Showing papers in "Alcohol and Alcoholism in 2001"

Frontal lobe changes in alcoholism: a review of the literature.

Abstract: Alcohol can induce a wide spectrum of effects on the central nervous system. These effects can be recognized at the neurophysiological, morphological and neuropsychological levels. Several studies of the effect of alcohol on the frontal lobes were identified for review from MedLine, PsychLIT databases and by manual searching. In this review article, the different changes are examined in detail. Computed tomography studies have reported changes of frontal lobe in alcoholism, while magnetic resonance imaging studies supported these findings. Neurophysiological studies with positron emission tomography and single photon emission computed tomography have reported a decreased frontal lobe glucose utilization and reduced cerebral blood flow. There is also evidence from neuropsychological studies that there are specific deficits in alcoholism that suggest frontal lobe dysfunction. Considered together, these studies lend a strong credence to the concept of frontal lobe pathology in alcoholism. However, frontal lobe is not an isolated part of the brain and should be considered with its heavy connections to different cortical and subcortical areas of the brain.

The course of anxiety, depression and drinking behaviours after completed detoxification in alcoholics with and without comorbid anxiety and depressive disorders.

Abstract: We studied the associations between comorbid anxiety and depressive disorders in treated alcoholics, the course of current anxiety and depression during the early and late post-detoxification periods, and drinking behaviours after discharge. Lifetime psychiatric comorbidity was assessed in 100 alcoholics using the Composite International Diagnostic Interview (CIDI). Three subgroups defined as group DA (comorbid depressive and anxiety disorders, n = 15), group A (anxiety disorder only, n = 23), and group NO (no comorbid disorder, n = 62) were studied. Beginning 21 +/- 13 days after cessation of drinking, state anxiety (STAI-X1), trait anxiety (STAI-X2) and depression (BDI) were assessed once per week (t1 to t4) and once more 6 months after discharge (t5, n = 68). The severity of psychopathology decreased during the first 4 weeks after detoxification in all subgroups. However, trait anxiety remained at higher levels in both the comorbid subgroups from t1 to t4. In the follow-up sample, 60.5% of the non-comorbid subjects remained abstinent, but only 26.7% of all comorbid patients and only 12.5% of those with comorbid depressive disorder plus severe current trait anxiety or depression at t1. Independent of their comorbidity status, relapsers at t5 had already reported more trait anxiety than abstainers at t1. We conclude that severe trait anxiety persisting after 3 weeks of abstinence, comorbid depressive and/or anxiety disorders, and combinations of these with moderate or severe current anxiety and depressive states represent the greatest risks of relapse and therefore may indicate a treatment need.

Naltrexone, a relapse prevention maintenance treatment of alcohol dependence: a meta-analysis of randomized controlled trials.

Abstract: The objective of this study was to review the evidence for the efficacy and toxicity of naltrexone, a treatment of alcohol dependence. A systematic review and meta-analysis of randomized controlled trials of naltrexone used in the treatment of alcoho l dependence was conducted. We searched MEDLINE, EMBASE, PsychLIT and the Cochrane Controlled Trials Registry for articles published between 1976 to January 2001. The manufacturer of naltrexone was asked to submit additional complete trial reports no t in the literature. We analysed data from seven studies that compared naltrexone to placebo. The meta-analysis of benefit indicates that naltrexone is superior to placebo. Subjects treated with naltrexone experience significantly fewer episodes of relapse, and sig nificantly more remain abstinent when compared to placebo-treated subjects {risk difference of relapse rates = -14% (95% confidence interval (CI): -23%, -5%); and risk difference of abstinence rates = 10% (95% CI: 4%, 16%)} after 12 weeks of treatment. The naltrexone- treated subjects also consume significantly less alcohol over the study period than do placebo-treated subjects. There is no si gnificant difference between naltrexone and placebo in terms of the number of subjects with at least one adverse event or the number of s ubjects who discontinued the trial due to an adverse event.

