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PubMed2003

A meta-analysis of the effectiveness of bibliotherapy for alcohol problems.

There has been increased interest in the use of brief interventions and the delivery of alcohol treatment services through nonspecialist health care settings. One possible resource for reaching untreated individuals is "bibliotherapy," the provision of self-help materials to motivate and guide the process of changing drinking behavior. Research on the effectiveness of self-help materials for problem drinkers has been done for three decades. This report summarizes a meta-analytic review of 22 studies evaluating the effectiveness of such self-help materials. Each study was rated on 12 methodological criteria, and effect sizes of bibliotherapy were computed. The methodological quality of studies was generally high relative to other treatment-outcome studies. Modest support was found for the efficacy of self-help materials in decreasing at-risk and harmful drinking. The weighted mean pre/post-effect size for bibliotherapy was .80 with self-referred individuals seeking help for drinking problems, and .65 for individuals identified through health screening. Between-group comparisons of bibliotherapy with no-intervention controls appear to have a small to medium effect, with a weighted mean effect size of .31 with self-referred drinkers; effect size was more variable in opportunistic interventions based on health screening. Finally, between-group comparisons of effects on drinking of bibliotherapy versus more extensive interventions yielded effect size values near zero. These findings provide support for the cost-effective use of bibliotherapy with problem drinkers seeking such help to reduce their consumption, and to a lesser extent with drinkers who are identified through screening as at risk.

Alcoholism↗

PubMed1987

Alcoholism in Mexican-Americans: intervention and treatment.

Studies have shown that Hispanic males have higher rates of heavier drinking and problems associated with drinking than the general population. The authors discuss Mexican-American cultural and religious views on alcohol consumption and sex-role differences that influence drinking behavior and intervention. Then, drawing on their experience with a chemical dependence program that serves a catchment area that is one-fifth Mexican-American, they discuss how clinicians can work with cultural beliefs and practices to effectively treat Mexican-American alcoholics within a traditional treatment program.

Alcohol Drinking↗

PubMed2005

Marital quality and congruent drinking.

OBJECTIVE: This research considered whether changes in marital quality over the early years of marriage were related to patterns of alcohol use among three groups of couples: congruent nondrinkers, congruent drinkers who usually drank with their spouses and congruent drinkers who usually drank apart from their spouses. METHOD: Newlywed couples (N = 418) were assessed for marital satisfaction and drinking behaviors and then were reassessed at their first and second anniversaries. Cross-sectional analyses compared couples at each assessment and multilevel modeling assessed changes in marital satisfaction over time. RESULTS: At each assessment, husbands and wives who usually drank with their partners reported greater levels of marital satisfaction. Over time, marital satisfaction declined for both husbands and wives. When we assessed changes in marital quality based on the three groups, husbands in each group experienced similar declines in marital quality. Among wives, however, the rate of decline was not the same. Although wives in the nondrinking group and wives who usually drank with their husbands had similar initial marital satisfaction, the nondrinkers experienced a greater decline in marital satisfaction than the wives who drank with their husbands. The rate of change for the wives in the nondrinking group was quite similar to wives who more often drank apart from their spouses. CONCLUSION: These findings suggest that alcohol use may be a part of the couple's socializing and may increase interaction, thereby increasing marital satisfaction.

Adult↗

PubMed2001

Osmoregulation in water-deprived rats drinking hypertonic saline: effect of area postrema lesions.

Rats drank rapidly when 0.3 M NaCl was the only drinking fluid available after overnight water deprivation, consuming approximately 200 ml/24 h. Although such large intakes of this hypertonic solution initially elevated plasma osmolality, excretion of comparable volumes of urine more concentrated than 300 meq Na(+)/l ultimately appears to restore plasma osmolality to normal levels. Rats drank approximately 100 ml of 0.5 M NaCl after overnight water deprivation, but urine Na(+) concentration (U(Na)) did not increase sufficiently to achieve osmoregulation. When an injected salt load exacerbated the initial dehydration caused by water deprivation, rats increased U(Na) to void the injected load and did not significantly alter 24-h intake of 0.3 or 0.5 M NaCl. Rats with lesions of area postrema had much higher saline intakes and lower U(Na) than did intact control rats; nonetheless, they appeared to osmoregulate well while drinking 0.3 M NaCl but not while drinking 0.5 M NaCl. Detailed analyses of drinking behavior by intact rats suggest that individual bouts were terminated by some rapid postabsorptive consequence of the ingested NaCl load that inhibited further NaCl intake, not by a fixed intake volume or number of licks that temporarily satiated thirst.

