Best Ways To Quit Alcohol
Ethanol is a known carcinogen and its consumption is causally associated with many neoplasms including head and neck, esophageal and hepatic cancers.3 Alcohol consumption has been shown to alter sex steroid metabolism and thus could theoretically play a role in prostate cancer causation or even protection.59-62 Alcohol is also known to clear serum androgens.63
The best-known support group is Alcoholics Anonymous (AA), formed in Akron, Ohio, in the late 1930's. AA groups now number in the tens of thousands and are found across the globe. AA is an outgrowth of the Oxford Group, a Christian student and athlete group formed at Oxford University in England in 1908. The Oxford Group's ideals of self-examination, acknowledgment of character defects, restitution for harm done, and working with others directly influenced the steps to recovery practiced by members of AA and other so-called twelve-step groups, including Al-Anon, Narcotics Anonymous, Smokers Anonymous, and many others.
Environmental programs, (2) discouragement of pregnancy at advanced ages through community education and family planning, (3) periconcep-tion folic acid supplementation or multivitamin fortification of basic foodstuffs, (4) rubella vaccination, (5) avoidance of alcohol consumption and smoking during pregnancy, and (6) prenatal and (7) prepregnancy (preimplantation) diagnosis. The decision to adopt any of the available preventive programmes depends on the differences in health services development, ethnic distribution of congenital disease, and the local attitudes to genetic screening and termination of pregnancy. For example, induced abortions are still not permissible in many countries on eugenic grounds. On the other hand, an increasing number of countries are gradually permitting prenatal diagnosis and termination of pregnancies for medical indications even in some strict religious settings.
Mental health care should be an integral part of the overall health care system, its curative-medical, disease prevention and health promotion sectors. Many disease prevention programmes, such as obstetric care, the prevention of alcohol abuse and the containment of human immunodeficiency virus (HIV) infection, pursue both physical and mental health objectives. The same also holds for the treatment of frequent mental comorbidity in physical illness and vice versa. Mental health is a vitally important aspect of public health that has long been segregated and neglected. . . . It is time to move mental health into the mainstream of health policy and practice 6 . But this ideal of a closely intertwined physical and mental health care, which I consciously place at the beginning of this chapter, is not yet fully realized nor has it even always been intended in the past. Cooperation in and coordination of mental health care actions are frequently indispensable not only between the providers...
Management of hepatitis C infection is difficult. The patients must be excluded from donating blood and should be advised about the known modes of transmission of the virus, particularly by the parenteral route. Alcohol may act synergistically with HCV in causing liver damage, and alcohol intake must be reduced to the absolute minimum, if any. Consideration of life style risks for other viral infections such as hepatitis B and HIV infection is essential.
In the area of mental health, more and more mentally ill persons are incarcerated because of conduct arising from their mental illness, often exacerbated by homelessness, drug addiction, and alcoholism. The frequency of jail suicide and failure to train staff on issues of mental health have been revealed in civil rights cases.50 However, it bears discussing the increasingly high burdens which the courts have placed on plaintiffs under the civil rights statute to understand how the ADA has changed the landscape.
Research on the physiological effects of meditation led to the application of meditative techniques as a treatment to combat stress-related illnesses. Meditators have often experienced significant decreases in such problems as general anxiety, high blood pressure, alcoholism, drug addiction, insomnia, and other stress-related problems. Researchers have also found that the scores of meditators on various psychological tests have indicated general mental health, self-esteem, and social openness. Many psychologists argue, however, that these effects are not unique to meditation and can be produced by means of other relaxation techniques. Meditation researcher Robert Ornstein has suggested that the long-term practice of meditation may induce a relative shift in hemispheric dominance in the brain from the left hemisphere, which is associated with such linear processes as language and logical reasoning, to the right hemisphere, which is associated with nonlinear processes such as music...
Furthermore, the social characteristics of neighborhoods, perhaps through shared cultural norms and values, may well influence health behaviors that are linked to reproductive outcomes. For example, individual-level smoking patterns (Cubbin et al., 2000 Diez-Roux et al., 1997), alcohol consumption, and dietary practices (Macintyre et al., 2002 Shepard, 1994 Taylor and Repetti, 1997 Yen and Kaplan, 1999 Yen and Syme, 1999), which seem particularly relevant to this discussion, have been significantly associated with area-level deprivation when individual attributes are controlled for. In addition to health behaviors, adverse conditions such as high crime rates, housing abandonment, and even noise pollution may act as either acute or chronic stressors that exert their influences through stress physiology and are thus potential intervening
Persons with chronic HBV infection serve as the primary source of infection for others (McQuillan et al., 1999 CDC, 2005). The majority of persons with chronic HBV infection are asymptomatic, and one third have no evidence of liver disease, despite high levels of viral replication (Lee, 1997). Chronic HBV infection can lead to cirrhosis and HCC. Lifetime risk of death from chronic liver disease or HCC is 15-25 (Beasley, Hwang, Lin, & Chien, 1981 Beasley, 1988 Chang et al., 1997 McMahon, 1997 McMahon, Holck, Bulkow, & Snowball, 2001). Rates of progression to cirrhosis and HCC are approximately 25 for persons who acquire infection during childhood and 15 for persons who acquire infection at older ages. Other factors that influence rates of progression include HBeAg status coinfection with HDV, HIV, HCV and alcohol abuse (Rizzetto, 1983 McMahon, 1997 Ockenga et al., 1997 Zarski et al., 1998 Monto & Wright, 2001 Gao, 2002). HBV-related liver disease and HCC cause approximately 4000-5000...
Changes in brain gene expression are thought to be responsible for the tolerance, dependence and neurotoxicity produced by chronic alcohol abuse. DNA microarrays have been used recently with some success in studies of alcoholism 20 . RNA was extracted from post-mortem samples of superior frontal cortex of alcoholics and non-alcoholics. Relative levels of RNA were determined by array techniques. Expression levels were determined for over 4000 genes, and 163 of these were found to differ by 40 or more between alcoholics and non-alcoholics. Analysis of these changes revealed a selective reprogramming of gene expression in this brain region, particularly for myelin-related genes, which were down-regulated in the alcoholic samples. In addition, cell cycle genes and several neuronal genes were changed in expression. The investigators conclude that the observed gene expression changes suggest a mechanism for the loss of cerebral white matter in alcoholics as well as alterations that may lead...