Measuring the facial phenotype of individuals with prenatal alcohol exposure: correlations with brain dysfunction

Abstract: The purpose of this report is to demonstrate how to measure the magnitude of expression of the fetal alcohol syndrome (FAS) facial phenotype using the new 4-Digit Diagnostic Code and the previously developed D-score and to demonstrate how these two measures of the FAS facial phenotype correlate with brain function and structure; correlations that fail to be identified by the older gestalt method of facial measurement. The D-score and the facial component of the 4-Digit Diagnostic Code quantitatively measure the magnitude of expression of the FAS facial phenotype using three facial features (palpebral fissure length, philtrum smoothness, and upper lip thinness). These facial measurement systems were developed by the Washington State FAS Diagnostic and Prevention Network (FAS DPN) of clinics and are used to screen and diagnose the facial component of FAS for all patients evaluated in the network of clinics (1500 to date). The 4-Digit Diagnostic Code is a comprehensive diagnostic system developed by the FAS DPN in 1997 to diagnose the full spectrum of outcomes among patients with prenatal alcohol exposure. The four digits reflect the magnitude of expression of the four key diagnostic features of FAS in the following order: (1) growth deficiency; (2) the FAS facial phenotype; (3) brain dysfunction; (4) gestational alcohol exposure. The 4-Digit Diagnostic Code was developed to overcome the subjective, highly variable gestalt method of diagnosis that has been used as the standard to date, worldwide. Prior to the development of the 4-Digit Diagnostic Code, the first 445 patients evaluated in the FAS DPN were diagnosed using the gestalt method. For research purposes, their gestalt diagnoses were transformed into 4-Digit Diagnostic Codes, presenting a unique opportunity to directly compare the two diagnostic methods. When the facial phenotype was measured using the 4-Digit Diagnostic Code or D-score, the magnitude of expression of the FAS facial phenotype was significantly correlated with structural, neurologic, and functional measures of brain damage, and the phenotype of those receiving a 4-Digit Diagnosis of FAS showed little variability. When the gestalt method of diagnosis was used, the magnitude of expression of the FAS facial phenotype did not correlate with structural, neurologic and functional measures of brain damage, and the facial phenotype of those receiving a gestalt diagnosis of FAS was highly variable. The 4-Digit Diagnostic Code and D-score thus provide more precise and accurate measures of the FAS facial phenotype and reveal important correlations with brain structure and function, suggesting that intermediate expressions of the FAS facial phenotype may serve as important risk factors for brain damage caused by prenatal alcohol exposure.

Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism.

Abstract: Eight double-blind placebo-controlled clinical trials in five countries have demonstrated the safety and efficacy of naltrexone as an adjunct in alcoholism treatment. The efficacy depends, however, on how naltrexone is used. Three of the trials tested naltrexone in two ways: (1) with supportive therapy, i.e. support of complete abstinence; (2) with therapy tacitly accepting that relapses may occur and teaching how to cope with them. Although all found benefits from naltrexone with the coping therapy, none of them found any significant benefit of naltrexone over placebo when combined with support for abstinence. These results are consistent with our pre-clinical studies in which naltrexone, naloxone, and nalmefene were effective when paired with drinking but ineffective when given during abstinence. This supported the hypothesis that the primary mechanism involved is extinction (as had been concluded earlier for the effects of naltrexone in opiate addiction treatment), because extinction only weakens responses that are made while reinforcement is blocked. On this basis, it was proposed that: (1) naltrexone should be administered to patients who were still currently drinking; (2) the instructions should be to take naltrexone only when drinking was anticipated; (3) this treatment should continue indefinitely. Subsequently, clinical trials have found that naltrexone used in this manner is safe and effective.

Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany.

Abstract: The goals of this study were to describe demographic variables, drinking history, and the 6-month prevalence of Axis I comorbidity among alcohol-dependent subjects in Germany. The variables: amount of alcohol consumption, age at onset of the firs t alcohol consumed, age at onset of daily alcohol consumption, age at onset of withdrawal symptoms and number of detoxifications were related to the different comorbid disorders and gender. In this study, 556 patients from 25 alcohol treatment centres were enro lled between 1 January 1999 and 30 April 1999. After a minimum of 10 days of sobriety patients who fulfilled ICD-10 and DSM-IV crite ria of alcohol dependence were interviewed for data collection using the Mini-DIPS (German version of the Anxiety Disorders Intervi ew Schedule) and a standardized psychosocial interview. The 6-month prevalence of comorbid Axis I disorders was 53.1%. Among the patients with comorbidity, affective and anxiety disorders were most frequent. Comorbid stress disorder was associated with an early start of drinking, an early beginning of withdrawal symptoms, highest number of detoxifications, and the highest amount of alco hol consumed. Female patients with anxiety disorder consumed more alcohol and started earlier than females without this comorbid di s- order. The data do not answer the question of the pathogenesis of comorbid disorders and alcoholism, but indicate that stress d isorders in alcoholic patients and anxiety disorders in female alcoholics influence the course and severity of alcoholism.

