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PubMedDate not supplied

Drinking by alcoholic cirrhotic patients under medical care: a literature survey.

In order to gain a broader perspective on the natural course of drinking by alcoholic cirrhotic patients receiving medical care, the medical and surgical literature from 1963 through 1982 was surveyed for prospective studies of patients with alcoholic cirrhosis in which follow-up drinking data were reported. Eleven studies with 1,039 patients were summarized. The patients were mostly urban men, averaging about 50 years old, treated in municipal, Veterans Administration, and university hospitals for either decompensated cirrhosis or for portal hypertension and bleeding varices; follow-up periods ranged from less than 1 to 10 years. The clinical investigators in the studies used various means to assess drinking and to categorize drinking behaviors, and expressed caution regarding validity. Between series, from 20 to 53% of the patients were reported to be abstinent from alcohol during the clinical follow-up periods. In five studies (373 patients) where the extent of drinking was determined, from 21 to 35% of the patients were reported to be drinking in a reduced or moderate manner, and from 17 to 42% to have resumed heavier drinking. The rates of improvement in drinking reported for the cirrhotic patients under medical care compare favorably to those for middle-aged male clients after alcoholism treatment, but the variables that predict course and outcome cannot be fairly compared between "medical" and alcoholism treatment populations. The substantial reduction or cessation of drinking reported in these large series of alcoholic cirrhotic patients over long follow-up periods may simple represent the natural, terminal course of alcoholism in the presence of severe liver disease; concomitantly, improvement may reflect the favorable impact of an alcohol-related disease and continued medical care on changing drinking behaviors.

Alcohol Drinking↗

PubMed1975

The aversive control of excessive alcohol consumption by chronic alcoholics in the laboratory setting.

The efficacy of several methods of aversive control of excessive alcoholic drinking was investigated in a semi-naturalistic setting that permitted objective measurement of the drinking behavior of chronic alcoholics. Studies 1A and 1B compared an excape-conditioning precedure with a control procedure in which aversive electrical shocks were administered before drinking. Neither procedure effectively decreased subjects' pretreatment, baseline alcoholic drinking behavior. In Study 2, aversive response-contingent shocks effectively suppressed alcoholic drinking, but drinking subsequently returned to its former levels after withdrawal of punishment. Self-administered shock appeared to be as effective as experimenter-administered punishment for controlling drinking, even when the punishment contingency was faded out over time. Study 3 replicated the suppressant effect of punishment, and demonstrated that contingent shock was significantly more effective than yoked, noncontingent shock. A direct comparison of self-versus experimenter-administered punishment suggested a possible slight advantage for the latter.

Adult↗

PubMed2005

Does participation in an alcohol administration study increase risk for excessive drinking?

It has long been thought that research protocols involving alcohol administration may exacerbate problem drinking in alcoholic subjects following their participation in such a study. However, recent studies suggest that involvement in an alcohol administration study does not, in fact, have a negative impact on subsequent drinking behavior. In the present study, 27 non-treatment-seeking alcohol-dependent subjects and 32 social drinkers participated in an alcohol administration study designed to investigate the effects of repeated doses of alcohol on craving, mood, and alcohol-seeking behavior. The volume of alcohol administered to the subjects was calculated in such a way that their blood alcohol concentration would reach a peak of 0.08 g/dl midway through testing. Before their release, alcohol-dependent subjects were given feedback regarding their level of alcohol consumption and provided with information about the potential harmful effects of their drinking behavior. Percentage of days abstinent (PDA), drinks per drinking day (D/DD), and percentage of heavy drinking days (PHDD, defined as >or=4 drinks per occasion for females and >or=5 drinks per occasion for males) were recorded for the 6 weeks preceding laboratory testing and for the 6 weeks following participation in the study. The alcohol-dependent subjects exhibited a significant increase of 24% in PDA during the poststudy period compared to the prestudy period. They also decreased their D/DD by 2.4 drinks per occasion, and decreased their PHDD by 21.6%. There were no differences in PDA or D/DD for the social drinkers between pre- and poststudy periods. There was, however, a small but significant increase of 3.5% in PHDD for the social drinkers following laboratory testing. These data suggest that participation in an alcohol administration study does not put alcoholic subjects at risk for increased alcohol consumption following study participation. In fact, participation in such studies may actually precipitate at least a temporary decrease in alcohol consumption, especially when paired with a brief intervention session. Thus, non-treatment-seeking alcoholics can be safely included in alcohol administration studies to provide results that are most relevant to the population of interest.

