines for Bone Density Testing in

Determining when testing is appropriate in men has become increasingly important with the advent of prescription pharmacologic therapy for the treatment of osteoporosis in men. The prevalence of osteoporosis in men, although not as great as that in women, is high. In one study (19), the prevalence of osteoporosis in a population-based sample of 348 men was 19 when osteoporosis was defined as 2.5 SD or more below the average peak BMD for men. The major risk factors for osteoporosis in men are not dissimilar from those seen in women cigarette smoking, advancing age, risk of falls, and the presence of diseases or the use of medications known to affect bone metabolism (20-22). Heavy alcohol consumption is considered a major risk factor in men, more so than in women. Other risk factors include a sedentary lifestyle, lifelong low calcium intake, and low body weight.

Approach To Jaundice History and Examination

Examination of the skin should document the jaundice and also look for clues to its cause. The stigmata of alcohol abuse (e.g caput medusa, spider veins) Alcohol abuse can cause an acute, severe hepatitis, or chronic fatty liver, hepatitis, and cirrhosis. Alcohol leads to a conjugated hyperbilirubinemia by impairing bile acid secretion and uptake. Transaminase levels from alcohol abuse typically show the aspartate aminotransferase (AST) being elevated out of proportion to the alanine aminotransferase (ALT) viral hepatitis usually causes greater elevations of the ALT (see Case 41 for a more thorough discussion of alcohol abuse).

Alcohol Assessment Questionnaires

Have you ever attended a meeting of Alcoholics Anonymous 7. Have you ever had DTs, sever shaking, heard voices or seen things that weren't there after heavy drinking From Pokomy, A., D., Miller, B. A., Kaplan, H. B. The Brief MAST a shorten version of the Michigan Alcoholism Screening Test. Am. J. Psychiat. 131 1121-1123, 1974. Two or more positive responses sensitive indicator of alcohol dependence. From Mayfield, D., McLeod, G. and Hall, P. The CAGE Questionnaire Validation of a New Alcoholism Screening Instrument. Am. J. Psychiatry. 131 1121-1123, 1974. A score of 8 produces the highest sensitivity a score of ten or more results in higher specificity. In general high scores on the first three items in the absence of elevated scores on the remaining items suggest hazardous alcohol use. Elevated scores on items 4 through 6 imply the emergence of alcohol dependence. High scores on the remaining items suggest harmful alcohol use. For details see Babor, T. F., Ramon de la Fuente, J.,...

Alcohol and Substance Use Disorders

Substance and alcohol abuse present a clinical challenge in the treatment of any psychiatric illness. For bipolar patients, a comorbid alcohol More recent studies of comorbid SUDs or AUDs in bipolar patients have also demonstrated an increase in suicide risk associated with substance and alcohol abuse (Dalton et al. 2003 Hoyer et al. 2004). SUD and AUD comorbidity may be particularly damaging in bipolar disorder and may reveal a unique factor of the disorder. The added suicide risk observed in bipolar patients with comorbid SUDs or AUDs may not be present in unipolar patients (Hoyer et al. 2004). Comparisons of suicide risk associated with comorbid AUDs versus that associated with co-morbid SUDs have not yielded a clear difference. Dalton et al. (2003) demonstrated that drug use may present greater risk than alcohol use, with a twofold increase in suicide risk for bipolar patients with comor-bid substance abuse. However, Tondo et al. (1999) did not find a similar difference....

Behavioral Economics Choice and Addiction

To reduce drug abuse, Vuchinich (1999) suggests a multifaceted approach that (a) increases the cost of using drugs by law enforcement that reduces the supply (i.e., price goes up) (b) provides easy access to other nondrug activities (e.g., sports, musical entertainment, etc.) and arranges reinforcement from family, friends, and work for staying drug free and (c) provides reinforcement for nondrug behavior promptly, as delayed reinforcement is ineffective. These principles can be applied to many behavior problems, including smoking, use of alcohol, and compulsive gambling (Bickel & Vuchinich, 2000). It is no longer necessary or sensible to treat people as if they had an underlying illness or disease (e.g., alcoholism). Behavioral economics and learning principles offer direct interventions to modify excessive or addictive behavior.

Transmission of Infectious Agents

Exposure to Infected Body Fluids As you learned in Chapter 9, AIDS is caused by exposure to infected blood. Hepatitis is another disease caused by contact with infected blood. There are at least six different hepatitis viruses, but the most dangerous is the virus known as hepatitis C. Exposure to hepatitis C leads to chronic liver diseases such as cirrhosis (irreversible, potentially fatal scarring of the liver), liver cancer, and liver failure. Hepatitis C ranks second to alcoholism as a major cause of liver disease and is the leading reason for liver transplants in the United States.

On The Applied Side The Token Economy

Systems of token reinforcement have been used to improve the behavior of psychiatric patients (Ayllon & Azrin, 1968), juvenile delinquents (Fixsen, Phillips, Phillips, & Wolf, 1976), pupils in remedial classrooms (Breyer & Allen, 1975), normal children in the home (Alvord & Cheney, 1994), and medical patients who must follow a plan of treatment (Carton & Schweitzer, 1996 Dapcich-Miura & Hovell, 1979). Token economies also have been designed for alcoholics, drug addicts, prisoners, nursing-home residents, and retarded persons (see Kazdin, 1977, for a review).

