Stop Alcohol Addiction

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. More here...

Alcohol Free Forever Summary


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Alcohol Withdrawal DRG cew 434

ithdrawal is a pattern of physiological responses to the discontinuation of a drug. Although most central nervous system (CNS) depressants produce similar responses, alcohol is the only one in which withdrawal is life threatening, with a mortality rate of about 25 . Withdrawal symptoms should be anticipated with any patient who has been drinking the alcohol equivalent of a six-pack of beer on a daily basis for a period of 6 months smaller patients who have drunk less may exhibit the same symptoms. Alcohol withdrawal involves CNS excitation, respiratory alkalosis, and low serum magnesium levels, leading to an increase in neurological excitement (Table 6). 52 Alcohol Withdrawal TABLE 6 Pathophysiology of Alcohol Withdrawal TABLE 6 Pathophysiology of Alcohol Withdrawal

Twin Studies of Alcoholism

That risk-related behaviors are evident early in life, remain stable into adolescence, and are associated with a family history of alcoholism suggests that those behaviors are, at least in part, of genetic origin. To establish that, researchers must use genetically informative study designs. One approach is to study child or adolescent twins and their parents. Several such studies, which specifically assess the initiation of alcohol use and the transition to alcohol abuse, are being conducted throughout the world. We illustrate with two ongoing studies from Finland. The ratings include multidimensional scales (i.e., scales that rate various characteristics) of behaviors associated with increased alcoholism risk. Two years later, at age fourteen, the twins were followed up, and, while most reported abstinence, about one-third were then using alcohol.

Alcoholism in Humans

Again, alcohol use and abuse provide an illustration. Alcoholism is a major social and medical problem in the United States and in most of the world. It is estimated that 10 percent of men and 4 percent of women in the United States experience alcohol dependency, at a cost of billions of dollars and 100,000 lives annually. Because use of alcohol is typically part of social interactions, familial (and possibly genetic) factors would be expected to contribute to variation in drinking. But where shall we begin its study Perhaps with diagnosed alcoholism Most adults in our society use alcohol, yet only a fraction of them ever experience clinical symptoms of alcoholism. Perhaps we should begin much earlier, studying the decision to begin drinking Obviously, one cannot become alcoholic without initiating drinking and then drinking large quantities regularly and with high frequency. Or perhaps much earlier yet, for behavioral predictors of alcoholism can be identified years before alcohol is...

Genetic Considerations

Susceptibility to alcohol abuse appears to run in families and is the subject of vigorous ongoing investigations to locate genes that contribute. It is probable that the effects of multiple genes and environment are involved in alcoholism. Twin studies have shown a stronger concordance between identical than between nonidentical twins (55 or greater concordance for monozygotic twins and 28 for same sex dizygotic twins). Genetic differences in alcohol metabolism may result in higher levels of a metabolite that produces pleasure for those with a predisposition toward alcohol abuse.

Gender Ethnicracial And Life Span Consideration

Overuse and abuse of alcohol are seen in all age groups and in females and males. More and more teens are identified as alcohol-dependent and should have their drug or alcohol usage assessed on admission to the hospital or clinic. Binge drinking (more than five drinks at one time for males and four for females) is a growing problem among college students. Approximately 70 of people who are alcohol dependent are males, but women are more likely to hide their problem. Of growing concern is the number of elderly who are abusing alcohol as a way to deal with their grief, loneliness, and depression. Ethnicity and race have no known effects on alcohol withdrawal.

Primary Nursing Diagnosis

Upon assessment of a pattern of heavy drinking, the patient is often placed on prophylactic benzodiazepines. These medications are particularly important if the patient develops early Although sedation should prevent withdrawal, if withdrawal occurs patients will often require intravenous hydration, with fluid requirements ranging from 4 to 10 L in the first 24 hours. Hypoglycemia is common, and often a 5 dextrose solution in 0.90 or 0.45 saline will be used. Monitor and replace electrolytes as necessary because people with alcohol dependence often have low calcium, magnesium, phosphorous, and potassium.

Discharge And Home Healthcare Guidelines

Following an alcohol withdrawal experience, the patient may be able to accept that he or she has a problem with alcohol abuse. Discharge plans may include behavior modification programs, sometimes in conjunction with disulfiram (Antabuse) or participation in AA. Families must also be involved in the treatment planning to gain an understanding of the part that family dynamics play in people who are alcohol dependent.

Alcoholrelated Dementia

The existence of alcohol-related dementia is complicated by the various syndromes described in individuals who abuse alcohol, as well as other possible comorbidities contributing to cognitive dysfunction in these individuals (vitamin B12 deficiency, subdural hematomas and head injuries, cerebrovascular disease, etc.). Knowledge about whether alcohol abuse may be a risk factor for other dementias is also sparse. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), classification relies on alcohol use to identify alcohol-related dementia, a process that may be subjective or based on limited information. Oslin et al. propose diagnostic criteria following the model used in the National Institute of Neurological and Communicative Diseases and Stroke Alzheimer's Disease and Related Disorders Association (NINCDS ADRDA) criteria for Alzheimer's disease (AD). It also uses cutoffs for heavy drinking of 28 drinks per week for women and 35 for men. As the authors...

