Tips For Quitting Drinking

Alcohol Free Forever

This powerful guide walks you step-by-step through exactly what you need to do to free yourself from your alcohol addiction without going through AA meetings or expensive sessions. There are three main types of relaxation techniques you can practice when you feel upset and stressed. If you practice regularly, they will become part of your lifestyle and you may find yourself habitually more relaxed as a result. Part 2 will exercise Neuro Linguistic Programming to release thoughts and a technique of progressive muscle relaxation also negative situations. Because of the mind body connection, exercises to relax the body will also flow through the mind. Much of the stress we feel is because of our resistance to certain feelings or emotions. Alcohol Free Forever is a lifesaver ebook. This guide was extremely eye-opening and the daily emails make it extremely easy to quit and to establish a routine that did not involve alcohol. Continue reading...

Alcohol Free Forever Overview


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Measurements ofalcohol intake

Alcohol consumption based on self-reported data consistently account for only 40-60 of alcohol purchases 43 , The greatest problem facing alcohol research is the lack of a reference standard with which to validate self-reported drinking. Collateral reports by significant others do not necessarily provide better information 43 , Biochemical markers, which are useful in the diagnosis of alcoholism and recent drinking, cannot be used to estimate absolute alcohol intake at an individual level. Most observational studies ask the respondents to recall their usual intake over a long period of time, say 1 month or 1 year. This approach is likely to yield information about modal frequencies and quantities and thus underestimate average intake. On the other hand, recalling the actual intake during all actual drinking occasions over a short period of time (e.g., 24 hours) ignores the day-to-day variations in alcohol consumption. Among the five main methods used to assess alcohol intake i.e.,...

Alcohol Consumption And The Risk Of Stroke

There is plenty of evidence that heavy drinking (> 60 g day) is related to increased risk ofboth hemorrhagic 19 and ischemic strokes 1,3,7,8,10-12 . In contrast, light ( 24 g day for men and 12 g day for women) and moderate (25-60 g day for men and 13-48 g day for women) drinking does not seem to increase and may even decrease the risk of stroke compared with non-drinking 7,13,14 . However, in order to understand the relationship between alcohol and the risk of stroke, one has to separately examine the effects of alcohol on each stroke subtype (i.e., subarachnoid and intracerebral hemorrhage, and cerebral infarction), the dose-response curve most probably differing from one subtype to another. The risk of subarachnoid hemorrhage seems to increase steeply with increasing alcohol consumption 7,15 , The relationship between alcohol and the risk of intracerebral hemorrhage is poorly known but may be U-shaped with lowest risk among light to moderate drinkers 7-9 , and that of ischemic...

Alcoholism In Women And Incidence Of Ahmd

Compared to men, women drink less and experience less alcohol-related medical problems 6 , However, one third of all alcoholics in the United States are women 6 , Over the last two decades, there is no evidence of any major increase in total alcohol consumption by women, however there has been an important change in the drinking patterns and prevalence of alcohol usage among women 7J. With regard to drinking patterns, younger women report frequent heavy drinking and frequent bouts of intoxication 8 , In addition, alcohol usage has increased among women who are employed full-time in nontraditional settings and among those who are unemployed and divorced 9 , This is of concern, because of the increase in the number of women in the work force as well as the number of women who are unemployed and divorced. Therefore, in the future, more women may experience alcohol-related medical problems. In the United States, long-term excessive alcohol consumption (of any beverage type) in both sexes...

Management of Alcohol Withdrawal Early Symptoms

Occurrence of withdrawal symptoms during abstinence from alcohol is evidence of physical dependency on alcohol and helps to confirm a diagnosis of alcoholism. Withdrawal symptoms are variable, ranging from mild tremulousness to delirium tremens (DT). Early symptoms of withdrawal, such as tremulousness and even seizures, may develop while there is still alcohol within the bloodstream. Withdrawal seizures have been noted in individuals with blood alcohol levels as high as 100 mg dL (0.1 ). In the early stages of withdrawal, alcoholics may experience nausea, vomiting, diaphoresis, mild tachycardia, hallucinations, illusions, and mild disorientation, in addition to tremor. All of these symptoms are relieved by ingestion of alcohol. Avoidance of withdrawal symptoms may be one reason why some alcoholics continue to drink despite other adverse health consequences.

Antisense Therapy in Pathophysiology Involving Lowered Protein Production Alcoholism

Alcoholism is associated with major changes in neurochemistry. One pep-tide that is especially affected is Met-Enk, an opiate peptide. In ethanol na ve animals, administration of Met-Enk is correlated with a decrease in the amount of ethanol drank (57). Conversely, in animals addicted to ethanol, endogenous Met-Enk levels are low (58-61). Both Met-Enk and Tyr-MIF-1 (a peptide with opiate-like properties) are transported out of the brain across the BBB by the saturable efflux peptide transport system (PTS-1). During alcohol dependency and physical withdrawal from alcohol, Met-Enk levels in the brain are independent of preproenkephalin mRNA levels (62). Because the mRNA levels do not correlate with the decreased brain levels of Met-Enk, one can assume that control is no longer at the level of transcription. Met-Enk levels at this point, therefore, are largely determined by posttranscriptional processes, including PTS-1 activity. susceptibility (64). Enzymes such as neutral...

Definitions of Alcoholism Alcohol Abuse and Hazardous Drinking

Alcoholism is a complex disorder with both behavioral and medical components, the cause of which is likely to be multifactorial. Many studies have highlighted the importance of genetic risk factors in the development of alcoholism and alcohol-related problems, although specific genes for alcoholism have not yet been identified. Definitions of alcoholism reflect the relapsing nature of alcoholism as well as the existence of physical dependence and tolerance to alcohol, lack of control of consumption, and continued use despite the development of problems or harmful consequences.

Approach to the Patients Suspected of Alcoholism

When patients present with obvious medical complications of alcoholism, the gastroenterologist has an opportunity and obligation to inform the patient of the suspected cause of the problems. Use of the CAGE questions as well as an estimation of quantity and frequency of consumption of alcoholic beverages is a useful starting point in the assessment. A nonjudgmental attitude is essential in gaining the trust of the individual. Withdrawal symptoms should be treated promptly to avoid adverse consequences. Prompt referral to AA or to other treatment programs with trained providers is helpful in initiating therapy at a time when the patient may be most amenable to treatment. At the same time as the referral is made, the gastroenterologist should advise the patient to abstain or cut down on drinking. Family members and others are often very helpful in supporting the patient in his or her decision to seek treatment. However, care should be taken to avoid discussing the patient's problems...

Psychiatric Comorbidity Alcoholism Mood and Personality

Of particular concern to the gastroenterologist is the high comorbidity between eating disorders and substance abuse, especially alcoholism. The overall rate of all substance use disorders among eating disordered patients was 37 in one study, and rates of alcoholism among bulimics were > 40 (Braun et al, 1994). Patients abusing alcohol exhibit high rates of GI comorbidity, and women suffer adverse consequences, such as cirrhosis, from consumption of alcohol more quickly than do men. We recommend screening all eating disordered patients for alcohol abuse behaviors (Redgrave et al,2003).

Nutritional Deficiencies and Support during Alcohol Withdrawal

Nutritional deficiencies are common in many alcoholics. Thiamine deficiency can lead to Wernicke's encephalopathy. Because of the potential for lasting brain injury, all alcoholics should be given 100 mg of thiamine daily for the first month of abstinence. Thiamine should be administered intravenously in those who are hospitalized because recent alcohol ingestion impairs the absorption of thiamine from the upper gastrointestinal tract. pharmacologic doses of thiamine (100 mg every day) can overcome the effects of alcohol on absorption, because high concentrations are transported passively across the mucosa. Folate deficiency is the most commonly observed vitamin deficiency in alcoholics. Alcohol ingestion impairs the absorption of folate and the resulting deficiency leads to loss of intestinal brush border. Damage to the intestinal villi leads to more generalized malabsorption and can result in diarrhea as well as folate deficiency in malnourished alcoholics. Mild steatorrhea,...

Medications for Treatment of Alcoholism Disulfiram

Disulfiram (Antebuse) is a medication that blocks metabolism of acetaldehyde, causing an aversive reaction if alcohol is consumed while taking it. It has been used for many years, but has fallen out of favor in recent years because of problems with compliance. It may be useful in certain subsets of alcoholics or when administered under direct observation. Drowsiness is the most common side effect, but usually is not a problem after the first 2 weeks of therapy. There are rare reports of serious adverse reactions, including hepatotoxic-ity therefore, monitoring liver enzymes is recommended. Stable chronic liver disease is not an absolute contraindication to treatment, but disulfiram should not be used during pregnancy, or in persons with severe depression, severe cardiovascular disease, or dementia. Disulfiram interferes with oxidative drug metabolism, so it should be used with caution in combination with phenytoin, warfarin, diazepam, and many other drugs that are metabolized by...

Alcohol Abuse And Cardiovascular Disease

Although there is considerable evidence that moderate drinking protects against mortality and morbidity from coronary heart disease 21,22 , heavy consumption is shown to have deleterious cardiovascular effects. It exerts its adverse effects by increasing the risks of cardiomyopathy, hypertension, and stroke 23 , Chronic ethanol consumption has been linked to the prevalence of hypertension, which contributes to an increased incidence of stroke. Heavy drinkers have alO mmHg higher systolic blood pressure than non-drinkers even though the relationship may differ between men and women 24 , Stroke is a leading cause of death and morbidity. Alcohol may increase the risk of stroke through various mechanisms that include hypertension, hypercoagulable states, cardiac arrhythmias, and cerebral blood flow reductions 25 , Hypertension, including borderline hypertension, is probably the most important stroke risk factor based on degree of risk and prevalence. Furthermore, cardiac morbidity,...

