Stop Alcohol Addiction

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...

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As a whole, this manual contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

The National Directory of Drug Abuse and Alcoholism Treatment and Prevention Programs DHHS Pub No SMA 013243

This publication, offered free by calling the National clearinghouse for Alcohol and Other Drug Information at (800) 729-6686, lists federal, state, local, and private providers of alcoholism and drug abuse treatment and prevention services. It gives the location and selected characteristics of substance abuse service providers and offers information about state authorities and prevention contacts. Each facility is identified by name, with address, telephone number, hotline (if applicable), and codes for types of service providers, facility location, and third-party payments.

Alcohol Dependency and Abuse

More adolescents in the United States drink alcohol than smoke tobacco or marijuana. Underage drinking accounted for at least 16 percent of alcohol sales in 2009. In 2007, 2 percent of eighth, 16 percent of tenth, and 28 percent of twelfth graders reported having five or more alcoholic beverages in a row in the last two weeks. Binge drinking by girls is increasing more rapidly than for boys. When compared with non-college-age peers, college students have higher binge drinking percentages (41 percent versus 34 percent).

Definition of Drinking Problems

The measurement of drinking problems in survey research has a long history, extending back to the early national surveys on drinking and drinking problems (Clark, 1966 Keller, 1962), although considerable debate still exists regarding the list of eligible problems and or the definition of such problems. There are also difficulties with the assessment of these consequences. The first of these is the issue of attribution. Although the definition of these items assumes that the outcome was the result of alcohol use and would not have occurred in the absence of alcohol consumption, none of the consequences is unique to alcohol exposure, and this assumption is difficult to prove. Moreover, as alcohol consumption increases, the tendency to blame problems on alcohol may also increase, confounding the relationship. In addition, negative labeling, as well as denial, both lead to a tendency to deny the role of alcohol in a given problem. The effect of these factors on the measurement of...

Prevalence and Correlates of Drinking Problems

In an earlier national survey, 72 of all drinkers reported no drinking problems, 10 reported one problem, and 14 reported three or more problems (Hilton, 1991c). These drinking problems were more common among men than women and were found at higher rates among younger people (Hilton, 1991b). African-American men had higher rates of drinking problems than did Caucasian men. Ten percent of African-American men reported high levels of dependence symptoms (four or more) and 13.2 reported high levels of consequences (four or more, on a weighted scale) compared to 5.1 and 6.6 for Caucasian men, respectively. Caucasian women had more dependence problems than African-American women, with rates of 2.7 and 2.3 , respectively, but there was no difference in the rates of consequences. Among men, the rate of drinking problems was highest among divorced or separated men, 13.6 reported a high level of consequences, with widowed (12.5 ) and never-married men (10.9 ) next in order, compared to a low...

Alcoholism Or Alcohol Abuse And Dependence Definition and Diagnosis

The use of the word alcoholism was proposed in Sweden in 1852 (Paredes, 1979) to remove the stigma of the term drunkenness, and was defined as the biological and behavioral symptoms resulting from the damage caused by excessive ingestion, an irresistible urge to drink, and a functional disturbance of the central nervous system. Jellinek (1960) laid the groundwork for current diagnostic thinking. He proposed that there were two types of alcoholics, those who suffered physical and physiological changes resulting from prolonged use (chronic alcoholism), and others who had alcohol addiction, characterized by an urgent craving for alcohol. There are as many different schemata for diagnosis as there are different names for the phenomenon. However, in general, the diagnoses include four concepts tolerance to alcohol, withdrawal during abstinence, impaired control over alcohol consumption, and problems related to the use of alcohol (Beresford, 1991). These core factors that define the...

Prevalence of Alcohol Abuse and Dependence

Three large surveys provide data on the prevalence of alcohol dependence and abuse in the United States, the Epidemiologic Catchment Area (ECA) study, a study conducted collaboratively at five sites throughout the United States, the Alcohol Supplement to the National Household Interview Survey (NHIS), and the National Comorbidity Study (NCS). The ECA study used standardized methods at all sites and diagnostic criteria from the DSM-III (Leaf et al., 1991). Data collection occurred between 1980 and 1984 across the separate sites. A structured diagnostic interview, the Diagnostic Interview Schedule (DIS), was developed and was administered by lay interviewers. Reliability studies of the diagnoses of alcohol abuse and dependence using this instrument are somewhat conflicting, however, the reliability seems to be moderate (Anthony et al., 1985 Helzer et al., 1985). The ECA study found high prevalence rates for alcoholism (defined by the authors as either abuse or dependence) 13.8 of all...

Correlates of Alcohol Abuse and Dependence

There were differing patterns in the prevalence of alcoholism by age, sex and race in the ECA study (Helzer et al., 1991). The lifetime prevalence rate for alcoholism in Caucasian males decreased from 28.3 to 27.0 between age groups 18-29 and 30-44, respectively, and the rate in Caucasian females decreased across the same ages from 7.5 to 5.5 . Thereafter, in both genders, the rates decreased with age. The decrease was greater for females and the male to female ratio increased from 3.8 to 1 in the youngest age group to 8.6 to 1 in the oldest. With respect to age, the pattern of alcoholism among Hispanics had a pattern similar to that of Caucasian men and women although the prevalence rates were higher for Hispanic males (35.9 at ages 30-44) and lower for Hispanic females (3.7 at ages 30-44). The pattern by age was different among African-Americans. For both males and females, the highest prevalence rates were found in the middle age groups, between ages 45 and 64, 32.9 for males and...

Alternative Models of Alcoholism

There are other formulations of the diagnostic spectrum of alcohol abuse and dependence, although few epidemiologic data exist for these proposed models. Cloninger (1987) has proposed a neurobiological learning model of alcoholism, based on personality dimensions, that has two subtypes. Type I or milieu-limited alcoholics have a later onset, psychological rather than physiological dependence, and they experience guilt over their use. Type II or male-limited alcoholics have problems at an earlier age, exhibit spontaneous alcohol-seeking behavior and are socially disruptive when drinking. Johnson and colleagues (2000) suggested that subtypes of alcoholics could be differentiated by age of onset. In contrast to the early onset - late onset subtyping, they considered age of onset in three categories under 20 years old, 20-25 years old, and over 25 years old. Zucker (1987), on the basis of developmental studies, has proposed a four-group subtype of alcoholism. Babor et al. (1992), using...

Genetic Factors in Alcohol Abuse and Dependence

Family studies have demonstrated that the risk of alcoholism was much higher among first-degree family members of an alcoholic on average, the risk was increased seven times (Merikangas, 1990). More recent work has also found a higher rates of alcohol dependence in adult siblings of an alcoholic (Bierut et al., 1998). In a sample of individuals diagnosed with DSM-III-R alcohol dependence, 49.7 of their brothers and 23.8 of their sisters also had a diagnosis of alcohol dependence. This compared to 19.8 of brothers and 6.0 of sisters of a nonalcohol dependent control group. Studies of twin pairs also demonstrated a genetic influence, although the effect was moderated by gender and diagnosis. Concordance rates were higher for men than for women and for alcohol dependence compared to alcohol abuse (Pickens, 1991).

Overview of Alcoholism Treatment

Alcoholics who are actively drinking are among the highest cost users of medical services in the United States. Several studies have documented that alcohol treatment has beneficial effects on health care expenditures, primarily as a result of decreased health care use by alcoholics and their families. A Harvard Study compared 587 lifesaving interventions and ranked all substance abuse interventions, including treatment of alcoholism, in the top 10 (Tengs et al., 1995). Physicians interface with the medical or behavioral effects of alcoholism when patients deteriorate to the point of trauma, end-organ damage, or behavioral impairment. As with other chronic disorders, alcoholism is slow but progressive. As the disease progresses, the ability to control drinking diminishes, which distinguishes an alcoholic from a nonalcoholic. Many physicians view detoxification as the treatment of this disorder, which is similar to giving diabetics one injection of insulin to control their diabetes. It...