Heritability in Humans

Most family, twin, and adoption studies have shown that addiction to alcohol has significant heritability. For example, there is an increased risk for alcoholism in the relatives of alcoholics. Depending on the study, the risk of alcoholism in siblings of alcoholics is between 1.5 and 4 times the risk for the general population. The identical twins of alcoholics (who share 100 percent of their genes) are more likely to be alcoholics than the fraternal twins of alcoholics (who share only about 50 percent). Adoption study data suggest that the risk for developing alcoholism for adopted children is influenced more by whether their biological parents were alcoholics than whether their adopted parents are alcoholics, suggesting that genes contribute to alcoholism more than environment. Similar but less extensive data has been collected for nicotine addiction. Very little genetic epidemiological data has been collected for illegal drugs. The only genes that have been conclusively shown to...

Gene Regulation and Protein Synthesis

Galton's ideas swept America during the Progressive Era of the early twentieth century. At that time, many scientists and laypeople believed that eugenics could facilitate social progress by eradicating problems ranging from alcoholism and prostitution to poverty and disease. What better way to prevent such misfortunes, eugenicists asked, than to prevent the birth of people genetically susceptible to them Eugenics seemed to offer an efficient and humane solution to society's ills. Unfounded hope in this imperfect science, however, ultimately contributed to repressive social policies, including marriage and immigration restriction, forced sterilization, segregation, and, in the case of Nazi Germany, euthanasia (mercy killing) and genocide, all in the name of human betterment.

Effects Of Corporal Punishment

As the frequency of CP administered to a child is increased, so too are the negative effects, including an increased probability of alcohol abuse, as well as children repressing feelings of anger, resentment, and humiliation, resulting in them becoming especially prone to suicidal thoughts, suicide, and depression (Straus & Kantor, 1994).

Genetic Engineering and Society

Other risks exist in the uses of biotechnology. From the late nineteenth century until World War II, a school of thought called eugenics suggested that the methods of genetics should be turned to improving the human gene pool. This idea led to forced sterilization first, of various criminal populations, and eventually, of alcoholics and epileptics. The

Complex Behaviors Complex Causes

Thus, for use and abuse of alcohol, we know that the importance of genetic and environmental effects changes with sequencing in the use and abuse of alcohol, from abstinence or initiation to frequency of regular consumption, to problems associated with consumption, and ultimately, to diagnosed alcoholism and end-organ damage from the cumulative effects of alcohol. Similar stories could be told for many other behaviors of interest. Thus, for the major psychopathologies, from depression and schizophrenia in adults to attention deficit disorder in children or eating disorders in adolescents, genetic influences are invariably part of the story but never the whole story.

Gender Ethnicracial And Life Span Considerations

Hispanic persons, than in other populations. Alcohol dependence and alcoholic liver disease are more common in minority groups, particularly among Native Americans. Primary biliary cirrhosis is more common in Northern Europeans and is less common in populations of African descent.

Molecular epidemiology

Confounding is the effect of a third variable that influences the exposure-disease relationship under study and is very important in epidemiology. The confounder variable is associated with the exposure being studied and is an independent risk factor for the health outcome under analysis. A cohort study on the relation between alcohol intake and risk of lung cancer might find a relative risk. However, people who consume alcohol often smoke (a confounding variable). Smoking is a known risk factor for lung cancer. Confounding variables usually have a stronger effect than the exposure under study. To find the correct relative risk of alcohol on lung cancer, either the study population has to be restricted to nonsmokers or else smokers and nonsmokers have to be separated. Therefore, a corrected estimate of the relative risk can be obtained by calculating a weighted average of the stratum-specific relative risks for smokers and nonsmokers, which usually involves statistical procedures to...

Multiple Lumbar Spine Surgery Failed Back Syndromes

Patients with profound emotional disturbances and instability (e.g., alcoholism, drug abuse, depression) and those involved with compensation and litigation should undergo a thorough psychiatric evaluation. Even if they are found to have a genuine neurosurgical problem, the psychosocial problem should be dealt with first, as additional low back surgery would otherwise fail again. After exclusion of the psychosocial group of patients, a smaller group of patients with back and or leg pain due to mechanical instability or scar tissue remains only those patients with mechanical instability will benefit from additional surgery.

Pharmacologic Highlights

Other Drugs Analgesics may be ordered for bone pain. Monitor the effectiveness of the pain medications. Avoid administering antacids that contain aluminum. If the patient develops alcohol withdrawal, the treatment of choice is the benzodiazepine class of medications. as possible. If the patient develops signs of alcohol withdrawal (restlessness, insomnia, thirst, and tremors progressing to fever, hallucinations, and combative and irrational behavior), notify the physician and decrease stimulation as much as possible. Place the patient in a quiet, darkened room with a cool temperature. Provide frequent sips of water and fruit juices, but avoid fluids with caffeine. Place the patient in a room where she or he can be monitored frequently to decrease the risk of injury.

Developmental Toxicants Which May Act Via Folate Perturbation

Alcohol is clearly a developmental toxicant in humans and animal models (reviewed in ref. 37). In humans, the fetal alcohol syndrome (126) consists of craniofacial, cardiovascular, and limb defects. Romitti et al. (89) found an association between cleft lip with without cleft palate and alcohol use, but Shaw et al. (91) did not find such an association between neural tube defects and alcohol use. Folate deficiency is associated with chronic alcohol abuse (127) however, the mechanism for the deficiency is unknown. Alcoholics tend to have poor dietary intake of folate (128). Alcohol has also been reported to decrease intestinal absorption of folate (129,130), although other studies have disputed this effect (131,132). Increased urinary excretion of folate has also been reported (133,134), although this effect does not appear to be the result of altered binding of folate by brush-border membranes in the rat kidney (135). Finally, alcohol has been reported to alter hepatic metabolism of...