Are Female Animal Models Of Alcoholism Helpful In Evaluating The Adverse Effects Of Alcohol

Female animal models of alcoholism should be used to study the effects oflong-term alcohol exposure. However, investigators need to consider variables such as the level concentration of ethanol intake, the pattern of weight gain as well as the absolute weight gain, and hormone levels. As noted above, we have found that female rodents drink less alcohol than male rodents (Table 4.6). Our findings differ from those of others, who have reported that female rodents drink more than male rodents 38,39 , In addition, the pattern of drinking appears to be different between cohorts of female animals (Figure 4.4). Lieber DeCarli liquid diet intake is shown in Figure 4.4 for two different cohorts of female rats one group drank for 5 months (preliminary data above) and another drank for 8 months (ongoing studies). Similar to others, we found that in both cohorts of female rats the average daily amount of diet consumed was variable 39 , However, the average daily ethanol intake (gm day) in the...

Treatment of Alcoholism and Alcohol Dependence

The most important aspect of treatment of alcoholism is recognition of the problem and referral for treatment.The need to state medical concerns about the level of consumption and the presence of any signs of physical dependence on alcohol is a key component of the intervention. This step does not need to be carried out by a specialist in treatment of alcoholism, but can be done by any concerned health care provider. It is important that additional steps be taken to refer the individual for further treatment as soon as he or she is willing to accept the diagnosis. Patients who have developed physical complications of heavy alcohol consumption, such as cirrhosis, pancreatitis, or gastritis, are often more amenable to beginning treatment. The gastroenterologist has an advantage over other providers in being able to state authoritatively that a medical problem is the result of alcoholism. Using this window of opportunity often makes a difference in the likelihood of an individual...


Alcoholism has been defined as excessive drinking that results in impairment of the subject's health and social activities.Alcohol has a wide range of effects on many organs and increases the risk of cancer. More patients present to surgical departments (particularly ENT) than to any other department in the hospital, and about 50 of patients who are injured sustain their injury whilst under the influence of alcohol (Spies & Rommelspacher 1999). If surgical treatment is required, three main problems must be considered 1. The effects of the numerous metabolic and endocrine changes that occur in longstanding alcoholics. 3. The problems of alcohol withdrawal, which can occur at any time between 8 h and 5 days after abstention. In known alcohol abusers, treatment should be given to prevent withdrawal syndrome. It is even better to persuade them to undergo a 1-month period of abstinence before elective surgery, which significantly reduces postoperative complications (Tonnesen et al...

Alcohol Withdrawal

Alcohol dependence is the physical and psychological dependence on alcohol. Any sudden cessation in the consumption in alcohol can lead to physical symptoms of withdrawal. These range from nausea and minor tremor to grand mal seizures (Kumar and Clark 2003). Alcohol dependence has seven essential elements. These are Alcohol withdrawal can be classified as mild, moderate and severe. Mild withdrawal does not require hospital admission.

Alcohol Abuse

Alcohol abuse is characterized by a maladaptive pattern of alcohol use manifested by recurrent and significant adverse consequences related to the repeated use of alcohol (American Psychiatric Association, 1994). Cognitive impairments have also been shown in this population. For example, patients with intermediate-stage alcoholism have been shown to have a V > P profile on the Wechsler instruments. In reviewing the literature, Parsons (1996) notes that sober alcoholic patients are mildly to moderately impaired in memory and learning, abstracting and problem solving, perceptual-spatial abilities, perceptual motor speed, and information processing speed (p. 179). However, these same alcoholics usually have verbal abilities that are in the normal range. Barron and Russell (1992) showed that tasks of fluid ability are more impaired than overlearned tasks or tasks of crystallized ability in alcoholic patients. Therefore, on the WAIS-III, a V-IQ > P-IQ and VCI > POI pattern is...

Alcohol and nonfatal myocardial infarction or incidence of CHD

Table 1.1 Large population studies examining alcohol intake and cardiovascular disease Sample Categories of CHD Size Alcohol Intake Sample Categories of Size Alcohol Intake acute myocardial infarction or CHD than do non-drinkers. However, it is unresolved as to whether there is a dose-response relation between increasing alcohol intake and decreasing incidence and whether there is an increase in risk at the high end of alcohol intake. An inverse relationship between alcohol intake and incidence of CHD was found in the Framingham Heart Study 7 , the Yugoslavia Cardiovascular Disease Study H , the Physicians' Health Study 14 , the Health Professional's Follow-up Study 19 , and in the middle-aged group (51-64 years) of the Honolulu Heart Program 9 , A clear dose-response relationship among drinkers was not found in the British Regional Health Study 26,28 , the Nurses' Health Study 12 , and the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study 23 , The...

Alcohol and CHD mortality

The observed relationship between alcohol intake and CHD death has been reported to be linear (direct or inverse), L-shaped, U-shaped, or showing no relation. In the 5-year follow-up study of 4,532 middle-aged Finnish men 30 , non-drinkers had the lowest CHD mortality. Increased alcohol intake was associated with increased age-adjusted CHD mortality, especially in men with prior CHD. The opposite was reported in the post-trial follow-up of the Multiple Risk Factor Intervention Trial 25 , The original 5-year trial was to determine the effects of multifactor intervention on death from CHD in a population of high-risk men randomly assigned either to a special intervention program or to their usual sources of medical care in the community. The post-trial follow-up was conducted in 11,488 men who did not develop CHD and survived to the end of the trial. A reverse dose-response relationship between alcohol intake and CHD death rate was found 25 , Many studies have found an L-shaped pattern...

Alcohol and sudden cardiac death

Evidence for a strong association between alcohol and sudden death has been reported among problem drinkers 37,38 , Findings among population studies published in the 1980s were, however, inconsistent. A positive association between alcohol consumption and the incidence of sudden coronary death was detected in the cohort of 4,532 Finnish men with or without prior CHD 30 , No association was found in the Puerto Rico Heart Health Program 10 , the Yugoslavia Cardiovascular Disease Study 11 , and the Framingham Heart Study 39 , The numbers of sudden deaths were small in these reports, however. In the Physicians Health Study, men who consumed light-to-moderate amounts of alcohol (2-6 drinks per week) had a significantly reduced risk of sudden cardiac death compared with those who rarely or never consumed alcohol 16 . Only 3 of the physicians drank 2 or more drinks per day. Men in this open-end category had neither an increase nor a reduction in risk. About 11 of men in the British Regional...

Inherent weakness in observational studies

Consistency is often cited as one of the criteria making an observed association more likely to be causal. However, results from studies with the same design can be wrong or artefactual and remain consistent. Most population studies rely on volunteers. This may bias the study samples toward cooperative persons, who are, perhaps, more health conscious than nonparticipants. The heaviest drinkers are not likely to be included in the large cohort studies and this may diminish the role ofheavier drinking in the overall results. Studies on the highly educated and health conscious groups 12-19,29,35 are more likely to miss the up-turn of a J-shaped relationship between alcohol and outcome. The most fundamental weakness in the observational studies is that the preference and quantity of alcohol intake are entirely self-determined by the participants. Hence, all reports on the benefit of small-to-moderate alcohol consumption to cardiovascular disease reduction are referenced to those who are...

Unhealthy abstainers question

A large proportion of abstainers (non-drinkers) are ex-drinkers 46 , Men who were heavier drinkers are more likely to reduce their alcohol consumption as they grow older 46-48 , This is at least in part associated with the accumulating burden of ill-health and medication as people grow older 49 , The British Regional Health Study suggested a strong downward drift from heavy or moderate drinking to occasional drinking or abstinence under the influence of accumulating ill-health not necessarily related to alcohol intake 47 , Ex- and never-drinkers were more frequently unmarried and had the highest prevalence rates of angina, ECG abnormalities, elevated blood pressure, and several other chronic conditions 50,51 , Thus, abstainers may constitute a misleading reference category for the analysis of the relation between alcohol and disease, and for the interpretation of alcohol-related dose-risk relations, leading to underestimates of alcohol-related effects or overestimates of...

What is moderate drinking

While it is generally agreed that we should do all things in moderation 58 , there is less agreement about the precise definition of 'moderate' drinking. Use of different sets of drinking categories in different reports has resulted in different interpretations, and the number and boundaries of categories appears to be determined by the sample size available in the study. Classification of moderate alcohol consumption ranges from a half a drink per day (or less) in some studies, up to six drinks a day in others 59 , Data from the National Health Interview Survey 52 demonstrated that people with different drinking habits perceived 'moderate' drinking differently. Only 25 of men who drink 3 or more drinks per day, in comparison to 56 of other men, considered 2 or fewer drinks per occasion as moderate. Likewise, only 6 of the women who drink at least 2 drinks per day (vs. 27 of other women) perceived moderate drinking as 1 drink or less per occasion. The National Health and Medical...