Adult↗

PubMed1996

Fundamental studies on alcohol dependence and disposition.

This article reviews some recent studies on alcohol preference, dependence, metabolism and pharmacokinetics which were mainly carried out in our department. The inbred strains of mice with genetically different alcohol drinking behavior and alcohol animal model treated with the neurotoxins, 6-hydroxydopamine and 5,7-dihydroxytryptamine, are useful for a behavioral and pharmacological approach to evaluate the contribution of specific neural systems to alcohol, drug dependence mechanism and alcohol drinking behavior. The relations between alcohol preference and some physiological conditions are reviewed. On the drug-alcohol interaction, some drugs containing the chemical group = CHONO2, antimony and methamphetamine are addressed. This article also deals with recent topics in the pharmacokinetics and pharmacodynamics of alcohol. The dose-dependency of the alcohol elimination rate, the first-pass metabolism during alcohol drinking, and the pharmacodynamic model for describing pulse rate reaction to plasma acetaldehyde are discussed.

Alcohol Drinking↗

PubMed1996

Recent thinking about the concept of alcohol dependence.

This paper reviews past definitions of alcohol dependence as well as that presently adopted in the 4th edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. The role of alcohol consumption in diagnostic criteria and the measurement of various dimensions of drinking (frequency, usual quantity per occasion, overall volume) are also discussed. Reliable criteria for identifying both alcohol abuse and dependence are available. Methodology for assessment of different dimensions of drinking behavior also exists. Epidemiologists examining the role of alcohol in health problems should consider the diagnostic category and the dimensions of drinking behavior that are important to their study. Measurements should be adopted in accordance with this assessment.

Alcohol Drinking↗

PubMed2004

Retirement, risky alcohol consumption and drinking problems among blue-collar workers.

OBJECTIVE: In this study, we assess the initial effects of employment status (not yet retired/continued employment, retirement with bridge employment and full retirement) on the alcohol consumption and drinking problems of retirement-eligible blue-collar workers. METHOD: Data were collected at two points from a random sample of members of nine unions within 6 months of retirement eligibility. Alcohol consumption and drinking problem data were collected from 1279 members 6 months prior to retirement-eligibility (T1) and from 1083 retained respondents 1 year later (T2). At T2 respondents were categorized as (1) not yet retired, (2) retired but engaging in bridge employment or (3) fully retired. RESULTS: Across all of the models tested, alcohol consumption and drinking behaviors at T1 were significant predictors of those same patterns of consumption or behavior at T2 and explained the greatest proportion of the variance in those same patterns at T2, suggesting that alcohol consumption and drinking behaviors remain largely stable over the period of time in which individuals become eligible to retire. Nevertheless, taking into account the effects of periodic heavy drinking prior to retirement and a variety of other factors, individuals opting to retire fully were twice as likely to engage in periodic heavy drinking (odds ratio = 2.01, p < .05) as those continuing to work. Bridge employment (as compared with continued employment) was also associated with significantly higher quantities of alcohol consumed on average drinking occasions (Beta = 0.14, p < .05). CONCLUSIONS: Retirement, at least in its early stages, is not associated with major shifts in alcohol consumption or problem drinking status. However, the particular retirement trajectory taken may have significant implications for individuals.

Adult↗

PubMed2001

Disinhibition and expectancy in risk for alcohol use: comparing black and white college samples.