Viruses Affecting the Pancreas

Some studies have suggested that enteroviruses, particularly coxsackie B viruses, may cause acute pancreatitis although the commonest etiological factors are biliary disease and alcohol abuse. In order to assess the incidence of enteroviruses as a cause of acute pancreatitis, large-scale multicenter clinical and virological studies are required, employing some newly developed virological techniques.

Description Surgical Tracheostomy for Face

Cancer of the larynx is more common in men than in women (5 1 ratio) because, heretofore, men have been more likely to smoke cigarettes and drink alcohol, but the incidence in women is rising as more women also smoke and drink. Cancer of the larynx occurs most frequently between the ages of 50 and 70. Women are more likely to get laryngeal cancer between the ages of 50 and 60 and men between the ages of 60 and 70. Laryngeal cancer is 50 more common in African Americans than in whites. HISTORY. Be aware as you interview the patient that hoarseness, shortness of breath, and pain may occur as the patient speaks. Obtain a thorough history of risk factors alcohol or tobacco usage, voice abuse, frequent laryngitis, and family history of laryngeal cancer. Obtain detailed information about the patient's alcohol intake ask about drinks per day, days of abstinence, and patterns of drinking. Ask the patient how many packs of cigarettes he or she has smoked per day for how many years.

Hypokalemia and Hypomagnesemia

Thiazide, because magnesium is absorbed mainly along the thick ascending limb. Moreover, chronic magnesium deficiency prevents correction of associated hypokalemia and this is one reason why potassium-sparing diuretics, which are also magnesium-sparing (particularly amiloride and triamterene), are more effective in treating hypokalemia than oral KC1 supplements. Hypokalemia, hypomagnesemia, and hypertriglyceridemia are more likely to be found in hypertension associated with excessive alcohol intake.

Description Surgical Stomach Esophageal

Mallory-Weiss syndrome, first described in people with alcohol dependence, is now recognized across the life span but is most common in men over the age of 40. In women, hyperemesis gravidarum, which in the first trimester of pregnancy causes persistent nausea and vomiting. There are no known ethnic or racial considerations.

Compression within the Spiral Groove of the Humerus

Lesions of the radial nerve occur most commonly in this region. The lesions are usually due to displaced fractures of the humeral shaft after inebriated sleep, during which the arm is allowed to hang off the bed or bench (Saturday night palsy), during general anesthesia, or from callus formation due to an old humeral fracture. There may be a familial history, or underlying diseases such as alcoholism, lead and arsenic poisoning, diabetes mellitus, polyarteritis nodosa, serum sickness, or advanced Parkinsonism.

Patients And Methods

Patients of both sexes, aged between 17 and 72 years, with clinical symptoms such as epigastric pain, dyspepsia, heartburn, or anorexia, were enrolled in this open, noncomparative study. They were included in the study on the basis of endoscopic findings (endoscopic appearance of duodenal ulcer, measuring between 5 and 20 mm in longest dimension, or endoscopic appearance of antral erosions, spotty erythema of antral mucosa, pale areas, goose-pimple-like appearance of antral mucosa, fine spotty erythema of the body of the stomach), histologically defined gastritis (by the Sidney system), and HP seropositivity (ELISA IgG > 1.0 U), Patients were excluded if they had received nonsteroidal antiinflammatory drug therapy, corticosteroids, antimicrobial drugs, or bismuth salts within 4 weeks prior to entry or antiulcer medications within 2 weeks prior to entry. Patients with evidence of chronic renal or liver disease, gastric surgery or vagotomy, pregnancy, and chronic alcohol abuse were...

Major Depression And Tissue Composition Studies

Symptoms (Ellis et al., 1977 Fehily et al., 1981), unfortunately these studies lacked diagnostic specificity, did not control for alcoholism or smoking, and did not specify the use of psychotrophic medications. Following those initial reports, eight studies have reported that lower concentrations of n-3 fatty acids in plasma or red blood cells (RBCs) predicted depressive symptoms (Adams et al., 1996 Maes et al., 1996 Peet et al., 1998 Edwards et al., 1998a Edwards et al., 1998b Peet et al., 1999 Maes et al., 1999 Hibbeln et al., 2000). Adams et al. (1996) were the first to report that lower measures of DHA in the phospholipids of red blood cells (r 0.80, p < 0.01) and a greater aracidonic acid (AA) to EPA ratio (r 0.73, p < 0.01) predicted more severe depressive symptoms. Edwards et al. (1998) carefully controlled common confounding factors that would alter omega-3 status among depressed subjects by controlling for both alcohol consumption and cigarette smoking while also...