Animals↗

PubMed1987

Central actions of atrial natriuretic polypeptides in spontaneously hypertensive and normotensive rats.

The effects of intracerebroventricular (i.c.v.) administration of ANP on blood pressure and intakes of water and salt were examined, using conscious, unrestrained normotensive Wistar rats and spontaneously hypertensive rats (SHR). In normotensive rats, i.c.v. administration of alpha-rat ANP (alpha-rANP), alpha-human ANP (alpha-hANP), alpha-rANP (4-28) and alpha-rANP (5-28) at the dose of 1.5 nmol significantly attenuated water intake induced by i.c.v. injection of 0.1 nmol of angiotensin II (AII). Centrally administered alpha-hANP (5 micrograms) also attenuated AII-induced pressor response. Centrally injected alpha-hANP (1 microgram) produced a greater reduction of water intake after 24-hour water deprivation in SHR compared to control Wistar Kyoto rats (WKY). Central infusion of alpha-hANP for 1 week also reduced the salt appetite of SHR, as shown by two bottle preference test with 0.3 M NaCl solution and tap water, while it had no effect on drinking behavior of WKY. These results suggest the central antagonistic relationship of the ANP and renin-angiotensin systems and the possible involvement of brain ANP in the pathophysiology of genetically hypertensive rats.

Angiotensin II↗

PubMed1995

[Current aspects of pharmacotherapy of alcoholism].

There is increasing evidence that "anticraving" drugs are promising agents in the treatment of alcoholics. Clinical studies indicate favorable effects of drugs with different pharmacological profiles (e.g., dopaminergic, serotonergic, anti-opioidergic, antiglutamatergic) on abnormal drinking behavior and relapse tendencies. Interactions with the limbic reward system seem to be involved. As several drugs will probably be registered in Germany, the need for integrating these drugs in a complex rehabilitation program is emphasized. Many clinical issues regarding the practical use of these drugs await further clarification.

Alcohol Deterrents↗

PubMed1976

Alcohol consumption during pregnancy as reported to the obstetrician and to an independent interviewer.

Data on the 67 women asked by this study and by their physician about their drinking indicate that most of them reported "occasional" consumption to the physician, no matter what their drinking behavior appeared to be as estimated by personal interview. That is, heavy drinkers (by the estimates of this study) underestimated and infrequent drinkers overestimated alcohol consumption relative to the personal interview when reporting to their physician. Becuase of the difficulty in classifying responses, a rather loose criterion of "disagreement" of the two estimates was established. About 10% of the women gave conflicting reports to the study interviewer and the physician by this criterion. In most cases of conflict, the report to the physician was lower. These data suggest that the reports of drinking to the physician were of limited usefulness, becuase all women tended to declare similar quantities. Furthermore, physician interrogation failed to detect almost all the heavier drinkers found by an independent interview.

Adult↗

PubMed1996

Alcoholic beverage consumption and associated factors in Porto Alegre, a southern Brazilian city: a population-based survey.

OBJECTIVE: To describe the pattern of alcoholic beverage consumption and the prevalence of at risk drinking behaviors, as well as their association with demographic and socioeconomic factors in the adult population of Porto Alegre, a southern Brazilian city. METHOD: In a cross-sectional, population-based, multistage random sampling study, 1,091 (600 female) individuals (92% of those eligible) were selected and interviewed at home. Exposure to alcohol was measured by the CAGE questionnaire and by inquiring about the type, quantity and frequency of alcoholic beverage consumption. An average consumption of 30 g per day or more, a level of exposure associated with health risks, was considered as heavy drinking. Two positive answers to the GAGE questionnaire represented the cutoff for indicating dependence. RESULTS: The prevalences were: 9.3% (95% CI: 7.6 to 11.0) for dependence, 15.5% (13.4 to 17.7) for heavy drinking and 12.3% (10.4 to 14.2) for daily drinking; 24.1% (21.7 to 26.6) were abstinent. Women consumed alcoholic beverages in lower frequency and amounts than men. The most widely consumed beverages were beer, wine and "cachaça," a Brazilian sugarcane spirit. In a logistic regression model, increasing age, lower education and income, and nonwhite race were associated with heavy drinking and dependence. Households with 3-4 persons were associated with the lowest risk of heavy drinking, but the prevalence of dependence was higher in crowded households. The presence of another heavy drinker or dependent in the household was associated with heavy drinking but not with dependence. CONCLUSIONS: The study characterized a detailed pattern of alcoholic beverage use and indicated that at risk drinking is an important public health problem in a developing country. The risk factors for heavy drinking and dependence were the same, with the exception of age at starting to drink, heavy drinking or dependence-positive household members.