Correlation between inhibition, working memory and delimited frontal area blood flow measured by 99MTc-Bicisate SPECT in alcohol-dependent patients

Abstract: Recently detoxified non-neurological alcoholic patients appear to be impaired in cognitive tasks measuring inhibitory processes as well as working memory (involving storage and manipulation of information). The aim of this study was to investigate in alcoholic participants the relationship between these two cognitive functions and regional cerebral blood flow (rCBF) studied at rest in regions of interest selected on the basis of recent PET studies which explored inhibitory and working memory in normal subjects. Twenty non-neurological alcoholic patients and 20 normal volunteers were selected for a neuropsychological exploration, including assessment of inhibition processes (by means of the Hayling test) and working memory (by means of the Alpha-span task). rCBF of alcoholics was also evaluated with a semi-quantitative method using a 99mTc-Bicisate single photon emission computed tomography (SPECT) procedure. Alcoholic patients performed worse than controls in the alphabetical condition of the Alpha-span task (involving manipulation and storage of information), and on the Hayling test. Significant correlation emerged between inhibition performance and both the bilateral inferior (left BA 47, r = -0.40; right BA 47, r = -0.599) and median frontal gyrus (left BA 10, r = -0.55; right BA 10, r = -0.59), but not with the region of reference (occipital/cerebellum, r = -0.13). Coordination of storage and manipulation was correlated with bilateral median frontal (left BA 10/46, r = -0.50; right BA 10/46, r = -0.45), but not with bilateral parietal area (left BA 7, r = -0.12, right BA 7, r = -0.18). These results suggest a relationship between inhibition and working memory deficits in alcoholic patients, and regional rCBF measured in frontal areas. Clinical implications of these data related to alcohol relapse are discussed.

Acamprosate during and after acute alcohol withdrawal: a double-blind placebo-controlled study in Spain.

Abstract: To test acamprosate's role as an aid in preventing relapse after detoxification, 296 alcohol-dependent patients entered a prospective, multicentre, randomized, double-blind, parallel comparison of acamprosate treatment consisting of two 333 mg tablets given three times daily for 180 days with matching placebo treatment. Unlike previous studies, acamprosate was prescribed from the start of alcohol withdrawal, rather than after the detoxification process. During the treatment period, 110 patients dropped out. The two treatment groups were balanced with regard to baseline values and reasons for discontinuation. There was no difference between the groups in the severity of withdrawal symptoms as measured by the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol scale). Acamprosate given during withdrawal did not cause unwanted effects. The cumulative abstinence duration (CAD, main end-point) was 19 days longer in the acamprosate treatment group than the placebo treatment group (analysis of variance on ranks, P = 0.0006) and the stable recovery duration, defined as the number of abstinent days between the last relapse into any drinking and the end of the trial, was 16 days longer in the acamprosate treatment group (P = 0.021). Continuous abstinence, estimated by survival analysis on time to first relapse, was achieved by 35% of acamprosate-treated patients and 26% of placebo-treated patients (log rank P = 0.068). The geometric mean of the ratio final/baseline values for serum carbohydrate-deficient transferrin was 0.802 (placebo) and 0.733 (acamprosate) (P = 0.059). The geometric mean of the ratio final/baseline values for serum gamma-glutamyltransferase was 0.496 (placebo) and 0.415 (acamprosate) (P = 0.024) which corroborated the greater abstinence reported by the acamprosate group.

Naltrexone versus acamprosate: one year follow-up of alcohol dependence treatment

Abstract: Naltrexone and acamprosate reduce relapse in alcohol dependence. They have not yet been compared in a published trial. The aim of this study was to compare the efficacy of these compounds in conditions similar to those in routine clinical practice. Random allocation to a year of treatment with naltrexone (50 mg/day) or acamprosate (1665-1998 mg/day) was made in 157 recently detoxified alcohol-dependent men with moderate dependence (evaluated using the Addictions Severity Index and Severity of Alcohol Dependence Scale). All were patients whom a member of the family would accompany regularly to appointments. Alcohol consumption, craving and adverse events were recorded weekly for the first 3 months, and then bi-weekly, by the treating psychiatrist who was not blinded. At 3-monthly intervals, investigators who were blinded to the treatment documented patients' alcohol consumption based on patients' accounts, information given by the psychiatrists when necessary, and reports from patients' families. Serum gamma-glutamyltransferase (GGT) was also measured. Efforts were made to sustain the blindness of the investigators. The same investigator did not assess the same patient twice. The integrity of the blindness was not checked. There was no difference between treatments in mean time to first drink (naltrexone 44 days, acamprosate 39 days) but the time to first relapse (five or more drinks in a day) was 63 days (naltrexone) versus 42 days (acamprosate) (P = 0.02). At the end of 1 year, 41% receiving naltrexone and 17% receiving acamprosate had not relapsed (P = 0.0009). The cumulative number of days of abstinence was significantly greater, and the number of drinks consumed at one time and severity of craving were significantly less, in the naltrexone group compared to the acamprosate group, as was the percentage of heavy drinking days (P = 0.038). More patients in the acamprosate than the naltrexone group were commenced on disulfiram during the study. Naltrexone patients attended significantly more group therapy sessions, though this could not explain their better outcome. There were non-significant trends for the naltrexone group to comply better with medication, to stay in the study longer, and to show greater improvement over baseline in serum GGT.