Risk Taking and Substance Abuse

If the creative act brings satisfaction and fulfillment, why do creative people often have affective disorders such as depression In addition to having a high prevalence of affective disorders, creative people, especially writers, composer-musicians, and fine artists, have a very high rate of substance abuse, such as alcoholism (Post, 1994, 1996). As I mentioned in the chapter on neurotransmitters (chapter 8), although creative people often go through many trials and tribulations to accomplish creative endeavors, creativity itself probably does not induce affective disorders, but rather the people who are creative probably have some of the anatomic, physiological, or neurotransmitter abnormalities that the midbrain to the nucleus accumbens, and this nucleus is a portion of the ventral striatum, which I describe in more detail later. The ventral striatum and its connections to the limbic system (e.g., amygdala) have been posited to be critical for alcohol addiction. Tupala and...

Human Data On Omega3 Fatty Acids And Neurotransmitter Metabolites

Correlational data from human studies are consistent with the proposition that omega-3 status is related to cerebrospinal fluid (CSF) neurotransmitter metabolite concentrations. We observed that plasma concentrations of DHA and AA predicted CSF 5-HIAA and CSF homovanillic acid concentrations in 234 subjects (Hibbeln, 1998a Hibbeln et al., 1998b). In healthy control subjects and late-onset alcoholics, higher concentrations of plasma DHA predicted higher concentrations of CSF 5-HIAA. It is remarkable that this correlational relationship was found between a cerebrospinal fluid measure of a neu-rotransmitter metabolite and a plasma level of a fatty acid. We have also replicated this finding among 104 adult rhesus monkeys. Higher concentrations of the omega-3 fatty acids DHA and EPA in plasma predicted higher concentrations of CSF 5-HIAA (Hibbeln, et al., unpublished data). Among these animals, higher EPA and DHA plasma concentrations also predicted more functional dominance behaviors....

Putative Mechanisms Involving Folate Metabolism That May Explain The Above Disorders

Chromosome breakage and DNA methylation are both thought to be factors in the development of certain cancers. Those with an etiology linked to C677T MTHFR include colon cancer (9,121) and acute lymphoblastic leukemia (11). As mentioned earlier, other cancers have also been associated with folate status. These include premalignant cervical cancer (7) and squamous metaplasia of the bronchial epithelium (8). The most recent work on folate and the development of cancer suggests low levels of the vitamin are a risk for breast cancer when associated with high alcohol intake (10), with

Pathogenesis and Clinical Disease

Other agents of viral hepatitis, alcohol intake, and iron overload. Extrahepatic manifestations can also occur in association with HCV infection, typically manifesting as skin and renal disease caused by a systemic vasculitis involving immune complexes with viral proteins.

Treatment of infertility

All couples trying for a pregnancy will benefit from some general advice such as cessation of smoking and limiting alcohol intake. Pre-treatment counselling should include advice about general lifestyle measures including the need to achieve an optimum BMI. This will involve weight loss in women with a BMI of over 30, but may require some

Nonendocrine agerelated abnormalities

Although endocrine factors appear to be the major cause of age-related bone loss, there are important non-endocrine factors that also contribute. The level of bone mass present prior to the onset of age-related bone loss is clearly important those persons who have high levels are relatively protected against osteoporosis whereas those with low levels are clearly at a greater risk. As has been long recognized, there are a number of episodic factors that increase bone loss in some, but not other, members of the ageing population. These include use of certain drugs such as corticosteroids, diseases such as malabsorption, anorexia nervosa and renal hypercalciuria, and behavioural factors such as smoking, alcohol abuse and inactivity to enumerate but a few. These may make major contributions to fractures in about 40 of men and 20 of women (Riggs et al 1986).

Charcot Neuroarthropathy

Charcot neuroarthropathy is a noninfectious progression of joint destruction characterized by pathological fractures and joint dislocations. Although it was initially described by Musgrave in 1704, its name was attributed to J.M. Charcot in 1868 (116). The disease involves joint destruction of accompanying common diseases that manifest with peripheral neuropathy, such as leprosy, tertiary syphilis, chronic alcoholism, and spina bifida (117). Diabetes mellitus is currently the primary cause of Charcot neuroarthropathy.

Sleepwalking and sleep terrors overview and clinical description

Categorized as non-violent (NV, N 26, 11 male), potentially harmful (PH, N 12, 6 male), and violent (V, N 26, 22 male). Histories of childhood abuse were found in 4 female cases (3 NV, 1 PH). Current DSM-III axis I diagnoses were described in 13 64 (20 ) of cases. Alcohol abuse (as a stressor associated with sleep-related behavior, not necessarily an axis I disorder) was noted in 11 64 (17 ) and some prior history of drug abuse in 24 64 (38 ). There was no systematic association between the sleep disorders and any psychiatric diagnosis and, on the SCL 90, there was no difference between the three groups 44 .

Fatty Acid Ethyl Esters As Markers Of Ethanol Intake

Fatty Acid Intake America

Because of the long half-life of FAEEs in adipose tissue, it was suggested that FAEE in adipose tissue could be a laboratory marker for previous alcohol intake, particularly for forensic applications where adipose tissue samples can be readily obtained. In postmortem samples from four chronically intoxicated subjects whose blood ethanol levels were zero, it was demonstrated that prior ethanol ingestion could be established by the presence of FAEEs in the adipose tissue (Laposata, 1989). In this report, a separate series of experiments determined the half-life of FAEEs to be 16.6 h in the adipose tissue of rabbits that received 10 ethanol in their drinking water for 10 mo.