Ondansetron, an anti-nausea drug best known for its use in cancer chemotherapy, has been reported to be effective in reducing drinking, especially in patients with early-onset alcoholism (before age 25) 81 . In their discussion, the authors speculate that ondansetron changes the balance of activity among the neurotransmitters dopamine and serotonin. In particular, it reduces the activity at one of the serotonin receptors, 5-HT3 in previous animal studies, blocking this receptor had been found to reduce the consumption of alcohol. It is hypothesized that early-onset alcoholics may carry a genetic variant of the receptor that makes them more vulnerable to the addictive effects of alcohol. Interestingly, the blood test used to measure alcohol use in this study is a new one it measures carbohydrate-deficient transferrin (CDT), which accumulates in the blood with sustained heavy drinking, as haemoglobin Aic does in diabetes, and persists at elevated levels for weeks after drinking stops....
Probably no one will ever know if two transplanted Vermont Yankees that first met in Akron, Ohio, in April of 1935, had read the works of Horney. But Bill Wilson and Dr. Bob Smith, the co-founders of Alcoholics Anonymous, surely came to concur with Horney's ideas of self-help. Neither Wilson nor Smith were strangers to psychoanalytic theory. One of the earliest members of the Oxford Group, a spiritual assemblage that was the predecessor of Alcoholics Anonymous, had been in therapy with Carl Jung. When Wilson joined the Oxford Group, Smith shared his insights. In fact, Wilson and Jung continued a dialogue via letters over a period of many years. More interesting, perhaps, is the group that developed as an off-shoot of Alcoholics Anonymous Al-Anon. It was begun by the loved ones of early members of AA who often accompanied their alcoholic family members or friends to meetings. As they talked over cups of coffee and snacks, they discovered that quite often they had a great deal in...
As discussed by Lynn Anderson, just as there are costs involved in belonging to a group, there are also benefits that accrue from group membership. Although the negative aspects of group membership may capture one's attention more forcefully, the positive aspects are no less common or important. A complete understanding of the purpose of groups requires a consideration of the positive side of belonging to a group. A considerable amount of evidence has documented the physiological, attitudinal, and health effects of social support systems. For example, people who belong to a varied and tight social support network have been found to be in better physical health and to be better able to resist stress than those lacking such support. As examples, one might consider the effects of such popular support groups as Alcoholics Anonymous and Mothers Against Drunk Driving as well as lesser known support groups that deal with specific issues such as loss and bereavement. These groups provide the...
The risk of position-induced nerve injuries increases with the length of the operation. But positioning injuries can also not be ruled out during short operations. For example, Mitterschiffthaler et al. 48 described severe paralysis of the arm plexus after an operation lasting only 20 min. Position-induced nerve injuries occur preferably at anatomically predisposed places. Thin patients are at greater risk from pressure injuries than obese patients. The risk during the anaesthetic is related to the reduction in muscular tone (particularly when using muscle relaxants) and to eliminating the physiological protection reflexes. If a patient were awake he would automatically correct his position after a few minutes because of paraesthesia and pain. A special predisposition can result from anatomic anomalies (for example lower arm plexus paralysis in cases of cervical rib). The tolerance of peripheral nerves to pressure or tension is reduced in cases of latent or manifest polyneuropathies...
Although pneumococci undoubtedly attack previously healthy people, several anatomical (dural tears and basal skull fracture) and physiological (mucociliary escalator dysfunction due to pollution, cigarette smoke or viral infection) defects predispose to pneumococcal infection. Defects of the reticuloendothelial system (hyposplenism due to any cause) and humoral immune system (hypogammaglobuli-naemia and complement defects) and AIDS also greatly increase host susceptibility. Other conditions that predispose to pneumococcal infection include alcoholism, diabetes mellitus and chronic cardiac, respiratory, liver and renal disease.
Nature and Causes of Homosexuality A Philosophic and Scientific Inquiry. New York Haworth Press, 1982. This volume is the third in an ongoing monograph series titled Research on Homosexuality, each volume of which was originally published as an issue of the Journal of Homosexuality. All volumes are valuable, although somewhat technical. This one is a good place to start others cover law, psychotherapy, literature, alcoholism, anthropology, historical perspectives, social sex roles, bisexual-ity, and homophobia.
First, in Chapter 8 we examined the role of the amino acid replacement alleles at the ApoE locus in a Canadian population of men from the mid-1980s upon the phenotype of total serum cholesterol level. The mean phenotype in that population was 174.2 mg dl. Hallman et al. (1991) studied the role of the same ApoE polymorphisms in nine different human populations, whose mean total serum cholesterol levels varied from 144.2 mg dl (Sudanese) to 228.5 mg dl (Icelanders). These mean differences in cholesterol levels span a range of great clinical significance, as values above 200 mg dl are considered an indicator of increased risk for coronary artery disease. Hence, these nine populations are greatly different in their phenotypic distributions in a manner that is highly significant both statistically and biologically. Despite these large differences in mean total serum cholesterol levels, a Fisherian analysis of the ApoE polymorphism within each of these populations results in estimates of...
Early efforts at substance abuse treatment for persons with a dual disorder often consisted of demanding abstinence and teaching consumers about the many dangers of drug and alcohol abuse. While some people responded to this approach, for many it was a failure. This service approach was ineffective for those who did not want to stop using substances or lacked the awareness of the consequences of their substance use. Clearly, another approach was needed.
Several models of group treatment for people with dual disorders have emerged either within day services for people with psychiatric illness or as stand-alone programs. These models may incorporate a combination of elements including (1) a 12-step recovery approach based on Alcoholics Anonymous, (2) stages of treatment as developed by Prochaska and colleagues (1994), (3) motivational interviewing strategies developed by Miller and Rollnick (2002), (4) social skills training, (5) cognitive-behavioral interventions, and (6) relapse prevention strategies (Mueser & Noordsy, 1996).
A general and pelvic examination is made, including chlamydia screening and updating of cervical cytology. The body mass index of the woman should be calculated (weight divided by height squared) and weight loss advised for any woman with a body mass index of greater than 30. Women are advised to stop cigarette smoking and reduce alcohol intake, not only in pregnancy, but also because they reduce fertility. Folate supplementation is recommended before conception and during the first 12 weeks of a pregnancy (400 g folic acid per day or if there is a history of neural tube defect or the woman is taking medication for epilepsy 4 mg daily).