The Cardiovascular System Multiple Choice

A 19-year-old college student presents to your office for evaluation of episodes of chest pain and shortness of breath. She has no medical problems. She does not smoke, drink alcohol, or use illicit drugs. She is on the dean's list and is studying electrical engineering. On auscultation of her heart, you hear a mid-systolic click at the apex. What is her most likely diagnosis

Successive approximation See shaping

A reinforcement system based on token reinforcement the contingencies specify when, and under what conditions, particular forms of behavior are reinforced. The system is an economy in the sense that tokens may be exchanged for goods and services, much like money is in our economy. This exchange of tokens for a variety of back-up reinforcers ensures that the tokens are conditioned reinforcers. Token economies have been used to improve the behavior of psychiatric patients, juvenile delinquents, pupils in remedial classrooms, medical patients, alcoholics, drug addicts, prisoners, nursing home residents, and retarded persons.

Antihypertensive Drugs

Blood pressure lowering therapy should be considered in individuals with repeated measures of systolic blood pressure > 140mmHg and or diastolic blood pressure > 90mmHg. Guidelines recommend that the overall cardiovascular risk should be considered.1 Treatment directed at lowering blood pressure should include lifestyle change encompassing smoking cessation, moderation of alcohol consumption, weight reduction, physical exercise, reduction of high salt intake and other dietary changes. When these measures fail, pharmacological treatment is indicated.

Druginduced liver damage

Sedatives, antidepressants and antiepilepsy drugs should be avoided or used with extreme caution in patients with advanced liver disease, and particularly those with current or recent hepatic encephalopathy. Enhanced sensitivity of the CNS to such drugs is well documented and adds to the pharmacokinetic changes. Treatment of alcohol withdrawal in patients with established liver disease using chlormethiazole is hazardous, especially given i.v. The temptation to give initial large doses to control agitation must be avoided because this drug, which normally has a high hepatic extraction, can readily accumulate to toxic concentrations. Chlordiazepoxide is preferred.

Basic Tests For Initial Evaluation Of Hypertension

Abdomen for enlarged kidneys, masses, or an enlarged abdominal aorta, evaluation of the lower extremities for edema and perfusion, and a neurologic examination should be standard. Some initial laboratory testing is also indicated (Table 9-3). Counseling patients on lifestyle changes is important at any blood pressure level and includes weight loss, limitation of alcohol intake, increased aerobic physical activity, reduced sodium intake, cessation of smoking. and reduced intake of dietary saturated fat and cholesterol.

Physical Examination Multiple Choice

A 68-year-old homemaker presents to your clinic complaining of difficulty swallowing. It began several months ago when she would attempt to eat steak. Over time, it has progressed to the point that she can only sip on soups and broths. She has sometimes had to regurgitate her food back up to get relief from the pain in her chest when she attempts to eat. Her past medical history is significant for diet controlled, type-2 diabetes. She had a 60-pack-year smoking history but quit smoking 15 years ago. She denies any drug or alcohol abuse. On review of systems, she has lost approximately 15 lbs in the past 3 months. She denies any heartburn, constipation, or diarrhea. On exam, you find a pleasant elderly woman in no acute distress. Her cardiac, pulmonary, and abdominal exams are all normal. What disorder of dysphagia is the most likely cause for her symptoms

Chronic Infection With Normal Alt Carrier

Although the bulk of the literature indicates that viremic patients with normal ALT typically exhibit a benign, nonprogressive clinical course, some centers have suggested that this group of patients is still at risk for progressive liver disease (37). In addition, the National Institutes of Health consensus conference suggested that liver biopsy is required in these patients, to define activity and stage disease (38). Also, patients with persistently normal ALT, but who have ALTs in the upper half of the normal range, are the subgroup at particular risk to have more aggressive grades of inflammation or grades of fibrosis. Heavy alcohol consumption is a risk factor for active disease and disease progression in this population. CHC in patients with persistently normal ALT. Mathurin et al. (39) performed a case-control study of 102 patients with positive hepatitis C virus antibody and normal ALT and 102 patients with positive hepatitis C virus antibody and abnormal ALT. HCV RNA was...

Nyha Functional Classification

Although heart failure has many causes (Table 2-2), identification of the underlying treatable or reversible causes of disease is essential. For example, heart failure related to tachycardia, alcohol consumption, or viral myocarditis may be reversible with removal of the inciting factor. In patients with underlying multivessel atherosclerotic coronary disease and a low ejection fraction, revascularization with coronary artery bypass grafting improves cardiac function and prolongs survival. For patients with heart failure, appropriate investigation is guided by the history but may include echocardiography to assess ejection fraction and valvular function, cardiac stress testing, or coronary angiography as indicated, and, in some cases, endomyocardial biopsy.