Role of Complement in Ethanol Induced Liver Injury

Alcoholic liver disease (ALD) develops in approximately 20 of all alcoholics with a higher prevalence in females (Lieber 1994). The development of fibrosis and cirrhosis is a complex process involving both parenchymal and non-parenchymal cells resident in the liver, as well as the recruitment of other cell types to the liver in response to damage and inflammation (Gressner and Bachem 1995). The progression of the alcohol-induced liver injury follows a pattern characteristic to all types of liver fibrosis, regardless of the causative agent. This progression is marked by the appearance of fatty liver, hepatocyte necrosis and apoptosis, inflammation, regenerating nodules, fibrosis and cirrhosis (Martinez-Hernandez and Amenta 1993). Fibrosis is thought to be initiated in response to hepatocellular damage, with inflammatory processes contributing to the progression of the disease (Gressner and Bachem 1995). Interestingly, many of the events involved in the development of fibrosis are...

Relapse prevention model

Relapse is a breakdown or setback in a person's attempt to change or modify target behaviour. The relapse prevention model was developed to treat addictive behaviours, such as alcoholism and smoking (Marlatt and Gordon, 1985). The model proposes that relapse may result from an individual's inability to cope with situations that pose a risk of return to the previous behaviour. For example, a former smoker finds himself or herself in a social situation with lots of smokers and is tempted to smoke. Thus, helping the individual to acquire strategies to cope with high-risk situations will both reduce the risk of an initial lapse and prevent any lapse from escalating into a total relapse. Simkin and Gross (1994) assessed coping responses to high-risk situations for exercise relapse (e.g. negative mood, boredom, lack of time) in 29 healthy women who had adopted exercise without formal intervention. The participants' activity levels were measured weekly for 14 weeks. The study found that 66...

Bernard E Bulwer MD MSc and Scott D Solomon MD

Enzyme inhibitor, furosemide, and digoxin. Investigations revealed no clear cause of his cardiomyopathy, but he admitted a 20-yr history of excess alcohol intake. An echocardiogram done at that time reported an ejection fraction of less than 20 . Cardiac catheterization was normal except for a 30 stenosis of the midleft anterior descending artery.

Necrotizing Fasciitis

Frostbite Histopathology

INTRODUCTION Necrotizing fasciitis is an uncommon and severe invasive soft tissue infection characterized by cutaneous gangrene, suppurative fasciitis, and vascular thrombosis. The disease is usually preceded by penetrating trauma in patients that have systemic problems, most commonly diabetes, alcoholism, and immunosupression, but may occur after blepharoplasty or other eyelid surgery. Necrotizing fasciitis represents a synergistic polymicrobial soft tissue infection with the release of endogenous cytokines and bacterial toxins. The disease is most frequently attributed to group A Streptococcus and Staphylococcus aureus. The mortality rate overall is 34 , and for those cases with periorbital involvement it is 12.5 . Death usually results from a fulminant course that may lead to septic shock, respiratory distress syndrome, and renal failure. The average age at time of infection is 57 years, but it may be seen in all age groups.

Tertiary prevention of hypothyroidism Avoiding Complications

Potential complications of recognized hypothyroidism and its treatment are preventable with sustained thyroxine therapy and appropriate clinical and laboratory monitoring. Myxedema coma is a life-threatening syndrome of multisystem organ failure resulting from prolonged profound thyroid hormone deficiency, usually with superimposed sepsis, drug intoxication, or an ischemic vascular event (52). Anecdotally, the hypothyroid patient who is elderly or has a history of previous noncompliance, other systemic illness, alcohol abuse, social isolation, and economic deprivation is at greatest risk. A second potential complication in hypothyroid patients who are suboptimally treated is persistence of risk factors for atherosclerosis. In this setting, the serum low-density lipoprotien cholesterol (53) concentration may remain elevated. In one small trial of patients with treated hypothyroidism and ischemic heart disease undergoing follow-up coronary catheterization after angioplasty, the patients...

Mitochondrial Encephalopathies

Metabolic activity within the central nervous system is relatively high, making brain tissue especially vulnerable to mitochondrial respiratory chain abnormalities. Mitochondrial encephalopathies are multi-system diseases characterized by biochemical and genetic mitochondrial defects with differing clinical symptomatologies and brain area involvements. Mitochondrial encephalopathies are age-related with respect to disease onset, occurring mostly in infants and young children, but also in adulthood in some patients (Barisic et al., 2002 Komura et al., 2003 Kremer et al., 1993 Lofberg et al., 2001 Scaglia and Northrop, 2006 Tarnopolsky et al., 1998 Walter et al., 2002). Included in this group of mitochondrial dysfunction disorders are lactic acidosis with stroke-like episodes (MELAS) Leigh syndrome myoclonus epilepsy and ragged-red-fibers (MERRF) Kearns-Sayre syndrome (KSS) neuropathy, ataxia, and retinitis pigmentosa (NARP) mitochondrial neurogastrointestinal encephalopathy (MNGIE)...

Overestimation of Carbohydrate Intake

One of the most common reasons for recurrent hypoglycemia is injecting too much insulin or taking too much oral medication for the amount of carbohydrates ingested. You may overestimate the amount of carbohydrate in the food or eat less than planned, or you may be delayed in eating after taking the insulin or medicine. For example, a number of times, I have had patients inject a dose of insulin in the car before they went to a restaurant. At the restaurant, the food did not come at the expected time, and so their glucose level went low. Another example is when patients are asked to fast for a lab test (such as a lipid profile) they do not realize that they should delay taking their insulin or diabetic medicine until after the test. Drinking alcohol in excess (see Chapter 8), especially on an empty stomach, can also cause hypoglycemia.