Roger apparently went though much of his adult life with little or no insight into his many problems. Sadly, this is quite common for dually diagnosed persons like Roger. One might effectively argue that in some ways Roger exhibited personal strength, some might still call it ego strength. Not believing he was sick, when the system was going to hospitalize him he left and began a life on the streets. Yet, while he was resourceful enough to survive on the street, that strength relegated him to the life of a reclusive outsider living alone and in poverty. The problems Roger had with his first encounters with the treatment system have been experienced by many people. Initially, a mental health system of credentialed professionals generally funded based on medical diagnoses and an emerging substance abuse system mostly staffed by ex-alcoholics and addicts and funded by grants and private donations represented two very different worlds. Recognition of the increasing number of dually...
Few public institutions are more important to the surveillance and treatment of communicable disease and mental health disorders than jails, prisons, and other detention centers. Due to the concentration and high turnover of high-risk individuals otherwise out of contact with other public and community health systems, correctional institutions are uniquely situated to implement testing, treatment and referrals for chronic diseases, STDs, HIV, and tuberculosis via cost-effective means (Lee, Vlahov, & Freudenberg, 2006). Proper TB control mandates prompt and uniform screening at facility admission. Finally, adequate screening for suicidality and drug and alcohol withdrawal syndromes helps ensure these two leading causes of preventable death among the incarcerated are greatly minimized. Intake and general screening recommendation are summarized in Tables 14.1 and 14.2.
Dreams with increased vividness, violent or aggressive contents and increased or uncontrolled motor activity (enacted dreams) suggest the presence of a REM sleep behavior disorder (RBD). The diagnosis is proven by the polysomnographic demonstration of a loss of physiologic atonia and increased motor phasic activity during REM sleep. RBD can be observed in the course of neurodegenerative disorders, brainstem lesions, narcolepsy, drug or alcohol abuse, and in the so-called parasomnia overlap syndrome.
A history of exposure to environmental risk factors should be sought. In individuals previously treated for cancer, previous treatments should be documented in order to be able to accurately assess secondary cancer risk. Previous and current levels of tobacco smoking and alcohol consumption should be clearly docu
Men with abnormal scans should first be provided with counseling on nutrition and lifestyle issues. They should be instructed to eat a balanced, healthy diet, especially high in calcium content. If appropriate, they should stop smoking, moderate alcohol consumption and begin a regimen of physical exercise. Exposure to sunlight is also suggested, providing that they do not have skin cancer.
Nightmares are more common in children and are not associated with specific physical findings. About 10 of individuals with frequent nightmares have family history of nightmares. Nightmares are more common in persons with mental retardation, chronic alcoholism, depression, and central nervous system disease, as well as in association with fever and treatment withdrawal from drugs. Nightmares may result from a severe traumatic event and indicate post-traumatic stress disorder.
Of the ten leading causes of disease burden in young adults (in the 15A4 year age group) four were neuropsychiatric conditions. In 1998, alcohol dependence, unipolar major depression, bipolar disorder and schizophrenia were among the leading causes of disease burden in adults aged 15A44 years.
This chapter outlines the important contributions that people who have been diagnosed with a psychiatric disability make to their own rehabilitation and the rehabilitation of others. Like the field of alcoholism and drug addiction treatment, there is a long tradition of mutual self-help among persons who have severe mental illnesses. Today, consumers are also moving into professional psychiatric rehabilitation service provider positions in larger numbers. They are involved in operating peer support agencies, participating on
Race (Afro-Carribean Caucasian, and the former tend to present at a younger age with more aggressive disease). Geographic distribution (higher in North America, Europe low in Far East). Family history (a gene on chromosome 1 implicated). Dietary factors (high fat, meat and alcohol consumption associated, with soy). Occupational exposure to cadmium and sexual partners suggested but not proven.
Individuals who have both a mental illness and a substance abuse disorder are still the consumers most likely to be referred to self-help groups. As discussed in Chapter 8, people with a dual diagnosis require specialized programs and supports. These individuals are often encouraged by their caseworkers to utilize self-help groups to supplement the professional supports and services that they receive. Alcoholics Anonymous and Narcotics Anonymous (NA) are the most commonly utilized mutual support groups for persons recovering from alcoholism and other substance abuse disorders. Unfortunately, some people have not felt welcome in these groups when they disclosed they had a diagnosis of mental illness and take medication. Apparently, the stigma associated with severe mental illness exists even within groups such as AA and NA. In addition, AA and NA groups often discourage the use of psychotropic medications because they are viewed as obstacles to recovery from addiction. Partly in...
Delirium tremens complicates sudden alcohol withdrawal after chronic alcohol abuse and carries a mortality of 5-15 156 . The main symptoms are agitation, tremor, increased autonomic activity and an acute confusional state with polymodal hallucinations and dream enactment. Polysomnography in acute alcohol withdrawal syndrome may show a markedly reduced sleep efficiency, reduction or absence of NREM sleep and long periods of wakefulness alternating with abruptly emerging periods of REM sleep without atonia observed by Plazzi et al. 157 . The patient repeatedly presented with intense enacting dreams with violent fighting behavior, jerks and talking throughout the night and also during daytime episodes of drowsiness. Whenever awakened he reported vivid dream content.
Suicide attempts were an important factor in being in contact with the system for people with schizophrenia, it multiplied the number of contacts by 20 for people with alcohol problems, by 5 and for drug addicts, by 6.6. The presence of a concomitant physical disease increased contacts for psychiatric symptoms it multiplied the number of contacts by 4 in the case of alcohol-related disorders, and hospitalization was multiplied by 3.7 for homeless people with schizophrenia.
Alcohol consumption before bedtime leads to a shortened sleep latency, increased NREM sleep and reduced REM sleep during the first hours of sleep. Since alcohol has a relatively short half-life, symptoms related to alcohol withdrawal occur in the second half of the night, such as shallow disrupted sleep, sympathetic arousals and increased REM sleep with more vivid dreams and nightmares. Similar symptoms may appear during the weeks after alcohol withdrawal in alcoholic patients. Hershon found that 29 of a group of 100 alcoholics reported that they started again drink
Like the non-mentally-ill homeless, the mentally ill homeless are at very high risk of substance abuse. Homeless subjects have almost twice the prevalence of alcohol dependence and six times the prevalence of drug abuse of housed subjects. These comparisons show that homeless persons, whether or not they are mentally ill, are more likely to be socially disadvantaged (less educated, ethnic minorities) and to have a high likelihood to be currently dependent on alcohol or drugs.
