Patterns of alcohol consumption and blood alcohol levels in emergency room patients.

The study was conducted in a public hospital of the province of Jujuy, Argentina.

A survey was conducted among all patients during the 24 hours of 4 consecutive days (N = 500) using the Alcohol Use Disorders Identification Test, short version (AUDIT-C). Blood samples were collected in 84% of participants.

Results showed that;

• 37% were hazardous drinkers (men 50% vs. women 23%),
• 29% had symptoms of dependence (men 48% vs. women 11%);
• 17% of men and 3% of women had high blood alcohol levels, equal or greater than 50 mg/dl.

In multivariate logistic regression models men had;

• increased likelihood of hazardous drinking (Adjusted OR 3.2; 95% CI 2.1-5.0),
• symptoms of dependence (Adjusted OR 7.5; 95% CI 4.4-12.7) and
• increased blood alcohol levels (Adjusted OR 8.0; 95% CI 2.2-28.8), compared with women.

Patients admitted due to accidents, violence, or drug use, had;

• increased likelihood of hazardous drinking (Adjusted OR 2.4; 95% CI 1.5-3.9),
• dependence symptoms (Adjusted OR 2.0; 95% CI 1.2-3.3) and
• increased blood alcohol levels (Adjusted OR 7.7; 95% CI 3.0-19.8), compared with those admitted for other reasons.

Alcoholism has a significant impact on the occurrence of injuries and on the demand imposed on health services.

Prevention programs can potentially reduce the negative health and social impact of alcoholism.

Research; Medicina (B Aires). 2008;68(1):31-6. Alcohol consumption in the emergency room. Alderete E, Bianchini P.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to BriefTSF by e-Mail

Understanding and Counseling: Persons With Alcohol, Drug, and Behavioral Addictions by Howard Clinebell Read more about this title…

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Research supports the idea that involvement with 12-step fellowships is a very good way to achieve and maintain recovery, but it is not for everyone.

Some research has indicated that although 12-step and other treatment approaches are compatible, patients’ level of commitment or engagement in prescribed behaviors is very low.

They stress that some way must be found to get patients engaged and committed and that the 12-step affiliation needs to be considered an important, rather than a casual, part of treatment.

Patients, many of whom have already been attending meetings before entering treatment, must recognize that 12-step organizations, including Alcoholics Anonymous (AA), are social organizations with a way of living with a program and a fellowship.

At the end of formal treatment, patients must become engaged in and committed to the processes of 12-step programs.

Research report; Forman, R.F.; Humphreys, K.; Tonigan, J.S. Response: The marriage of drug abuse treatment and twelve-step strategies. Science and Practice Perspectives, 2(1):52-54, 2003.

Brief-TSF is designed to increase levels of commitment to recovery.

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Students with a dense family history of alcoholism are most at risk of alcohol-use disorders

This study looks at first-, second- and third-degree relatives instead of just one parent, usually paternal

Not all university students will “mature out” of their heavy-drinking habits.

A new study examines the density of college students’ family history of alcoholism.

This type of measure – looking at first-, second- and third-degree relatives – identified a significant number of at-risk individuals who would have been missed using regular family-history measures.

While many university students tend to “mature out” of heavy-drinking behavior by the time they become young adults, some go on to develop alcohol-use disorders (AUDs). Most genetic research on an individual’s family history of alcoholism (FHA) has looked at the parents’ – usually paternal – alcohol use. New findings indicate that looking at the density of FHA – including first-, second- and third-degree relatives – is much more telling.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“Using a density measure of FHA can identify a greater number of individuals who may be at risk for developing an alcohol problem,” said Christy Capone. “The greater number of affected relatives … the greater the potential risk of developing an AUD. Ours is the first published study to examine this measure among college students.”

“Family density appears to be a promising method to identify a higher percentage of at-risk individuals,” agreed John Hustad, research associate at Brown University. “For example, in this study, approximately 44 percent of the at-risk participants would have been missed if a typical family-history measure had been used instead of the family-history density approach.”

The study population for this research consisted of 408 undergraduate students (293 females, 115 males) from a northeastern U.S. university who were asked to complete an anonymous survey for course credit during the 2005-2006 academic year.

“Our use of a density measure identified a large proportion of students, about 29 percent, who are at potentially greater risk for development of AUDs based on their report of alcoholism among first- and second-degree relatives,” said Capone. “Our other key finding was the relationship between FHA and other potential risk factors – behavioral undercontrol, age of onset of drinking (AOD), and cigarette use.”