Mendelian Inheritance Intelligence Testing and American Eugenics

The advent of intelligence testing in the 1900s provided a new way to quantify Galton's notion of genius. American eugenicists assessed an individual's eugenic worth by combining his intelligence quotient (IQ) with a Galtonian study of the family pedigree. Psychologist Henry Herbert God-dard published one famous study, The Kallikak Family, in 1912. Goddard traced two family lines that originated with a common male ancestor, whom he called Martin Kallikak (from the Greek words for beautiful kalos and bad kakos ). One branch appeared healthy and eugenic, descended from Martin's marriage to a respectable woman. The second branch was composed of Defective degenerates (alcoholics, criminals, prostitutes, and particularly the mentally feebleminded) born of Martin's dalliances with a feebleminded tavern mistress. Goddard thus proved the inheritance of feeblemindedness, and its social cost.

Primary Hypertriglyceridemia

In these disorders, the pathophysiologic mechanisms are not well defined. The clinical presentations depend on the degree of lipemia. Most patients manifest abdominal pain and pancreatitis, as well as eruptive xanthomas and lipemia retinalis. In some patients, associations with insulin resistance, hypertension, hyperuricemia, and obesity have been described (2). The laboratory diagnosis is characterized by elevated levels of VLDL, representing endogenously generated lipids, and by chylomicrons, representing exogenously acquired lipids. The degree of lipemia is variable but is clearly exacerbated by alcohol intake, administration of estrogens, uncontrolled diabetes, and obesity (2).

Transient Global Amnesia

These are features (see Table 55) that caution against, but do not firmly exclude, a diagnosis of frontotemporal lobar degeneration (FTLD). A history of alcohol abuse raises the possibility of an alcohol-related basis for a frontal lobe syndrome. However, excessive alcohol intake may also occur in patients with frontotemporal dementia (FTD) as a secondary manifestation of social disinhibition or hyperoral tendencies. The presence of vascular risk factors, such as hypertension, ought to alert investigators to a possible vascular etiology. Nevertheless, such risk factors are common in the general population and may be present coincidentally in some patients with FTLD, particularly in those of more advanced age.

Effects on Particular Organs or Organ Systems

Mechanisms that impair the release of triglycerides to the blood. Carbon tetrachloride and ethanol are among the substances that can cause this. Necrosis is caused by carbon tetrachloride, which forms free radicals in the liver, as well as by other halogenated hydrocarbons. Cirrhosis is the formation of scar tissue in the liver. It is also caused by carbon tetrachloride, although ethanol is most commonly associated with this condition. Although there is evidence to the contrary, the effect of ethanol may be related to nutritional deficiency associated with alcoholism. Cholestasis is an inflammation of the ducts carrying bile or a decrease in bile flow by other mechanisms. There are many types of liver cancer, and many chemicals are known to cause cancer in laboratory animals. The role of chemicals in human liver cancer is less clear, except for the notable case of vinyl chloride, which is known as a potent cause of angiosarcoma. Physical damage may target either the long axons by...

Environmental And Genetic Factors That Determine The Bioavailability Of Folic Acid And Vitamin B12

Alcoholism is associated with significantly reduced levels of tissue folate, vitamin B12, and vitamin B6 in humans at intakes greater than 3.0 g kg d, there was a doubling in the level of DNA hypomethylation of lymphocytes (57). The reduced folate level in alcoholics may be the result of reduced absorption or suboptimal dietary intake. However, if results in the rat model reflect the situation in humans, then there is a good probability that the microbial metabolism of alcohol can result in exceedingly high levels of acetaldehyde, which destroys folate in the intestine this has been shown to be associated with localized folate deficiency in the colonic mucosa (58).


There is some controversy about the relationship between alcohol and the ability to conceive. According to RESOLVE The National Infertility Association, even moderate alcohol consumption (five drinks per week) can impair conception. Other studies state that no definite link exists between moderate alcohol intake and the ability to become pregnant. Medical research studies have shown that women who partake in heavy alcohol consumption, more than six drinks per day, are more likely to suffer from irregular menstrual cycles and ovulation abnormalities. Heavy drinking has been shown to disrupt the normal menstrual cycle and reproductive function ranging from infertility and increased risk for miscarriage to impaired fetal growth and development, according to a 1993 study published by the National Institutes of Health.


Many people with chronic alcohol dependence have low magnesium intake because of inadequate nutrition. Compounding the problem is the loss of magnesium from the gastrointestinal tract that is caused by alcohol-related diarrhea and the loss of magnesium in the urine that is caused by alcohol-related diuresis. Maintaining magnesium levels in the normal range of 1.8-2.5 mEq L decreases neuromuscular irritability during withdrawal. Chronic alcohol use alters cell membrane proteins that normally open and close ion channels to allow electrolytes to enter and exit the cell. With the cessation of alcohol intake, the altered proteins produce an increase in neurologic excitement. Approximately 30 of the patients on a general hospital unit are alcohol-dependent however, only 2 of them have a diagnosis of alcohol dependence or alcoholism. The other 28 have been admitted for a variety of reasons. Illnesses such as esophagitis, gastritis, ulcers, hypoglycemia, pancreatitis, and some anemias can be...