Some statistical issues

The non-continuous feature of the measures of drinking habit has limited studies on the alcohol-health relationship to categorical analyses. The categories selected, the number of categories, and the distance between the categories were determined by the available data, the sample sizes and number of outcome events. The clear demonstration of a U- or J-shaped relationship requires a much larger amount of data than is generally appreciated. Some studies have combined all cardiovascular diseases or all types of stroke as the endpoint. This is often necessary because of the small numbers of cases for some of the diagnostic endpoints, but might result in partial cancellation of positive and negative associations. Furthermore, as the result of a loss of power in the categorical analysis, many reports drew conclusions based on visual observation on the trends in relative risks by drinking categories and ignored the results of formal statistical tests. Another drawback of the categorical...

Genuine Alcoholic Cardiomyopathy Asymptomatic Type

There is ample evidence that acute or chronic alcohol ingestion may be a myocardial depressant. There is also evidence that acute or chronic alcohol ingestion may be a skeletal muscle depressant. In one study in asymptomatic alcoholics, almost one third of the men and half of the women showed histologic evidence of deltoid muscle myopathy with accompanying muscle weakness and depression of ejection fraction . Low doses of ethanol, even as little as two cocktails, have been shown to be able to decrease myocardial contractility in normal subjects 2-5 , If the subject is alcoholic or already has some cardiac muscle disease on which alcohol is superimposed, the depressant effect of acute alcohol ingestion is exaggerated 6,7 , Partly responsible for the deleterious effects of alcohol in patients who have cardiac disease is the finding that in such patients alcohol acts as a vasoconstrictor 8 , However, when a decreased afterload is necessary for improving the function of a heart in Class...

Smallvessel Occlusion

Small-vessel occlusions, i.e., thrombosis of a single perforating cerebral artery, cause lacunar ischemic strokes. A lacunar infarct usually occurs in the internal capsule or thalamus and presents clinically as a pure motor stroke, pure sensory stroke, sensomotor stroke, dysarthria clumsy hand or ataxic hemiparesis. Patients with typical lacunar infarct syndromes account for approximately 20 of all ischemic strokes, and hypertensive small-vessel disease seems to be the most important etiology 29 , Because heavy drinking of alcohol is a frequent cause of arterial hypertension, it is assumed to associate with small-vessel occlusion as well. However, conflicting observations have also been reported. Some studies have not shown alcohol to be a significant risk factor 29-31 , whereas others have 9,32 , The study ofYou et al. included a rather large series of young adults with lacunar infarcts 33 . This study suggested that long-term heavy alcohol consumption is a risk factor for ischemic...

British Regional Heart Study

In 1978-80, research nurses administered to each man a standard questionnaire which included questions on frequency, quantity and type of alcohol consumption, smoking habits and medical history. Several physical measurements were made, and blood samples (non-fasting) were taken for measurement of biochemical and haematological variables. All men were followed up for all-cause mortality and cardiovascular morbidity 21 Analysis was restricted to men with no recall of a doctor diagnosis of CHD or stroke (N 7272 men) in whom there were 901 major CHD events and 1308 deaths from all causes (595 cardiovascular and 713 non-cardiovascular) during a mean follow-up period ofl6.8 years. The men were classified into five groups according to their estimated reported weekly intake none, occasional (< 1 unit week), light (1-15 units week) moderate (16-42 units week) and heavy (> 42 units day). One UK unit of alcohol (one drink) is defined as half a pint ofbeer, a single measure of spirits, or a...

Largeartery Atherosclerosis

It is generally thought that thromboembolic strokes are mainly caused by atherosclerotic disease. Atherosclerotic disease is less prevalent among populations regularly consuming alcohol than among binge-drinking populations. The high risk of stroke in a population with a high alcohol intake does not seem to be due to large-artery atherosclerosis 24 , but may be caused by other diseases promoting the onset of stroke, i. e., alcoholic cardiomyopathy. On the other hand, the age-adjusted relation between alcohol intake and carotid artery atherosclerosis has been reported to be U-shaped, with light drinkers facing a lower atherosclerosis risk than either abstainers or heavy drinkers 25 , A strong positive relation between alcohol consumption and the risk of mortality from stroke is apparent 26 , In the Scandinavian countries, binge drinking has been observed to associate with both an increased risk for ischemic stroke mortality 27 and the progression of atherosclerosis 28 , It is therefore...

What Have Animal Models Taught Us

Animal models of alcoholism have revealed that long-term alcohol consumption is associated with numerous histological and cellular changes in the myocyte. Specific histological changes include myocyte loss and disarray, interstitial and perivascular fibrosis, deposition of lipids with the myocardial tissue, accumulation of fatty acid ethyl esters within intracellular organelles, and mitochondrial and sarcoplasmic reticulum disorganization 22-27 , In terms of cell function, there are reports of altered mitochondrial and sarcoplasmic reticulum function, decreased myofibrillar ATPase activity and decreased calcium sensitivity of the myofilaments 28-32 , In animal models, these changes often precede changes in cardiac structure and function. These studies have been exclusively performed in male animal models. The only exceptions are the studies reported by Lochner and colleagues and Brown and colleagues 33,34 , Therefore, the effects of both acute and chronic alcohol consumption on the...

Alphatocopherol And Ethanol Consumption

Chronic alcohol consumption produces an increased breakdown oflipid-soluble vitamins such as hepatic alpha-tocopherol, possibly secondary to a marked increase in the formation ofhepatic alpha-tocopherol quinone, a metabolite of alpha-tocopherol formed by free radical reaction 82 , Since chronic ethanol consumption has been associated with compromised antioxidant status and an increase in lipid peroxidation, the significant decrease of vitamin E compared to other lipid-soluble antioxidants may contribute, at least in part, to enhanced hepatic lipid peroxidation seen in alcoholics. Besides vitamin E, other antioxidants such as vitamin C, glutathione and selenium are also strikingly decreased following chronic ethanol ingestion 83 . It is also interesting that chronic alcohol consumption significantly alters the distribution of alpha-tocopherol and gamma-tocopherol not only in hepatic tissue but in extrahepatic tissues as well 84 ,

Histological Features Of Alcohol Induced Cardiomyopathy In Clinical Studies

Been described, though most pertinent to this chapter are the perturbations in myofibrillary architecture (also reviewed in 10 ). At the light microscopic level, in alcoholic cardiomyopathy there are considerable size variations between the myofibrils, with concomitant loss of cross striations, destruction, vacuolization and oedema 15,16 , At the electron microscopic level, degenerative changes are apparent with disruption, fragmentation or loss of the myofibrils, loss of structural arrangement, dissolution and rearrangement of the filamentous structures 11-14 , Although many of the histological features of dilated cardiomyopathy and alcoholic cardiomyopathy are traditionally thought to be indistinguishable 14 , subtle differences have been described 9 , Thus, in dilated cardiomyopathy the degree of myocyte hypertrophy, fibrosis and nuclear alterations is greater than for corresponding measurements in myocytes from alcoholics 9 , The differences between these two disorders may result...

The Coeffect Of Alcohol And Tobacco Smoking

Alcoholics are commonly heavy smokers. There is a synergistic effect of alcohol consumption and smoking on cancer development, with long term ethanol consumption enhancing the mutagenicity of tobacco-derived product 24 , The combined ingestion of ethanol resulted in a significant formation of smoke-related DNA adducts in the esophagus and in their further, dramatic increase in the heart. Thus ethanol consumption increases the bioavailability of DNA binding of smoke components in the upper digestive tract and favors their systemic distribution. Formation ofDNA adducts in the organs examined may be relevant in the pathogenesis oflung and esophageal cancers as well as in the pathogenesis of other types of chronic degenerative diseases, such as chronic obstructive pulmonary diseases and cardiomyopathies 29 , Numerous studies have indicated a correlation between ethanol intake and cigarette smoking in heavy drinkers 30 , On a pharmacological basis, an ethanol-induced potentiation of...

Fatty Acid Ethyl Esters

The majority of ingested alcohol is rapidly absorbed from the small intestine into the bloodstream, and is distributed to tissues that possess high water content and blood flow, e.g., myocardium 5J. Once ethanol has reached myocardium, it has been shown to affect both the sarcolemma (muscle cell membrane) and the sarcoplasmic reticulum (SR). In rat myocytes, chronic alcohol intake creates sarcolemma leaking along with an intracellular calcium increase 23,24 , Several studies also exhibited decreased Ca2+ binding and uptake by the SR 25-29 , Normal function of these components is essential for proper contraction of the heart. Indeed, several investigators have reported depressed cardiac function with acute and chronic exposure to ethanol 26,30-34 , To determine the accumulation of FAEEs in the body, Lange et al. have measured the amount of the ethyl esters in autopsy samples 18 , They have reported FAEE concentrations ranging from 9-115 M in human left ventricles. The autopsy samples...

Ongoing Research In Female Rats

Our laboratory has been studying the effects oflong-term alcohol consumption in both female and male rats. Presented below is preliminary data from our laboratory. The primary aim has been to describe in an animal model (male and female rats) the evolution of alcohol-induced changes in cardiac structure (hypertrophy and dilation) that lead to the development of a cardiomyopathy. The second aim has been to determine if these changes are associated with activation of specific peptide and neurohormonal systems. Preliminary experiments were conducted in male (n 5) and female (n 5) Sprague-Dawley rats which received the Lieber DeCarli liquid diet for 5 months 35 , In brief and as previously described by this laboratory, control (CON) and ethanol (ETOH) groups received The female rats in this study drank a 6.7 vol vol concentration of alcohol as compared to the males, which drank 9 vol vol concentration. Therefore, even though the female group consumed less alcohol (gm day), there were...