All of these risks factors are inter-related, added Hustad. “First, family-history density was related to AOD, behavioral undercontrol, and current cigarette use which, in turn, are related to alcohol use and/or alcohol-related problems in this sample of college students. Second, behavioral undercontrol was associated with alcohol problems but not the degree of alcohol consumption; this suggests that individuals with a family-history density of AUDs and behavioral undercontrol are more likely to behave irresponsibly when drinking.”

“The importance of identifying these risk factors is the idea that they can be useful markers of at-risk status and can help us to develop appropriate intervention strategies,” said Capone. “Although, given the fact that many students come to college already having experience with alcohol, I believe that preventive interventions should begin early in the high-school years or during the transition from middle school to high school.”

Hustad agreed. “Due to the relationship between earlier AOD and more alcohol-related problems during college, it is clear that education and prevention efforts should begin well before the college years,” he said. “Until that happens, the risk factors identified in this research can be easily implemented in any screening and brief intervention for incoming college students. For example, these results suggest that effective interventions addressing tobacco use may have a positive influence on both smoking and alcohol-related consequences.”

“It is important to remember that not everyone with density of familial alcoholism will go on to develop a long-term problem with alcohol themselves,” said Capone. “Alcohol dependence is a very complex disorder and FHA is but one influence on its development. However, college students who are heavy drinkers and have a greater density of familial alcoholism are certainly at higher risk of continuing to drink in a problematic fashion after the college years.”

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• AA Offers Recovery Not Religion
• Twelve Step Facilitation
• Subscribe to BriefTSF by e-Mail

Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism by AA Services Read more about this title…

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What can be confidently said about AA in general and about the role of spirituality in AA in particular?

• First, there is convincing evidence that alcoholism severity predicts later AA attendance.
• Second, atheists are less likely to attend AA, relative to individuals who already hold spiritual and/or religious beliefs. However, belief in God before AA attendance does not offer any advantage in AA-related benefits, and atheists, once involved, are at no apparent disadvantage in deriving AA-related benefits.
• Third, the spiritually-based principles of AA appear to be endorsed in AA meetings regardless of the perceived social dynamics or climate of a particular meeting, eg, highly cohesive or aggressive.
• Fourth, significant increases in spiritual and religious beliefs and practices seem to occur among AA-exposed individuals.
• Fifth, in spite of much discussion to the contrary there is little evidence that spirituality directly accounts for later abstinence.

We are finding, however, that spirituality has an important indirect effect in predicting later drinking reductions. Specifically, in the past 20 years a number of effective methods have been developed to facilitate initial AA attendance. Such as Brief-TSF.

Interventions that lead to initial increases in spirituality appear to lead to sustained AA affiliation, which, in turn, produces sustained recovery over time.

Research; Tonigan JS. Spirituality and alcoholics anonymous. South Med J. 2007 Apr;100(4):437-40.

See also;

• What About This Spiritual Awakening Thing?
• 12-Step Treatment More Effective than Alternative

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The relation between alcohol and jealousy is a deeply rooted belief within the general population as well as in the medical, and particularly psychiatric, environment.

Furthermore, in recent years there has been a growing interest on the forensic aspects of pathological jealousy, since they are a frequent cause of severe violence, homicide and suicide.

Some authors have described a high prevalence of pathological jealousy in alcoholic patients, even awarding it a specific value in alcoholism.

Nevertheless, recent studies do not completely support this relation, and draw attention to other factors.

Results from the various studies contain several definitions and classifications of pathological jealousy, and although most of them highlight the prevalence of jealousy in alcoholic patients, they question its specific quality.

Also, the presence of pathological jealousy in subjects with psychiatric disorders other than alcoholism is suggested, indicating the existence of predisposing and triggering factors which could explain the development of pathological jealousy.

Yet, the important methodological difficulties in the published articles and the shortage of studies do not allow the confirmation of the alcoholic etiology in pathological jealousy; this is the reason why considering alcoholic jealousy as a separate entity is debatable.

In this sense, the best diagnosis in these patients would be paranoid disorder combined with alcoholic dependence, hence, a dual diagnosis.

