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PubMed1992

Models for effective prevention.

The social influence models do provide some optimism for primary prevention efforts. Prevention programs appear most effective when 1) the target behavior of the intervention has received increasing societal disapproval (such as cigarette smoking), 2) multiple years of behavioral health education are planned, and 3) community-wide involvement or mass media complement a school-based peer-led program (45,46). Short-term programs and those involving alcohol use have had less favorable outcomes. Future research in primary prevention should address concerns of high-risk groups and high-risk countries, such as lower income populations in the United States or countries that have large adolescent homeless populations. The utilization of adolescent leaders for program dissemination might be particularly critical in these settings. A second major and global concern should focus upon alcohol use and alcohol-related problems. In many communities adolescent alcohol use is normative and even adult supported. Thus, young people are getting quite inconsistent messages on alcohol from their schools, from TV, from peers, and from parents. This inconsistency may translate into many tragic and avoidable deaths for young people. Clearly, in the area of alcohol-related problems, community-wide involvement may be necessary. A third direction for prevention research should involve issues of norms, access, and enforcement including policy interventions, such as involve the availability of cigarette vending machines or the ease of under-age buying or levels of taxation. These methods affect adolescents more acutely since their financial resources, for the most part, are more limited. These policy level methods also signify to adolescents what adults consider appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Substance abuse among sexually abused adolescents and their families.

The concurrence of substance abuse and history of sexual abuse among adolescents has prompted this study of substance abuse patterns among families of adolescents who report incest or extrafamilial sexual abuse. A total of 3,179 ninth-grade students in a rural midwestern state completed a survey that included questions about individual and family substance abuse. Adolescents who had been sexually abused were more likely to report substance abuse for themselves as well as for members of their immediate families. They were also more likely to report that they used substances because of family problems, school problems, and because they were sad, lonely, or angry. Adolescents reporting a parent with an alcohol or a drug problem were more likely to use cigarettes, marijuana, alcohol, or "speed." Adolescents experiencing extrafamilial abuse reported more alcohol abuse and more alcohol-related problems than those who experienced incest. There were similar reports of parental and familial alcohol and drug problems among these experiencing incest and those experiencing extrafamilial abuse. Those with drug-abusing parents, however, were most likely to report some kind of sexual abuse history.

Adolescent↗
PubMed1992

Animal models of prenatal alcohol exposure.

Since the first reports of fetal alcohol syndrome (FAS), thousands of studies have examined the effects of antenatal alcohol exposure in humans and in animal models. Research with animal models has led to discoveries which would be difficult if not impossible in human subjects. Most importantly, these models have resulted in valuable insights into the actions of alcohol on various parts of the developing embryo and have helped researchers come closer to identifying the mechanisms of its teratogenic action. Both the direct and indirect biological effects of alcohol exposure in utero appear to work in conjunction with other concurrent and predisposing factors such as genotype, nutritional status, pattern of exposure and use of other drugs such as nicotine and cocaine. At present animal research indicates a multifactorial mechanism of the teratogenicity of alcohol resulting from nutrient deficiencies, fetal hypoxia and alterations in enzyme activities and cell function important in cell division and membrane integrity. This review examines how animal models are used to clarify issues associated with alcohol-related birth defects and to shed light on the underlying mechanisms.

Abnormalities, Drug-Induced↗
PubMed1976

Seizure admissions to a city hospital: the role of alcohol.

Among 472 adult seizure admissions to a municipal hospital, 41% had a history of alcohol abuse. Those were predominantly men aged 40 to 50 years. The primary underlying conditions were the alcohol withdrawal state (59%) and posttraumatic seizures. The nonalcohol groups included men and women equally, commonly between 20 and 40 years old, and frequent causes were vascular disease and posttraumatic seizures. However, many patients (24% in the alcohol and 39% in the nonalcohol groups) had no demonstrable cause. Focal sizures comprised 24% of the alcohol and 20% of the nonalcohol groups. Nonalcoholic focal seizures had a tumor or vascular lesion in 47%; above age 50 the association was 60%. Alcohol-related focal seizures had such a lesion in 15%, and only 19% above age 50. Conditions associated with alcoholic focal seizures were alcohol withdrawal and posttrauma sequelae.

Adult↗
PubMed1992

The role of instructional set on alcoholic performance.