Moderate alcohol consumption in social drinkers raises plasma homocysteine levels: a contradiction to the ‘French Paradox’?

Abstract: Evidence from observational studies suggests that elevated levels of homocysteine are associated with an increased risk of cardiovascular diseases. We assessed whether moderate alcohol intake in healthy social drinkers, suggested to be cardioprotective according to the ‘French paradox’, influences the cardiovascular risk factor homocysteine. A total of 60 normal nourished subjects who had no evidence of vascular disease or other risk factors for hyperhomocysteinaemia were assigned to receive mineral water or 30 g of alcohol per day (as beer, red wine or spirits) for a period of 6 weeks. Homocysteine levels of social drinkers, independent of which beverage was consumed, increased during the observation. We postulate that elevated levels of homocysteine in social drinkers with regular moderate alcohol intake are at risk of developing cardiovascular diseases, which contradicts the suggested cardioprotection of alcohol according to the ‘French paradox’.

Sweet liking and family history of alcoholism in hospitalized alcoholic and non-alcoholic patients.

Abstract: The present study was designed to test the hypothesis that preference for stronger sweet solutions may be associated with the genetic risk for alcoholism. Thirty-two male patients with alcohol dependence admitted for alcoholism in-patient treatment and 25 non-alcoholic control subjects were used in the study. Hedonic response to sweets was evaluated using the sweet preference t est. Family history of alcoholism was evaluated using a Russian version of the Michigan Alcoholism Screening Test modified for the assessment of the alcohol-related behaviour of the subject's biological father. Similar to our previous findings, alcoholics were far more likely to prefer the highest offered sucrose concentration (0.83 M), compared to non-alcoholic controls. Such preference was de termined by two factors: positive family history of alcoholism and alcoholic status. Statistically, these factors contributed to the lik elihood of preferring sweet solutions independently. Therefore, the effects of these factors may enhance each other. These findings suppor t the hypothesis that preference for a stronger sweet solution is associated with a paternal history of alcohol dependence and may re flect a genetic predisposition to alcoholism.

Alcohol cue-reactivity in heavy and light social drinkers as revealed by event-related potentials.

Abstract: An elevated cue-reactivity evoked by alcohol-related stimuli (cues) in alcohol-dependent patients has been described for different physiological variables, including electrophysiological measures, such as event-related potentials (ERPs). Cue-reactivity has, however, also been reported for social drinkers. The aim of this study is to assess the effect of the drinking behaviours of social drinkers on cue-reactivity as measured with ERPs. Forty alcohol-related and 40 neutral pictures were presented to 15 heavy and 15 light drinkers (all males). ERPs were recorded using 21 scalp electrodes. Stimuli were presented for 500 ms with an inter-stimulus interval of 2000 ms. Heavy social drinkers displayed a cue-reactivity of significantly higher amplitude at the frontal electrode location Fz, elicited by alcohol-related, as compared to neutral, pictures. This effect was not found in light social drinkers. The results indicate that the cue-reactivity previously found in alcohol-dependent patients is also present in social drinkers, and that electrophysiological cue-reactivity is associated with alcohol consumption.

Temperament and Character Inventory (TCI) personality profile and sub-typing in alcoholic patients: a controlled study.