Staying Sober

Franks, Mr. Edwards is an alcoholic and drank heavily for four years prior to the therapy. Dr. Franks uses a psychodynamic approach and incorporates behavioral techniques specifically designed to address the drinking problem. Two months into therapy when it became apparent that outpatient psychotherapy alone was not effective, Mr. Edwards agreed to attend Alcoholics Anonymous (AA) meetings as an adjunct to his therapy. During the past nine months of therapy Mr. Edwards had generally been sober, suffering only two relapses, each time falling off the wagon for a long weekend. Now, a year into therapy Mr. Edwards suffers a third relapse. He comes to the session having just had several drinks. During the session, Dr. Franks and Mr. Edwards conclude that some of the troubling material that has been emerging in the therapy had led Mr. Edwards to begin drinking again. At the end of the session, Mr. Edwards feels that he has gained some additional insight into...


In order to assess alcoholism, or any form of addiction, a clear definition of the condition is necessary. The American Psychiatric Association and the World Health Organization have developed clinical criteria (DSM-IV and ICD10, respectively) that are widely used for the diagnosis of substance-use related disorders. DSM-IV criteria recognizes ten classes of substances (alcohol, amphetamines, cannabis, hallucinogens, inhalants, nicotine, opioids, phencyclidine, and sedatives) that lead to substance dependence, another term for addiction.

The Opioid System

Historically, the nociceptive analgesic effect of naturally occurring opiates such as morphine has long been recognized by humans. Advances in research in the last several decades have revealed the existence of the so-called endogenous opioid peptides, can be divided into three classes dynorphins, enkephalins, and -endorphins. Contrary to the initial understanding, in addition to the cells of the central nervous system, those of peripheral tissues such as cardiac myocytes and heart tissues also express opioid peptides (1-3). The wide distribution of opioid peptides throughout the body underscores their involvement in a variety of cellular activities including pain regulation, respiration, immune responses, and ion channel activity (4) as well as possibly pathophysiological conditions such as asthma, alcoholism, and eating disorders (5-7).


Over the last 30 yr, the ever increasing realization of the involvement of opioid systems in a wide variety of physiological as well as pathophysiological conditions, beyond the initially described roles in the nociceptive analgesic systems, has certainly prompted an intensive screening of opioid receptor antagonists for potential therapeutic purposes. Because of its potent antagonistic activity, ease of crossing the blood-brain barrier, and relatively low systemic toxicity, (-)-naloxone has been tested for beneficial effects in a variety of experimental disease models. Mechanistically, the efficacy in the experimental treatment of conditions such as opiate dependence is certainly related to its activity as an opioid receptor antagonist (14), whereas in the treatment of eating disorders (15) and alcoholism (16), the opioid system most likely plays a role.

Antenatal education

Because alcohol passes freely across the placenta, women should be advised not to drink excessively during pregnancy. Current evidence suggests that there is no harm in drinking 1-2 units of alcohol per week. Binge drinking and continuous heavy drinking causes the fetal alcohol syndrome, characterized by low birthweight, a specific facies, and intellectual and behavioural difficulties later in life.


Diabetes mellitus Chronic alcoholism Malnutrition Obesity Liver cirrhosis Poor personal hygiene Immunosuppression Chronic steroid use Organ transplantation Chemotherapy for malignancy HIV AIDS Tuberculosis Syphilis Chronic alcoholism, malnutrition, liver cirrhosis, poor personal hygiene, and personal neglect are quite common in patients with Fournier's gangrene (Benizri et al. 1996 Hejase et al. 1996 Yeniyol et al. 2004). Other conditions causing depressed immunity that may predispose to the development of Fournier's gangrene include chronic steroid use, organ transplantation, chemotherapy for malignancies such as leukemia, as well as HIV infection (Paty and Smith 1992 Elem and Ranjan 1995 Heyns and Fisher 2005).

Nadp Nadph

A well-characterized neuropsychiatric disorder, the Wernicke-Korsakoff syndrome, is caused by transke-tolase hypoactivity (Blass and Gibson, 1977). The Wernicke-Korsakoff syndrome is characterized by a severe impairment of memory and of other cognitive processes accompanied by balance and gait dysfunction and by paralysis of oculomotor muscles. The syndrome is due to a lack of thiamine (vitamin B1) in the diet it affects only susceptible persons who are also alcoholics or chronically undernourished. Thiamine pyrophosphate is a thiamine-containing cofactor essential for the activity of transketolase. In patients with the Wernicke-Korsakoff syndrome, thiamine pyrophosphate binds 10 times less avidly to transke-tolase than to the enzyme of normal persons. This enzymatic dysfunction renders patients with the Wernicke-Korsakoff syndrome much more vulnerable to thiamine deficiency. This syndrome illustrates the ways in which an anomaly in a discrete metabolic pathway of energy metabolism...

Secondorder neuron

Significance Argyll Robertson pupil is traditionally ascribed to injury to the central parasympathetic pathway in the periaqueductal area. It is a classical sign of meningovascular syphilis (e.g., neurosyphilis, tabes, and general paresis). It is also occasionally seen in epidemic brain stem encephalitis, alcoholism, pinealomas, and advanced diabetes.