Human and nonhuman primate studies

Acute administration of alcohol has no or little effect on apolipoprotein A-I levels. Valimaki et al. examined the time course of 60 g day of alcohol (16 of total calories were derived from alcohol) for 3 weeks in men on total apolipoprotein A-I levels 7 , Apolipoprotein A-I levels did not increase until after 1 week of alcohol consumption. In contrast, in a study using young, healthy men consuming 160 g day of alcohol in three divided doses over three days did not change total apolipoprotein A-I levels or total HDL cholesterol. However, there were pronounced changes in the HDL subfractions. The apolipoprotein A-I content ofHDL2 increased which was mitigated by the decrease in apolipoprotein A-I content of HDL3 8 , The lipid composition of both subfractions was characterized by a relative increase in phospholipids but decrease in cholesterol. These changes in HDL composition likely have important effects on HDL function, since the conformation of apolipoprotein A-I on the surface of...

Cervical Arterial Dissection

Cervical arterial dissection is probably one of the most common causes of ischemic stroke in young subjects. It is diagnosed by imaging with conventional or MR angiography and typically occurs after major trauma, but may also occur spontaneously or after trivial injury. Needless to say, alcoholic intoxication is a major risk factor for all types of trauma. Therefore, it is not surprising that cervical arterial dissections have also been described to have occurred in connection with alcohol abuse 22,37 , Some reports have emphasized that extracranial vessel compression due to unusual posturing during alcoholic stupor or coma could also result in a brain infarct 38-40 , but it has remained unclear whether cervical arterial dissection is the underlying mechanism or not. In at least one of the reported cases dissection was excluded 40 , Surprisingly, case-control studies have not yet been able to prove alcohol as a risk factor for ischemic stroke caused by cervical arterial dissection 13...

Cardiovascular Function

Prostaglandins such as prostacyclin (PGI2) and thromboxane (TXA2) are involved in cardiovascular homeostasis (Figure 16.3) and may play a role in the pathophysiology associated with alcohol consumption 104,105 , Alcohol abuse may lead to an increased incidence of hypertension, angina, myocardial infarct and stroke 106-108 , Conversely, moderate consumption of alcohol may produce qualitatively different effects in the cardiovascular system than does high consumption. Postmortem and epidemiologic data suggest that moderate consumption of alcohol protects against atherosclerosis-related cardiovascular disease 109-111 , Animal data that is consistent with these observations have demonstrated that moderate alcohol inhibited cholesterol- and saturated fatty acid-induced atherosclerosis in rabbits 112,113 , Data obtained from both humans and animals have demonstrated systemic administration of alcohol may induce vasoconstriction or biphasic effects on peripheral blood flow 126-129 ,...

Dual activity of synthasecarboxylesterase

The important roles that have been established for the carboxylesterase enzyme family have prompted a look into its gene structure. Identification of the respective genes of the carboxylesterase enzyme family will offer insight into the structural and functional tenets of its many enzymes as well as making it feasible to establish a genetic link between alcohol abuse and alcohol-induced heart muscle disease.

Specific Effects Of Ethanol Consumption On Platelets

While these observations suggest that an anti-platelet effect of ethanol could contribute to the reduced risk of CHD-related mortality in drinkers, it must be emphasized that any contribution of a platelet action of ethanol must be viewed in the context of other actions of ethanol and alcoholic beverage components. Furthermore, the duration of the antiplatelet effect is not known, nor are the effects of chronic vs. acute alcohol consumption or pattern of consumption (regular consumption vs. binge drinking). Nonetheless, this is the first clear demonstration of dose-dependent, inhibitory effects of acute, moderate alcohol consumption on platelet function.

Effects Of Light Drinking

Several studies have shown regular light (10-20 g of ethanol daily) or moderate (less than 300 g of ethanol per week) drinking to associate with a decreased risk for ischemic stroke of atherothrombotic origin 43-45 , but the observations on the effects of light and moderate alcohol consumption on stroke mortality have been conflicting 27,46,47 , For example, one study showed light-to-moderate drinking to be associated with a 36 reduction in deaths from ischemic heart disease, but had no effect on death from stroke 47 , A recent study 48 reported that light-to-moderate alcohol consumption reduces the overall risk of stroke and the risk of ischemic stroke in men. The benefit was apparent with as little as one drink per week. More abundant consumption, up to one drink per day, did not increase the observed benefit. Several possible mechanisms have been proposed to explain the beneficial effect oflight-to-moderate alcohol consumption 49 , However, almost all of the proposed mechanisms are...

Epidemiological Studies

Recently, the South Bay Heart Watch (Torrance, CA) reported a study ofl,196 asymptomatic subjects with coronary risk factors who were assessed for alcohol consumption history and for the presence of calcium deposits in coronary atherosclerotic lesions as measured by electron beam computed tomography (EBCT). Participants were followed prospectively for 41 months for coronary events, defined as the occurrence of myocardial infarction or CHD death 6 , Subjects who drank alcohol had a relative risk of 0.3 ofhaving a coronary event compared with abstainers. The diminished risk of myocardial infarction or CHD death associated with moderate alcohol consumption was independent of serum HDL cholesterol levels, EBCT coronary calcium scores, and all other coronary risk factors. Abstention from alcohol in this study was as strong a predictor of coronary events as diabetes, smoking, hypertension, and coronary calcification 6 , Also reported recently was an analysis of the relationship between...

Apolipoproteins CII and CIII

Apolipoproteins C-II and C-III both play a major role in VLDL metabolism. Apolipoprotein C-II and C-III stimulate and inhibit, respectively, lipoprotein lipase, the enzyme responsible for hydrolyzing the triglycerides in VLDL. In one study comparing apolipoprotein E levels among low (< 20 g alcohol day), moderate (20-50 g day), heavy (> 50 g day) and alcoholic (> 100 g day) drinkers showed a significant increase in serum apolipoprotein C-III levels with increasing alcohol consumption 43 , Incubating human hepatoma cells with alcohol with concentrations up to 50 mM had no effect on apolipoprotein C-II or apolipoprotein C-III secretion 43 ,

Alcohol And The Heart

Ethanol has important effects on the cardiovascular system and particularly on anti-oxidant systems (reviewed in 75,158 ). Although the relative incidence of alcohol consumption reduces the overall risk of cardiovascular disease by a number of mechanisms (for example, increasing HDL LDL ratio, reducing platelet function and aggregation 140,159 ) excessive alcohol is damaging and can lead to the development of alcoholic cardiomyopathy 160-163 , Paradoxically, moderate alcohol consumption has been advocated to reduce the incidence of coronary artery disease, albeit within the confines of a multifactorial approach 147 , For example, an interaction between alcohol consumption and vitamin C has been proposed to account for the reduced incidence of angina in alcohol consumers 164 , The situation regarding ATC status in alcohol studies is confusing with some reports showing higher plasma ATC in average drinkers 165 whilst others have shown reduced levels in heavy drinkers 166,167 , Apart...

Gastrointestinal Tract Including Carcinogenesis

Chronic alcohol consumption is associated with an increased risk of cancer in the upper alimentary tract and the colorectum 109 , It might be possible that the production ofROS is involved in alcohol-associated carcinogenesis since chronic alcohol consumption leads to an induction of cytochrome P450 in the oral mucosa in the esophagus and in the colon of rodents 110,111 , Such an induction can also be demonstrated in the human oral mucosa 112 . In addition, the presence of xanthine oxidase has been located in the epithelial cells of the mouse and of the esophagus 113 . In an experiment by Eskelsson and co-workers, it has been shown that the number of esophageal tumors induced by nitrosamines and stimulated by chronic alcohol administration can be significantly reduced by the concomitant application of vitamin E 114 . Furthermore, this reduction is associated with a reduction in lipid peroxidation products in the esophagus. This is indirect evidence for the involvement ofROS in alcohol...

Ethanol And Other Aspects Of Hemostasis

Because a variety ofhemostatic factors beyond those associated with platelets also contribute to the complications associated with coronary heart disease, it is important to consider the above information on platelets in the context of some of these other observations. One of the strongest risk factors for myocardial infarction is elevated plasma fibrinogen level 41 . The association of fibrinogen and alcohol consumption was evaluated by Mennen and colleagues 42 , Alcohol consumption was associated with plasma fibrinogen levels in a U-shaped fashion for men only, with fibrinogen being the lowest in those subjects who drank 20-59 grams of alcohol per day. Fibrinogen levels were greater for nondrinkers and those who consumed over 60 grams of alcohol per day. The type of alcohol consumed also apparently played a role, with a lower level of fibrinogen in those who drank wine and spirits as opposed to those who drank beer and cider (in which no association was found).