Risk for Development of HCC

Dual infection with HBV and HCV may accelerate the progression of chronic liver disease to cirrhosis and HCC (35-38). In one study of patients with HCC, the presence of both anti-HCV and HBsAg was found in 12 of cases (38). 45 did not have HBsAg, but integrated HBV DNA was detected in the tumor tissue. The relative risk of developing HCC was highest in those with HBsAg and anti-HCV positivity (RR 40.05), compared to those who are positive for only anti-HCV (RR 27.12) or HBsAg (RR 13.96), and those who were negative for both markers (RR 1.00). In a multivariate analysis of cirrhotic patients, male gender, older age, alcohol abuse, and dual positivity for HBsAg and anti-HCV were determined to be independent risk factors for the development of HCC. Benvegnu et al. (35) suggested that HBV might act as the initiating factor, by altering the arrangement of the hepatocyte genome, and that HCV is the promoting factor, by virtue of its contribution to continuing liver injury and regeneration.

Ethyl alcohol Ethanol

Alcohol is chiefly important in medicine because of the consequences of its misuse abuse. Alcohol misuse is a social problem with pharmacological aspects, which latter are discussed here. The history of alcohol is part of the history of civilisation 'ever since Noah made his epoch-making discovery'.23

Optic Neuropathies of Malnutrition Definition

An optic neuropathy of malnutrition is one caused by a dietary deficiency. In the developed parts of the world, this is most commonly a deficiency of vitamin Bi2. Such cases are uncommon, and are most often caused by macrocytic anemia. Vitamin Bi2 and folate levels are easily measured. Other risk factors for malnutrition include intestinal bypass or gastric stapling for weight loss and the hepatic cirrhosis of alcoholism. Treatment should include intramuscular injections of high doses of hydroxycobolamine.

Safe Limits For Chronic Consumption

Alcoholics with established cirrhosis have usually consumed about 23 units (230 ml 184 g) daily for 10 years. It has long been thought that total consumption accumulated over time was the crucial factor for cirrhosis. Heavy drinkers may develop hepatic cirrhosis at a rate of about 2 per annum. The type of drink (beer, wine, spirits) is not particularly relevant to the adverse health consequences.

Ranson Critieria For Severity Of Pancreatitis

Processes, but in the United States, alcohol use is the most common cause, and episodes are often precipitated by binge drinking. The next most common cause is biliary tract disease, usually due to passage of a gallstone into the common bile duct. Hypertriglyceridemia is another common cause and occurs when serum triglyceride levels are > 1000 mg dL, as is seen in patients with familial dyslipidemias or diabetes (etiologies are given in Table 14-2). When patients appear to have idiopathic pancreatitis, that is, no gallstones are seen on ultrasonography and no other predisposing factor can be found, biliary tract disease is still the most likely cause either biliary sludge (microlithiasis) or sphincter of Oddi dysfunction.

Human Correlational Studies

Low MAO levels are also found in various forms of psychopathology, including attention-deficit hyperactivity disorder, antisocial and borderline personality disorders, alcoholism and drug abuse, pathological gambling disorder, and paranoid schizophrenia (see Table 3.2). With the possible excep- High sensation seeking (normal trait) Attention-deficit hyperactivity disorder Antisocial personality disorder Chronic criminality Borderline personality disorder Alcoholism Relatives of alcoholics Drug abuse Bipolar disorder Relatives of bipolar disorder Pathological gamblers tion of paranoid schizophrenia (sensation seeking is actually low in more withdrawn individuals with schizophrenia), these are disorders characterized by impulsive and sensation-seeking behaviors in their active stages. Mania is a caricature of sensation seeking in its active stage, but even when patients with bipolar disorder are not having a manic episode, they score high on the SSS. Relatives of persons with alcoholism...

Spousal Distress and

Peters were of a different order. Mr. Peters, with a long history of alcoholism and back pain, had a great deal of difficulty in demonstrating his affection for his wife, and prior to the onset of his difficulties their sex life was only marginally satisfactory. Apart from the fact that Mr. Peters's own health problems further reduced their level of sexual activity, Mrs. Peters herself developed serious gastrointestinal problems. She also felt overburdened by her family responsibilities. In the course of the interview she flatly stated that she simply was not interested in sex, and had other more important matters on her mind. Mr. Peters concurred with her position.

Clinical Correlation

There are several methods for determining glycated hemoglobin, including ionexchange and affinity or high-performance liquid column chromatography. These methods all separate hemoglobin forms by their interaction with a mobile and stationary phase within a column. Quantitation of the glycated versus total hemoglobin can then be achieved spectrophotometrically. Some of these methods do experience analytical interferences due to temperature, altered forms of hemoglobin due to disease states such as uremia or alcoholism, or the presence of abnormal forms of hemoglobin such as S, C, or F.15

Antituberculosis Drugs

Isoniazid is a structural analogue of pyridoxine and accelerates its excretion, the principal result of which is peripheral neuropathy with numbness and tingling of the feet, motor involvement being less common. Neuropathy is more frequent in slow acetylators, malnourished people, the elderly and those with HIV infection, liver disease and alcoholism. Such patients should receive pyridoxine 10mg d by mouth, which prevents neuropathy and does not interfere with the therapeutic effect some prefer simply to give pyridoxine to all patients. Other adverse effects include mental disturbances, incoordination, optic neuritis and convulsions.