Alcohol Dependency and Psychiatric Comorbidities Dual Diagnosis

Dual diagnosis is defined as alcohol dependency with one or more other psychiatric comorbidities. Frequently, alcoholics abuse other substances, such as crack cocaine, nicotine, and even opiates (Tallia et al., 2005). Comorbidity estimates among alcoholics, gender preferences for addictive substances, and patterns of progression vary widely (Crum, 2009). Assessment of long-term outcomes highlights the impact of comorbidities on level of functioning, educational achievement, occupation, and social relationships (Crawford et al., 2008). Patients with alcohol problems and anxiety or depression should have their alcohol problem treated first. If depressive symptoms persist for more than 2 weeks after treatment for alcohol dependence, the physician should consider use of a selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant (TCA), or referral for supportive psychotherapy and cognitive-behavioral therapy (CBT), along with relapse prevention (SIGN, 2003). CBT has been...

Physician with Alcohol Use Disorders

The prevalence of alcohol use disorders among physicians is comparable to the national lifetime prevalence of 13.5 (Reiger et al., 1990). Family physicians, along with anesthesiologists, were overrepresented in a study of 1000 physicians with substance use disorders (Talbott et al., 1987). Male physicians outnumber female physicians in studies of substance use disorders. Risk factors used in other patient groups apply to physicians as well (see online discussion of causative factors). The pattern of physician abuse differs from that in the general population by the increased use of alcohol, benzodiazepines, and prescription opiates (Hughes et al., 1992). Much of the prescription drug use is self-prescribed. Impairment is generally noted first in the alcohol-abusing physician's family and social life. Marital discord, relationship problems, and heavy drinking at social events can progress to work dysfunction and impairment (Talbott et al., 1987). The physician's thinking initially...

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. '104' 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. yj This 3-Hz tremor is associated with alcoholic cerebellar degeneration affecting the anterior superior vermis and cerebellar hemispheres. '106' 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 , '108 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...

Alcohol Abuse and Pregnancy

Whether a safe threshold of alcohol consumption exists before or during pregnancy is controversial. Many U.S. authorities recommend against any alcohol intake before or during pregnancy. The effects of alcohol on a fetus depend on the amount of alcohol consumed at one time, timing of alcohol consumption in gestation, and duration of alcohol use in pregnancy. This is complicated by studies using various definitions of light and heavy alcohol use, with categories that often overlap among different studies. Binge drinking, defined as more than five drinks in a single day, even when episodic, is more dangerous to fetal brain development than non-binge drinking (Muchowski and Paladine, 2004). Less severe problems can occur, although a high level of alcohol use in pregnancy is associated with more severely affected offspring. A 1984 study of 31,000 pregnancies showed a higher risk of growth retardation if a mother had even one drink a day. A 2001 study of more than 600...

Alcohol consumption

The relationship between alcohol and overall and ischemic stroke risk was described as J-shaped 25, 26 . This suggests that benefits overcome the harmful effect of alcohol at light-moderate alcohol consumption. Light alcohol consumption (< 12 g day) was associated with a reduction in all stroke (RR 0.83 95 CI 0.75-0.91) and ischemic stroke (RR 0.80 95 CI 0.67-0.96), and moderate consumption (1224 g day) with a reduction in ischemic stroke (RR 0.72 95 CI 0.57-0.91) 26 . A positive linear relationship was found between alcohol consumption and hemorrhagic stroke 25, 26 . The relative risk reduction for total stroke for light alcohol drinking (< 12 g day) seems to be larger for women (RR 0.7 0.6-0.7) than for men (RR 0.9 95 CI 0.8-1) 26 . The apparently positive effect of light to moderate alcohol consumption is still under discussion. Beneficial effects on lipids and hemostatic factors have been reported 27 . Especially the flavonoids of red wine have been presumed to be involved in...

Alcohol Withdrawal

Denial of alcohol intake in the perioperative period may result in disturbances associated with acute withdrawal. Delirium tremens is characterized by extreme disorientation, increased psychomotor activity, hallucinations, marked autonomic activity and hyperpyrexia. Usually, the syndrome lasts for 7-10 days.

Nonpharmacologic Interventions

Modification of classic risk factors, such as tobacco and alcohol consumption, is important to minimize the potential for further aggravation of heart function. Data from observational studies suggest that patients with HF who smoke have a mortality rate 40 higher than those who do not consume tobacco products.1 All HF patients who smoke should be counseled on the importance of tobacco cessation and offered a referral to a cessation program. Patients with an alcoholic cardiomyopathy should abstain from alcohol. Whether all patients with other forms of HF should abstain from any alcohol intake remains controversial. Proponents of moderation of alcohol base their rationale on the potential cardio-protective effects. However, opponents to any alcohol intake point out that alcohol is cardiotoxic and should be avoided.

The Odds Ratio As A Measure Of Association

Not only is the odds ratio useful for comparing the association between two dichotomous variables for different populations, it also has a great advantage over the relative risk and the risk difference for a single population when a retrospective sampling scheme is utilized, as shown by the following example. Consider the data for our retrospective study of the association between family history of alcoholism and a particular psychiatric disorder given in Table 3 and summarized in Table 7. From Table 7 we estimated that 40 of the disorder population has a positive family history of alcoholism compared with 8.333 of the control popula tion. Let p( ) denote the probability of a subject with the disorder having a positive family history of alcoholism and p2f ), denote the probability of a subject without the disorder having a positive family history of alcoholism. Because samples were taken from the populations with and without the disorder, the sample estimates p1 0.4 and p2 0.08333...

Sociology and Psychiatry Some Paradigmatic Contrasts

By contrast, the assumption that mental disorder originates in the brains or other malfunctioning organs of individuals effectively turns the Mills assertion on its head by implying that the proper study of social problems is the study of personal problems. That is, certain social problems - e.g., school failure, drug and alcohol abuse, premarital pregnancy and marital disruption, unemployment and occupational instability, domestic violence, homelessness, and criminality, to name a few - result from the aberrant dispositions or inadequacies of individuals. One might conclude from this sort of orientation that the treatment - or incarceration -of the deficient and troubled individuals is the way to rid the society of some of its noxious problems. Of course, it is reasonable to suppose that social problems may contribute to personal problems and, once established among large numbers of disadvantaged people, personal problems exacerbate those that are social.

Is the Disorder Familial

Relationship between the disorder used to select cases and the disorders that were screened from controls (Kendler, 1990). For example, we know that alcoholism and anxiety disorders both run in families. Consider a family study of alcoholism that screens control, but not alcoholic, probands for anxiety disorders. Since anxiety is familial, the rates of anxiety among relatives of controls will be decreased by the screening process. In contrast, the rates in relatives of alcoholics will not be decreased. Thus, anxiety disorders will be more prevalent among the relatives of alcoholics due to the choice of control group. Other studies have shown that the accuracy of family history assessments varies by diagnosis. Thompson et al. (1982) found that sensitivities for major depression and alcoholism were much higher than for generalized anxiety, drug abuse, phobic disorder, and depressive personality. Moreover, diagnoses based on spouse or offspring reports were more sensitive than those...