OBJECTIVE: This study tested several predictions of the "acquired preparedness" model in both black and white samples of college students. The acquired preparedness model holds that trait disinhibition affects alcohol-related learning and, ultimately, alcohol use. This model maintains that the reward focus typical of disinhibited individuals increases the likelihood of forming overly positive expectancies about the effects of alcohol. Alcohol expectancy, then, acts as a mediator of the relationship of disinhibition and drinking behavior. METHOD: Participants (N = 479, 341 women) were 279 white and 200 black college students. Self-reported alcohol expectancy, disinhibition and drinking behavior were assessed. Covariance structure analysis was used to test hypotheses separately for each sample, controlling for socioeconomic status. RESULTS: Black participants scored significantly lower on disinhibition, expectancy and drinking. However, invariance testing indicated that the relationships between these variables were not different across groups. Results were consistent with the stated hypotheses in both samples--alcohol expectancy functioned as a mediator of the disinhibition-drinking relationship. Results did not differ across expectancy content. CONCLUSIONS: These results provide support for the validity of the acquired preparedness model. Despite mean differences in risk and drinking levels between black and white samples, psychosocial learning appears to mediate the influence of disinhibition on drinking for both groups.

Adolescent↗

PubMedDate not supplied

Does comorbid anxiety or depression affect clinical outcomes in patients with post-traumatic stress disorder and alcohol use disorders?

Post-traumatic stress disorder (PTSD) is commonly comorbid with other psychiatric disorders, including substance use disorders. In spite of this, pharmacologic treatment trials for PTSD often exclude individuals with significant psychiatric comorbidity. This study is a post hoc analysis of a 12-week double-blind placebo-controlled trial investigating sertraline in the treatment of patients with comorbid PTSD and an alcohol use disorder. Individuals with additional anxiety and affective disorders were included. Patients (N = 93) were stratified into four groups depending on presence or absence of additional anxiety or depressive disorders and evaluated for the effects of comorbidity on PTSD symptoms, depressive symptoms, and drinking behaviors. We hypothesized that additional comorbidity would be associated with poorer outcomes. Patients in all four subgroups showed marked and clinically significant improvement in alcohol drinking behaviors over the course of the study. For the entire sample, over the course of the 12 weeks, mean drinks per drinking day fell from 13.0 +/- 8.4 (SD) to 3.0 +/- 5.0 (SD); t = 10.2, df = 92, P <.000. There were, however, no significant differences among groups. Patients in all four groups showed moderate improvement in Hamilton Depression Rating Scale (HAMD) scores and Clinician-Administered PTSD scale (CAPS) scores at endpoint. For the entire sample, mean CAPS scores fell from 59.3 +/- 19.4 (SD) to 40.8 +/- 26.0, t = 8.9, df = 92, P <.000. Mean HAMD scores fell from 17. 9 +/- 6.7 (SD) at baseline to 11.8 +/- 9.4 (SD) at endpoint; t = 6.7, df = 92, P <.000. There were, however, no significant differences among groups for change in HAM-D or CAPS scores. Hence, contrary to our hypothesis, having additional anxiety or mood disorder comorbidity did not decrease treatment response in individuals with comorbid PTSD and an alcohol use disorder.

Adult↗

PubMed2002

Ondansetron reduces the craving of biologically predisposed alcoholics.