This study was conducted to determine whether alcoholic and control subjects respond differently to manipulations that either enhance personal involvement (PI) or reduce negative affect (R, relaxation) on tests of neuropsychological function. In Phase 1, 48 male alcoholics and 36 male control subjects completed neuropsychological tasks under standard instructional sets. In Phase 2, subjects completed equivalent forms of these tests under one of three randomly assigned conditions; the PI condition in which subjects were encouraged to identify specific ways of improving their performance, the R condition in which subjects participated in a short relaxation exercise designed to reduce anxiety, or a No Treatment (NT) condition in which no attempt to manipulate the subjects' involvement or affect was made. Alcoholics were inferior to controls in both Phase 1 and Phase 2 [Fs (1,82) > 5.03, ps < 0.03]. The experimental manipulation differentially affected measures of negative affect and effort in the predicted direction. There were no group x condition interactions. Alcoholic and control subjects responded comparably to the experimental manipulations. This investigation, in combination with others using related manipulations, reinforces the hypothesis that alcohol-related cognitives dysfunction reflects an underlying deficit in brain states.

Adult↗
PubMed1992

Alcoholism in older persons: a review of the literature.

Alcohol abuse and dependence in elderly persons is of growing social concern. The most consistent findings of cross-sectional and longitudinal studies are that the quantity and frequency of alcohol consumption is higher in elderly men than in elderly women, as is the prevalence of alcohol-related problems. Most studies show a decrease with age in consumption and alcohol-related problems among heavy drinkers. Longitudinal studies show no changes in consumption among light drinkers. Elderly persons with lower incomes consume less alcohol than those with higher incomes. Hospitalized and outpatient populations have more problem drinkers, and the elderly alcoholic is at greater risk for medical and psychiatric comorbidity. About one-third to one-half of elderly alcoholics experience the onset of problem drinking in middle or late life. Outcomes seem to be better for those who have late-onset drinking and may be improved for those treated in same-age rather than mixed-age groups.

Aged↗
PubMed1976

Verbal and nonverbal marital interaction patterns of alcoholics and nonalcoholics.

In a study of the interaction of hospitalized alcoholic and nonalcoholic husbands and their wives, husbands tended to speak more during alcohol-related conversations, while wives spoke more when discussing other topics. Wives in both groups looked at their spouses more than their husbands did during alcohol-focused periods.

Adjustment Disorders↗
PubMed1979

Biological investigations in alcohol research.

The biological mechanisms examined in this paper cover only a small portion of those that may be involved in the pathogenesis of alcoholism. Certain areas on which a great deal of work has already been done have been entirely omitted. Among these are studies on brain acetylcholine and gamma-aminobutyric acid metabolism in alcohol-related conditions; the effect of alcohol on brain proteins and nucleotides and the relationship of changes in these to the development of tolerance and physical dependence; and a variety of other areas involving biochemical and physiological parameters. The omission of any of these areas in no way suggests that they are less significant than those that have been covered. It is just that I have attempted to present a cohesive and coherent review of some areas of biological research which thus far appear to throw light on the clinical development and phenomenology of the alcoholism syndrome. In order to present such a thesis, I have inevitably crowded the evidence to fit some of my pet hypotheses. However, in controversial areas (which are many), I have tried to present some of the evidence on both sides and, hopefully, have succeeded in offering a fair overview of the state of the science as it exists today.

Alcohol Drinking↗
PubMed2025

Global Changes in Gene Expression and Splicing in Alcoholic Liver Disease.