Recurrence12 Alcohol and SCD

The question of the effect of alcohol on heart and vessel diseases has been the subject of intense controversy in recent years. The consensus is now that moderate alcohol drinking is associated with reduced cardiovascular mortality, although the exact mechanism(s) by which alcohol is protective are still unclear. In experimental models, an ethanol preconditioning phenomenon13 has been reported, suggesting that low dose ethanol drinking protects the myocardium against damages provoked by ischemia. In contrast, chronic heavy drinking has been incriminated in the occurrence of atrial as well as ventricular arrhythmias in humans, an effect called the holiday heart because it is often associated with binge drinking by healthy people, specifically during the weekend. Studies in animals have shown varying and apparently contradictory effects of alcohol on cardiac rhythm and conduction, depending on the animal species, the experimental model, and the dose of alcohol. If given acutely to...

Genes In Causal Pathway Of Disease Cholesteryl Ester Transfer Protein Polymorphism

In addition, Kuivenhoven et al. found no difference in plasma lipoprotein response to pravastatin between the different genotypes, but the B2B2 genotype (about 16 of all Caucasian men) with low CETP and high HDL concentrations did not respond to pravastatin in terms of decreased disease progression 40. Furthermore, in a case-control study, Fumeron et al. showed that HDL-C levels were only increased in subjects with the B2B2 genotype after ingesting at least 25 g of alcohol per day (50). In the cohort of Kuivenhoven et al., alcohol consumption did not affect the association between the CETP genotype and the angiographic outcome in the control group, nor in the group treated with pravastatin (51). In the WOSCOPS trial (one of the primary prevention trials) the same

Cannabinoid receptor gene expression

The emergence of novel research tools has accelerated cannabis research in the last decade, more than at any time in the thousands of years of marijuana use in human history. Although it is not yet known why the marijuana (cannabinoid) system is so abundant in the nervous system, the analysis of the receptor proteins and genes encoding these Cnrs may shed some light on the mode of action of can-nabinoids, and the biological role of these genes in the nervous system. In our studies, we have analyzed both CB1 and CB2 Cnr genes in normal humans who do not use marijuana. The expression of the Cnr proteins in different human population according to gender and ethnic background in Asians, blacks and whites were compared. The finding that the expression of Cnrs in humans varies according to gender and ethnic differences among whites, blacks and Asians population, while a significant observation, should be confirmed in a larger sample size. The implications and physiological relevance of this...

The Lipid Oxidation Theory of CHD

Finally, a significant correlation was found between certain dietary fatty acids and the fatty acid composition of human atherosclerotic plaques, which suggests that dietary fatty acids are rapidly incorporated into the plaques. This implies a direct influence of dietary fatty acids on plaque formation and the process of plaque rupture. It is conceivable that fatty acids that stimulate oxidation of LDL (n-6 PUFA) induce plaque rupture whereas those that inhibit LDL oxidation (oleic acid) inhibit leukocyte function (n-3 PUFA), or prevent endothelial activation, and the expression of pro-inflammatory proteins (oleic acid and n-3 fatty acids) helps to pacify and stabilize the dangerous lesions. In this regard, it is noteworthy that moderate alcohol consumption, a well-known cardioprotective factor, was recently shown to be associated with low blood levels of systemic markers of inflammation, suggesting a new protective mechanism to explain the inverse relationship between alcohol and CHD...

Identifying Evaluating and Exploring Client Problems and Goals

Common problems presented by clients include anxiety, depression, and relationship conflicts. Other problems include eating disorders, alcoholism or drug addiction, social skill deficits, physical or sexual abuse, stress reactions, vocational confusion, and sexual dysfunction. Because of the wide range of symptoms or problems clients present, it is crucial that interviewers have at least a general knowledge of psychopathology and DSM-IV-TR (American Psychiatric Association, 2000). However, every problem Even if you believe an issue different from what the client identifies should be explored (e.g., alcoholism), it's best to wait and listen carefully to what the client thinks is the main problem (chief complaint). Acknowledging, respecting, and empathizing with the client's perspective and helps you be effective, gain trust, and keep the client in counseling. In time-limited circumstances (e.g., managed care), nondirective em-pathic responses arebrief and intermittent. Usually, there...

Dietary Influence on Blood Pressure Regulation

Medical nutrition therapy for the management of hypertension has focused on weight reduction and reducing sodium intake.20 In both normoten-sive and hypertensive individuals, a reduction in sodium intake lowers blood pressure. In hypertensive patients, the goal should be to reduce sodium intake to 2400mg (100mmol) or sodium chloride (salt) to 6000mg day. Other nutritional variables that have been considered include alcohol, potassium, calcium, and magnesium intake. An association between high alcohol intake (> 3 drinks day) and elevated blood pressure has been reported. However, there is no major difference in blood pressure between people who consume < 3 drinks day and non-drinkers. Clinical trials have reported a beneficial effect of potassium supplementation on lowering blood pressure. Such high potassium intake can be provided by high intake of fruits and vegetables (five to nine servings day). In contrast, evidence for a beneficial effect from calcium and magnesium...

Peer Social Influence

An important direction for future research is the extension of peer influence research to younger age groups. Most of this research has focused on adolescents, for good reasons. Behaviors investigated in peer pressure studies are typically health-risk-taking behaviors such as smoking, drinking alcohol, and drug use that are simply not as prevalent in childhood as they are in adolescence. Further, the importance of making friends as a way of finding a sense of belonging has been hypothesized to be a more salient developmental task in adolescence (Erikson, 1968). And although children do make attempts to influence the behavior of their peers, there has been an implicit assumption that true peer pressure, arguably the exclusive domain of the adolescent, is the only kind of influence that researchers should be concerned about.