Nonhuman animals are currently the experimental organisms of choice for research geneticists interested in human diseases and other traits. The reason is simple the experimental work necessary to understand the genetic basis of a characteristic is often invasive and typically involves the rapid breeding of large numbers of offspring, procedures that cannot readily be applied to humans. For example, in research that focuses on the genetics of a behavior in mice* that may be similar to alcoholism in humans, it is necessary to inject mice with a standard dose of alcohol so that researchers can assess its effect on them. Animals also have to be euthanized (see EUTHANASIA) so that we can do necessary analyses. There are three types of genetic research that involve animals. The first is the use of animal models* for human genetic diseases. These include diseases caused by abnormalities in single genes, such as cystic fibrosis, sickle-cell anemia, and Huntington's disease, as well as...

Pulmonary Disease

Predisposing factors 6 for the development of pulmonary disease include alcoholism, bronchiectasis, cyanotic heart disease, cystic fibrosis, prior mycobacterial disease, pulmonary fibrosis, smoking, and chronic obstructive lung disease. Radiological features include thin-walled cavities, parenchymal infiltrates, and pleural involvement. High-resolution computed tomography of the chest shows a combination of multifocal bronchiectasis and nodular parenchymal disease. 7


There are no objective tests (physical, biochemical or endocrine) to assist in making the diagnosis. Prospectively completed specific symptom charts are required (Fig. 41.1). This is partly because the retrospective reporting of symptoms is inaccurate and because significant numbers of women who present with PMS have another underlying problem such as the perimenopause, thyroid disorder, migraine, chronic fatigue syndrome, irritable bowel syndrome, seizures, anaemia, endometriosis, drug or alcohol abuse, menstrual disorders as well as psychiatric disorders such as depression, bipolar illness, panic disorder, personality disorder and anxiety disorder.

Spastic gaits

Bilateral cerebellar signs imply a toxic, metabolic or familiar disorder. Dystaxia of the legs and gait, with little or no dystaxia of the arms, and no dysarthria or nystagmus, suggests a rostral vermis syndrome, most commonly secondary to alcoholism. Truncal ataxia alone implies a flocculonodular lobe or caudal vermian lesion, often a fourth ventricular tumor

Baseline Comparison

In clinical trials the baseline data usually consist of demographic data such as age, gender, or race initial disease status as evaluated by the primary efficacy, safety endpoints, and other relevant data and medical history. The ICH Guideline on Structure and Contents of Clinical Study Reports requires that baseline data on demographic variables and some disease factors be collected and presented. These disease factors include (1) specific entry criteria, duration, stage and severity of disease and other clinical classifications and sub-groupings in common usage or of known prognostic significance, (2) baseline values for critical measurements carried out during the study or identified as important indicators of prognosis or response to therapy, (3) concomitant illness at trial initiation, such as renal disease, diabetes, and heart failure, (4) relevant previous illness, (5) relevant previous treatment for illness treated in the study, (6) concomitant treatment maintained, (7) other...

About the Editors

Norman Salem Jr. is Chief of the Laboratory of Membrane Biochemistry & Biophysics within the National Institutes on Alcohol Abuse and Alcoholism at the National Institutes of Health. He is also a Research Professor at the F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences and Adjunct Professor at the Georgetown University Medical School. He has worked on studies of DHA composition, i metabolism and biological function for more than 25 years, with j an emphasis on the nervous system. His current research is focused upon the role of DHA in neural development and the means by which DHA is obtained by the brain. His professional affiliations include the American Society for Biochemistry & Molecular Biology, the American Society for Neurochemistry, the International Society for the Study of Fatty Acids and Lipids, the American Oil Chemists Society and the Research Society on Alcoholism. He is an author of about 150 scientific papers and book...

What About Alcohol

Should you count the carbohydrates in the alcohol you drink When you drink alcohol, it is metabolized (that is, broken down) by the liver, and there is less glucose production while the alcohol is being broken down. In people with diabetes who are on insulin, this can cause hypoglycemic reactions. It is therefore important that you drink alcohol with a meal rather than on an empty stomach. The recommended amount of alcohol is the same as for people without diabetes two drinks for men and one for women. One drink is defined as twelve ounces of beer, five ounces of wine, or one and a half ounces of distilled spirits. You generally do not need to

DHA n3 C226

Finally, it is important to note that there is another experimental paradigm that results in depletion of brain DHA levels other than n-3 dietary restriction. Chronic consumption of high levels of alcohol results in a specific depletion of DHA from the brain. When cats are given 1.2 g ethanol kg d (a value not different than is the case with chronic human alcoholics), their brain DHA levels are reduced by about 20 (Pawlosky and Salem, 1995). About a 30 reduction in brain DHA levels has also been observed in elderly patients with Alzheimer's disease compared to normal geriatric controls (Kyle, et al., 1999, Prasad, et al., 1998). It is interesting to note that human infants fed standard infant formulas without supplemental DHA also have about a 30 lower level of brain DHA at about 4 mo of life compared to infants fed their mother's DHA-containing breast milk (Farquharson, et al., 1992).

Alcohol No More

Alcohol No More

Do you love a drink from time to time? A lot of us do, often when socializing with acquaintances and loved ones. Drinking may be beneficial or harmful, depending upon your age and health status, and, naturally, how much you drink.

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