Accuracy of Screening

Several effective screening instruments are available for use in the primary care setting. The Alcohol Use Disorders Identification Test (AUDIT) incorporates questions about consequences of drinking along with questions about quantity and frequency. Its specificity ranges from 78 to 96 and the sensitivity from 51 to 97 . The CAGE questionnaire (i.e., feeling the need to cut down, annoyed by criticism, guilty about drinking, and need for an eye-opener in the morning) is widely used in primary care. Specificity for CAGE ranges from 70 to 97 and sensitivity from 43 to 94 . The TWEAK and the T-ACE instruments are designed to screen pregnant women for alcohol misuse (Whitlock et al., 2004). The CRAFFT questionnaire has been validated for screening adolescents for substance abuse in primary care settings (Knight et al., 2003). Tools are available at http www.maaa. nih.gov Publications AlcoholResearch . Biologic markers, such as carbohydrate-deficient transferring and serum...

Effectiveness of Counseling Intervention

Counseling interventions can be delivered wholly or partly in the primary care setting, and their effectiveness varies in terms of duration and frequency of the sessions. Effective interventions include feedback, advice, and goal setting, and most also include follow-up and further assistance. Depending on the intensity of the counseling, reduction in alcohol consumption ranges from three to nine drinks per week after 6 to 12 months of follow-up (Whitlock et al., 2004). The benefits of behavioral intervention for preventing or reducing alcohol misuse in adolescents are not known.

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).

Target Characteristics

Once a person is categorized as a member of a group, the nature of the stigmatizing elements that characterize the social category strongly influence whether and how discrimination will occur. As suggested earlier, the extent to which a person's membership in a negatively viewed outgroup (i.e., a stigmatized group) is perceived to be controllable is one of the strongest determinants of whether individuals will openly express negative feelings and beliefs and discrimination (Weiner, 1995). Those who possess stigmas that are perceived to be more controllable (e.g., homosexuality, obesity, alcoholism) particularly when the person's failure to exercise control is seen as violating cultural values, such as the Protestant Ethic (Crandall & Martinez, 1996) are regarded much more negatively and are generally the targets of open discrimination. In contrast, when group membership is perceived to be uncontrollable (e.g., as with stigmatizing conditions such as physical disabilities)...

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

Modernity Unnatural Compromise And Asocial Freedom

Sometimes, when cultures suddenly come into contact, one culture is overwhelmed and thrown out of equilibrium. Much of the actual research examining the relationship between modernization and mental health has focused on the issue of culture change. One consistent finding has been that rapid culture change from a non-Western to a Western orientation raises the level of mental illness. A cultural disintegration model would explain the escalating rates of psychopathology in terms of the affected culture's diminished capacity to accommodate the essential needs of its members. A similar type of interpretation could be made with regard to the research that has found strong correlations between modernization and specific types of mental disturbances, such as depression, psychosomatic disorders, anxiety disorders, and alcoholism.18

Assessing for Unhealthy Alcohol

When physicians suspect that a patient has a problem with unhealthy alcohol use, they can ask a validated, single-question screening test (Smith et al., 2009) How many times in the past year have you had x or more drinks in 1 day (for men, x 5 for women, x 4). Any response other than zero (0) is considered positive for unhealthy alcohol use. The question is 81.8 sensitive and 79.3 specific for disclosing unhealthy alcohol use. The single-question screen is recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (LOE Grade A).

Vulnerabilities To Human Trafficking And Prostitution

Prostitution and trafficking are rooted in social inequality the inequality between men and women, between the rich and the poor, and between ethnic majorities and minorities.4 The macro forces and individual risk factors contributing to human trafficking are multiple and relate to each other in complex ways. At their roots, risk factors include varying combinations of being young, poor, female, and being a member of a marginalized ethnic minority. Risk factors vary depending on the individual's country, region, city, community, and family and community supports. For example, in Latin America the growing problem of trafficking is exacerbated by sexist environments that discriminate against women and girls including by their physical and sexual abuse 5 by limited economic opportunities for women 6 by multinational corporations' demand for inexpensive labor by sophisticated recruitment methods used by traffickers by government corruption and disinterest in the protection...

Practical Ways To Maintain Wellness

She asked her friends whether they would feel any differently about her if she went out with them but didn't drink. None seemed particularly bothered by this, Although she did not stop drinking entirely, Amy did find that limiting her alcohol intake helped her sleep better, which in turn made her feel less irritable, anxious, and depressed the next day. She made clear to her therapist that she had no intention of giving up her outrageous side. But with time, she has become more consistent with these lifestyle habits, pleasantly surprised by the beneficial effects they've had on her mood stability. drinking alcohol to relax, staying up late at night). It will probably be impossible for you to avoid every risk factor and take full advantage of every protective factor in the table. For example, some people are able to stay scrupulously close to their medication regimen and have learned to avoid alcohol but find it impossible to prevent sleep disruption. Others are able to keep relatively...

Squamous Cell Carcinoma

In common with squamous cancers at other upper aerodigestive sites, chronic abuse of tobacco is the most important etiologic factor, and alcohol abuse may potentiate its carcinogenic effect synergisti-cally. Other factors such as genetic, environmental and dietary influences also play a part, and may explain some of the geographic variations in incidence. The disease is more common in men than in women (2.5 1) and is most frequently seen between the sixth and seventh decades of life. Premalignant lesions such as leukoplakia and erythroplakia do not seem to have the same significance in predisposition for oropharyngeal cancer as they do for squamous carcinoma of the oral cavity.

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.

Epidemiology And Etiology

Variations occur, but cirrhosis secondary to alcohol abuse typically develops after 10 or more years of daily ingestion of 80 g of ethyl alcohol this is an average of 6 to 8 drinks per day (a drink is equivalent to 1 ounce 30 mL of hard liquor, 4 ounces 120 mL of wine, or a 12-ounce 360-mL beer).4 With equivalent alcohol intake, women usually develop cirrhosis more quickly than men do. Differences in the rate of alcohol metabolism may account for this gender disparity women metabolize less alcohol in the GI tract this allows delivery of higher levels of ethanol (which is directly hepato-toxic) to the liver.5 Genetic factors also play a role in development of alcoholic liver disease some persons will progress to cirrhosis with much less cumulative alcohol intake than that of a typical cirrhotic patient (either fewer drinks per day, or faster disease development), while others do not develop the disease with even more excessive intake.

An Incompetent Parent

Unlike good-enough parents who may be concerned about their effectiveness as parents, most incompetent parents minimize or deny their incompetence. Incompetent parents are unable to handle responsibility for their own lives, much less for their children's lives. Because incompetent parents have difficulty controlling their own impulses, they are vulnerable to substance abuse and alcoholism. They are insensitive to the needs of others and are unreliable. They do not form dependable attachment bonds with their children. They alternately neglect or overreact to their children's behavior with unpredictable and inconsistent sequences of indifference, idle threats, and severe punishment.

Neurotransmitter Correlates

Another means of making inferences about brain serotonin in humans involves neuroendocrine challenges. For example, researchers have infused serotonin agonists such as fenfluramine into subjects' veins, which bind to serotonin receptors in the hypothalamus and cause release of the hormone prolactin from the pituitary gland into the peripheral circulation. Thus, the prolactin response to d,l-fenfluramine is thought to provide an index of brain serotonergic function. A number of studies conducted on this topic (but not all) have revealed inverse relationships between fenfluramine-induced prolactin release and indices of behavioral aggression and hostility in personality-disordered patients. Studies utilizing other serotonin agonists such as meta-chlorophenylpiperazine and ipsapirone have also revealed inverse associations with prolactin release and ratings of hostility in personality disordered subjects (Coccaro, 1998). Although comor-bid alcoholism was a potential confounding factor in...