Abstract: Cloninger's Temperament and Character Inventory (TCI) personality profile was used to compare alcohol-dependent patients with non-psychiatric control subjects, and a search made for sub-types of alcoholics with different TCI profiles, usin g the criteria age of onset of alcohol-related problems, paternal dependence on alcohol and familial antecedents of alcohol dependence. Alcoho l- dependent patients (n = 38) were characterized by higher Novelty-Seeking (corresponding to Diagnostic and Statistical Manual of Mental Disorders (4th edition) group B personality type) and lower Self-Directedness than non-psychiatric control subjects ( n = 47). Lower Self-Directedness indicates a higher probability of personality disorder in the alcohol-dependent population. Only age of onset of alcohol-related problems delineated the two sub-populations with different TCI profiles: early-onset alcoholics (  25 years of age, n = 19), but not late-onset ones ( n = 16), in comparison with control subjects, were associated with higher Novelty-Seeking. Both early and late-onset patients scored lower on Self-Directedness than control subjects. Self-Directedness and Cooperation scores were lower in early-onset than in late-onset patients. These results in part support Cloninger's typology, and the TCI data add to evidence concerning a higher probability of personality disorder in alcohol-dependent patients, particularly those with early-onset.

Predictors of alcohol intake and heavy drinking in early adulthood : A 5-year follow-up of 15-19-year-old Finnish adolescents

Abstract: Relative contributions of earlier drinking and smoking vs mental health risk factors in predicting alcohol intake and heavy drinking in young adulthood were assessed. Higher average alcohol intake and heavy drinking (13 or more drinks on one occasion) in 1995 were significantly related to male gender and earlier high scores in 1990 of relief smoking, relief drinking, and their interaction. Parental alcohol problems, social group, perceived degree of social support, trait anxiety, number of negative life events, self-esteem, grade-point average, somatic symptoms score, or immature, neurotic, or mature defence style measured in 1990 did not predict alcohol intake or heavy drinking 5 years later. The findings suggest that alcohol intake and heavy drinking in young adulthood can be predicted by earlier self-reports on relief smoking and alcohol intake in adolescence.

United Kingdom Alcohol Treatment Trial (UKATT): Hypotheses, design and methods

Abstract: The United Kingdom Alcohol Treatment Trial (UKATT) is intended to be the largest trial of treatment for alcohol problems ever conducted in the UK. UKATT is a multicentre, randomized, controlled trial with blind assessment, representing a collaboration between psychiatry, clinical psychology, biostatistics, and health economics. This article sets out, in advance of data analysis, the theoretical background of the trial and its hypotheses, design, and methods. A projected total of 720 clients attending specialist services for treatment of alcohol problems will be randomized to Motivational Enhancement Therapy (MET) or to Social Behaviour and Network Therapy (SBNT), a novel treatment developed for the trial with strong support from theory and research. The trial will test two main hypotheses, expressed in null form as: (1) less intensive, motivationally based treatment (MET) is as effective as more intensive, socially based treatment (SBNT); (2) more intensive, socially based treatment (SBNT) is as cost-effective as less intensive, motivationally based treatment (MET). A number of subsidiary hypotheses regarding client-treatment interactions and therapist effects will also be tested. The article describes general features of the trial that investigators considered desirable, namely that it should: (1) be a pragmatic, rather than an explanatory, trial; (2) be an effectiveness trial based on 'real-world' conditions of treatment delivery; (3) incorporate high standards of training, supervision and quality control of treatment delivery; (4) pay close attention to treatment process as well as treatment outcome; (5) build economic evaluation into the design at the outset. First results from UKATT are expected in 2002 and the main results in 2003.

Flupenthixol decanoate and relapse prevention in alcoholics: results from a placebo-controlled study

Abstract: Flupenthixol, with its broad receptor profile, interacts with a variety of dopamine and serotonin binding sites which are important in the neurobiology of alcohol dependence. Its pharmacology, together with encouraging results from both animal studies and clinical trials with cocaine users, led us to postulate that flupenthixol would significantly prevent relapse in detoxified alcohol-dependent individuals. We conducted a prospective, randomized, double-blind, placebo-controlled, multi-centre trial with two parallel groups and appropriate statistical evaluation. Subjects met criteria for moderate to severe alcohol dependence (DSM-III-R), without any concomitant psychiatric disorder. After complete detoxification, 281 women and men received either 10 mg of flupenthixol decanoate or placebo as i.m. injection every second week for 6 months on an out-patient basis, followed by 6 months of follow-up. Efficacy was based on absolute abstinence, with relapse being defined as consumption of any alcohol after inclusion in the study. In contrast to the hypothesis, flupenthixol did not reduce, but was associated with more, relapses. Though well tolerated, relapse rates after 6 months of treatment were 85.2% (flupenthixol) versus 65.5% (placebo), a highly significant difference from the medication. Flupenthixol was also inferior to placebo with regard to other secondary criteria of efficacy (cumulative abstinence duration, relapse rate after 12 months). These results indicate that a 10 mg dose of flupenthixol decanoate does not have a beneficial effect on abstinence maintenance in alcohol-dependent individuals.