Effect Of Ethanol On Prostacyclin

The effects of ethanol on PGI2, another endothelium-derived vasodilator and potent inhibitor of platelet aggregation, have also been investigated. Ethanol increased PGI2 production in cultured human umbilical vein endothelial cells and elevated plasma levels ofPGI2 in volunteers administered ethanol 29 , Guivernau et al. found that while ethanol did not affect vascular PGI2 release in control rats, in aortas from alcohol-fed animals ethanol stimulated PGI2 production 30 , These data imply that this response to ethanol may be altered by chronic alcohol consumption. In any case, ethanol's modulatory effect on endothelial PGI2 production could

Alcohol And The Immune System

Alterations of the immune system due to alcohol consumption have been a focus of multiple studies that have revealed impaired delayed-type hypersensitivity responses and ameliorated host defense against infections. Acute alcohol use has been associated with increased susceptibility to infections, posttrauma immunosuppression, and a decrease in antigen-specific T-cell proliferation response 13,16 , Malnutrition and cirrhosis are two of the conditions that develop with chronic ethanol consumption that affect the efficiency of the immune system to combat infections 11,12 , Ethanol influences the function of lymphocytes, monocytes and polymorphonuclear cells 13-15 ,

Lipids And Cardiovascular Disease

Higher levels of cholesterol, LDL-cholesterol and lipoprotein(a) and lower HDL-cholesterol 136 , However, total plasma ATC was comparable in all three groups (control, stable angina and unstable angina), except when expressed per LDL particle, whereupon it was lower in patents with unstable angina pectoris. Values in patents with stable angina pectoris were higher than the latter, but lower than controls 136 , Thus, it seems that the type of cardiovascular disorder needs to be defined and careful attention needs to be paid as to how ATC levels are expressed. Internal factors relevant to the determination of ATC status include triglycerides and apoproteins 10 , However, geographical and cultural dietary habits further compound the relationship between ATC and the etiology ofheart disease. Whole grain intake and nuts correlate negatively with coronary heart disease, which is not explained by the contribution of ATC (nor fiber, folate, vitamin B6) 137,138 , Another example pertains to...

Histological Features In The Rat Model

Similar histochemical changes to those seen clinically above can be reproduced in animal models, including myofibrillary lysis, separation and disintegration, with scattered foci of lesions (fibrosis) and loss of parallel array 17-19 , The severity of these lesions worsen with increasing alcohol intake 20 , Overall, there are clear indications that the contractile apparatus is perturbed via experimental alcohol feeding. In the chronic alcoholic feeding model (using the Lieber-DeCarli feeding regimen), left ventricle weights are increased at 411 months, though no changes are seen at 2 months 21 , These changes are accompanied by functional defects, such as reduced cardiac output 21 , The model employing 6 weeks alcohol feeding in a pair-feeding regimen represents a transient phase in the development of the cardiomyopathy, and hence provides a suitable means of studying the pathogenesis of the disease process. The concepts of pair-feeding in chronic alcohol dosing studies have been...

The Role Of Lifestyle

Lower risk of all cause and cardiovascular mortality seen in wine drinkers in this and other studies is a consequence of the multiple healthier lifestyle characteristics and higher socio-economic status in wine drinkers resulting in lower fatality, rather than the result of a specific benefit of wine. HDL-cholesterol cannot explain the lower absolute risk of wine drinking compared to other types of alcohol drinkers as the dose-response relationship between alcohol intake and HDL-cholesterol was similar in male beer, spirit and wine drinkers 27 and wine drinkers showed identical levels of HDL-cholesterol to non-wine drinkers (Table 3.2).

Concommitant Cocaine And Ethanol Consumption

20-32 years of age) of varied socioeconomic status in 1987, and then to evaluate the relationship between lifetime cocaine use in 1987 and cardiovascular disease risk factors 5 years later. The longitudinal design, the cardiovascular focus of CARDIA, and the inclusion of essentially healthy individuals at baseline, provided a unique opportunity to assess the cardiotoxicity of chronic cocaine use. Results of the CARDIA study indicate that lifetime cocaine use experience in 1987, after adjustment for age, ethnicity, daily alcohol intake, cigarettes smoked per day, body mass index, sum of skinfolds, physical activity, and other illicit drug use, was not related to blood pressure, blood pressure difference, heart rate, or hypertension prevalence in cross-sectional analysis in either men or women. Regarding the long-term, multivariate relationships between lifetime cocaine use experience in 1987 and blood pressure, blood pressure difference, and heart rate in 1992, the data from CARDIA...

Alcoholic versus viral or idiopathic chronic dilated cardiomyopathy DCM

The pathology of the heart in alcoholic patients with chronic DCM is somewhat different from non-alcoholics with chronic DCM. The alcoholics tend to have more myocardial hypertrophy, interstitial fibrosis, and electrical irritability 26,27 , Although gross microscopic examination has not been able to distinguish chronic idiopathic DCM from the chronic DCM found in alcoholics 28 , electron microscopy has shown that patients who have also been chronic alcoholics have swelling of the sarcoplasmic reticulum which is more severe and generalized rather than focal 29,30 , However, these differences from the DCM in non-alcoholics do not mean that the severe cardiomyopathy was caused by the alcohol but may only mean that the alcohol, in addition to the other causes of idiopathic DCM, can cause characteristic pathologic changes. Likewise, even though it is true that patients with chronic DCM due to alcohol have less muscle strength and more histologic findings of skeletal myopathy than patients...

Cardioprotective Effect Of Moderate Wine Drinking

What is the mechanism of alcohol cardioprotection The beneficial effects of moderate drinking have been addressed on factors involved in atherogenesis 17 , First of all, alcohol increases plasma HDL level and activity oflipoprotein lipase, which showed an inverse relationship with the risk of CAD. Secondly, in animal models, ethanol reduced atherogenic plaques by influencing the inflammatory process of endothelial lesions. Alcohol interferes with the expression of vascular adhesion molecules such as VCAM-1 and ICAM-1 by inhibiting the transcription factor NF-kB 18 , Additionally, inhibition of the enzyme HMG-CoA reductase, a key enzyme in the synthesis of cholesterol, results in the reduction of plasma cholesterol. Furthermore alcohol has antithrombotic effects which could contribute to its cardioprotective effects. Possible factors responsible for the effects of moderate alcohol consumption on clotting include an increase in the prostacyclin thromboxane ratio, decreased platelet...

Drinking patterns and beverage types

Drinking patterns have been studied surprisingly little. Yet, drinking patterns vary and are of obvious health relevance. The frequency of drunkenness, the frequency ofhangover and morning drinking have been found to be related to mortality from several causes 54 , Changes in drinking between years may influence mortality 9,55 . Most reports classify participants using a total consumption variable (e.g., drinks per day) based on estimates of customary drinking frequency and amount of alcohol consumed on a typical occasion. This does not quantify variability in drinking frequency or amount consumed binge drinkers may be classified with controlled, regular drinkers on the basis of their common average daily alcohol intake. Because the health effects of moderate drinking may depend on drinking pattern, failure to differentiate between binge drinkers and regular drinkers may obscure real associations. Type ofbeverage may have a role even if the amount of ethyl alcohol imbibed is the same....

The Effect Modification Of Alcohol By Smoking

There are only two epidemiologic studies on the effect modification of alcohol by smoking and neither of them examines it in relation to the risk of stroke. In a Japanese cohort of 19,231 men, alcohol consumption and all-cause mortality had a J-shaped association in nonsmokers but not in smokers 78 , In a cross-sectional study of 5,312 German men and women, the rise in blood pressure associated with drinking was higher in smokers than in nonsmokers 79 , Some studies have instead examined the effect modification of smoking by alcohol. In a cohort of 22,071 US male physicians, alcohol attenuated the linear effect of smoking on the risk of total stroke 38 , In a Japanese cohort of 1,775 men, a dose-dependent decrease in diastolic blood pressure and serum HDL cholesterol by increasing cigarette smoking was evident in nondrinkers but not in drinkers The effects of both alcohol and tobacco are manifold, which makes them complicated to examine and understand. The effects may be additive or...

Cardiogenic Brain Embolism

Stroke admission rates have been observed to be high among heavy drinkers 10 , Some studies also suggest that alcohol abuse may associate with ischemic stroke recurrence 11,12 . A study on recent alcohol intake showed that heavy drinking is an independent risk factor for most subtypes of ischemic stroke and particularly a risk factor for cardiogenic brain embolism 13 . Table 7.1 Previously published and new case histories illustrating several different mechanisms that could link alcohol abuse to an increased risk of ischemic brain infarct Table 7.1 Previously published and new case histories illustrating several different mechanisms that could link alcohol abuse to an increased risk of ischemic brain infarct The association between alcohol abuse with cardiogenic brain embolism suggests several mechanisms via which heavy drinking could precipitate brain infarct. First, there is the possibility of alcoholic heart muscle disease. Excessive chronic alcohol consumption leads to dilated...

The Editors

Watson, Ph.D., initiated the Specialized Alcohol Research Center at the University of Arizona College ofMedicine and had directed the center for 6 years. Dr. Watson has edited 50 books, including lOon alcohol abuse and 4 on other drugs of abuse. He has worked for several years on research for the U.S. Navy Alcohol and Substance Abuse Program. Dr. Watson attended the University of Idaho but graduated from Brigham Young University in Provo, Utah with a degree in chemistry in 1966. He completed his Ph.D. degree inl971 in biochemistry at Michigan State University. His postdoctoral schooling in nutrition and microbiology was completed at the Harvard School of Public Health and included a 2-year postdoctoral research experience in immunology. He was an assistant professor of immunology and did research at the University ofMississippi Medical Center in Jackson from 1973 to 1974. He was an assistant professor of microbiology and immunology at the Indiana University Medical School...