How Do Lifestyle And Living Conditions Affect Seizure Control

For many people with epilepsy, it is possible to identify factors that may provoke seizures. In one study, patients reported that forgetting to take medication (84 ), emotional state (58 ), sleep loss (56 ), menses (54 ), physiologic state (32 ), specific sensory stimuli (21 ), alcohol consumption (20 ), and illness (11 ) were the most common factors that exacerbated their epilepsy.24 For some persons, relaxation therapy or avoidance of stressors can help reduce seizure frequency, but

Prevalence and incidence of secondary organic personality change following TBI

This notion of the preexistence of antisocial tendencies in the impulsive aggressive individual following TBI supports a number of other findings in the literature regarding aggression. Rosenbaum and Hoggs (1989) note that of 31 consecutive patients referred for evaluation of marital violence, 19 (61.3 ) had prior histories of severe TBI. Of this group, a large percentage (48.4 ) had coincidental high levels of alcohol abuse. The suggestion that TBI and impulsive aggression may be implicated in forensic presentation was also observed by Allgulander and Nilsson (2000) in their epidemiological study of 1739 homicides between 1978 and 1994 in Sweden. They found that TBI, physical abuse, alcohol dependence, and criminal recidivism increased the risk of being murdered. The second and third cases described by Labbate et al. (1997) again prove interesting. The second case involved an initial presentation of a man with antisocial personality disorder, including an extensive forensic history...

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.

Maintaining Friendships While Avoiding Alcohol or Drugs

What if your social circle is one that relies heavily on alcohol or drugs Dispensing with alcohol, marijuana, or hard drug use can indeed have negative social implications. For example, some people find it hard to go out with their friends without drinking (this was the case for Amy). Some say that their friends devalue their efforts to stay sober. If these problems apply to you, consider discussing your dilemma with one or more trusted friends. Do they understand about your disorder and the likely impact of alcohol or drug use

Issues in Using Self Report Data

Several concerns arise with regard to the accuracy of information obtained from evaluees. In clinical evaluations, self-report data are typically the basis for diagnostic and treatment decisions. Self-report tests are commonly used in screening for alcohol problems in primary care medicine (Allen et al. 1995). Traditional psychological tests, such as the Minnesota Multiphasic Personality Inventory (MMPI), are self-report testing instruments. Research,

Population Measures of Onset

Age of onset for alcohol abuse or dependence among males. Prospective data from four sites of the Epidemiologic Catchment Area Program. (Adapted from Eaton et al., 1989.) Figure 5(a). Age of onset for alcohol abuse or dependence among males. Prospective data from four sites of the Epidemiologic Catchment Area Program. (Adapted from Eaton et al., 1989.) Comparison of results between these studies is important because the numerators are so small that the findings from any one study are statistically volatile. Analysis of the onset of alcohol abuse or dependence in the ECA cohort (Figure 5) shows sharply declining incidence after young adulthood and a slight rise at the beginning of the seventh decade. The rise is caused by only five individuals who had onset in that age range. A similar curve from the Lundby study has the same shape (Ojescho et al., 1982), with the rise after age 60 based on only three individuals who had incidence in that age range. These results suggest...

Common risk factors and prevention

The aim of primary prevention is to reduce the risk of first-ever stroke in asymptomatic people. Seven factors are regarded as potentially modifiable risk factors for vascular diseases high blood pressure, high cholesterol, smoking, excessive or heavy regular alcohol consumption, physical inactivity, overweight and dietary factors. The strategy in primary prevention is to lower stroke risk attributed to these factors through education, lifestyle changes and medication. Non-modifiable risk factors arising from diseases such as atrial fibrillation or diabetes mellitus can be lowered by controlling and treating the underlying disorder. Targets of primary stroke prevention can be the entire population or high-risk - but stroke-free - individuals partly suffering from disorders such as hypertension or diabetes mellitus.

The Communication of Risk

Mental defectives were the products of recessive matings, and responsible for a goodly portion of society's ills. Eugenicists focused on mental traits like feeblemindedness because they believed that problems like low intelligence, poverty, crime, and alcoholism were directly passed down through family lineage. Inbreeding and the general reproduction of inferior stock were threatening to swamp society with inherited social ills. By the turn of the century, when the Mendelian rules of genetic transmission had been rediscovered and were highly influential if controversial, complex forms of mental deviancy were considered by most eugenicists to be unit traits that is, they were thought to be inherited as a single package. Thus the problem of mental defectives was viewed as potentially enormous after all, known imbeciles represented only the tip of the iceberg of conditions that many believed were endemic to the lower classes and to immigrants (Paul 1995, 1998).

Search for causes of disease occurrence Why does disease occur

Liver cirrhosis is due to alcohol abuse (Premise B) Alcohol abuse causes liver cirrhosis (causal proof f rom etiological research) That liver cirrhosis is caused by alcohol abuse (from the field of etiological research as That stopping alcohol consumption will improve the patient's health and survival (from

Etiology and Epidemiology

A more satisfactory explanation of the biological factors that contribute to the career phase of anorexia nervosa is the addiction to starvation model proffered by the British psychiatrists George I. Szmukler and Digby Tantum (1984). According to Szmukler and Tantum, patients with fully developed anorexia nervosa are physically and psychologically dependent on the state of starvation. Much like alcoholics and other substance abusers, anorectics find something gratifying or tension-relieving about the state of starvation, and possess a specific physiological substrate that makes them more susceptible to starvation dependence than individuals who merely

Family losses other than death

Pete was a 13-year-old boy who had been mandated for counselling by the county's children protective services and juvenile court. He had had four foster home placements over the last six years, failed three grades, had been diagnosed with ADHD, and had severe anger problems. The initial assessment (plus past records) indicated multiple issues of loss over his entire lifetime. He was the oldest of three children and had taken on the role of protector for his alcoholic mother and two sisters when he was 7. In addition to mom's alcohol abuse, she had had multiple abusive relationships. Pete prided himself on beating up one of mom's boyfriends with a wooden board when he was 11. The pattern over time showed that mom had multiple attempts to reclaim her children, but was not capable of any consistent stability. Pete's foster home placements were never successful. He always found a way to sabotage himself and develop a negative relationship with any adult or system that offered support. His...

Does the Brain Ever Get Back to Normal

After someone has been an addict, does his or her brain ever normalize This is one of the most important questions in the field. Some believe that at least some of the changes caused by drugs last forever, which if true, will impact treatment. Although evidence is still accumulating, there are some findings that we can examine. Twelve-step programs such as those used by Alcoholics Anonymous and Narcotics Anonymous assume that addicts have a chronic disease and chronic vulnerability. Using this assumption, these programs suggest that addiction is never cured, but can be treated by avoiding drugs. This is perhaps the safest approach to treatment. These programs have an effective track record with effective procedures. Perhaps some brains carry a chronic vulnerability that can't be completely reversed, and perhaps some can be changed by treatment. Additional research is needed to discuss this question in a more informed way.

Mood and Biological Rhythms Including PMS

However, studies in which the possible effects of expectation have been indirectly controlled do show premenstrual tension exists. For example, in one study somatic symptoms persisted premenstrually even though placebos reduced mood effects (Metcalf & Hudson, 1985). This suggests that the mood reports may be suppressed by experimental manipulation, but the underlying physical determinants of the mood resisted such manipulation. Another study showed that depression was more easily induced premenstrually than at other cycle times (Boyle, 1985). And, in another indirect indication of increased tension, there were observations of more alcohol consumption premenstrually (Sutker et al., 1983).