Brief intervention for male heavy drinkers in routine general practice: a three-year randomized controlled study.

Abstract: The aim of this research was to evaluate the effectiveness of long-term brief intervention in routine general practice. In five primary care out-patient clinics in a Finnish town, 296 male early-phase heavy drinkers consulting a general practitioner (GP) for various reasons were identified. Control group C (n = 88) was informed of the risks of drinking after the screening and were advised at the subsequent feedback about 2 weeks later to reduce their drinking. Groups A (n = 109) and B (n = 99) were offered in addition seven and three brief intervention sessions, respectively. All GPs took part, whether or not they indicated a special interest. The main outcome measures were differences between beginning and end-point at 3 years in self-reported alcohol consumption, mean corpuscular volume (MCV), and serum carbohydrate-deficient transferrin, aspartate aminotransferase, alanine aminotransferase and gamma-glutamyltransferase. There were no statistically significant differences between study groups A, B and C in mean changes in outcome measures. Within all the groups, MCV decreased. Depending on the outcome measure used and the study group analysed, clinically significant reduction of drinking was found in 25-53% of the subjects. In routine general practice, giving additional sessions of brief intervention may not be as effective as in special research conditions. Factors reducing the effectiveness of brief intervention programmes should be investigated, so that primary health care staff can be better supported in their efforts.

Study of axis–shield new %cdt immunoassay for quantification of carbohydrate-deficient transferrin (cdt) in serum

Abstract: Carbohydrate-deficient transferrin (CDT) in serum has emerged as a useful biochemical marker for identifying current alcohol misuse and monitoring abstinence. This study evaluated the performance of Axis-Shield new %CDT turbidimetric immunoassay (TIA; microtitre and Cobas Mira applications). Comparison was made with the previous Axis %CDT-TIA immunoassay (reference value <5.5%) and %CDT with the high-performance liquid chromatography (HPLC) technique (reference value <1.2%). The new %CDT assay measures primarily the asialo, monosialo and disialo transferrin isoforms, and the result is expressed as the amount relative to total transferrin. The analytical precision (coefficient of variation: CV) of the %CDT assay ranged between 3.1 and 8.5% for kit controls and serum samples. The %CDT values in serum from healthy social drinkers [i.e. Alcohol Use Disorders Identification Test (AUDIT) score 1-7 for men, and 1-5 for women] were 2.07 +/- 0.37% (mean +/- SD, range 1.4-3.3%, n = 100) and this was not significantly different from healthy non-drinkers (1.88 +/- 0.43%, 1.3-2.9%, n = 14), whereas abstinent alcohol patients showed slightly higher values (2.26 +/- 0.41, 1.7-3.4, n = 25). In chronic heavy drinkers (mean daily intake 225 +/- 137 g ethanol according to self-report), the %CDT values were markedly increased (6.33 +/- 4.01%, 1.2-18.0%, n = 107). There was no significant difference in %CDT values between male and female social drinkers. The reference value of the new %CDT assay to be used in clinical practice was tentatively set at <3.0%, which is slightly higher than that obtained by receiver operating characteristics (ROC) curve analysis (<2.8%) and that proposed by the manufacturer in the Instruction Manual (<2.6%). The %CDT assay showed good overall correlation with %CDT-TIA (r = 0.986, P < 0.0001) and %CDT-HPLC (r = 0.978, P < 0.0001). The specificity of the %CDT assay in healthy social drinkers was 98% (%CDT-TIA 100%, %CDT-HPLC 99%) and the sensitivity for any drinking during last week in the alcohol patients was 75% (%CDT-TIA 71%, %CDT-HPLC 80%). The new Axis-Shield %CDT assay can be recommended for routine use. However, whenever a positive immunoassay test result could lead to serious consequences for the individual, it is recommended to confirm the CDT result by the HPLC technique.

Arousal-related P3a to novel auditory stimuli is abolished by a moderately low alcohol dose.