RATIONALE: Early onset alcoholics (EOA) differ from late onset alcoholics (LOA) by having greater serotonergic abnormality, familial history, and a range of antisocial behaviors. Previously, we showed that ondansetron, a selective 5-HT3 antagonist, effectively treated EOA. Proximate motivational drives such as craving could have determined drinking behavior. We therefore investigated whether ondansetron treatment would reduce alcohol craving significantly among EOA. OBJECTIVES: We tested the hypothesis that the craving outcomes of EOA, compared with LOA, would be differentially improved by ondansetron. We also tested the prediction that craving would be significantly correlated with drinking behavior. METHODS: We studied a cohort of 253 out of 321 enrolled alcohol dependent subjects. These 253 subjects were entered into a 1-week lead-in single-blind placebo period followed by 11 weeks of double-blind outpatient treatment. Study design was a 2 (EOA versus LOA)x 4 medication dose (placebo, or ondansetron 1, 4, or 16 microg/kg b.i.d)x 13 (visits) factorial analysis of variance. Craving was measured at each visit using seven visual analogue scales. Subjects received 12 weekly sessions of standardized group cognitive behavioral therapy. RESULTS: Data reduction by factor analysis of the visual analog scale items yielded one dimension, overall craving. Ondansetron 4 microg/kg b.i.d. reduced overall craving significantly among EOA. In contrast, ondansetron (1 microg/kg b.i.d.) increased craving significantly in LOA. Decreased overall craving was positively correlated with reduced drinking and negatively associated with increased abstinence. CONCLUSIONS: Compared with placebo, ondansetron (4 microg/kg b.i.d.) was associated with significant reductions in overall craving in EOA but not LOA, presumably by ameliorating serotonergic abnormality.

Adult↗

PubMed2003

The impact of alcohol use in community-dwelling older adults.

The purpose of this study was to explore the use of alcohol in community-dwelling older adults and to consider differences in physical and mental health, function, cognitive status, and social supports between those who drink minimal (1 to 3 glasses weekly), moderate (4 to 7 glasses weekly), or no alcohol. A total of 3305 older adults with a mean age of 81.6 -/+ 6.0 participated in the study. Twenty-two percent (n = 709) of the participants had 1 to 3 drinks weekly, only 1% (n = 18) reported 4 to 7 drinks weekly, and none of the participants admitted to 8 or more drinks. There was no difference in drinking behavior with regard to age (F = 1.1, p >.05) or social supports (F =.39, p >.05). There was a difference in drinking behavior with regard to physical health (F = 4.9, p <.05), functional status (F = 7.7, p <.05), cognitive status (F = 11.8, p <.05), and mental health (F = 6.9, p <.05). Health care providers should use an individualized approach to alcohol use in older adults and help these individuals establish, as appropriate, safe drinking habits that will augment health and quality of life.

Activities of Daily Living↗

PubMed1996

The influence of religious affiliation on sociocultural predictors of drinking among Black and White Americans.

Although religious denominations have been shown to affect the drinking behavior of their members, few studies have examined this topic among Black Americans. The following study explored whether a model predicting drinking from religious denominations through a series of intervening cognitive and social variables (drinking attitudes and norms, social contexts, social networks, and home use of alcohol) would be the same for Blacks and Whites. The results showed that there are a number of racial differences in how religious background influences intervening social characteristics, but few in the predictors of drinking behavior. Many significant racial differences were observed among Baptists, a moderate number among Catholics, and few or none were observed for Conservative Protestants and Methodists.

Adolescent↗

PubMed1988

Predictors of reduction and cessation of drinking in community-dwelling men: results from the normative aging study.

As part of a longitudinal study of health and aging, the conditions and motivational factors that prospectively predicted either cessation or reduction in alcohol consumption were compared. Data were from 1,517 community-dwelling men who in 1973 (Time 1) and 1982 (Time 2) completed mailed questionnaires about their drinking behaviors. Time 2 quitters (n = 62) had consumed no alcohol for at least the 6 months before that survey; reducers (n = 255) had decreased their yearly alcohol consumption by at least one-half. Compared to 971 controls, quitters reported more drinking problems at Time 1; reducers reported higher consumption at Time 1, which was the only factor predictive of subsequent reduction (p less than .001). Regression analyses considering contextual-motivational factors for drinking showed that at Time 1 quitters were less likely than controls to have consumed alcohol during evenings out (p = .008), in family-home settings (p = .013), or for salutary reasons (p = .084); conversely, they were more likely to have consumed alcohol to reduce negative affect (p = .011). Reducers cited more social-situational reasons for curtailing drinking; quitters cited more personal reasons related to health and alcohol effects. These findings indicate that in a community sample of men, problematic drinking behaviors tend to predict subsequent abstention rather than reduced drinking.