Clinical observations of cognitive impairment following adverse life events have been paralleled by biological observations that exposure to severe stress, notably maternal separation in childhood and combat-related post-traumatic stress disorder, leads to increases in glucocorticoids, hippo-campal damage and subsequently disorders of memory 85, 86 . An 8 reduction in right hippocampal volume has, for example, been observed in war veterans with stress disorder 85 . Two principal areas of cognitive functioning appear to be affected in stress disorders attention and organization of sequential stimuli, and secondary declarative memory. As subjects experiencing severe stress have also usually been exposed to physical trauma such as head injury, and are also at high risk for drug and alcohol dependency, it is often difficult for the neuropsychologist to attribute test performance difficulties specifically to psychological stress-related changes in the CNS. Hickling et al. 87 have, however,...
Paluszny and Zrull (1971) studied 50 applicants for missionary service. They found that, although the majority appeared to be well adjusted, seven (14 ) had significant psychological difficulties. One anonymous aid organization admitted in a survey that 'Some situations require people who can destroy themselves and thrive on chaos . . . at times we have employed workaholics and alcoholics' (McCall and Salama, 1999, p. 114).
Medical history taken for expatriates needs some exploration of specific components. These include any unusual health and safety risks, psychosocial factors, failed expectations, causes of sleep disturbance, signs of abnormal stress, sexual health risks, alcohol consumption, risks specific to hostile or dangerous environments and occupational health risks from HIV, hepatitis B or hepatitis C. Structured questionnaires or protocols can provide the majority of the information and make the consultation more effective.
Gene therapy is a rapidly growing field of research. Besides those described in this article, a number of other human disorders are being explored at the molecular level. The genes responsible for hearing loss syndrome have been identified (107). Gene therapy also seems to be the treatment of choice for many complex hematological and lysosomal storage disorders (108,109). Considerable evidence has accrued to deduce that behavioral changes like alcoholism are also under the influence of certain genes (110). It has been suggested that the characterization of such genes will help in the understanding of human behavioral mechanisms.
I don't see how you can hold a job until you get control of your drinking problem. ), using motivational interviewing the counselor engages John in a review of past work experiences and in an exploration of what would need to be different in order to make this next employment attempt successful. The counselor might ask John to list the benefits and costs of using alcohol. In this way the counselor could help John find alternative ways of getting the benefits (e.g., socializing with friends, feeling relaxed) while also examining the costs (e.g., missing work and other appointments, feeling ill, losing money) and helping John to see the discrepancy between his goals and his behavior.
Homocysteine exists in plasma as single molecules, as two molecules linked together (homocystine) and as mixed homo-cysteine-cysteine disulphides. Serum homocysteine levels are raised in both early cobalamin and folate deficiency, but they may be raised in other conditions, e.g. chronic renal disease, alcoholism, smoking, pyridoxine deficiency, hypothyroidism therapy with steroids, cyclosporin and other drugs. Levels are
Researchers using something called an odds ratio, which measures the odds of having one disorder if an individual has the other disorder, have measured the rates of comorbid Substance Abuse and PTSD. Studies have revealed the range of odd ratios for comorbid Alcohol Dependence or Abuse is 2.06 to 4.25. This means that if someone has PTSD, his or her odds of having an Alcohol Abuse or Dependence Disorder is anywhere from two to four times higher than if they did not have PTSD. Regarding Substance Abuse or Dependence, the range of odds ratios from various studies is 2.48 to 8.68. Again, this means that the odds of someone with PTSD also having a comorbid Substance Abuse or Dependence Disorder is anywhere from 2.5 times to 8.5 times higher than if he or she did not have PTSD.
Immunity functioning when compared to individuals not diagnosed with PTSD. There is also a tendency for such individuals to rate themselves as less physically healthy overall when asked. Keep in mind that the jury is still out as to the exact nature of the relationship between PTSD and physical health problems and disease. Some researchers propose the existence of mediating variables such as drug or alcohol abuse to be responsible for the observed relationships thus far. It is not clear from the research so far whether physical health problems associated with PTSD are the result of somatization physical health problems resulting from the actual physical aspects of the event (e.g., smoke inhalation from a fire, starvation as a prisoner of war, or exposure to Agent Orange) nonspecific physical responses associated with PTSD but not caused by it or associated behaviors related to PTSD, such as alcohol abuse, smoking, or medication side effects. The comorbid occurrence of other mental...
When diagnosing dissociative amnesia and fugue, a number of other disorders and conditions have to be excluded. A number of medical conditions such as vitamin deficiency, head trauma, carbon monoxide poisoning, and herpes encephalitis can produce similar symptoms. Amnesia can also be found in conjunction with alcoholism and the use of other drugs.
Alcoholics Anonymous (AA), founded in 1935, is the oldest self-help organization in the United States (Robertson, 1988). Another early self-help initiative was started by a psychiatrist named Abraham Low. In the 1930s Low developed a treatment method similar to what is now known as cognitive-behavioral therapy. He worked with people who suffered from a wide range of mental and emotional disorders, teaching them to control their symptoms and take responsibility for their lives. His methods are outlined in Mental Health through Will Training (Low, 1950). In 1952, two years before his death, he founded Recovery Inc., the second oldest self-help organization in the United States, which concentrated on the self-help aspect of his treatment.
The United States has the highest rates of STIs among developed countries (Eng & Butler, 1997). Chlamydia and gonorrhea are the two most commonly reported infections with 976,445 and 339,593 cases reported in 2005 (CDC, 2006a). Chlamydia and gonorrhea are most common in persons aged 25 and younger, with peak rates among females aged 15-19 and males aged 20-24 (CDC, 2006a). Rates also are substantially elevated in some racial ethnic minority populations. Compared with whites, chlamydia rates are more than 7 times greater among blacks, nearly 5 times greater among American Indians Alaskan Natives, and 3 times greater among Hispanics (CDC, 2006a). Even greater disparities exist in gonorrhea rates, with the rates more than 19 times greater among blacks, more than 3 times greater among American Indians Alaskan Natives, and more than 2 times greater among Hispanics compared with whites (CDC, 2006a). In addition to demographic characteristics, other risk markers for STIs include multiple sex...
Quaternary ammonium compound, is actively transported from the GIT, its transport is depressed on acute alcohol ingestion (Thomson et al., 1971 Thomson and Leevy 1972 Thomson and Majumdar, 1981). Consequently, chronic alcoholics, due to this inhibition and poor diet, often demonstrate symptoms consistent with Wernicke's disease and the accompanying bilateral and ocular palsy resulting from thiamine deficiency (Baker et al., 1974). In Mediterranean populations, where garlic is frequently used in cooking, these symptoms are seen
There are other controllable lifestyle factors supposed to affect the risk of developing CRC. Several epidemiological research studies 145 , but not all 146 , have shown that alcohol consumption is associated with a moderate increase in the risk of CRC. Specifically, high alcohol intake, particularly of beer, has been implicated for both men and women in the development of rectal cancers 147,148 .