Abstract: Concurrent measures of event-related potentials (ERPs) and skin conductance responses were obtained in an auditory oddball task consisting of rare target, rare non-signal unique novel and frequent standard tones. Twelve right-handed male social drinkers participated in all four cells of the balanced placebo design in which effects of beverage and instructions as to the beverage content (expectancy) were independently manipulated. The beverage contained either juice only, or vodka mixed with juice in the ratio that successfully disguised the taste of alcohol and raised average peak blood-alcohol level to 0.045% (45 mg/dl). ERPs were sensitive to adverse effects of mild inebriation, whereas behavioural measures were not affected. Alcohol ingestion reliably increased N2 amplitude and reduced the late positive complex (LPC). A large, fronto-central P3a (280 ms latency) was recorded to novel sounds in the placebo condition, but only on the trials that also evoked electrodermal-orienting responses. Both novel and target stimuli evoked a posterior P3b (340 ms), which was independent of orienting. Alcohol selectively attenuated the P3a to novel sounds on trials with autonomic arousal. This evidence confirms the previously suggested distinction between the subcomponents of the LPC: P3a may be a central index of orienting to novel, task-irrelevant but potentially significant stimuli and is an important component of the arousal system. P3b does not have a clear relationship with arousal and may embody voluntary cognitive processing of rare task-related stimuli. Overall, these results indicate that alcohol affects multiple brain systems concerned with arousal, attentional processes and cognitive-autonomic integration.

A comparison of rating scales for the alcohol-withdrawal syndrome

Abstract: This paper reviews the literature on the use of rating scales within the treatment of the alcohol-withdrawal syndrome. A computer-assisted literature search identified trials of therapy for and rating scales used in alcohol-withdrawal states. Eighteen rating scales were identified. There is a wide variation in symptom items included in these scales. Scales also vary in their length and ease of application. We conclude that it is important to use validated and reliable assessment scales in research if proper comparisons of treatments for the alcohol-withdrawal syndrome are to be made.

Opinions on alcohol-related issues among professionals in primary, occupational, and specialized health care.

Abstract: The objective of this study was to analyse differences in health care personnel's knowledge, skills, and attitudes in relation to alcohol-related matters by a postal questionnaire between primary, occupational, and specialized health care. Heavy drinking was considered to be common among patients at all health care levels, and particularly in specialized health care. However, early recognition and treatment of heavy drinkers was considered more appropriate in primary and occupational health care, than in specialized health care. Alcohol consumption was found to be an easy subject to discuss at all health care levels. In addition, 90% (165/183) of the respondents thought that patients had a positive or neutral attitude towards questions on their alcohol consumption. Of the respondents, 32% (58/182) considered discussing alcohol-related matters unacceptable and 81% (121/149) believed that they could not influence patients' drinking using brief intervention; there was no significant difference between different settings. Additionally, motivational skills of doctors and nurses were found to be poor at all health care levels. Our study shows that, although discussing alcohol consumption is easy, better motivational skills and more positive attitudes are needed in primary, occupational, and specialized health care. Professionals need further education at all health care levels, but particularly in specialized health care.

Alcoholic polyneuropathy: a clinical and epidemiological study

Abstract: — In the present study, we investigated the frequency of polyneuropathy in a sample of 296 alcoholics who were admitted to the ‘S. Maugeri’ Medical Centre for detoxification from October 1997 to November 1999. Results revealed a high frequency of polyneuropathy in the sample under study. The disorder was often clinically asymptomatic and demonstrable only on electroneurographic investigation. Significant correlations were found between polyneuropathy, the duration of alcoholism, the type of alcoholic beverage consumed (wine) and the presence of liver disease and macrocytosis.

Genetic association studies of alcoholism--problems with the candidate gene approach.

Abstract: In recent years, progress has been made in the identification of causative factors in most single gene disorders and those with genes of major effect. In comparison, no genes contributing to a complex disorder have been unambiguously identified. A number of reasons for this have been previously presented in theoretical papers. Alcoholism is such a complex illness and genetic studies into its underlying genetic causes have suffered from lack of power due to small subject numbers, poor selection of control subjects, and over-emphasis on markers with low prior probability of involvement.

Peripheral neuropathy in chronic alcoholism: a retrospective cross-sectional study in 76 subjects

Abstract: A consecutive sample of 76 chronic alcoholic patients was studied clinically, biochemically and electrophysiologically to assess clinical and/or subclinical signs of alcohol-related neuropathy as well as the most important and disputed risk factors for neuropathy such as age, parental history of alcoholism, nutritional status, alcoholic disease duration and total lifetime dose of ethanol (TLDE). The results show that alcohol-related neuropathy, especially when subclinical, seems to be frequent and mostly characterized by axonal degeneration of peripheral nerve fibres with earlier and more frequent involvement of sensory fibres and lower limbs. Moreover, positive family history of alcoholism, but above all alcoholic disease duration and TLDE, could be more important factors than malnutrition in determining neuropathy.