Initial Evaluation History and Physical Examination

A detailed history and physical examination on the initial patient-physician encounter, will provide the most important early information leading to the therapeutic plan, and ultimately aid in managing the potential side effects of treatment. Taking a detailed history from the patient with chronic viral hepatitis will provide the approximate time and source of infection in many cases, symptoms of liver disease, if present, and disease co-factors, such as alcoholism and drug addiction. Furthermore, significant co-morbidities, such as uncontrolled depression or heart disease, which would be contraindications to treatment, will also be identified by the initial patient history (see Table 1).

Interviewing Clients with Substance Issues or Problems

Many professionals who work with alcohol and substance-abusing clients have a personal history of substance abuse or dependence. Obviously, if you choose to work with this population, having your own substance abuse history can be a benefit or a liability. If you have experienced substance problems, you are more likely to know about the big issues from the inside out and this can give you greater empathy for substance-abusing clients and greater knowledge about how alcoholics or drug addicts typically avoid facing their problems. Alternatively, having had your own personal substance abuse problems makes it more likely for you to project your issues onto clients and view them less accurately (see Putting It in Practice 7.1).

Patients Not Suitable for Treatment Developing the Therapeutic Plan

Alcohol Abuse Treatment Algorithms

Of drinking, and treating the alcoholic, should be the first line of therapy. Abstinence for at least 6 mo is necessary, prior to considering further treatment. In fact, alcohol use should be condemned for all HCV-infected patients. One of the few positive outcomes of the HCV epidemic has been the cessation of drinking in many HCV-infected patients, including alcoholics. In a recent concise review (31), an algorithm for assessing the risk of the hepatitis patient for developing neuropsychiatry side effects of IFN, and for managing the side effects when they occur, has been proposed. In developing the therapeutic plan for the patient with chronic viral hepatitis, this approach recommends identifying the patient who has underlying psychiatric disease, or who is at risk for developing psychiatric disease during IFN therapy. Prior to initiating therapy, a psychiatric evaluation should be obtained for patients who have a significant past or present history of depression, and, most notably,...

Exploring Your Personal Attitudes Toward Substances

In one way or another, everyone has a personal substance use or abuse history and an attitude toward alcohol and drug use worth examining. Whether you grew up in a family with strong prohibitions against drinking alcohol or a family with members suffering from cocaine addiction, your family experiences undoubtedly shaped how you think about people who use (or do not use) alcohol, cocaine, and other drugs. To become more effective in working with substance-abusing clients, you should reflect on your personal alcohol and drug history, your current attitude toward substances, and your family's alcohol and drug history (almost every family has someone perhaps an uncle, a father-in-law, or a sister-with substance use problems). What do I think about the CAGE assessment questions (see text) How about the NIAAA criteria (see text) for alcohol consumption How would I answer the questions Do I, or have I ever had a problem with alcohol or other drugs

Alcohol and Fitness for Interview

Alcohol withdrawal states and the complications of alcohol withdrawal can impair cognitive functioning and affect a suspect's ability to both cope with interrogative pressure and provide reliable testimony. Even the after effects of alcohol, or hangover, impair critical task performance, such as aircraft operation, and can impair judgment (71). Research evidence has also suggested that alcohol withdrawal can increase a suspect's suggestibility, although it is not totally clear whether this is a direct result of the alcohol withdrawal or is secondary effect of its treatment (72).

Comprehension Questions

29.2 A 55-year-old man with a long history of alcohol abuse presents with a 3-week history of progressive confusion and stupor. On examination he is afebrile, but he has a new right sixth cranial nerve palsy and tremulousness of all four extremities. His CSF has 250 WBCs mm3, with 68 lymphocytes. There are 300 RBCs mm3. Protein levels are high, and the ratio of CSF to serum glucose is very low. He is started on ceftriaxone, vancomycin, and acyclovir. A purified protein derivative (PPD) placed on admission is positive, and bacterial cultures are negative at 48 hours. Which of the following would help to confirm the diagnosis

Avoidability Of Cancer

If, as a number of cancer epidemiologists contend, lifestyle accounts for about 80 of all malignant cancers, then presumably the same proportion of cancers should be avoidable. To be more specific, about 30 of all cancers are thought to be related to smoking, 3 to alcohol consumption, 30 to diet, 7 to sexual and reproductive patterns, and another 5 to occupational hazards and industrial products.50,51 Moreover, about1 are estimated to be related to drugs and medical procedures (primarily X-rays)

Alcoholic Liver Disease Nutritional Effects of Alcohol Substance Abuse

The physician suspected that the night blindness was due to his poor diet. In particular, the physician was concerned about vitamin A deficiency. Mr. Green was referred to the dietitian at the clinic to assess this aspect of his diet and because of his history of alcohol abuse, weight loss, and suspected poor dietary intake. The dietitian performed a complete nutritional assessment. His nutritional assessment showed him to be a 5-foot 10-inch, 145-pound man with a BMI of 20.8 kg m2 (normal for his height and weight). His history and physical examination included difficulty seeing at night, normal blood pressure, spider angioma, esophageal varices, and mild gastritis.6

Dietary Hazards Caffeine and Alcohol

About 1 of a maternal dose of caffeine (whether from coffee, tea, soft drinks, chocolate, or medicines) is transported into the breastmilk. Infants metabolize caffeine more slowly than adults, and caffeine in breast milk may cause irritability and wakefulness. High intake of alcohol can inhibit milk production. Moreover, infant exposure to alcohol during breast-feeding may have serious adverse effects on development. Ethanol itself readily passes into the milk at concentrations approaching those in maternal blood and can produce lethargy and drowsiness in the breast-feeding infant. Heavy alcohol consumption (more than 4-5 drinks day) by nursing mothers may impair psychomotor development in their infants.10 The effects of occasional light drinking are unknown.