Adult↗

PubMed1998

Blocking GABA(A) receptors in the anterior ventral tegmental area attenuates ethanol intake of the alcohol-preferring P rat.

The effect of blocking the A subtype of gamma-aminobutyric acid (GABA(A)) receptors in the anterior ventral tegmental area (VTA) on ethanol (EtOH; 10% v/v) and saccharin (SACC; 0.0125%) consumption was investigated in alcohol-preferring P rats. Picrotoxin (0.005, 0.01, 0.05 and 0.10 microg/0.5 microl) was injected into the VTA, and consumption of EtOH and SACC was assessed in two 2-h limited-access drinking paradigms (concurrent EtOH/SACC access, and alternate-day-access to EtOH and SACC). Under concurrent-access conditions, the picrotoxin microinjections resulted in a 55 and 84% decrease in EtOH consumption at the 0.05 and 0.10 microg doses, respectively, compared with consumption following microinjections of vehicle solution (P<0.05). Saccharin intake was not significantly altered by picrotoxin. Under alternate-day-access drinking conditions, the picrotoxin microinjections resulted in dose-dependent decreases in EtOH consumption of 37-68%, with significant decreases following the 0.005, 0.05 and 0.10 microg doses (P<0.04). Saccharin intake was significantly reduced only at the 0.05 microg dose. The decrease in EtOH consumption after 0.10 microg picrotoxin was attenuated by co-administration of 0.01 microg muscimol. This dose of muscimol had no effect on EtOH consumption when injected alone. Intra-VTA injections of bicuculline (0.04 microg), another GABA(A) antagonist, reduced EtOH intake, comparable to the reduction following 0.10 microg picrotoxin. Microinjections of 0.10 microg picrotoxin in regions outside the VTA failed to decrease EtOH intake. These results suggest that anterior VTA mechanisms regulating alcohol drinking behavior are under tonic GABA inhibition, mediated by GABA(A) receptors. The results also suggest that different neural mechanisms are regulating voluntary EtOH and SACC drinking behaviors.

Alcohol Drinking↗

PubMed1986

Occasional drinking among university students.

Data from a survey of university students are analyzed using a logistic regression model. The results reveal interactions among factors associated with drinking behavior that are not easily detected when more traditional linear additive statistical models are employed. The utility of employing indicators of personal beliefs, demographic attributes, and contextual descriptors in a single model of drinking behavior is demonstrated. Implications for intervention planning are discussed.

Alcohol Drinking↗

PubMed1996

Social drinking history, behavioral tolerance and the expectation of alcohol.

This research tested the hypothesis that a compensatory response to cues for alcohol contributes to the greater behavioral tolerance displayed by more experienced social drinkers. Sixty male social drinkers, ranging from 19 to 24 years of age, participated in the study. Thirty subjects had been drinking for 20 months or less (mean = 11.0 months), and were classified as novice (N) drinkers. The remaining 30 subjects had been drinking for 24 months or more (mean = 40.8 months), and were classified as experienced (E) drinkers. All subjects practiced a pursuit rotor task that measured psychomotor skill. Equal numbers of E and N subjects were then assigned to one of three groups (n = 10). Two groups were led to expect alcohol and performed the task after receiving either 0.56 g/kg alcohol, or a placebo. The third group received no beverage, E subjects displayed more behavioral tolerance to alcohol than did N drinkers. In accord with the hypothesis, E drinkers displayed a drug-opposite improvement in performance under a placebo, whereas N drinkers showed no appreciable change in performance. These observations support the hypothesis that the acquisition of a compensatory response to cues predicting the administration of alcohol contributes to the greater behavioral tolerance of more experienced drinkers.

Adult↗

PubMed2005

The anxious amygdala: CREB signaling and predisposition to anxiety and alcoholism.