Adult↗

PubMed1985

Absorption, distribution and elimination of alcohol: highway safety aspects.

Key aspects of the pharmacokinetics of alcohol are highly relevant to highway safety. Of particular pertinence are the partition of alcohol between various body tissues and fluids and the resulting alcohol concentration ratios for blood: breath and other body fluids, as well as the irregularity and short-term fluctuations of the blood and breath alcohol curves. Most alcohol pharmacokinetics parameters are subject to wide intersubject variability, as exemplified by peak blood alcohol concentrations reached on ingestion of identical weight-adjusted doses, time to peak after end of drinking and the rate of alcohol elimination from the blood. This great biological intersubject variability, when combined with sex-, age- and time-related differences, makes the blood alcohol information in widely distributed alcohol consumption nomograms and tables based on mean data inappropriate as a guide for the drinking behavior of individuals. Although there is good statistical correlation between the alcohol concentration of different body tissues and fluids in the fully postabsorptive state, wide individual variations from the population mean alcohol partition values exist. It is often impossible to determine whether the postabsorptive state has been reached at any given time. Those factors make it impossible or infeasible to convert the alcohol concentration of breath or urine to the simultaneous blood alcohol concentration with forensically acceptable certainty, especially under per se or absolute alcohol concentration laws. Inclusion of breath alcohol concentrations in drinking-driving statutes, as definitions or per se offense elements, makes unnecessary the conversion of breath alcohol analysis results into equivalent blood alcohol concentrations. Urine alcohol concentrations are inadequately correlated with blood alcohol concentrations or with driver impairment, and analysis of bladder urine is, therefore, inappropriate in traffic law enforcement. Significantly large sex-related differences in pharmacokinetic parameters have been demonstrated (e.g., in peak blood alcohol concentrations for weight-adjusted doses). The effects of age and time of day have been less extensively studies and are less clear. Breath and blood alcohol time curves are subject to short-term fluctuations from the trend line and other irregularities, and often do not follow the typical Widmark pattern. From the existing information on pharmacokinetics of alcohol and the characteristics and variability of blood and breath alcohol versus time curves, the following conclusions can be reached.(ABSTRACT TRUNCATED AT 400 WORDS)

Accident Prevention↗

PubMed2006

Contribution of central nitric oxide to the regulation of blood pressure and sodium balance in DOCA-salt hypertension.

We examined whether central nitric oxide is involved in blood pressure (BP) regulation in deoxycorticosterone acetate (DOCA)-salt hypertension. DOCA-salt rats were intracerebroventricularly infused (ICV) NG-monomethyl L-arginine (L-NMMA) for 4 weeks at either low (0.08 mg/kg/d; n = 8) or high (0.16 mg/kg/d; n = 8) dose. Saline ICV (n = 9) and intraperitoneal infused L-NMMA (low, n = 6; high dose, n = 6) were served as controls. Also, L-NMMA ICV (low, n = 6; high dose, n = 6) was conducted in normal rats. At week 3 and after, DOCA-salt with low L-NMMA ICV showed a higher BP than saline ICV (at week 4: 167.4 +/- 3.6 vs. 150.3 +/- 3.9 mm Hg, P < 0.01); this difference of BP was cancelled after ganglionic block. High L-NMMA ICV did not affect the trend of BP; however, it caused a reduced amount of saline drinking and a less estimated sodium retention than saline or low L-NMMA ICV (for 3 wk; 47.5 +/- 1.1 vs. 66.0 +/- 3.7 and 61.7 +/- 2.5 mmol, P < 0.01). In normal rats, high, but not low, L-NMMA ICV elevated BP with no effect on drinking behavior. Intraperitoneal infused L-NMMA did not affect the development of hypertension and/or sodium balance. These data suggested that, in DOCA-salt, central nitric oxide is involved in BP regulation through the dual action on sympathetic nervous activity and sodium balance.

Animals↗

PubMed1986

Lithium compliance in alcoholic males: a six month followup study.