Vitamin A Night Blindness

Green was counseled to stop drinking and select a healthier diet. Since Mr. Green lives alone with no available social support, a high-protein, high-kilocalorie diet along with dietary supplement was recommended to meet his nutritional needs. The dietitian explained how to select and prepare foods to improve overall dietary quality, using his microwave only. She also recommended a multivitamin and mineral supplement, including zinc, to improve his overall dietary intake. Elemental zinc supplement was also recommended, for the short term, to improve his current zinc status. Since zinc supplementation may interfere with copper absorption and thereby cause a compromise in copper status, the recommended multivitamin and mineral supplement also contained the recommended intake of copper12 to prevent a possible deficiency. He was scheduled for routine follow-up visits with both his primary healthcare provider and the dietitian, at which time he will have repeat analysis of protein...

NNitroso compounds Diet and Smoking

Tobacco smoke is a potent source of NOCs and polycyclic aromatic hydrocarbons (PAHs), among other carcinogens. Meta-analyses have provided little evidence of an association between maternal smoking during pregnancy and childhood brain tumors 20, 21 . Preconception and childhood exposure to paternal tobacco smoke revealed a raised risk, but confounding with other risk factors could not be ruled out 20 . The results of studies of smoking as a risk factor for CNS tumors in adults have been inconsistent 8 . Likewise, there is no consistent evidence for an elevated risk associated with alcohol consumption 8 .

Cytochrome P450 Family Of Enzymes

Cytochrome P450s have a role in the metabolism of drugs and other xenobiotics, some of which may be involved in chemical carcinogenesis. The covalent binding of chemicals to cellular macromolecules (e.g., DNA, RNA, and proteins) is considered to be a key step in the multistage carcinogenesis process. The formation of chemicals with the high electrophilicity necessary to form DNA adducts very often requires metabolism by P450s, e.g., the metabolism by the CYP1A family of benzo a pyrene to its diol-epoxide. P450s can also damage macromolecules due to the production of reactive oxygen species as by-products of P450-catalyzed reactions. On the other hand, P450 may also metabolize certain compounds to less reactive metabolites. Many studies have demonstrated that P450 enzymes can be modulated and induced by factors such as smoking and alcohol consumption, prior exposure to drugs and medications, and dietary parameters. The remainder of this chapter will focus on the modulation by...

Diseases Of The Adrenal Cortex

When the cortex region of the adrenal gland is overfunctioning, it is often due to a secreting adenoma, a benign hormone-secreting tumor. Primary hypercorti-solism is the name of this disorder because the disease resides in the primary organ of this endocrine structure, the adrenal cortex. It is associated with increased levels of cortisol throughout the day, loss of diurnal variation, and decreased levels of ACTH. ACTH is low due to the negative feedback response of the pituitary gland, which is functioning normally in primary hypercortisolism. Hypercortisolism in the adult is characterized by hyperglycemia and changes in fat and water distribution. Other characteristics include bruising and poor wound healing, weight gain, weakening of bones, and depression. The weight gain tends to be located in the middle of the body with accompanying muscle wasting, known as truncal obesity. Fat accumulation on the upper shoulders and collar bone causes a hump on the upper back and jutting...

Utility of Event Related Potentials in Substance Abuse Research

Because many of the illnesses believed to have genetic components are characterized by some type of abnormal brain function, it has been postulated that abnormalities in latency, amplitude or topography of ERP components could serve as markers of genetic vulnerabilities. To date, most of the data supporting this notion in substance abuse is in the area of alcoholism. The P300 is a good candidate as a biological marker because there is ample evidence to indicate that its generation is genetically determined (Begleiter et al., 1998) and a number of studies have found that young children with a family history of alcoholism have significantly reduced P300 amplitudes before ever being exposed to alcohol compared with children without such a history (Begleiter et al., 1984, 1987 Porjesz and Begleiter, 1990). In addition, findings of reduced P300 amplitudes in chronic (Porjesz et al., 1980) and recovering (Porjesz et al., 1987) alcoholics further support the notion that that P300 amplitude...

Vitamin B1 Thiamine Deficiency

Thiamine pyrophosphate (TPP) is an important cofactor of the enzyme transketolase, which is involved in glucose metabolism. Deficiency develops in various clinical settings malnutrition, malabsorption syndromes, chronic gastritis, gastrointestinal malignancies, persistent vomiting, and prolonged intravenous feeding without vitamin supplement. Alcoholics are at particular risk for the disease because of malnutrition moreover, alcohol interferes with the metabolism, absorption, and storage of thiamine.