Alcohol One line of research has been concerned with the potential deleterious effects of chronic alcohol abuse on prospective remembering. Persistent abuse of alcohol results in cortical and subcortical damage, neurotransmitter impairments, brain shrinkage, inhibition of prefrontal cortex functioning, and reduction of the number of cholinergic neurons in the basal forebrain resulting in reduced hippo-campal function (Heffernan, Moss, & Ling, 2002 Ling et al., 2003). These brain anomalies have been found to be associated with impaired retrospective memory, working memory, and executive functioning (Heffernan, Ling, & Bartholomew, 2004 Heffernan et al., 2002). On the basis of this neuropsychological profile, an adverse effect of alcohol abuse on prospective memory was expected. An initial study investigated prospective memory in amnesic Korsakoff patients and nonamnesic chronic alcoholics by administering an event-based prospective memory task (Brunfaut et al., 2000). Because Korsakoff...
One of the most successful models for dealing with substance abuse, Alcoholics Anonymous was begun in 1935 in Akron, Ohio, by a New York City stockbroker, Bill W., and an Ohio surgeon, Dr. Bob (http www.alcoholics-anonymous.org). Based on self-help in the form of mutual support and a 12-step process, the goal of AA is total abstinence from alcohol. In fact, the first step of the process is to admit that one is powerless over alcohol. The AA website reports having more than 2,000,000 members attending 100,000 AA groups worldwide. AA has helped virtually millions of people with alcohol addiction.
Also, the medical model has focused research attention on the genetic inheritance of mental illness. One way to study the genetic basis of behavior is to compare identical twins with fraternal twins. An identical twin of a schizophrenic who was adopted into an entirely different family and never even met the other twin is still twice as likely to be schizophrenic as a person identified randomly from the general population. Another way to study the genetic basis of behavior is to compare adopted children to their adoptive parents and to their biological parents. Using these types of research, scientists have implicated heredity in a number of mental disorders, including schizophrenia, depression, and alcoholism.
Certainly a patient's general health status and any problems should be part of a comprehensive assessment. Some professionals are not licensed or qualified to perform a standard medical history and physical, but general inquiry should always be performed. Of particular interest when discussing health issues in PTSD assessment are cardiac functioning, general immunity or immune functioning, and neurological status. As was discussed in Chapter 3, trauma victims may suffer from neurological problems as a direct result of the traumatic event they experienced. Patients should be assessed for a history of traumatic brain injury closed-head injury, such as anoxic injuries (for example, from drowning accidents or exposures to gases) neurotoxic or toxic exposures and chronic Alcohol Abuse and its complications.
Many people commonly take stimulant drugs like nicotine, amphetamine, cocaine, or depressant drugs like morphine or alcohol, all of which affect behavior and are thus said to be psychoactive. The long-term consequences of abusing psychoactive drugs are now well-documented, and it has been hypothesized that some of the behavioral symptoms observed in drug addicts or alcoholics are related to abnormalities in the functioning of the prefrontal regions (Robbins and Everitt, 2002). One experimental demonstration of
Self-help groups are just one way that persons who have severe mental illnesses help others who are coping with similar challenges. There are also other categories of peer-delivered services, which have been defined as services provided by individuals who identify themselves as having a mental illness who are specifically employed to help other consumers (Solomon, 2004 Solomon & Draine, 2001). Almost from its inception, the field of substance abuse counseling recognized the benefits of utilizing individuals recovering from alcoholism and other substance abuse disorders as regular service providers (Moxley & Mowbray, 1997). An obvious benefit of this strategy is the ability of an individual who is in recovery to truly empathize with the experiences of the persons to whom he or she is providing services. Providers who share the experience of coping with a similar illness or disability may also have an advantage over other professional providers in the length of time it takes to...
In endemic regions, melioidosis accounts for an unusually high proportion of community-acquired sepsis, being the most common source of fatal community-acquired sepsis in the northern territories of Australia. Most patients have an underlying metabolic or disease process such as alcohol abuse, an immunosuppressive disorder, diabetes mellitus, renal disease, liver disease or pregnancy, although melioidosis does not appear to be an AIDS-associated opportunistic infection. Melioidosis may be localized or disseminated and might only present clinically after many years of bacterial latency.
Cardiac failure accounts for a 7-21 mortality rate after liver transplantation. Therefore, recognition and proper treatment of cirrhotic cardiomyopathy are essential. Such dysfunction can occur independent of prior alcohol abuse. It may be missed by standard echocardiographic techniques. The liver transplantation procedure, with its attendant hemodynamic and volume shifts, stresses the heart significantly. Acid-base abnormalities, hypothermia, and electrolyte disturbances can also affect myocardial function. As the hyperdynamic physiology of cirrhosis is corrected postprocedure, vasoconstriction causes increased afterload and may precipitate heart failure. Management strategies include diuretics, salt restriction, afterload reduction, and possibly mechanical ventilation. Cirrhotic cardiomyopa-thy may improve after liver transplant.
To more than 25 days) can be due to variations in the timing of menstrual cycles, ovulation, and implantation of the blastocyst. Changes in age, levels of physical activity, body mass index (BMI), nutrition, breast-feeding, interpregnancy interval, smoking, alcohol consumption, and stressful life events can influence the length of an individual woman's menstrual cycle, and can therefore influence accuracy of LMP in estimating the duration of a pregnancy (Kato et al., 1999 Liu et al., 2004 Munster et al., 1992 Rowland et al., 2002).
Another historical factor that has favored the growth of cognitive therapy since the 1970s is the rapid proliferation of self-help groups and the growing popularity of self-help books. Bibliotherapy, or the use of books to help people solve problems or train themselves in such techniques as those used in cognitive therapy, has become widely used since it was first discussed in the early 1980s. In addition, the Twelve Steps of Alcoholics Anonymous (AA) and similar groups (Al-Anon, Overeaters Anonymous, Gamblers Anonymous, etc.) have been described in the psychiatric literature as a form of cognitive restructuring that helps uncover the distortions of stinkin' thinkin' and the emotional problems associated with addictions. Beck has contributed to the self-help movement both theoretically and practically. His theoretical contribution lies in his emphasis on the collaborative aspect of the therapist patient relationship and the therapist's role in teaching the patient techniques for...