Alcohol and stroke

Alcohol was recognized as a possible risk factor for stroke as early as the 17th century 41 , Results gathered from large prospective studies were not available until the late 1970s to early 1980s and the epidemiological evidence has been highly inconsistent. Variations in the reported alcohol-stroke relationship are much greater than for the alcohol-CHD relationship. Increasing alcohol consumption was related to an increased incidence of all strokes (fatal and non-fatal) in men from the Honolulu Heart Program 8 , in the Swedish conscripted men 33 , and in the male smokers in the Finnish Cancer Prevention Study 31 . Alcohol intake was also associated with an increased total stroke mortality in men from the Yugoslavia Cardiovascular Disease Study 42 and the Japanese male physicians 35 , On the other hand, some studies 17,21 have reported an L-shaped alcohol-stroke relationship. The Cancer Prevention Study II 21 found that men who consumed alcohol less than daily through 4 or more...

Other confounders

The difficulty of controlling completely for correlates of alcohol use and of cardiovascular disease is obvious. For example, alcohol use is related to age, sex, race ethnic background, geographical location, smoking, coffee use, educational attainment socioeconomic status, marital status, adiposity, salt use and other dietary habits, religious affiliation, social network, stress, psychological well-being, and physical activity. People who drink (excluding heavy drinkers) had a better self-perceived health status than did non-drinkers 52 , The differences in self-perceived health status accounted for one-fourth to one-third of the lower risk of


In March 1996, a 26-year-old healthy nonsmoking man who was an infrequent weekend drinker woke up at 8 a.m., and three hours later, whilejogging, suddenly developed a right visual field defect. He had been drinking alcohol during the preceding evening (alcohol intake amounted tol50g of ethanol), and had experienced distinct signs and symptoms ofhangover and vomited that morning. An arch angiogram was normal, but TEE showed a moderate-to-large patent foramen ovale, but not spontaneous right-to-left shunt. Venography was not performed, but a hematologic examination revealed resistance to protein C (APC resistance, heterozygous for the prothrombin gene). The latter case suggests that paradoxical embolism could have been transported via a patent foramen ovale during a Valsalva manouver precipitated by vomiting, a common consequence of intoxication and hangover. Thrombocytosis and associated platelet hyperactivity have been considered as contributing factors for alcohol-induced ischemic...


When alcohol is fed to experimental animals, a transient alpha receptor blocking activity has been observed. A single dose of alcohol or chronic use decreased the sensitivity of adrenergic receptors 31 . In chronic alcoholism however, elevated norepinephrine levels and Beta-receptor antagonist drugs have been found to be useful in a wide variety of clinical conditions and are firmly established in the treatment ofhypertension, ischemic heart disease, arrhythmias, endocrinologic and neurologic disorders. Short-term studies in normal subjects indicate that ethanol increases both the elimination rate and bioavailability of propranolol 35 , The plasma clearance rate of propranolol, which is metabolized by the liver, is increased and the blood pressure-reducing effect of the drug is diminished. Ethanol and beta blockade individually affect heart rate and arterial pressure in the opposite direction. The combination of ethanol and propranolol will produce effects that are dose dependent, but...

Cryptogenic Stroke

Finally, ischemic brain infarcts of unknown origin (cryptogenic stroke) have also been described in connection with heavy drinking of alcohol 41,42 , Alcohol also has complex effects on cerebral blood flow and autoregulation. Whether or not these mechanisms play a significant role is unclear. Thus far, we have not found an alcoholic binge to result in marked hypotension and watershed infarcts. We believe that many of the cryptogenic ischemic brain infarcts are due to emboli of unknown origin.

Human studies

Little information is available about the effects of alcohol consumption on apolipoprotein E metabolism in humans. In one study, comparing apolipoprotein E levels among low (< 20 g alcohol day), moderate (20-50 g day), heavy (> 50 g day) and alcoholic (> 100 g day) drinkers showed no difference in serum apolipoprotein E levels between groups 43 , Conversely, other studies have shown that alcohol intake is associated with increases or decreases in apolipoprotein E 11,44 , Interestingly, there may be a gender difference in the alcohol effect on apolipoprotein E in that male alcoholics have a higher level of apolipoprotein E levels compared to controls whereas this difference does not exist between female alcoholics and controls 11 . In examining the distribution of apolipoprotein E between VLDL and HDL, Lin et al. found that alcoholics have a lower level of VLDL apolipoprotein E and higher level of HDL apolipoprotein E than controls 11 .

Skeletal Muscle

Alcoholic myopathy is arguably the most prevalent skeletal muscle disease in the Western Hemisphere, occurring in between 30-60 of all chronic alcohol misusers (see reviews in 213-215 ), In a UK study, serum levels of ATC were shown lower in alcoholics with skeletal muscle myopathy compared to those alcoholics or non-alcoholic subjects without myopathy 166 , However, this has not been reproduced in Spanish alcoholics, which may reflect geographical or other differences between the patient population and or nutritional intake 216 ,

Apolipoprotein B

VLDL secretion from liver is regulated by a number of factors including the availability of lipid for packaging and the production of apolipoprotein B. If excess apolipoprotein B is produced, it is degraded. Microsomal triglyceride transfer protein (MTP) assembles VLDL within the endoplasmic reticulum. MTP appears to regulate the number of apolipoprotein B-containing lipoproteins secreted and not the lipid composition. Epidemiological studies in humans have shown that the effect of alcohol consumption on total serum apolipoprotein B is varied. This discordance may reflect the fact that total serum apolipoprotein B does not differentiate between apolipoprotein B-containing lipoproteins, i.e., VLDL-apolipoprotein B may increase while LDL-apolipoprotein B decreases. In addition, dietary and genetic factors may influence the response to alcohol. Like apolipoprotein A-I, the alcohol effect on total serum apolipoprotein B may be dose dependent. In squirrel monkeys, total serum...

Vitamin E

Excessive alcohol consumption is a major health problem in the United States. Prolonged consumption of alcohol results in alterations of immune responses, ultimately manifested by increasing susceptibility to infectious agents. Vitamin E supplementation has been associated with enhancement of immune response and improvement of host defense, and may provide a useful therapeutic approach for treatment of alcoholics to improve host defense 34-38 ,


Both cigarette smoking and alcohol drinking are involved in lipid metabolism and proinflammatory response. They are also related to unhealthy eating patterns. Alcohol abuse can promote the formation of smoke-related DNA adducts distributed in organs including the heart, which may be responsible for cardiomyopathies. Furthermore, ethanol intake has a correlation with nicotine addictive.

Cytochrome P450 2E1

Alcohol consumption results in an induction of cytochrome P450 2E1 associated with enhanced activity of Acute alcohol exposure increases superoxide production in the respiratory chain of mitochondria, which may be responsible for the damage to this subcellular organelle during alcohol consumption 27 , When hepatic mitochondria from chronically ethanol fed rats are incubated with NADH or NADPH in vitro, an increased production ofROS is observed 27 , It is noteworthy that ethanol stimulates the activity of rotenone-insensitive NADH cytochrome C-reductase, an enzyme of the outer mitochondrial membrane 28 ,


Most of the data available with respect to the production ofROS following ethanol administration have been obtained from studies in hepatic tissue. However, since many of the enzymes responsible for ethanol metabolism are also present in extrahepatic tissues such as the gastrointestinal mucosa, ROS can also be produced in these tissues. In the liver, alcohol consumption increases the amount of reactive oxygen species by several mechanisms

Exposure To Ethanol

Because no clinical trials actually test prospectively the relationship between alcohol consumption and coronary heart disease, efforts to identify the mediators of ethanol-induced cardiac protection in humans focus on statistical modeling of observational data. These analyses have identified increased HDL cholesterol levels 8,9 , decreased platelet aggregation 10 , and increased expression of tissue-type plasminogen activator 11 as potential mechanisms underlying ethanol-induced cardiac protection. Moderate ethanol exposure may also protect against CHD through direct effects on heart muscle. For example, Auffermann et al. reported that ethanol significantly reduces the functional and structural damage caused by one component of ischemia-reperfusion injury, the pathological influx of Ca2+ into myocardial cells termed the calcium paradox injury 12 . Using isolated Langendorff-perfused rat hearts, these investigators found that addition of 2.5 (vol vol) ethanol to the perfusate...


Because activation of epsilon protein kinase Cisa critical event in several important forms of cardiac preconditioning, interest in the field is now focused on uncovering the downstream mediators of protection. Exhaustive examination of ischemic preconditioning in a conscious rabbit model by Ping et al. has identified p44 p42 mitogen-activated protein kinases 33 , p46 p54 c-Jun NH2-terminal kinases 34 , and Src and Lck tyrosine kinases 35 as downstream elements of ePKC-mediated signal transduction. Studies to determine the precise mechanisms linking ePKC to these signaling molecules, the requirement for their activation in other forms of preconditioning, and their own downstream cellular targets, are ongoing. Our laboratory has cloned the anchoring protein or RACK (receptor for activated c- inase) for activated ePKC, that was identified as the COPI coatomer protein yft-COP 36 , The ePKC inhibitor peptide, eVl-2 19 , acts by competing for binding of activated ePKC to y0'-COP 36 and...


As discussed elsewhere in this volume, quite a few epidemiological studies have examined the association between morbidity and mortality from CHD and moderate alcoholic beverage consumption, and an inverse association has been established in studies involving nearly a million subjects 29 , One example of such reports is a study of American Cancer Society volunteers, which showed that the rate of death from all cardiovascular diseases was 30-40 lower among men and women who consumed at least one alcoholic drink daily than among nondrinkers. While it should be emphasized that alcohol consumption is associated with higher death rates from injuries, violence, suicide, cirrhosis, certain cancers and hemorrhagic stroke 30 , the incidence of death from heart disease is much greater compared to these other causes, making any role of platelets potentially important. Cross-cultural studies have shed light onto the French paradox involving the Mediterranean diet. A Mediterranean diet typically...