A follow-up survey of alcohol consumption and knowledge in medical students

Abstract: We surveyed a medical school's students' drinking habits and knowledge 12 years after a previous survey. In this current survey from two academic years, final year students drank less than second year students did. Women in their second year drank as much as men. Overall, 28% of students drank more than the safe limits; 27% of students were problem drinkers, as measured by the CAGE questionnaire, and 52%, as measured by the AUDIT questionnaire. The proportion of students not drinking any alcohol rose from 6% in the previous survey to 27% in the current survey, possibly due to context and demographic changes. In spite of this difference, there have been no statistically significant reductions in either unsafe drinking levels or CAGE scores over 12 years. A third of students overestimated the safe levels of drinking. All medical schools should write and implement an alcohol policy.

Health care professionals referred for treatment of alcohol and drug problems.

Abstract: This study reports on 62 health care professionals referred to a specialist drug and alcohol treatment service. Most patients used more than one type of substance. Health problems were common, but were seldom reasons for referral. Self-referral was infrequent. Referral was often subsequent to intoxication at work or persistent absenteeism. Just over half of admissions completed treatment. Multiple drug use was a poor prognostic indicator with fewer multiple drug users engaging with, or completing, treatment.

Young people and alcohol: an international insight.

Abstract: A survey of the drinking, smoking and illicit drug use of more than 90 000 teenage school students was carried out in 1999. This exercise, known as the European School Survey Project on Alcohol and other Drugs (ESPAD), revealed marked differences in the substance use patterns of those surveyed in different countries. Teenagers in a group of northern countries reported the highest rates of heavy drinking and intoxication (drunkenness). Teenagers in southern Europe reported much lower levels of such behaviours and experiences. Some of these findings are presented and discussed in relation to aetiology and health promotion.

Exploring attitude and belief correlates of adhering to the new guidelines for low-risk single-occasion drinking: an application of the theory of planned behaviour.

Abstract: The present study explores the correlates of adhering to the recent low-risk single-occasion drinking (LRSOD) guidelines. This was achieved by exploring key beliefs and attitudes underlying adherence to these guidelines within the framework of the theory of planned behaviour (TPB). Female students (n = 173) provided information about their LRSOD and beliefs and attitudes pertaining to LRSOD. Analyses of the resultant data showed the TPB to be significantly predictive of LRSOD, accounting for 27% of the variance, with normative beliefs, behavioural beliefs, and attitude emerging as significant predictors in the regression analysis. The implications of the study findings are discussed in terms of the current utility of the LRSOD limits for reducing alcohol-related harm.

Plasma levels of beta-endorphin, adrenocorticotropic hormone and cortisol during early and late alcohol withdrawal

Abstract: Endogenous opioid peptides are thought to participate in the phenomena of alcohol tolerance and withdrawal. Since in the pituitary gland, beta-endorphin (beta-EP) and adrenocorticotropic hormone (ACTH) are produced from the same precursor molecule, pro-opiomelanocortin, it may be expected that alterations in plasma ACTH and cortisol levels should parallel changes in plasma beta-EP levels during alcohol withdrawal. The aim of the present study was to investigate the alterations of beta-EP, ACTH and cortisol secretion patterns in alcohol-dependent patients with heavy intake in the early withdrawal period and, if any, whether these changes remained stable on long-term withdrawal. Twenty-two hospitalized male patients (mean age +/- SD: 43.45 +/- 9.22 years, mean daily amount of alcohol +/- SD: 421.59 +/- 116.57 g) who were diagnosed to have alcohol withdrawal and 20 age-matched healthy men (mean age +/- SD: 38.35 +/- 7.63 years) were included in the study. Morning and night levels of plasma beta-EP, ACTH and cortisol were measured in the patients during the early (first week) and late (fourth week) withdrawal periods following alcohol cessation, and only once in the control subjects. It was found that both morning beta-EP and morning ACTH levels were reduced during both early and late withdrawals, whereas cortisol levels were increased in early withdrawal and normalized towards the late withdrawal period. The finding that beta-EP deficiency continued despite withdrawal symptoms subsiding in patients suggests that their beta-EP deficiency is independent of the withdrawal syndrome and that reduced beta-EP activity may be a trait contributing to alcohol craving.