Chronic liver disease is usually secondary to chronic alcohol abuse or chronic viral hepatitis. Alcoholic liver disease is most common and begins with the accumulation of fat vacuoles within hepatocytes and hepatic enlargement. There is a decrease in cytochrome P450 content per weight of tissue, but this is compensated for by the increase in liver size so that drug metabolism is not impaired (18). Alcoholic fatty liver may be accompanied or followed by alcoholic hepatitis, in which hepatocyte degeneration and necrosis become evident. In neither of these conditions is there significant diversion of blood flow past functioning hepato-cytes by functional or anatomic shunts.
Jerrell and Ridgeley 121 followed up 146 subjects over two years, comparing three different approaches to dual diagnosis, one based on behavioural skills training, one on intensive case management and one on an Alcoholics Anonymous (AA) model. Over the two-year study period, the sample as a whole showed improvements in drug and alcohol-related symptoms, reductions in service use and costs, and a trend towards better social adjustment. Outcomes were better in the groups receiving behavioural skills training and intensive case management than for the AA-based programme. In Washington, an integrated programme combining mental health, substance abuse and housing interventions was compared with standard management for homeless individuals with dual diagnosis 122 . There was some evidence of benefit from the integrated programme, with fewer days in institutions, more stable housing and greater improvement in alcohol problems. Differences between the programmes in degree of recovery from...
Comparisons of brain MRI data generally find more morphological deviations in schizophrenic patients than in those with affective disorders or alcohol abuse 32, 33 . The most consistent structural change in depressive patients is the observation of deep subcortical hyper-intensities in patients with severe and old-age depression 34, 35 . In some studies, expansion of the ventricular system and reduction of prefrontal lobe volumes have also been observed 36 . Although authors of the latter study found reduced volumes of the left hippocampus in depressed patients, such a change has been questioned by other authors 37 . In a structural brain MRI study of depressed children, Steingard et al. 38 found a significantly lower frontal lobe volume in the depressive patients with early onset. The incidence of cavum septum pellucidum, which has often been regarded as a neurodevelopmental anomaly, has been found to be higher in patients with schizophrenia. Shioiri et al. 39...
Psychopharmacological treatment is based on the medical or biological model of mental disorders, with two primary assumptions (Gitlin, 1996) (1) mental disorders can be reliably classified according to diagnostic methods used in medicine before the introduction of laboratory tests and, (2) medications are effective in treating a variety of psychiatric disorders. I would add that both of these are built upon the assumption that mental disorders are, at their core, biological disorders and therefore alteration of the biological underpinnings constitutes treatment. This assumption is predicated on a monist view of the mind-body or mind-brain relationship. However, an alternative view of psychopharmacological treatment can be taken. That is, medications that successfully alleviate the symptoms of a mental disorder may not directly address underlying biological abnormalities but may instead influence the expression of symptoms or related systems that subsequently impact underlying...
Reduction in negative consequences (harm reduction) In general, the idea is that the focus should be on reducing the harm or negative consequences of substance use rather than insisting on abstinence. In short, if a client can be helped, for example, to drink less or less frequently the harm caused may be reduced. This is a controversial issue in the substance abuse community where abstinence has been considered the gold standard for some time. Still, based on Prochaska and colleagues' work (1994) it seems likely that many individuals in early treatment stages with respect to readiness for change are more likely to respond to a harm reduction approach than a request for abstinence.
The first systematic application of the CT technique in psychiatric research was made by Johnstone et al. 4 , These authors demonstrated unequivocally the occurrence of wide ventricles, wide cortical sulci and reduced size of cortical gyri in patients with schizophrenia as compared to healthy control subjects. Since then many studies have replicated these findings, and recent meta-analyses of studies in schizophrenic patients demonstrate a high consistency in this regard 5 . Alterations of the attenuation property of brain tissue and a reduced volume of specific neocortical and cerebellar regions in schizophrenia have also been reported in studies using the CT technique 6-9 . However, similar changes are often observed in pre-senile and senile dementia as well as in many cases of affective disorders, chronic alcoholism and drug abuse. Brain morphology as examined by CT also varies considerably with regard to the age of the patient and other individual factors. For this reason, all CT...
Another factor consistently associated with decreased medication compliance is substance abuse (Heyscue, Levin, & Merrick, 1998). Some individuals discontinue medication when drinking alcohol or abusing substances. Some of these individuals also take to self-medicating with both legal prescription drugs and illicit drugs on a dosage and schedule they choose. This is discussed in more detail in Chapter 8, which addresses dual diagnoses.
Alcohol abuse is the most common cause of liver disease, and the extent of application of LT to alcoholic liver disease remains controversial. Available evidence suggests that, among selected alcoholics, survival after LT up to 3 years is comparable to that of nonalcoholic patients. Cost analyses in North American transplant centers also suggest that resource utilization by alcoholic recipients is essentially the same as that by nonalcoholic recipients. A recent study from France (Gut 1999 45 421-426) concluded that LT can be successful in alcoholic cirrhosis, and that recidivism did not affect survival or compliance with immunosuppressive regimen. However, this area is still controversial. At present, most centers require 6 months of documented sobriety, psychosocial evaluation, completion of a rehabilitation program, and appropriate social support systems in place, before a candidate is accepted for LT. Active alcoholism or subs lance abuse
Health (NIH) Guide (1989) both recommended that biomedical and behavioral research should be expanded to ensure emphasis on conditions unique to, or most prevalent in, women of all age groups 'in addition, studies are needed to study the metabolism and disposition of drugs and alcohol by age and gender'. The National Institute for Drug and Alcohol Abuse (NIDAA) (1990) policy provides detailed, almost affirmative-action instructions for the inclusion of women and minorities into study designs, according to their prevalence in the diseases being studied.
Finally, Dohrenwend (1998) and McNally (2003) report that being African American, having a family history of psychiatric illness, having a childhood history of conduct problems, having a history of prior traumatic event exposure, having a history of Major Depression, and having a history of drug or Alcohol Abuse puts someone at greater risk for exposure. This issue of race has been found to be significant with respect to combat exposure. Minority status has been shown to be a risk for combat and war exposure and thus higher risk for PTSD (Green, Grace, Lindy & Leonard, 1990 MacDonald, Chamberlain, & Long, 1997).
Another possibility involves attribution theory, particularly beliefs about the cause of the condition (Weiner et al., 1988). It seems that people are more likely to be stigmatised if they are seen as having control over the onset or maintenance of their condition (Weiner et al., 1988 Crandall & Moriarty, 1995 Martini & Page, 1998). This idea is particularly relevant to understanding the stigmatisation experienced by people who have nicotine or alcohol dependence, but perhaps also to acne since there is a widespread belief that a poor diet and an unhealthy lifestyle can contribute to its development. The Just World Hypothesis is related to attributions. This is the notion that negative events occur to people because of retributive justice for their actions (Lerner & Miller, 1978). That is, people get what they deserve if someone has a skin disease they must have done something to merit their appearance.