Two thirds of Americans report using alcohol and since social drinking is a potentially modifiable behavior, the relation between alcohol consumption and cardiovascular disease is a subject of considerable importance. Although the literature is not unanimous, evidence from large epidemiologic studies leads to the conclusion that moderate alcohol intake decreases risk of non-fatal and fatal CHD and ischemic stroke. The observed differences in the shape of the relationship between various studies might be partly explained by varying distributions of other risk factors and partly by the variation of alcohol intake in the study populations. If heavy drinking was infrequent in a study sample, an L-shaped relationship would be observed instead of a J-shape. If only abstainers and light drinkers were studied, an inverse linear association should appear. If the study sample did not include abstainers, a positive linear trend could emerge. A randomized, controlled clinical trial is the gold...


Studies on interactions between alcohol and tobacco are most challenging, not only because of the complexity of the effects of either factor, but also because of many inherent methodological problems. Epidemiologic studies on alcohol and tobacco are prone to imprecision in measurements and various biases, their interactions thus being even harder to evaluate in a reliable and valid manner. Alcohol consumption and smoking are usually self-reported and the measurement of either habit is susceptible to both recall and response bias. The reporting of alcohol use especially tends to be differential, heavy drinkers more likely reporting themselves as moderate-to-light drinkers than nondrinkers 24 , Differential misclassification is likely to lead to biased estimates of relative risks, and the amount and direction of such bias is hard to evaluate. Furthermore, the classification of alcohol intake and cigarette smoking, and the selection of respective reference categories (e. g., current...

Development Of Ahmd

Female alcoholics develop a multitude of symptoms more rapidly than male alcoholics during the first few years of drinking, a phenomenon which is refered to as 'telescoping' 41,42 , Lewis et al. examined the effect of other co-morbidities on the rapid accrual of symptoms in women and found that this rapid accrual was independent of the number of co-morbidities 41 , Others have found that women are at greater risk for the development of alcoholic liver disease and brain damage 43-45 , These data, along with the data reviewed in this chapter, suggest that women are more vulnerable to the medical consequences of alcohol. Putative gender-related effects may be due to sex-related differences in alcohol pharmacokinetics which allow women to achieve higher blood alcohol levels (BAL) compared to men, after consuming an equivalent amount of alcohol. Some reports suggested that higher BALs in nonalcoholic women were attributable in part to a difference in the first-pass metabolism of alcohol...

Assessing Alcohol and Substance Abuse in the Elderly

In the late 1960s Cahalan and his associates developed a survey assessment instrument for alcohol consumption and problems. It assessed alcohol consumption using three different scales (1) the usual number of drinks of beer, wine, and distilled spirits consumed nowadays, as reported in drinks per day, week, month, or year (2) the number of drinks of beer, wine and distilled spirits consumed the day before completing the questionnaire and (3) the regularity of alcohol consumption on specific days of the week. For example, a respondent may indicate that, in a typical week, he or she drinks one glass of wine during the evenings and two drinks each on Friday and Saturday night. Thus, this individual, on average, drinks nine drinks a week, which then usually is translated into drinks per year. Independently of consumption, respondents indicate the frequency (e.g., never, once per week, month, or year) of experiencing alcohol problems. These items assess the frequency with which alcohol...

Auguste Ds case history

Auguste D. was admitted to the clinic in Frankfurt on November 25, 1901. The case history in the file reads as follows D., Auguste, wife of an office clerk, aged 51-and-a-half years. The patient's mother suffered convulsive attacks after menopause it seems that she did not lose consciousness and did not drop objects that she was holding in her hands. Her mother died at the age of 64 of pneumonia her father died at the age of 45. Three healthy brothers. No alcoholism or mental illness in the family history.

Psychological Counseling

Psychological (counseling) approaches remain the mainstay of therapy for alcoholism. Over the years, many different approaches, including social skills training, motivational enhancement, cognitive therapy, aversion therapy, and behavioral contracting, have been used in treating alcoholism. Most approaches are more effective than no treatment, but none has been universally effective in producing long term or even short remissions. Because there are different manifestations and personality types in alcoholism, many providers within the treatment community believe that specific counseling approaches might work only within a given personality type. However, a large multicenter evaluation of matching treatment approaches to personality type in alcoholics failed to demonstrate that this approach was superior to the use of any one approach to treatment. This observation suggests that engaging in therapy for alcoholism may be as important as the type of treatment program. Many alcoholics...

If my clinician does not discuss screeningfor osteoporosis at what age should I make sure that I am screened

You and your clinician should discuss your bone health during every annual exam, regardless of your age. Your calcium and Vitamin D intake, your level of physical activity, and your lifestyle factors such as smoking and drinking alcohol can affect bone health at any age.

Supplemental Reading

Beresford TP, Blow FC, Hill E, et al. Comparison of CAGE questionnaire and computer-assisted laboratory profiles in screening for covert alcoholism. Lancet 1990 336 482-5. Buchsbaum DG, Buchanan RG, Centor RM, et al. Screening for alcohol abuse using CAGE scores and likelihood ratios. Ann Intern Med 1991 115 774-7. Cornelius JR, Salloum IM, Ehler JG, et al. Fluoxetine in depressed alcoholics a double-blind, placebo-controlled trial. Arch Gen Psychiatry 1997 54 700-5. Geerlings PJ, Ansoms C, van den Brink W. Acamprosate and prevention of relapse in alcoholics results of a randomized, placebo-controlled, double-blind study in out-patient alcoholics in the Netherlands, Belgium and Luxembourg. Eur Addict Res 1997 3 129-37. Hasin D. Classification of alcohol use disorders. Alcohol Research and Health 2003 Vol. 27. Mayfield DG, McLeod G, Hall P. The CAGE questionnaire validation of a new alcoholism screening instrument. Am J Psychiatry 1974 131 1121-3. O'Malley SS, Croop RS, Wroblewski JM....

Assessment of Severity

Assessment of the severity of withdrawal is an important aspect of treatment. Most units that treat alcohol withdrawal assess symptoms in a semiquantitative manner. This approach avoids under or overtreatment of patients. This author prefers the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-r) scale. The scale employs semiquantitative estimation of 9 symptoms using a score of 1 to 7. The higher the score the greater the severity of the withdrawal. Disorientation is scored on a 1 to 4 scale (Table 37-3). Individuals with scores > 10 usually require pharmacotherapy. Benzodiazepines have been the primary category of drugs used in treating alcohol withdrawal for many years. They are safe and effective, but require monitoring of therapy to avoid unwanted effects such as oversedation. All drugs in this category are effective in both treating and preventing seizures. In recent years, short acting drugs such as lorazepam (Ativan) have been used more frequently. This...

Predictors of Failure to Control Acute Variceal Bleeding

A reliable model that could predict the failure of hemosta-sis after an acute bleeding episode will be very useful for risk stratification, management, and research purposes. Many studies have been done, but small sample size, retrospective nature of the study, the heterogeneity of offered therapy and different patient characteristics make it difficult to draw any definite conclusions. However, active bleeding at the time of endoscopy has been shown to independently predict failure to control bleeding as well as early (30 day) mortality in many studies. Other factors include higher HVWPG, encephalopathy, low platelet counts, history of alcoholism, shorter interval to admission, and bacterial infections.

Brief Interventions in Nondependent Hazardous Drinkers

Over the last decade, a large number of studies have examined the role of brief interventions to reduce alcohol consumption in those who are drinking amounts above the safe limits of consumption. Those who drink at hazardous levels are at higher risk for the future development of alcohol-related problems. The goal of brief interventions is to return alcohol consumption to more normative and safe levels and to identify situations in which individuals lose control of drinking. The National Institute of Alcoholism and Alcohol Abuse has recommended that health care providers follow these three basic steps during a brief intervention Brief interventions have been demonstrated in primary and emergency care settings, as well as in college students, to reduce consumption and or harmful consequences significantly in heavy drinkers. Despite the demonstrated effectiveness of this approach, there is still not widespread use in most practices today. It is important to recognize that there is not...

Oscar Joe HinesMD and Howard A ReberMD

Chronic pancreatitis is characterized by chronic inflammation with fibrosis and obliteration of both the endocrine and exocrine components of the gland. These changes are irreversible, progressive, and may culminate in clinically significant pancreatic insufficiency and diabetes. Although chronic alcoholism is the usual etiology, some patients develop the disease because of chronic ductal obstruction, some because of genetic predisposition, and a substantial number for reasons as yet unknown. Regardless of the cause, the most common symptom of the disease is chronic abdominal pain, and pain relief is the most frequent reason for surgical intervention. Other reasons include various intra-abdominal complications of pancreatitis (eg, bile duct or duodenal obstruction, pseudocyst), and the concern that pancreatic cancer may be present. We will describe the surgical considerations related to each.

Therapeutic Possibilities

Antisense oligodeoxynucleotides (AS-ODNs) are potential neuropharma-ceuticals that would be useful for the treatment of CNS diseases, such as Huntington's disease, Alzheimer's disease, and alcoholism, in which overproduction or underproduction of endogenous protein causes disease. Either the protein's mRNA can be directly inhibited or antisense can be directed at the protein's receptor, synthetic enzymes, catabolic enzymes, or brain efflux systems. Antisense directed at the last two categories would allow for the treatment of conditions in which protein levels are low, not high. AS-ODNs are advantageous for therapeutic use because they can be easily synthesized with equipment found in most laboratories. However, AS-ODNs are large, highly polar molecules that are readily digested in blood and tissues by nucleases the body's defense against stray DNA. Two general approaches have been developed to overcome these issues (1) enzymatically resistant analogs have been produced to overcome...