One hundred alcoholic patients were followed at monthly outpatient clinics for 6 months. Half were assigned low to moderate doses of lithium carbonate and half to chlordiazepoxide (10 mg tid) (active placebo). Drinking behavior and medication compliance were monitored at monthly clinics. After 6 months 52% of the lithium and 44% of the chlordiazepoxide patients were medication compliant. Of the 48% remaining in the lithium group, 14% did not return for a single visit while 14% came only once. Twenty percent came to clinic regularly; however they had never taken the medication as assigned. Of the 56% non-compliant chlordiazepoxide patients, 16% did not attend a single clinic; 24% came only once or twice and the remaining 16% attended clinics regularly although they were never medication-compliant. Drinking days and the percentage of patients reporting abstinence for one or more months were determined for medication compliant patients and for patients who attended clinic regularly but who did not take medication. Data were analyzed by Kruskal-Wallis one way analysis of variance tests. While lithium and chlordiazepoxide compliant patients tended to report fewer mean drinking days per month (4.6 and 4.8 respectively) than the non-medication group (6.9) these differences were not significant; however, compared to 44% in the non-medication group, 60% of the lithium patients and 58% of the chlordiazepoxide patients reported having significantly more months of abstinence (p less than .05). These results do not show that lithium is differentially efficacious in reducing alcohol consumption.

Adult↗

PubMed2003

Effects of concurrent access to a single concentration or multiple concentrations of ethanol on the intake of ethanol by male and female periadolescent alcohol-preferring (P) rats.

The objectives of this study were to assess the effects of access to different concentrations of ethanol and sex of the animal on ethanol consumption during periadolescence [postnatal days (PNDs) 30-60] in alcohol-preferring (P) rats. On PND 28, female and male P pups were single housed in hanging stainless steel cages with ad libitum access to water and food. Beginning on PND 30, the rats were also given access to either a single concentration [15% volume/volume (vol./vol.)] or multiple concentrations [10%, 20%, and 30% (vol./vol.)] of ethanol. Differences between sex (male vs. female) and ethanol conditions (single concentration vs. multiple concentrations), for the average amount of ethanol consumed for each week (starting on PND 33) of access, were examined. Analyses of the data for ethanol drinking revealed significant (P<.025) main effects of week and ethanol condition, as well as a significant weekxethanol condition interaction. For the first week, both male and female P pups consumed more ethanol under the multiple-ethanol-concentration condition than under the single-ethanol-concentration condition. However, across the second through fourth weeks, this pattern was seen only in female P pups. When preference for one concentration of ethanol over the other concentrations was assessed, it was found that male P pups tended to choose the 30% concentration over the 10% and 20% concentrations, whereas female P pups did not display a preference. The findings of this study corroborate previous work indicating that periadolescent P rats readily acquire high-ethanol-drinking behavior and that, similar to adult P rats, concurrent access to multiple concentrations of ethanol further enhances ethanol intake. These findings suggest to us that innate genetically influenced mechanisms promoting high ethanol intake are present at this stage of development.

Aging↗

PubMed1995

Injury as a motivator to reduce drinking.

OBJECTIVES: To identify predictors of readiness to change drinking behavior by minor-injury patients who had positive saliva alcohol tests (SATs) in the ED. To develop and test a model intended to be prognostic of readiness to change, which included predispositional and injury-event-related variables. METHODS: An on-site survey was conducted of minor-injury ED patients sampled consecutively during predesignated periods. Patients were identified as SAT-positive during their screening evaluations. After giving their consent, they were administered a self-report battery that assessed predispositional and injury-event-related variables as well as readiness to change their drinking. Predictors of readiness to change drinking were tested with regression analyses. RESULTS: Twenty-four SAT-positive patients participated; there were 18 men and six women (average age 34 years). Preinjury predispositional variables were by themselves unrelated to the patient's readiness to change while in the ED. Aversiveness of the injury and perception of degree of alcohol involvement were injury-event-related variables predictive of readiness to change (p < 0.008). Negative consequences attributed to drinking prior to the injury event strengthened the association of injury aversiveness and alcohol involvement with readiness to change (p < 0.0075). CONCLUSION: Interventions to decrease drinking in this population should focus on increasing patient awareness of the association between drinking, injuries, and other alcohol-related negative consequences.

Adult↗

PubMed1988

Influence of rearing conditions on voluntary ethanol intake and response to stress in rats.

The effects of exposure to four environmental rearing conditions on subsequent voluntary ethanol intake and response to immobilization stress were examined. Male weanling rats were reared in an enriched environment, with a female partner, with a male partner, or individually, for 90 days. At 111 days of age, voluntary consumption of ethanol in increasing concentrations (3 to 9%, v/v) was assessed. Following the ethanol-exposure period, rats were randomly divided into stressed and nonstressed groups and exposed to 3 h of immobilization. Results indicated that the enriched animals consumed greater amounts of ethanol as compared to all other groups, suggesting that the enriched environment and not handling, housing conditions, or the presence of another male or female is responsible for the observed increase in ethanol drinking behavior. Ulcer data indicated that among environmentally enriched rats, ethanol attenuated stress ulcer development relative to their non-ethanol-exposed but stressed controls. In nonstressed enriched rats, ethanol alone exacerbated stomach damage. We suggest that environmental rearing conditions markedly influence the complex interaction between ethanol intake and the response to stress.