Transplant centers need to be aware of the public debate about whether it is morally acceptable to treat alcoholic cirrhotics differently than other candidates. Most, if not all centers, believe that alcoholism is a medical diagnosis and that end-stage liver disease secondary to alcohol dependence, if in remission, should not prevent a patient's acceptance in a transplant program. At our Center, a Beresford Alcoholism Prognosis Scale (Fig. 5.1) is also performed. This scale is intended for comparative purposes only. Its use presupposes that the clinician has made a diagnosis of alcohol dependence, as described in the third, revised edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association. Washington DC American Psychiatric Press, 1987), for any patient under study. The scoring system offers a method of quantifying clinical impressions for the purposes of statistical comparison. Neither the scale nor any parts thereof are used in isolation...
Malabsorption of folate has been described in patients receiving salazopyrine, cholestyramine and triamterene. It has also been associated with anticonvulsant drug therapy, alcohol abuse and folate deficiency, but these relationships are less well established. In the intestinal stagnant loop syndrome, the predominant effect of the small intestinal bacteria is to cause a rise in serum, red cell and urinary folate by synthesizing folate, which is then absorbed.
P450 2E1 is a microsomal P450 present in the liver and other tissues of many mammalian species that has been shown to catalyse the oxidation of over 80 compounds, including benzene, ethanol, acetone, chloroform, many nitrogenous compounds together with drugs such as acetaminophen and chlorzoxazone. Having as substrates ethanol and many suspect carcinogens, P450 2E1 has been considered of great interest for its possible relevance to alcoholism, chemical carcinogenesis and other diseases 84 . Its substrates have diverse structures but most of them have the common characteristic ofbeing low molecular weight molecules 146 .
Traditionally, mental health treatment consists of psychotropic medication (Chapter 3), individual and or group counseling, perhaps day program services (Chapter 6), and case management services (Chapter 7), which are typically used for persons with severe and persistent mental illness. Traditional substance abuse treatment often requires abstinence (refraining from the use of all drugs), sometimes including abstinence from psychotropic medication, attendance at Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings, and working a 12-step process based on the AA 12-step model (Evans & Sullivan, 1990).
TB case management efforts must include an assessment of substance abuse, mental health, or social service needs that may adversely influence the inmate's ability to adhere to the TB discharge plan. Substance abuse and mental health issues are significant barriers to continuity of care postrelease and should be addressed by discharge planning staff in correctional facilities (Hammett et al., 2001). After release from jail or prison, many reentrants return to their old neighborhoods and are challenged to avoid the same influences or circumstances that led to their recent incarceration, which places them at risk for defaulting on their TB care. Relapse to substance abuse postincarceration often occurs and can impact all aspects of a reentrant's life including his or her health, housing, relationships, employment, parole conditions, and likelihood of reincarceration (Rich et al., 2001). Inmates with mental illness have similar postrelease issues as those with substance abuse problems....
Both men and women will thus lose bone mineral density as a natural consequence of the aging process however, men will lose less bone density with aging.5 Overall, men will lose about 15-45 of trabecular bone and 5-15 of cortical bone, as compared to women who will lose 30-50 and 25-30 , respectively.9 This loss of trabecular bone in both men and women explains the increase in fractures seen and why, although hip fractures occur in both sexes, it is twice as common in women.5,9 Additional risk factors include lifestyle decisions, such as smoking and excessive alcohol consumption, inactivity and low calcium intake.
Anticoagulant therapy or coagulopathy, e.g. renal dialysis, liver disease. Alcoholics are especially at risk as resulting symptoms may be mis-ascribed. Less commonly associated with underlying brain injury. A subdural hygroma (a collection of blood-tinged fluid in the subdural space) is also a risk factor.
When diagnoses are given for substance use disorders, diagnoses should be given in terms of a specific type of substance. A diagnosis of substance abuse would be too general because it does not specify the substance causing the problem. Having problems with one substance does not automatically mean that a person has problems with all substances. Thus, any diagnosis for a substance use disorder should be substance-specific examples might include alcohol abuse, inhalant abuse, marijuana dependence, marijuana abuse, cocaine dependence, or stimulant abuse.
In psychology, the systemic and popular study of substance use became most extensive as the field of pharmacology blossomed and access to substances of abuse increased. The creation of the National Institute of Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse helped to fuel research in this area in the 1970's and later. During the 1980's and 1990's, there was an increase in exploration of the biological mechanisms underlying substance use disorders and the possibility that pharmacological interventions might be useful to prevent and treat substance use disorders. The 1990's also brought an increase in awareness among the research and clinical communities that attention to specific demographic characteristics, such as age, gender, and ethnicity, was also important for understanding the etiology, pre
Suicide risk is associated with particular behavioral or psychological variables depression, isolation, stress, pain or illness, recent loss, and drug or alcohol abuse. These factors may help explain why certain of the demographic variables are related to suicide. For example, people who are unemployed may experience higher levels of stress, depression, and isolation than people who are employed. Similarly, divorced people may experience more stress and isolation than married people. The elderly may experience more isolation, depression, and pain or illness than younger people.
Excessive alcohol consumption and a high rate of extramarital sexual activity are common among certain groups of expatriates (Lange and McCune, 1989 Mac-nair, 1995 De Graaf et al., 1998a). In some cases these behaviors are related to peer pressure and expectations, while in other instances they are a consequence of stress, or an attempt to avoid unpleasant thoughts and feelings, or a result of loneliness and separation from the social support network (perhaps including the spouse). Boredom and a lack of opportunity for recreational activities may also be a factor. In many cases expatriates do not use condoms during sexual activity (Moore et al., 1995), increasing the risk of HIV infection and other sexually transmitted diseases.
Of all problems that are mentioned by patients at psychological and psychiatric clinics, some form of depression is most common. It is estimated that approximately 25 percent of women in the United States will experience at least one significant depression during their lives. Contrary to a popular misconception that depression is most common among the elderly, it is actually most common in twenty-five- to forty-four-year-olds. About 10 percent of the college population report moderate depression, and 5 percent report severe depression. Suicidal thoughts are common in depressive clients. In long-term follow-up, it has been found that approximately 15 percent of depressed individuals eventually kill themselves. Alternatively viewed, approximately 60 percent of suicides are believed to be caused by depression or by depression in association with alcohol abuse. As has been vividly portrayed in the media, teenage suicide in the United States is increasing at an alarming rate.