Genetic And Environmental Associations With Breast Cancer Subtypes

There may also be differences in environmental risks for development of different subtypes of breast cancer. Much of the evidence at this time is indirect and based on observed differences by hormone receptor status. For example, large epidemiological studies suggest that the risk factors for ER-negative breast cancers, which are comprised primarily of basal-like and HER2-subtypes, differ from those of ER-positive, or luminal breast cancers. Investigators from the Nurses' Health Study have found that the traditional hormonal risk factors are far more useful in predicting ER-positive breast cancer than ER-negative (23) and hormone replacement therapy is associated only with increases in ER-positive breast cancer (24). Chemoprevention with the selective estrogen receptor modulator tamoxifen reduces only ER-positive breast cancer (25). Alcohol consumption appears to correlate with increased risk of development of ER-positive, but not ER-negative tumors in some studies (26). Conversely,...

EtOH and Increased Acetaminophen Toxicity

Acetaminophen in low doses (< 2.5 g d) is not absolutely contraindi-cated in patients with underlying liver disease. However, in conjunction with chronic alcohol consumption, enhanced metabolism of usually safe doses of acetaminophen to a toxic derivative may occur (1,9). The mechanisms by which this occurs are shown in Fig. 2.

EtOH and Increased Methotrexate Toxicity

In addition, careful patient screening and selection are advisable. Patients should be screened, at baseline, for potential risk factors for liver disease, including chronic viral hepatitis. The American College of Rheumatology recommends routine periodic measurement of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, albumin, total bilirubin, hepatitis B and hepatitis C serologies, complete blood count, and serum creatinine in all patients receiving MTX. A pretreatment liver biopsy is recommended for patients with prior excessive alcohol consumption, persistently abnormal baseline serum AST or ALT values, and or chronic hepatitis B and or CHC infections. Serum AST, ALT, and albumin levels should be monitored at 4- to 8-wk intervals during MTX therapy. The American College of Rheumatology recommends liver biopsy, if 5 9 AST determinations within a 12-

Alcohol and Chronic Viral Hepatitis

The most common form of nonalcohol-induced liver disease seen in patients with alcoholism is CHC (7). In patients with CHC, chronic alcoholism has been shown to cause more severe and rapidly progressive liver disease. This can lead more frequently to cirrhosis of the liver and hepatocellular carcinoma. Alcohol intake in excess of 10 g d has been associated with increased serum hepatitis C viral RNA and amino-transferase levels (7). The mechanisms of these increases are poorly understood, but, as mentioned, Fe may enhance viral replication and or reduce immune-dependent viral killing. The histological picture in hepatitis C patients with chronic alcohol abuse is usually indistinguishable from that in CHC patients who do not use EtOH. In alcoholic patients, compared with nonalcoholic patients, IFN therapy has been shown to be less effective, even after a period of abstinence. Alcohol intake should be restricted to 10 g d or less in patients with CHC. If cirrhosis is present, or IFN...

Test Methodology 1111 Total Magnesium By Metallochromic Indicator Method

Mone may play a minor role, with a direct relationship between PTH secretion and plasma magnesium response as with calcium, versus the indirect relationship with plasma phosphates. Diet is the main source of magnesium, as evident in starvation, poor diet in chronic alcoholism, long-term parenteral feeding, or gastrointestinal malabsorption and steatorrhea, which may result in hypomagnesemia. Hypoparathyroidism, especially secondary to surgical removal of the parathyroid glands, and renal or acid-base disorders also are causes of hypomagnesemia. Neonatal hypomagnesemia and hypocalcemia result from prematurity, acid-base disturbances, or exchange transfusions, with serious consequences. Mineral replacement therapy may be needed for magnesium and calcium in those situations. Hypermagnesemia can result from renal insufficiency and or excessive treatment with antacids or other magnesium-containing medications. Cardiac and neuromuscular changes occur similar to those with hyperkalemia, and...

Current Drugs on the Market

Opioid antagonists (Table 7.4), predominantly naloxone, are used clinically to reverse the effects of opiates in overdose or postoperative sedation. Naltrexone, which has oral bioavailability, is used for the treatment of narcotic addiction and alcohol dependence. As discussed below (Section, peripherally selective antagonists are being evaluated for treatment of constipation and other gastrointestinal side effects associated with opioid agonist use.

Historical Context

In Virginia, Carrie Buck was an institutionalized 18-year-old unwed mother whose mother and child were also feebleminded. She was forcibly sterilized under Virginia's 1924 eugenics law. Her case was appealed to the Supreme Court, claiming that the plaintiff, under the Fourteenth Amendment, was denied due process and equal protection of the laws. However, Supreme Court Justice Oliver Wendell Holmes in Buck v. Bell (1927) upheld the state eugenics law, declaring three generations of imbeciles are enough. With this precedent, over the next 40 years 60,000 people nationwide were sterilized for other types of unacceptable behaviors or conditions, such as alcoholism, promiscuity, criminal acts, epilepsy, and running away from home. In an attempt to make restitution, several governors have formally apologized to their states' eugenics victims.