Alcohol use disorder is a widespread illness commonly leading to alcoholic liver disease (ALD) and cirrhosis with an increased incidence of hepatocellular carcinoma (HCC), but the mechanisms of alcohol-related oncogenesis in the liver are incompletely understood. We tested the hypothesis that ALD predisposes to HCC via dysregulation of splicing. RNA sequencing was performed on liver biopsies from patients with different stages of ALD: early alcoholic steatohepatitis (eASH), non-severe alcoholic hepatitis (nsAH), and severe alcoholic hepatitis (sAH); furthermore, explants were collected from patients who underwent liver transplantation due to sAH (exAH). We found that alcohol caused widespread changes in transcriptome in all stages of ALD: among ~ 58,000 analyzed genomic features, ~ 4,900 were altered in eASH, ~ 9,100 - in nsAH, 14,100 - in sAH, and ~ 14,300 - in exAH. We observed thousands of missplicing events in all hepatic conditions, with mutually exclusive exons (MEE) being the most common event and exon skipping (ES) - second most common event. Analysis of ~ 600,000 exons revealed that ALD is associated with a genome-wide effect on exon expression, with ~ 50,000 exons being differentially expressed in eASH, ~ 130,000 - in nsAH, ~ 150,000 - in sAH, and ~ 120,000 - in exAH. To determine whether alcohol directly perturbs splicing, we subjected rats to alcohol vapor for 7 weeks and found that the expression of multiple snRNAs was drastically decreased, while expression of splicing factors was not affected. Screening of oncogenes and tumor suppressors, commonly involved in HCC pathogenesis, revealed that ALD affected the hepatic expression and/or splicing of most of these cancer-related genes. In summary, it appears that alcohol causes profound genome-wide changes in gene expression and splicing in the liver, likely via affecting the spliceosome. This results in altered expression and missplicing of key oncogenes and tumor suppressors involved in HCC, suggesting a novel mechanism of oncogenesis in the liver of patients with ALD.

alcohol use disorder↗
PubMed1992

Progression of dependence in male cocaine addicts.

We studied the self-reported temporal sequence of cocaine-related problems in 45 male predominantly Black (85%), lower SES cocaine addicts undergoing inpatient treatment at a large urban VA psychiatric hospital. Subjects reported recent average use of 2.5 g of cocaine per day for 14 days each month and experiencing a mean of 14 cocaine-related problems. The temporal sequence of cocaine-related problems was roughly consistent with the sequence of alcohol-related problems reported for alcoholics, with the earliest problems being interpersonal (e.g., arguments with others) and the most recent problems the severest (e.g., job loss, marital separation). The cocaine addicts showed a faster progression from first cocaine use to first cocaine-related problems (mean of 3.75 years) than that reported for alcoholics from first drink to first heavy drinking (8-10 years). Cocaine smokers had a faster course (3.4 years) than intranasal users (5.3 years).

Adult↗
PubMed1992

A case-control study of risk factors of alcohol misuse in Czech women: are there four types of female alcoholism?

Three samples of Prague women aged 20-49 were interviewed with regard to hypothetical risk factors of alcoholism: 139 inpatients diagnosed as alcohol dependent, 39 inebriated females admitted for 1-day detoxification, and 718 randomly selected women (the controls). Irrespective of case definition, father's alcoholism, incomplete family of origin, conduct disorders in childhood and adolescence, and social surroundings marked by heavy drinking were supported as risk factors of alcoholism. A factor analysis of alcohol-related problems led to two dimensions (dependence, disruptiveness) and consequently to four types of female alcoholism with different patterns of risk factors.

Adult↗
PubMed1992

The consequences of drug and alcohol use for Indian youth.

Indian youth have higher rates of using alcohol and drugs in ways that increase their risk--getting very drunk, drinking while driving, and using drugs and alcohol together. The highest rate is found among reservation youth, a lower rate among non-reservation Indians, and the lowest rate among non-Indian youth. Frequency of self-reported consequences from alcohol and drug use follow the same order, with 15% of reservation seniors involved in an alcohol-related accident. The most frequent consequences involve relationship problems. Drug injection is rare in all groups.

Adolescent↗
PubMed1975

Death in amphetamine users: causes and rates.

The world medical literature contains 43 reports of deaths associated with amphetamines in a 35-year period. These included seven cerebrovascular accidents, six sudden cardiac deaths, three cases of hyperpyrexia, eight poisonings of uncertain mechanism and seven cases of medical complications of intravenous injection; the remainder were of uncertain cause. In contrast, in Ontario alone, in 1972 and 1973 there were 26 deaths in amphetamine users, of which 16 were due to accident suicide or homicide. Of the remaining cases, two were cardiac, two hepatic and the rest were mixed drug overdose. Pulmonary granulomata, subacute hepatitis and other lesions resulting from intravenous drug use were common findings at autopsy. On the basis of the estimated number of regular users of intravenous amphetamine in Ontario, the mortality rate in such users is at least four times as high as in the general population of the same age, and is comparable to that in alcoholics and heroin addicts. However, the absolute number of alcohol-related deaths is far greater than the number of deaths in amphetamine or heroin users.

Adolescent↗