Behavioral Problems in Children and Adolescents

Behavioral problems are common reasons for parents to bring their child to see the family physician. In addition, addressing behavioral issues is an important component of the well-child visit. Childhood behavioral problems are a complex assortment of individual mental disorders, genetic and medical disorders, family interaction difficulties, social and school problems, and combinations of these. The rates of many psychosocial problems in children and adolescents, including depression, suicide, conduct disorders, and drug and alcohol abuse, have been rising in recent years throughout Western culture (Fombonne, 1998). This increase is only partly explained by changes in diagnostic criteria and reporting. The trend is particularly troubling when economic conditions and physical health of the population have been improving. The implication for office physicians is that psychosocial problems will encompass a growing proportion of patient care both as presenting problems and as cofactors...

Socioeconomic issues affecting applicability

The accuracy of questionnaires is particularly prone to social, cultural and economic differences among patients. One reason is that a lot can be lost in the translation of questionnaires. However, even if the language used is the same, interpretation and reaction may vary. For example, cognitive tests tend to underestimate the abilities of elderly people from ethnic minorities. This can lead to overdiagnosis of dementia in these communities'15'. The CAGE questionnaire (which is commonly used to detect alcoholism) performed poorly in some ethnic groups, particularly African-American men'16'. Similarly, a questionnaire to detect autism developed in the US and UK could not be used in families in Hong Kong because of perceived cultural differences'17'. These examples (and many more) should lead us to look for local validation studies before accepting the accuracy of diagnostic tests, especially in the form of questionnaires.

Clinical Manifestations and Diagnosis

Prognosis need not be poor, as cirrhosis can be checked, for example, in the alcoholic who abstains from alcohol abuse. Treatment can reverse the hepatic fibrosis and improve the outlook of patients with chronic active hepatitis, primary hemochromatosis, or Wilson's disease. On the other hand, after ascites has developed, the 5-year survival rate falls to below 50 percent.

Confabulation making it up as we go along

Alcohol has many effects on memory, both short term, such as the memory loss associated with a previous night of heavy drinking, and also long term. One severe problem is Wernicke's encephalopathy, in which extensive and excessive drinking leads to a deficiency of thiamine (vitamin B1) in the diet. This can lead to catastrophic bleeding into the mamillary bodies in the limbic system once the person eats, because of a surge in glucose in the blood stream. This can also occur because of other conditions that cause nutritional problems, such as prolonged morning sickness. The person may be uncoordinated and have eye movement problems. Even with treatment, up to a fifth of sufferers may die. Those who survive develop Korsakoff syndrome, a condition marked by severe short- and long-term memory problems. The person is unable to make new memories and has great difficulty recalling events from several years before the illness. They spend their time not knowing when or where they are, although...

Alcohol and Nicotine Exposure

The cumulative research unequivocally makes the case that mothers should abstain from heavy and moderate drinking of alcohol during pregnancy, or even while trying to conceive a child. Binge drinking is especially harmful. The effects of modest amounts of alcohol a nightly glass of wine with dinner or drinking any alcohol only a few times a week are still being debated. Some studies show a higher risk of miscarriage and lessening of IQ scores after a mother has had four or more drinks per week. Others do not.

Nonpharmacologic Therapy Lifestyle Modifications

Lifestyle modifications should always be addressed in the management of ED. A healthy diet, increase in regular physical activity and weight loss are associated with higher International Index of Erectile Dysfunction (IIED) scores and an improvement in erectile function.14 The clinician should recommend smoking cessation, reduction in excessive alcohol intake, and discontinuation of illicit drug use.

Nutritional Counseling

Since alcoholics and other addicts are chronically malnourished, nutritional counseling is a priority (Beasley, 2001). Clients with addiction disorders often eat poorly, limiting their supply of essential nutrients, which negatively affects their energy and their body's ability to maintain vital health. Alcohol is exceeded only by fat in calories per gram. As a result, while drinking, clients experience a sense of fullness despite having eaten very little or nothing. These empty calories inevitably lead to malnutrition (Reider, 2000).

Controversial Issue

Patient exhibited four syndromal patterns (schizophrenia, alcohol abuse, depression and anxiety), it was customary to use only schizophrenia. A major achievement of the ECA was demonstrating the pervasiveness of multiple categories (Boyd et al.,1984). This has led to recognizing the value of relaxing exclusionary criteria in situations where hiding such comorbidity should be avoided.

Disability Definitions Private Insurance Public Insurance and the Americans With Disabilities

B's insurance policy covered his regular occupation, which at the time he filed his claim was administrative, not clinical, medicine. As a result, his insurance company concluded he was not disabled for the purposes of his private policy. Dr. B hired an attorney and litigated to contest the finding. The proceedings included expert testimony regarding Dr. B's psychiatric condition and functioning. The experts for each side agreed that Dr. B had a diagnosis of alcohol dependence that would raise serious concerns if he were to treat patients, especially since he was refusing ongoing treatment.

Jacinto Blas V Mantaring III Antonio L Dans Felix Eduardo R Punzalan

Studies on harm try to establish if a particular exposure is responsible for causing an undesirable outcome. Harmful exposures can be behaviours (e.g. tobacco or alcohol abuse), treatments (e.g. aspirin or warfarin intake) or patient characteristics (e.g. hypertension or exposure to pollution). In any of these situations, the questions on harm (or causation) should be phrased in terms of the following variables P, the patient population that might be at risk E, the potentially harmful exposures and O, the outcomes that these exposures might cause. For example

Appraising directness

As in therapy and diagnosis, before reading an article on harm, we must first evaluate how well the PEO in the study (the research question) corresponds to our own PEO (your clinical question). Did the study recruit the types of patients you are interested in Did they evaluate the exposure you are interested in Even if the question is not exactly the same, sometimes the study can still provide some answers. For example, much of what we think we know about the effect of alcohol on health is derived from studies on red wine. The two exposures are not exactly the same, but whatever we learn about red wine can certainly provide some answers about the impact of alcohol intake in general. If you feel the article might help answer your question, then go ahead and evaluate it as in previous chapters.

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,...

The Loving Fearless Searching and Honest Moral Inventory

This activity is patterned after the Moral Inventory of Alcoholics Anonymous. When grocers inventory their shelves, they simply count what is there without judging. This counting enables them to rationally make needed adjustments. Likewise, when we inventory our own strengths and weaknesses, we can simply notice what is there without judging the core self.

Prevalence and incidence of secondary affective disorders including demographic and psychiatric correlates

Van Reekum and colleagues (1996) assessed 18 subjects (10 with severe TBI and 8 with mild or moderate TBI) an average of 4.9 years following the TBI and subjected them to a structured diagnostic interview (the Schedule for Affective Disorders and Schizophrenia (SADS-L) (Endicott & Spitzer, 1978), which gives a DSM-III Axis I diagnosis. Of the sample, 11 (58 ) received a post-TBI diagnosis of major depression, although two of these also experienced a manic episode. Of these nine subjects, five had their first episode of major depression after the TBI, while the remainder had had another episode prior to the injury. Bipolar affective disorder was found in three subjects (16 ) and cyclothymia in a further two subjects. Four of these five subjects featured onset after the injury. Seven subjects (37 ) received a diagnosis of anxiety disorder, with five of the seven featuring generalized anxiety disorder. The remaining subject had panic disorder (1), with the others having mixed phobias...

Model of road transport demand

The consumption of alcohol is used in many countries as a powerful indicator of social activity. There is a strong correlation between the frequency of social outings and the frequency of alcohol consumption. In effect, it is found that a 10 per cent increase in wine consumption per adult implies, ceteris paribus, a 3.5 per cent increase in road transport demand for recreational purposes.