IQ Discrepancies A Clinical Approach

This is the second of two chapters on V-P IQ discrepancies. Chapter 8 explored Verbal-Performance IQ discrepancies as related to brain damage. The patterns obtained by patients with left versus right lesions provided some insight into the greater sensitivity of the V-P IQ difference for patients with right damage (V > P of 9 points) compared to those with left damage (P > V of only 3K points), and examined the relationship between patient variables and V-P discrepancy in adults with brain damage. This chapter focuses on Verbal-Performance discrepancies in various types of clinical profiles, such as learning disabilities, delinquency, bilingualism, autism, mental retardation, psychiatric disorders, alcoholism, multiple sclerosis, and dementia. The chapter will conclude with the presentation of clinical case reports that exemplify V-P discrepancies within a profile.

Psychiatric Disorders

Couples and family therapists have developed specialized interventions for a wide variety of psychiatric disorders, including depression, alcohol, and a variety of anxiety disorders. Outcome studies have generally found that intervening with couples and families (rather than individuals) leads to lower drop-out rates and higher treatment success rates. Behavioral and cognitive couples treatments for depression have been found to reduce depression and increase satisfaction when the depressed person is in a distressed relationship. Behavioral Couples Therapy has also been shown to reduce alcoholism and to improve couples' satisfaction. Finally, spousal involvement has been shown to increase the effectiveness of behavioral treatments for agoraphobia.

Pyridoxine neuropathy

How pyridoxine deficiency and overdose cause neuropathy is unclear. Deficiency results from polynutritional deficiency, chronic alcoholism, and from treatment with isoniazid and hydralazine. Isoniazid inhibits conversion of pyridoxine to pyridoxal phosphate. Increased pyridoxine can be detected in the urine, but this is not important for diagnosis. Pyridoxine is toxic at doses over 200 mg day. 100-1000 mg pyridoxine given daily during isoniazid or hydralazine treatment is effective. Deficiency caused by alcoholism or other states of malnutrition should be treated with pyridoxine and other vitamins, since other deficiencies are likely concurrent.

Porphyria Cutanea Tarda Diagnosis

The major clinical feature in porphyria cutanea tarda (PCT) is fragility of sun-exposed skin which causes the formation of blisters and erosions after minor trauma, particularly on the backs of the hands. Chronic skin damage may lead to scarring and thickening of the skin which resembles scle-roderma. Skin lesions are accompanied by liver abnormalities which vary from mild portal inflammation to cirrhosis. In patients with long standing untreated PCT there is an increased incidence of hepatocellular carcinoma. Neurological symptoms do not occur in PCT. Alcoholism and use of estrogens are precipitating factors of PCT.

Christian MendezMD Luis MarsanoMD Daniell B HillMD and Craig J McClainMD

Alcoholic liver disease (ALD) remains a major cause of morbidity and mortality worldwide. In the western world, alcohol is the single most significant cause of liver disease, responsible for between 40 and 80 of cases of cirrhosis. In the United States, alcohol was responsible for 44 of deaths from cirrhosis between 1978 and 1988, with endstage liver disease being the sixth leading cause of death in the age group of 45 to 64 years. The mortality rate of this form of liver disease is higher than in many forms of cancer, such as breast, colon, and prostate. In some studies, the mortality from alcoholic cirrhosis is higher than that of nonalcoholic cirrhosis. Although the per capita alcohol consumption has declined in the United States and northern Europe in the last decade, in Latin America and Asia alcohol use has increased. In the United States, almost 14 million people still meet criteria for alcoholism. Among this group, more than 2 million are suspected of having liver disease, and...

Aspiration Pneumonia and Lung Abscess

Aspiration of food and vomitus is common in those who are prone to aspirate because of debilitation, dysphagia, alcoholism, nasogastric tube feeding, congenital malformations of the upper airways, central nervous system disorders such as seizures, and altered consciousness. If active or passive clearance of the aspirate is not achieved, there is a short latent period of several hours before the onset of pneumonia. Poor oral hygiene, gingivitis, and periodontitis, as well as therapy with diphenylhydantoin contribute to poor oral hygiene and promote the development of pneumonia in those who aspirate.

Alcohol polyneuropathy

Difficult to separate from nutritional or vitamin deficiency neuropathy. There is axonal degeneration with loss of large and small myelinated fibers in autonomic and sensory and motor nerves. Incidence is 9-30 of hospitalized alcoholics. Occurs after several years of consuming at least 100mg alcohol daily. Women are more susceptible.

Factors not associated with anaesthesia and surgery

And compartment syndrome have been described in young alcoholics undergoing treatment with benzodiazepines (Rutgers et al 1991). Rhabdomyolysis and acute renal failure occurred from a beta-2 adrenoreceptor agonist terbutaline (Blake & Ryan 1989), secondary to intense beta receptor stimulation.

Inpatient and Partial Hospital Psychiatric Treatment

Inpatient treatment for BN is uncommon and is reserved for patients who have failed outpatient interventions, are medically unstable, or have serious comorbidity (eg, suicidal symptoms, alcohol dependence, or brittle diabetes). In AN, however, a significant proportion of patients require inpatient treatment for weight restoration. Dedicated eating disorder specialty units are multidisciplinary in nature, with important contributions made by various disciplines including nursing, nutritionists, occupational therapists, psychotherapists (social workers or psychologists), med

Pancreatic Polypeptideoma

Pancreatic polypeptide-omas (PPoma) are clinically silent however, they are the most common neuroendocrine tumor in MEN type I. The true incidence is unknown. They occur throughout the pancreas and may be large at presentation. Malignancy is common and occurs in 64 to 92 of patients.30 These tumors generally present after 40 years. The diagnosis is made by an increase in the PP level.31-33 Other causes for an increase in PP levels include old age, inflammatory conditions, bowel resection, alcohol abuse, chronic renal failure, and diabetes mellitus.

Followup of Transplantation Recipients

According to the current allocation system, patients on the transplantation list in each organ procurement area (country divided into regions and further subdivided into organ procurement areas) receive priority according to their blood type and MELD score. Waiting period is used only if there is a tie with MELD score. Patients who present with ALF are given the highest priority (UNOS status 1) and MELD score is not calculated for those patients. Waiting time is the only factor that is considered to prioritize patients on status 1. For other patients on the list, MELD scores are recalculated at fixed intervals depending on the level as depicted in Table 110-2. Whenever there is a major change in a patient's medical condition, the committee may opt to reevaluate their candidacy. If they are deemed unsuitable due to a new medical (eg, major cardiovascular event) or social condition (eg, drug or alcohol abuse), then they may be taken off the list. Patients with active infection are often...

Preoperative Investigation and Preparation for the Procedure

Alcohol abuse, chronic abdominal pain, steatorrhea, diabetes, family history of pancreatitis or pancreatic cancer, and usage of pain medication. - If narcotic alcohol dependency is active, encourage commitment to undergo detoxification in a controlled chemical dependency unit postoperatively.

Variables Believed to Be Correlates of High Verbal IQ

In Chapter 8, right-hemisphere damage was shown, based on extensive data, to be associated with high Verbal IQ, relative to Performance IQ, a finding that also generally applied to patients with diffuse brain damage (including some samples tested on the WAIS-III). The following variables are also believed to be associated with V > P profiles for samples tested on Wechsler's adult scales attendance at college, psychiatric disorders (e.g., schizophrenia, depression), alcohol abuse, motor coordination problems, Alzheimer's-type dementia, and having a Full Scale IQ of 110 or above.

Substance Use Disorders

According to data presented by Wilens and others (1998, 2000) having ADHD (1) heightens the risk of developing a drug use disorder, (2) accelerates twofold the transition from less severe drug or alcohol abuse to more severe dependence, and (3) more than doubles the duration of sub

Fetal Alcohol Syndrome

The identification of FAS stimulated widespread interest in the effects of alcohol consumption by pregnant women. The offspring of approximately 6 percent of alcoholic mothers suffer from pronounced FAS. In major cities, the incidence of FAS is about 1 in 700 births. Its incidence increases to as many as 1 in 8 births on one Native American reservation in Canada. Severe FAS is also more likely to coincide with binge drinking, which produces high blood-alcohol levels. O ther fac tors related to a more severe out come are poor nutritional healt h of t he mot her and the mother's use of other drugs, including the nico tine in cigarettes. A major problem is that women who are most at risk for bearing FAS babies are poor and not well educated, with alcohol-consumption problems that predate pregnancy and little access to prenatal care. It is often difficult to inform these women about the dangers that alcohol poses to a fetus and to encourage them to abstain from drinking while they are...

Pancreatic Insufficiency

A past history of heavy alcohol consumption, with recurrent abdominal pain and steatorrhea should suggest chronic pancreatitis as a cause for diabetes. Stool fat, pancreatic function tests (such as duodenal intubation with secretin-cholecystokinin stimulation, endoscopy-based duodenal fluid collection (Conwell et al, 2003) or less invasive techniques involving breath testing (such as 13C-mixed triglyceride breath test), confirm the diagnosis. If functional tests are suggestive of pancreatic insufficiency, pancreatic enzymes can be supplemented with each meal.

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