Research; Jiménez-Arriero MA, Hernández B, Mearin Manrique I, Rodríguez-Jiménez R, Jiménez Giménez M, Ponce Alfaro G. Alcoholic jealousy: an old and current dilemma. Adicciones 2007; 19(3): 267-72

Emotional Wellness: Transforming Fear, Anger, and Jealousy into Creative Energy

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Or how to avoid burnout

1. We admitted difficulty living as a health-care professional only, that our problems arise from this single focus in life.
2. We came to believe that accepting help and support from everything life has to offer could restore our physical, mental, emotional, social and spiritual health.
3. We made a decision to turn our will and our lives over to the care of our fellows who have learned these lessons and a Higher Power as we understand one.
4. We made a searching and fearless personal inventory of our problems, strengths, goals and dreams.
5. We shared our list with trusted others, including our Higher Power, acknowledging our character weaknesses, virtues and humanity.
6. We became entirely ready to accept the help available to address our basic human needs.
7. With humility and an open mind we sought to correct the shortcomings in our lives.
8. We made a list of all persons and institutions we resented or harmed and became willing to address these issues.
9. We made direct amends where necessary and took any action required to relieve these tensions, except when to do so would harm others.
10. We continue to monitor internal feelings and needs, promptly admitting when we had a problem.
11. We remained open and responsive to the help, guidance and love we can receive from others who care about us, including our Higher Power.
12. Having achieved personal revitalisation as the result of these steps, we try to carry this message to the others in our lives and to practice these principles in all our affairs.

After Kaufman M. (1999) The Twelve-Steps for physicians who seek rehumanising. Ontario Medical Review. November.

Resilient Practitioner, The: Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers, and Health Professionals by Thomas M. Skovholt Read more about this title…

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By Michael A. Sayette, Ph.D.

For centuries, people have used alcohol to relieve stress-that is, the interpretation of an event as signaling harm, loss, or threat. The person usually responds to stress with a variety of behavioral, biological, and cognitive changes. Alcohol consumption can result in a stress response dampening (SRD) effect, which can be assessed using various measures.

Numerous individual differences and situational factors help determine the extent to which a person experiences SRD after consuming alcohol.

Individual differences include

• a family history of alcoholism,
• personality traits,
• extent of self-consciousness,
• cognitive functioning, and
• gender.
• Situational factors influencing alcohol’s SRD effect include
• distractions during a stressful situation and
• the timing of drinking and stress.

The attention-allocation model and the appraisal disruption model have been advanced to explain the influence of those situational factors.

Alcohol Research & Health, Vol. 23, No. 4, 1999

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A recent large multicenter research study of alcohol dependence supported by the National Institute of Alcoholism and Alcohol Abuse (NIAAA), the COMBINE Study, suggested that naltrexone produced a modest but significant benefit but another FDA-approved medication, acamprosate, was ineffective.

Perhaps consistent with its modest effects in COMBINE, naltrexone is not widely prescribed in the treatment of alcoholism. Yet, clinicians report that naltrexone may have significant benefits for individual patients.

To make naltrexone a more useful medication, it would be important to begin to identify groups of patients who might be more or less likely to show a significant clinical benefit from naltrexone prescription and to understand the causes of differential naltrexone efficacy. A new study that will appear in the September 15th issue of Biological Psychiatry suggests that alcohol dependent individuals with a family history of alcohol dependence may be more likely than alcohol dependent individuals without a family history of alcohol dependence to reduce their drinking in the laboratory when prescribed naltrexone.

Krishnan-Sarin and colleagues at the NIAAA Center for the Translational Neuroscience of Alcoholism studied alcohol consumption in the laboratory by alcohol-dependent individuals who were not seeking treatment.

The participants were studied in the laboratory after 6 days of treatment with 0 mg (placebo), 50 mg, or 100 mg of naltrexone. The authors discovered that naltrexone decreased drinking in those with a family history of alcoholism and this effect was greatest with the highest naltrexone dose.

However, it increased drinking in those without a family history of alcoholism and this effect was greatest at the highest naltrexone dose.

John H. Krystal, M.D., one of the authors, notes that “When studied in large groups, naltrexone appears to have a rather small effect upon the ability to reduce drinking or remain abstinent from alcohol.

However, there is growing evidence that there are subgroups of patients who show substantial benefit from naltrexone, even when naltrexone fails to work in the overall trial (see Gueorguieva R et al. Biol Psychiatry. 2007 Jun 1;61(11):1290-5).”

According to Suchitra Krishnan-Sarin, Ph.D., the lead author,  “The results suggest that family history of alcoholism may be an important predictor of clinical response to naltrexone and could potentially be used to guide clinical practice.”

Dr. Krystal agrees, “These data suggest that family history might influence the optimal dosing of naltrexone and the nature of the clinical response.” Their hope is that these findings ultimately can contribute to a better treatment experience for some who are seeking to end their battle with alcohol.