Behavior Genetics Today

Tiousness and public sensitivity to the issue. Behavior geneticists such as Robert Plomin at Pennsylvania State University and Joel Gelernter at Yale University argue that the field has been misrepresented. They point out that many human behavioral genes, or at least chromosomal or molecular markers thought to be associated with specific genes, have been correlated with specific behavioral types such as Tourette's syndrome (leading to uncontrollable movements and speaking), schizophrenia, manic depression, alcoholism, attention deficit hyperactivity disorder (ADHD), and homosexuality, to name just a few. These correlations suggest strongly that there might be a significant genetic component to these behaviors. Human behavior genetic researchers emphasize that they do not discount the role of environment, nor the additive effect of many genes impinging on any given behavior. In fact, they make a point of emphasizing that the outcome of any behavioral development in humans (or any other...

Lesion location and mechanism of secondary affective disorders

One month postinjury using a structured clinical interview (PSE), an observer-rated symptom checklist (HDRS) and the mini-mental status examination (MMSE), 17 subjects (26 ) met the DSM-III symptom and duration criteria for major depression and a further two patients had dysthymia. There was a significantly higher frequency of previous psychiatric disorder and alcohol abuse in the depressed subjects.

Primary and Secondary Disorders

Given the importance of comorbidity, a question arises as to which disorders in comorbid sets have the earliest ages at onset. The results in Table 2 show that there was considerable variation across disorders in the NCS in the probability of being the first lifetime disorder. Simple phobia, social phobia, alcohol abuse, and conduct disorder were the only disorders considered in the NCS where the majority of lifetime cases were temporally primary. In general, anxiety disorders were most likely to be temporally primary, with 82.8 of NCS respondents having Alcohol abuse Alcohol dependence

Additional Resources

In the past, drug dependency was viewed as a sin committed only by people with weak moral character. In 1956, the American Medical Association (AMA) published a statement saying, Alcoholism must be regarded as within the purview of medical practice (N. S. Miller, 2001, p. 104). The Council on Mental Health, the AMA's Committee on Alcoholism, promoted the idea that alcoholism is an illness that requires the participation and attention of physicians. This realization is based on the pioneering work of Jellinek (1960) who observed that alcoholics are more likely to have alcoholic family members. In these studies, environmental influences cannot be separated from the genetic influences, because alcoholic parents raise alcoholics.

Lifetime Accumulation of Stress and Disadvantage

To this point we have begun to make the case that cumulative lifetime social stress can be re-framed as a problem of cumulative life course disadvantage, a shift that serves to emphasize the underlying processes of stratification that govern the accumulation of stress and pathways into adulthood that diverge both in resources and well being (Dannefer, 2003 Kerckhoff, 1993). However, life course perspectives recognize that processes of individual action or agency are also at play, as evidenced in extensive evidence on the role of individual characteristics and behavior in selecting into environments and shaping stressful interpersonal relations (Caspi, Henry, McGee, Moffitt, & Silva, 1995 Caspi, Moffitt, Wright, & Silva, 1998 Hammen, 1991 Quinton, Pickles, Maughan & Rutter, 1993 Ronka & Pulkkinen, 1995). One such problem that can be viewed as a selection process in transition to adulthood is the role of an early onset psychiatric disorder in shaping the subsequent...

Analysis of results by explanatory factor

The TAG model seeks to assess the incidence on the accident toll of user behaviour vis-a-vis alcohol (figure 16). Driving under the influence of alcohol is a frequent cause of accidents. According to a survey conducted by ONSER2 in 1997, 36.5 per cent of drivers or pedestrians involved in fatal traffic accidents had a blood-alcohol level exceeding the legal limit of 0.8g l. According to Dally (1985), the probability of being involved in a fatal accident is multiplied by 1.9 for blood-alcohol levels of between 0.50 g 1 and 0.79 g 1 and by 10, 35 and 75 respectively for blood-alcohol levels of between 0.8 g 1 and 1.19 g 1, 1.2 g 1 and 1.99 g 1, and > 2 g 1. In the TAG model, a 10 increase in wine consumption per adult increases fatal accidents by 1.6 per cent and the numbers of minor injuries, serious injuries and fatalities by 1.2 per cent. 1.4 per cent and 2.1 per cent respectively. Alcohol consumption also has an indirect effect through its impact on speed, but that is more...

Recreational Drugs and ROS Production in Mammalian Spermatozoa

Abstract Oxidative stress is caused by an imbalance between the production of reactive oxygen species (ROS) and antioxidant capacity of the cell. Oxidative stress appears to be the major cause of DNA damage in the male germ line. Furthermore, many studies have indicated a significant correlation between DNA damage and high levels of ROS in infertile patients. Male reproductive health is already under threat from a range of environmental factors including endocrine disruptors, toxic pollutants, ionizing and lifestyle factors such as sexually transmitted infections, alcoholism, smoking, and anabolic steroid use. Further hazards such as fast food, recreational drugs, and stress levels may also impair male fertility. Recreational drugs such as alcohol, barbiturates, amphetamines, THC, PCP, cocaine, and heroin, but also includes caffeine in coffee and cola beverages, and environmental factors may increase ROS production, leading to DNA damage and further male infertility.

The Tracsca Model for California

In addition to speed limit and mandatory seat belt use, policies related to traffic enforcement, alcohol availability, and alcohol consumption have gained widespread attention. Although traffic enforcement is widely thought to enhance highway safety, there is relatively little information Kenkel, 1993 McCarthy, 1999a McCarthy and Oesterle, 1987), often due to the unavailability of traffic arrest data, on the extent to which enforcement is beneficial. And several recent studies have analyzed alcohol availability, generally finding a positive relationship between availability and highway crashes (Brown et al., 1996 Chaloupka et al., 1991 Ruhm, 1995). Various studies have studied the effect of alcohol consumption, measured by total or per capita gallonage consumed, typically finding that increased consumption has a deteriorating effect on highway safety American Medical Association, 1986 Borkenstein et al., 1964 Laixuthai and Chaloupka, 1993).

Effects Of Sexual Assault

Researchers have identified a myriad of psychological effects of sexual assault on women. Burgess and Holmstrom's classic study18 first described rape trauma syndrome in sexual assault survivors, and more recent studies have documented numerous psychological consequences of rape (e.g., depression, anxiety, sexual problems) including PTSD.19-21 An alarming 17 to 65 of women with a lifetime history of sexual assault develop PTSD.22 Many (13 -51 ) meet diagnostic criteria for depression.22-24 An overwhelming majority of sexual assault victims develop fear and or anxiety (73 -82 )25 and 12 to 40 experience generalized anxiety.26-27 Approximately 13 to 49 of survivors become dependent on alcohol, whereas 28 to 61 may use other illicit substances.2,28 Further, it is not uncommon for victims to experience suicidal ideation (23 -44 )29 and 2 to 19 may attempt suicide.30 It is also important to note that some research has shown that multiple perpetrator rape incidents may be more serious and...

Individual Level Antecedents

This research suggests that prejudiced heterosexuals can make work life difficult to intolerable for lesbian and gay colleagues. At best, gay and lesbian workers are avoided at worst, they face overt job discrimination or even physical assault. To date, very few studies have directly investigated the effects of workplace heterosexist behaviors on lesbians and gays, but the existing research provides some insight. First, heterosexism thwarts career progression for many lesbians and gay men (Friskopp & Silverstein, 1996). For example, one study found that lesbians limited their job and career choices to avoid heterosexist work environments (Fassinger, 1996). Gay male workers have been found to earn significantly less compensation than their heterosexual counterparts, although this finding was not replicated for lesbians (Badgett, 1995, 2001 Black, Makar, Sanders, & Taylor, 2003 Clain & Leppel, 2001). Other studies confirm that heterosexism has a negative effect on lesbians' and...