Marijuana Withdrawal Syndrome

Chronic marijuana users often fit the profile for addictive disease, characterised by compulsion, loss of control, and continued use in spite of adverse consequences. In recovery, these individuals may respond well to such supported recovery fellowships as Alcoholics Anonymous (AA) and Marijuana Anonymous (MA). Subtle withdrawal symptoms may persist for extended periods of time, however, and it is not uncommon to hear chronic marijuana smokers in long-term recovery comment that it was several years into abstinence and sobriety before they were truly aware of the adverse effects marijuana had on their thinking and behavior.

Alcoholic Ketoacidosis

Alcoholic ketoacidosis is seen foliowing binge drinking of large amounts of ethanol complicated by poor food intake and vomiting (usually due to alcohol-induced gastritis) 113, 114 . The lack of food iniake and the ECF volume depletion lead to suppression of insulin secretion via an a-adrenergic effect 115 . This combination of hormonal changes both increases lipolysis in adipose tissue (stimulation of hormone-sensitive lipase) and diminishes hepatic lipogenesis (inhibition of hepatic acetyl-CoA carboxylase (ACC)) (Figure 16). produce ATP 85, 86 . This, together with the inhibition of the synthesis of fatty adds in liver (inhibition of ACC by the low insutin and high circulating counter-insulin hormones such as adrenaline and glucagon), leads to the rapid formation of ketoacids. The acidosis may be quite severe and have a relatively rapid onset, with ketoacid anion levels of up to 20 mM it is associated with an increase in the anion gap in plasma. Establishing the diagnosis of...

Neurodegenerative Pathology within the Hippocampus

The hippocampus is a prime target for expression profiling studies due to its central involvement in learning and memory and failure in a variety of neurodegenerative disorders, such as AD and ischemia. Indeed, microarray analysis has been utilized in the hippocampus for a variety of downstream genetic analyses in animal models, including regional hippocampal studies of alcohol consumption 159 , aging 120 , amyloid overexpression 143, 160 , antidepressant administration 161 , axotomy 145 , epilepsy 162, 163 , hippocampal cytoarchitecture 164, 165 , hypergravity 166 , hypoxia ischemia 167, 168 , learning and memory 169, 170 , nerve agent exposure 171 , and traumatic brain injury 172 , among others. Regional analysis of hippocampal gene expression has also been performed on postmortem human brain tissues, including studies assessing AD 128, 135, 136, 173 and epilepsy 140, 162, 174 .

Ghb With Synthetic Glycogen For Cancerous Cells

Gastritis, in alcohol abuse, 342 Gastrointestinal tract. See also specific components anatomy of, 32-34, 33f, 356-357 cancer of, tumor markers for, 471t function of, 32-34, 33f, 356-357 Gaussian distribution in quality control, 54-55, 54f in reference range determination, 71 GEM Premier 3000 blood gas analyzer, 328-329

TABLE 1712 Diagnostic Facies in Infancy and Childhood

Babies born to women who are chronic alcoholics are at increased risk for growth deficiency, microcephaly, and mental retardation. Facial characteristics shown here include short palpebral fissures, a wide and flattened philtrum (the vertical groove in the midline of the upper lip), and thin lips.

Recreational Drugs and the Nervous System

Drugs affect each of us differently because of differences in overall metabolism, weight, and gender. The gender difference is clearly illustrated by the way alcohol consumption affects males and females. Impaired judgment, slurred speech, unsteady gait, slower reaction times, uncontrollable emotions. Chronic alcohol abuse leads to loss of intellectual ability and liver damage. Alcohol kills nerve cells that cannot be regenerated. As nerve cells die, the brain actually gets smaller. The frontal lobes, where judgment, thought, and reason are centered, are the first to die.

Host Factors

For management of CHC, examined patients for factors associated with disease progression. Most of the patients had established liver disease, 16.8 had cirrhosis on entry, and 7.4 died during a mean follow-up of 26.9 mo. Death resulting from complications of liver disease, including liver failure and HCC, occurred only in cirrhotics and accounted for half of the total deaths. Risk of death was increased in patients with cirrhosis, long duration of disease, alcohol consumption, injection drug use, and older age. Acquisition of infection at a young age was associated with higher risk of dying from liver disease. Risk of death was decreased by use of interferon. Male sex may be another risk factor for more rapid progression of fibrosis (47,54). Or, conversely, female sex may be protective. In the studies of women who acquired hepatitis C after anti-D immunoglobulin, rates of development of cirrhosis, after approx 20 yr of infection, were 0.4-4 (19,20). In contrast, a group of...

Extraneous Factors

Most studies have suggested that chronic heavy consumption of alcohol is an important co-factor in progression of CHC to cirrhosis and hepatoma. Early epidemiological surveys (80,81) established the relationship between HCV infection and alcohol liver disease. Subsequent investigations indicate that chronic heavy alcohol use may promote HCV replication (82,83). In numerous epidemiologic studies, alcohol is often identified as a major factor in promoting progression of liver disease (84-88). An Australian study of 234 patients with CHC, who underwent liver biopsy, demonstrated cirrhosis in 21 , and that the risk of cirrhosis was related to two primary factors patient age, and total lifetime alcohol consumption (89). One could conclude that, in general, alcohol intake, especially exceeding 50 g d, promotes progression of fibrosis, accelerates liver disease, and is also linked to an increased risk for HCC (90). Two case-control studies (91) from Italy are consistent with the fact that...

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Supreme Sobriety

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