Alcohol Drinking↗

PubMed1983

"Never believe an alcoholic"? On the validity of self-report measures of alcohol dependence and related constructs.

A study of 114 male and female alcoholics was conducted to evaluate the validity of information obtained by means of self-report questionnaires. Factor analysis was used to derive composite measures of alcohol dependence, withdrawal symptomatology, pathological intoxication, and alcoholic psychosis. Validation was conducted by comparing these measures with independent and external criteria; that is drinking estimates made by collateral informants, measures of general alcohol involvement, and drinking behavior 6 months after treatment. The results support each type of validity, and thereby contradict the assumption that the alcoholics' self-reports were not accurate. The question of unreliable self-report data due to the demand characteristics of the situation under which the information is obtained is also addressed.

Adult↗

PubMed1984

Alcohol use patterns of graduate students in social work and in business.

This comparative study is among the first to survey the drinking behavior of graduate students in social service (N = 256) and in business (N = 147). A large majority (88%) drank. A significantly greater number of social service students abstained. Irrespective of school, age or religion, men and women drank at a similar level of frequency--several times weekly. Only business school women, controlling for age and religion, were significantly heavier drinkers than were women in social service. Older Hispanic social service men were significantly lighter drinkers than similar Caucasians. All women preferred wine, whereas men had no particular beverage preference. Although there was no significant difference in the location of drinking--in bars, restaurants or at home--most students drank in restaurants. Irrespective of previous course work or work experience with alcoholics, social service students wanted alcohol education. However, business students showed almost no interest in this area of study, despite the known deleterious role that alcohol misuse plays in the employment arena. Major conclusions are that both business and social service students lack alcohol education, although most drink. This is an important blind spot among business students, who will be making critical business decisions. It is also inadequate preparation for social service practice.

Adult↗

PubMed1996

Enhanced water intake after asymmetric hindbrain lesions.

Previous reports indicate rats with lesions of the lateral parabrachial nucleus (IPBN) or lesions of the area postrema (AP) and adjacent nucleus of the solitary tract (NTS) consume abnormally large amounts of water after treatment with SC isoproterenol (ISOP) or angiotensin II. In the present study, we found that IPBN bilateral lesions resulted in increased water intake after ISOP treatment as noted previously. We also found that rats with ibotenic acid lesions of the left IPBN and a knife cut on the right side of the AP drank an abnormally large amount of water after treatment with ISOP. Interestingly, rats with lesions of the right IPBN and a knife cut on the left side of the AP did not show the enhanced drinking behavior. Rats with AP and adjacent NTS lesions had an increased sodium appetite, but water intake after ISOP treatment was not enhanced. Bilateral IPBN lesions and asymmetric lesions of the AP and IPBN did not result in enhanced sodium appetite. These data suggest that a pathway from the AP/mNTS to the 1PBN is important in the regulation of fluid balance.

Animals↗

PubMed1996

The role of heavy drinking in the risk of traffic fatalities.

Recent studies have identified a "hard core" of drinking drivers who do not fit a "social" drinker profile and may require medical intervention. This article builds on these studies by quantifying the role of heavy drinking in motor vehicle fatalities. Data on male alcohol-involved fatally injured drivers (AIFIDs) were obtained from the U.S. Fatal Accident Reporting System (FARS) for the years 1989-1990 (n = 8876). The AIFIDs were grouped into either a "heavy" or "light" drinking category based on drinking behaviors inferred from prior driving records and blood alcohol concentrations (BAC). The majority of male AIFIDs were between the ages of 20-39 (70%). Sixty-five percent had a BAC of 150 mg/dl or greater, and 41% had a BAC in excess of 200 mg/dl. AIFIDs with high BACs were more likely to have histories of DUI convictions and license suspensions than AIFIDs with low BACs. According to the study's criteria, 73% percent of the AIFIDs could be classified as "heavy" drinkers. There were no driving variables that differentiated the heavy and light drinker groups, indicating that heavy drinking per se is the primary factor that distinguishes the groups. Male alcohol-involved fatally injured drivers are comprised mostly of heavy drinkers who may suffer from serious drinking problems or alcoholism. Successful interventions may require medical treatment as well as punitive criminal justice policies.

Accidents, Traffic↗