Demographic Characteristics

One of the most consistent epidemiologic findings is the inverse relationship between social class and schizophrenia (Dohrenwend and Dohren-wend, 1969). Eaton et al. (1988) concluded that there is a three to one difference in rates between the lowest and highest class. Since the publication of the Faris and Dunham study in 1939 described above, two sets of hypotheses have been tested to explain this association. One hypothesis is that environmental exposures that are more common in lower social class populations are responsible in large part for the elevated rate of schizophrenia found in these populations. These exposures include infectious agents, noxious workplace conditions (Link et al., 1986 Muntaner et al., 1991), poor quality maternal and obstetric care leading to higher risk of fetal injury, inadequate nutrition early in life, and social factors (isolation, trauma exposure, paternal alcoholism, daily stress). A recent analysis of incident cases in Maastricht,...

Is ED a normal process of aging Is ED preventableIs it curable

Other factors that aren't necessarily restricted to older men can compound age-related changes for example, morbid obesity and excessive alcohol consumption over a long period of time decrease testosterone levels. and diabetes mellitus can be improved by lifestyle changes, such as exercise and proper diet. If you have diabetes mellitus, tight control of your blood sugar level may not totally prevent the occurrence of ED, but it may prevent the ED from progressing. Avoiding excessive alcohol intake and smoking may also help to decrease your risk of ED. Similarly, if you are a long-distance bicycle rider and experience genital numbness when you finish a bike ride, you may want to start using a bicycle seat designed to put less pressure on the perineum.

Common variable results

For each of the sub-models, some measure of alcohol consumption or alcohol availability significantly affected the highway safety measure. However, from these results it is not possible to say that a particular category of (apparent) alcohol consumption affected all measures of highway safety. In the risk exposure equation, a 1 increase in per capita beer consumption increased the demand for travel, suggesting some increased risk taking activities on the part of beer drinkers. Increased risk exposure effects were not identified for increased wine and distilled spirits consumption.

Residential And Outpatient Treatment Programs

Treat alcohol problems, many of these programs diversified during the cocaine epidemic of the mid-1980s to treat addictions to illicit drugs as well as alcohol. The original residential treatment approach developed by Hazelden consisted of a 3- to 6-week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in a self-help group, such as Alcoholics Anonymous (see Principles of Drug Addiction Treatment, National Institute on Drug Abuse, 1999b, pp. 28-30).

Choosing a Protocol and Medical Treatment Plan

Problems occur if the patient reports (or the clinician has reason to suspect) that there is a large or escalating butalbital usage. Barbiturate withdrawal is potentially lethal and is more dangerous than opioid withdrawal it resembles acute alcohol withdrawal, replete with withdrawal seizures that can lead to status epilepticus. It is therefore prudent to assume that a patient with a long history of butalbital ingestion is underestimating usage. Caution is the better part of valor.

Different types of memory and learning are processed and stored in functionally distinct brain regions

The nervous system has many functions, so it has different mechanisms to store experiences, plans of action, or codes of behavior and these are associated with specific brain circuits. Different types of memory loss can be observed as a result of brain diseases and brain surgery affecting different brain regions. In the late nineteenth century, there were also several descriptions of amnesias the most striking was Korsakoff's syndrome, a severe form of amnesia with multiple brain lesions that were produced by a combination of alcoholism and malnutrition. More recently, the now classic studies of Penfield and coworkers 10, 11 have provided important information on different kinds of memory and on their specific brain locations (Chap. 4). The recollection of memories induced

Noncarious Tooth Wear

Noncarious tooth wear is a common problem. Exposed dentin can result from acidic erosion, abrasion, and attrition, but most toothwear has erosion as the dominant etiological factor. Localized anterior toothwear of the upper anterior teeth is often caused by the consumption of erosive carbonated beverages, fruit juices, and citrus fruits. Regurgitated stomach acid in gas-troesophageal reflux disease, hiatus hernia, and esophagitis and vomiting in bulimia, alcoholism, and psychosomatic disorders can cause erosive tooth wear of the palatal surfaces of the anterior teeth. Drugs that tend to reduce the amount of saliva in the mouth, such as antidepressants, recreational drugs (LSD and Ecstasy, which is 3,4-methylene-dioxymethamphetamine), and diuretics, also diminish the buffering capacity available to neutralize dietary or stomach acids. Users of Ecstasy commonly complain of a dry mouth, and erosion from carbonated beverages is thought to be an important etiological factor. However, the...

Concepts Of Health And Their Impact

It is common to come across cases where a problem previously understood in terms of socialization, individual personalities, and the like is now framed in the language of medicine, invoking the terms ''health'' and ''disease.'' Alcoholics and persistent gamblers, rather than being seen as individuals with various psychological weaknesses or moral failings, may now be regarded as victims of a disease. The restless, rebellious child or the poor learner, rather than merely exhibiting youthful energy, poor upbringing, or mediocre intelligence, may be diagnosed as someone with a disease for example, attention deficit disorder. Even street violence, a prob In many cases, the warrant for using the language of disease is not some empirical discovery about human physiology but instead a general argument arising from a particular conception of health or disease. For example, if a disease is understood to be an undesirable condition over which the individual has no direct control but that seems...

Other Mental Disorders

Recent work has extended historical accounts of traumatic or abusive childhoods in eminent creatives and posited a connection with post traumatic stress disorder (PTSD). Linkages with substance and alcohol abuse have already been mentioned, and there is a rich anecdotal literature on associations between alcoholism and the use and abuse of other substances and creative functioning. However, a more recent and popular stream of literature has focused on the documented ill effects of addiction on creativity, creative individuals, and those around them, and on the role of recovery from substance abuse in tapping personal creativity and also recovering from traumatic events.

Consumption of alcohol

An increase in alcohol intake has a direct impact on road risk indicators (cf. Table 7). The variables used to take account of this factor are not generally expressed in terms of a level. In effect, to offset the problems of multicolinearity, consumption can be treated as a reference variable. For example, the DRAG (6Q) model looks at sales of alcohol per adult, because there is a positive and virtually systematic relationship between these two variables. In terms of the numbers of personal injury and fatal accidents, the DRAG (6Q) model generates coefficients that are close to zero and not at all significant. But given the available data, the variable describing alcohol consumption per adult does have some limitations. For one thing, since this variable was constructed on the basis of sales of alcohol, there may be a lag between the purchase and the effective consumption of alcoholic drinks, especially when it comes to purchases for the festive season. For another, this variable...

Comorbidity and Bipolar Disorders

Kessler (1994) reported the comorbidity of different psychotic disorders in the NCS and in the ECA. In both surveys, mania was accompanied by a comorbid disorder in more than 50 of the cases. Goodwin and Jamison (1990) argued that comorbidity in bipolar patients has not been studied as comprehensively as it has in major depressive disorder and stressed the importance of studying the effects of comorbidity in illness course. They summarized the existing literature and estimated a 35 prevalence of Bipolar Illness and alcohol abuse. They also raised the issue of determining the chronologic sequence of the onset of each disorder and the lack of much needed empirical information in this area. The ECA study (Regier et al., 1990) reported that the Bipolar I group had a prevalence of substance abuse of 60.7 . The ECA investigators suggested that a high degree of comorbidity in bipolar disorders greatly complicates treatment. Interestingly, the ECA Study (Helzer and Pryzbeck, 1988) reported...