Research articles; Suchitra Krishnan-Sarin, John H. Krystal, Julia Shi, Brian Pittman and Stephanie S. O’Malley. Family History of Alcoholism Influences Naltrexone-Induced Reduction in Alcohol Drinking” Biological Psychiatry, Volume 62, Issue 6.  and R. Gueorguieva, R. Wu, B. Pittman, J. Cramer, R.A. Rosenheck, S.S. O’Malley and J.H. Krystal. New Insights into the Efficacy of Naltrexone Based on Trajectory-Based Reanalyses of Two Negative Clinical Trials. Biol Psychiatry. 2007 Jun 1;61(11):1290-5.

Brief-TSF is designed as adjunctive therapy to complement anti-craving pharacotherapy.

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Alcohol use disorders represent a substantial public health problem all over the world affecting approximately 2 billion alcohol users worldwide as estimated by the WHO in 2000.

Given the harmful effects of alcohol on the distressed individuals and society as a whole, there is an increasing urge for the development of new, more efficient medications.

Although, investigation of the mechanisms underlying the actions of ethanol in the central nervous system has been ongoing for more than a century, the exact mechanism by which ethanol exerts its effect is still a matter of debate.

In recent years, scientists discovered evidence that alcohol acts on several neurotransmitter systems in the brain to create its alluring effects.

Besides altering the release of neurotransmitters like dopamine, ethanol alters the function of a number of neurotransmitter receptors as well as transporters.

When ethanol is used for longer period of time, changes in these specific neurotransmitter functions occur possibly underlying the development of alcohol dependence.

Therefore, modulators of these targets of ethanol can be useful pharmacotherapeutic agents in the treatment for alcohol dependence.

The aim of this review is to summarize the patent background of these potential candidates clustering them according to their mechanism of effects.

Research; Nagy J. Recent patents on pharmacotherapy for alcoholism. Recent Patents CNS Drug Discov. 2006 Jun;1(2):175-206.

See also;

• Twelve Step facilitation
• Brief-TSF professional training is complimentary to pharmacotherapy.

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All the elements of TSF have moderate to strong research support, most of which has been replicated.

NB: AA does not participate in research but individual members do. The huge volume of peripheral research supports a strong case for recommending AA participation by alcoholics.

We know: -

• that Twelve Step Facilitation reduces alcohol abuse , improves related consequences, and improves employment prospects.
• that Alcoholics Anonymous has good efficacy, and that Peer Sponsoring/social support is an essential element in AA’s success.
• that recovering people who help recovering people maintain better sobriety and have greater involvement in the general community.
• that men, women, adolescence, African-Americans, Hispanics and gay men benefit from AA. That all socio-demographic groups are represented.
• that AA is suitable for head trauma victims, and methadone patients.
• that AA has wide acceptance and is readily available in almost all communities. The current global membership of AA is approximately 2.06 million.
• that participation in Alcoholics Anonymous improves medication compliance for mental health patients, improves psychological functioning, Improves coping, reduces child abuse and domestic violence, reduces healthcare usage, reduces hospitalisation, reduces medical symptoms, reduces subsequent treatment demand, reduces mortality, and reduces associated costs.
• that healthcare workers have good success rates for substance abuse treatment and recovery from alcoholism that can be improved with AA participation.
• that alcoholics with social networks supportive of drinking have better outcomes if they initiate AA attendance while in treatment.
• that affiliation with AA is enhanced if prospects gain an awareness of the culture and methods used by AA and that sobriety is better than drinking prior to attending AA.
• that 80% of Australian, 87% of USA, and 65% of UK doctors believe that Alcoholics Anonymous is the treatment of choice for alcoholism, but overall they do not understand how AA works.
• that more than 80% of specialist alcohol and drug treatment staff support Alcoholics Anonymous treatment referral and 92% of another specialist A & D service requested training in 12 Step approaches.
• that AA Peer Sponsor contact at the healthcare worker office/institution increases initiation and sustained attendance at AA meetings.
• that active and regular AA participation is one of the more effective ways to effect lifestyle changes for alcoholics.
• that routinely engaging patients in continuing outpatient care is likely to yield better outcomes..
• that most people in the early stages of alcoholism seek help from GP’s or Community Health Centres.
• that individuals with substance abuse medical conditions benefit from integrated medical and substance abuse treatment, and approaches such as TSF can be cost-effective.
• that for every $1.00 invested in intervention $4.30 is saved in future healthcare costs.

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