The amygdala is believed to play a key role in assigning emotional significance to specific sensory input, and conditions such as anxiety, autism, stress, and phobias are thought to be linked to its abnormal function. Growing evidence has also implicated the amygdala in mediation of the stress-dampening properties of alcohol. In this issue of the JCI, Pandey and colleagues identify a central amygdaloid signaling pathway involved in anxiety-like and alcohol-drinking behaviors in rats. They report that decreased phosphorylation of cAMP responsive element-binding protein (CREB) resulted in decreased neuropeptide Y (NPY) expression in the central amygdala of alcohol-preferring rats, causing high anxiety-like behavior. Alcohol intake by these animals was shown to increase PKA-dependent CREB phosphorylation and thereby NPY expression, subsequently ameliorating anxiety-like behavior. These provocative data suggest that a CREB-dependent neuromechanism underlies high anxiety-like and excessive alcohol-drinking behavior.

Alcohol-Induced Disorders, Nervous System↗

PubMed2003

[Gene-environmental interactions in alcohol-related health problems--contributions of molecular biology to behavior modifications].

High alcohol sensitivity among Asians is mainly due to a genetic polymorphism in the low Km aldehyde dehydrogenase (ALDH2) gene. Strong correlations between the ALDH2 genotype and alcohol sensitivity or alcohol drinking habits have been reported. Another prevalent polymorphism in the alcohol dehydrogenase beta-subunit (ADH2 gene) among Asians appears to modify skin flushing reactions after exposure to ethanol but does not influence alcohol drinking behavior. Both the ADH2 and ALDH2 genotypes have been significantly correlated with the risk of alcoholism. In a Japanese occupational population, a gene-environment interaction of the ALDH2 genotype and daily hassles scores for development of problem drinking behavior was observed. Habitual drinkers with the ALDH2*1/*2 genotype had higher frequencies of sister-chromatid exchange in cultured lymphocytes and higher 8-OHdG levels in polymorphonuclear leukocytes than those with the ALDH2*1/*1 genotype. Alcoholics and heavy drinkers with the ALDH2*1/*2 genotype have been shown to have significantly elevated risks for esophageal and multiple cancers in upper digestive organs than those with the ALDH2*1/*1 genotype. In Japan, bronchial asthma patients with the ALDH2*1/*2 genotype have been shown to have a significantly elevated risk for experiencing alcohol-induced asthma compared with the ALDH2*1/*1 genotype. Providing services to determine these genotypes would be of great help for each individual to make a plan for tailor-made health promotion.

Alcohol Dehydrogenase↗

PubMed2006

High- and low-dose expectancies as mediators of personality dimensions and alcohol involvement.

OBJECTIVE: The present study examined the influences of personality dimensions (extraversion, neuroticism) on college alcohol involvement both (1) directly and (2) mediated by positive and negative alcohol expectancies across two imagined (high and low) alcohol doses. METHOD: Participants (N = 339; 176 women) were regularly drinking college students who completed a questionnaire battery on demographic characteristics, personality, expectancies, and alcohol use and problems. RESULTS: Structural equation modeling analysis of low- and high-dose models revealed partial support for the Social Learning Theory conceptualization of expectancies as mediators of more distal (personality) influences. Interestingly, patterns of association differed by dose. At high-expectancy doses, positive alcohol expectancies fully mediated the extraversion-use association. At low doses, positive expectancies did not play a critical role. Two distinct pathways from neuroticism to alcohol use were observed: a direct pathway, whereby neuroticism is a protective factor for alcohol use, and an indirect pathway, through positive expectancies, whereby neuroticism is a risk factor. The protective pathway was evident regardless of expectancy doses, whereas the risk pathway was evident only at high doses. Negative expectancies partially mediated the association between neuroticism and alcohol problems at both high- and low-expectancy doses. CONCLUSIONS: These data underscore the unique role of both positive and negative expectancies in the association between personality and drinking behavior and point to the importance of considering alcohol dose when assessing expectancies. Findings suggest that it may be beliefs about the effects resulting from heavy (rather than moderate) drinking that may be the active mechanism underlying drinking behavior.

Adolescent↗