What Is Successful Treatment

When we say that treatment has been successful, does it mean that the patient never takes the drug again Is it total and permanent abstinence Well, that is certainly the ideal and would be best. The goal of many treatment groups such as Alcoholics Anonymous (AA) is total abstinence, but no one denies that it can be a difficult and lifelong process. Many doctors believe that a reduction in drug use has to be considered at least a partial success. By this book's definition, drug abuse is causing distress and harm in your life, and a reduction of harm, even if not completely eliminated, is a good thing.

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.

Therapeutic Interventions

Assign the client to read the promises on pages 83 and 84 of the Alcoholics Anonymous (AA) Big Book encourage him her to verbalize hope for the future. 18. Assign the client to read the promises on pages 83 and 84 of the Alcoholics Anonymous Big Book encourage him her to verbalize hope for the future.

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...

Metabolic Syndrome

Lifestyle changes (increased activity, weight loss, smoking cessation, decreased saturated fat and increased fiber intake, moderation in alcohol intake) are the only treatment shown to affect all components of the metabolic syndrome and should be implemented in all patients (Finnish Medical Society, 2007) (SOR A).

Mania And Substance Misuse

Sample of manic or mixed episode patients with psychotic features, 32 had antecedent drug abuse and 20 had abused alcohol. Patients with antecedent substance abuse required hospital admission sooner than patients without. Alcohol abuse was, however, associated with a later age of onset of illness.

Drinking And Drinking Practices Populationbased Estimates of Alcohol

On a population basis, there are several ways of estimating the amount of alcohol consumed. The most common is to estimate per capita alcohol consumption based on either alcohol production or sales. Apparent alcohol consumption, a measure derived by dividing the total quantity of alcohol sales by the total population in the United States aged 14 and older, was 2.21 gallons of absolute alcohol in 1994 (Stinson et al., 1997). This breaks down into 1.26 gallons of beer, 0.29 gallons of wine, and 0.66 gallons of spirits per capita. This is an underestimate of individual consumption, however, since abstainers were included in this calculation and illegal alcohol, home production, and duty free purchases were not included in this estimate. In the United States, the highest levels of per capita consumption occurred in the West (2.33 gallons per capita) and the lowest occurred in the Northeast (2.14 gallons). States with the highest per capita consumption included Nevada (4.15 gallons), New...

Measurement of Drinking

A number of scales have been developed that allow researchers to combine the various drinking parameters. The most common of these is average daily volume, an averaged estimate across all quantities, frequencies, and beverages. While this scale has the advantage that it is a continuous variable, it has the disadvantage that it ignores the diversity of drinking patterns. This diversity is important because, as noted above, drinking patterns correlate with other covariates of drinking, with consequences of drinking, and with alcohol abuse and dependence. Other ways of combining the data have also been developed, including measures of binge, or clustered drinking, or frequent heavy drinking, the frequency of consuming five or more drinks per occasion. Other researchers have constructed typologies of drinking to describe different patterns. These measures usually focus on only one dimension of drinking behavior and therefore can only be used to explore the effects of a specific pattern of...

The Prevalence of Alcohol

Heavy drinking (five or more drinks on five or more days in the past month) 9.3 of men reported heavy drinking compared to 2.3 of women. Drinking and patterns of consumption changed with age (Substance Abuse and Mental Health Services Administration, 2000). Among men, the percentage who reported drinking in the past year did not vary greatly by age (79.3 for men aged 18-25 77.7 for men aged 26-34 70.2 for men over 35). However, younger men (18-25 years of age) were more likely to binge drink than were older men. Younger men (18-25 years of age) also had higher rates of frequent heavy drinking. One-fifth of the men aged 18-25 years reported drinking five or more drinks per occasion at least five or more times in the previous month, compared to 11.5 of the men 26-34 years of age, and 7.6 of the men aged 35 and over. Among women, similar patterns were found with respect to age although the levels of consumption were much lower. The prevalence of drinking increased with income (Stinson et...

Other Systemic Disease

Total hip replacement may be required in patients who have developed avascular necrosis of the femoral head as a result of alcoholism or sickle cell disease (Table 45.2). In addition to the precautions detailed in Chapter 23 for patients with sickle cell disease, a plan for blood transfusion management should be agreed with a haematologist. The use of a limb tourniquet is contraindi-cated, even for patients suffering from sickle cell trait. Alcoholism

Criminal Sentencing Dispositions and Release Decisions

Risk assessments for purposes of sentencing will be most effective from an adjudicative perspective if the psychiatrist addresses contextual issues. For example, if the offender is an alcoholic given to binge drinking on weekends and barroom fights while intoxicated, the consultant may advise initiating rehabilitation in jail and then continuing rehabilitation efforts, including Alcoholics Anonymous and avoidance of bars, when the individual is placed on probation. If the defendant is found guilty, the judge may use the consultant's recommendations to order the defendant placed on probation with the conditions that he attend Alcoholics Anonymous and substance abuse counseling and that he be prohibited from visiting bars. Although less restrictive than imprisonment, these conditions could be experienced by the offender as less lenient than total confinement (Felthous 1989d). Nonetheless, the consultant will have addressed appropriate risk and contextual factors without recommending a...

Substance abuse issues

The literature indicates that between 44 and 79 of TBI patients have a positive history for alcohol abuse that predates the injury, while 21-37 report a history of illicit drug abuse (Taylor, Kreutzer, Demm, & Meade, 2003). This history is most commonly associated with the demographic features of failure to complete high school, an aetiology related to violence, male gender, being unmarried, and being unemployed at the time of the injury. Kelly and colleagues (1997) observed that there is an additive effect of substance abuse in association with TBI that causes more pronounced neuropsychological impairment, particularly on measures of memory functioning. These patients also feature higher mortality rates although there has not been unequivocal support for this suggestion in the literature (Fuller, 1995 Kaplan & Corrigan, 1992 Ruff et al., 1990), as well as featuring higher levels of neurobehavioural and occupational problems (Sabhesan, Arumugham, Ramasany, & Natarajan, 1987)....

Relations Between the Sociological and Clinical Viewpoints

It is difficult to make a transition from drinking and drinking problems, a concept from the survey and sociological literature, to the diagnosis of alcoholism. These disparate approaches, as noted earlier, represent different conceptual models. Those who support the sociological model contend that there is no unitary phenomenon, pointing to the fact that there is a wide distribution of drinking patterns, problems, and consequences and that the correlations between these variables are quite low in the general population (Clark, 1991 Tarter et al., 1991). Proponents of the disease concept of alcoholism point to the biological elements in the development of alcoholism, the development of tolerance and withdrawal, and the heritability of the disease. The diagnostic criteria for alcohol use disorder, in fact, incorporate the sociological approach. The diagnosis is the end of a continuum which is defined by a combination of drinking, consequences, and problems, and the point between having...

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...

Acupuncture and Addiction

Michael Smith, M.D., began and still administers the acupuncture detox program at that hospital. The program combines treatment of five-needle ear acupuncture and herbal detox tea, along with case managers to coordinate conventional health and substance abuse counseling, social services, urinalysis, and a recommended 12-step program in Narcotics and or Alcoholics Anonymous. The ear acupuncture alters the blood and brain chemistry of dopamine receptors and other neurotransmitters. After treatment, the patients can opt for tiny, stainless steel balls taped in their ears. In between treatments, they can press on these balls to simulate the relaxation they experienced during acupuncture, which will help them through the detox. The acupuncture detox protocol is for the patients to have acupuncture treatment six days a week, whether they're trying to quit using tobacco, alcohol, heroin, or crack. During the course of the next four to six weeks, the treatments can taper off as the patients...

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