In 2005, 22 of deaths in the United States were from cancer. Along with heart attacks and strokes, it is one of the three leading causes of death. Although life-style choices such as the use of tobacco products, alcohol consumption, and diet are thought to be responsible for a majority of cancers, it is also known that cancer can result from exposure to ionizing radiation and to some chemicals in the environment. In fact, cancer is often the primary stochastic effect analyzed in risk assessments. Cancer is of particular concern because it can be induced at doses far below the level required to induce an observable systemic effect (and possibly, at any nonzero dose). Thus, controlling exposures to prevent systemic effects may be ineffective in providing an acceptable level of protection against cancer.
Sideroblastic anaemia associated with pyridoxine deficiency has been described, although not completely documented, in a few patients with gluten-induced enteropathy, in pregnancy, and with haemolytic anaemias, such as sickle cell disease and mechanical or autoimmune haemolytic anaemia. Sideroblastic anaemia may be found as a complication of antituberculous chemotherapy, particularly with isoniazid and cycloserine (pyridoxine antagonists). Sideroblastic anaemia occurs in alcoholism if there is associated malnutrition and folate deficiency. Suggested mechanisms include interference with haem formation and pyridoxine metabolism. The anaemia rapidly reverses with abstinence from alcohol, a normal diet and pyridoxine therapy. Chloramphenicol inhibits mitochondrial protein synthesis and in some patients causes ring sideroblast formation, Pyridoxine therapy is almost always ineffective in primary acquired sideroblastic anaemias. Some secondary sideroblastic anaemias may, however, be...
Of course, not all of Terman's Termites achieved happiness and success as adults. For example, the study included two half-sisters raised by the same mother, both of whom went to college at Stanford University. One became well-known as a freelance writer. The other died of alcoholism. Terman's study showed that high IQ was helpful in adulthood, but, by itself, it was clearly no guarantee of the good life. Among the personal traits that seemed to be associated with adult success were the ability to set goals and the perseverance to achieve them. In addition, a stable marriage and a satisfying job also were related to happiness as an adult. If nothing else, then, the study underscored the fact that people with high IQs have basically the same needs and desires as everyone else. At best, they may just have a running start at fulfilling those needs.
Adoption studies have also had an important role in contributing to the evidence that genes play a part in antisocial behaviour, alcoholism and affective disorders. However, in the case of affective disorders, the pattern of findings has been less than clear-cut. Thus, in contrast to twin studies, all of which point to a genetic contribution, some of the adoption studies are inconclusive, and this seems at least in part a result of the fact that they have relied upon indirect sources of information rather than direct examination of the subject themselves 15 .
FIGURE 16.6 Metabolism of isoniazid to hydrazine, which is then activated by cytochrome P450 enzymes to a chemically reactive metabolite. N-Acetyltransferase (NAT2) acts at several points in this scheme to reduce hydrazine concentrations. This accounts for the fact that rapid acetylators are less likely than slow acetylators to develop isoniazid-induced hepatitis. On the other hand, chronic alcohol consumption induces cytochrome P450 enzymes, thereby increasing the extent of toxic metabolite formation from hydrazine and the risk of hepatitis. FIGURE 16.6 Metabolism of isoniazid to hydrazine, which is then activated by cytochrome P450 enzymes to a chemically reactive metabolite. N-Acetyltransferase (NAT2) acts at several points in this scheme to reduce hydrazine concentrations. This accounts for the fact that rapid acetylators are less likely than slow acetylators to develop isoniazid-induced hepatitis. On the other hand, chronic alcohol consumption induces cytochrome P450 enzymes,...
Portal hypertension in schistosomiasis is intra-hepatic and presinusoidal, very much like idiopathic portal fibrosis and non-cirrhotic portal fibrosis. The pathology is primarily related to portal venular injury (Warren, 1984). Hepatic parenchymal damage is unusual until very late in the disease. Furthermore, preservation of the hepatic arterial blood flow protects the hepato-cytes from classical cirrhosis (micronodular lesions). True cirrhosis (micrononodular lesions) can be observed only when there is co-infection with another agent such as hepatitis B or C or associated alcohol abuse (Lyra et al., 1976 Koshy et al., 1993). The fibrotic deposits observed in chronic schistosomiasis were thought in the past to be an irreversible sequela of infection. Population studies using ultrasound, however, show that many dense deposits can slowly resolve if the individual can be kept free of recurrent infections (Doehring-Schwerdtfeger et al., 1992 Ohmae et al., 1992). In studies from China and...
Euphoria-inducing substance use, or pleasure seeking, is characteristic of virtually all species tested. Some theorists have proposed that pleasure seeking is an innate drive not easily kept in check even by socially acceptable substitutes. Other theorists believe that these types of substance use disorders related to the positively reinforcing aspects of the substances may have developed as a function of biological causes such as evolutionary pressure and selection. For example, organisms that could eat rotten, fermented fruit (composed partly of alcohol) may have survived to reproduce when others did not people who could tolerate or preferred drinking alcohol instead of contaminated water reproduced when those who drank contaminated water did not live to do so.
Benzodiazepines are used for two major problems anxiety and insomnia. Anxiety disorders appropriate for this kind of treatment include generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, phobic disorder, and dissociative disorder. The benzodiazepines commonly used for anxiety include alprazolam, chlordiazepoxide, clonazepam, cloraze-pate, diazepam, lorazepam, and oxazepam. For most of these disorders, however, behavioral, cognitive, group, and social therapy, or one of these therapies plus medication, are more effective than medication alone. Ben-zodiazepines used for insomnia include estazolam, flurazepam, midazolam, quazepam, temazepam, and triazolam. Benzodiazepines may also be used to prevent the development of delirium tremens during alcohol withdrawal. Patients become tolerant to the effects of these drugs, meaning they have the potential for physical dependency and addiction. In addition, benzo-diazepines interact with many other drugs, including...
Recurrent severe epigastric pain, radiating to back, relieved by sitting forward. Exacerbated by eating or after an episode of binge drinking. May be associated with bloating and pale offensive stools (steatorrhoea). Diarrhoea, weight loss, thirst and polyuria. There may be epigastric fullness (due to pseudocyst). Signs of weight loss, malnutrition and alcohol abuse.
The pressing need to reduce the racial disparities in infant mortality, low birth weight, and preterm birth in the United States has led to new theories and new research directions on the pregnancies of African-American women (Hogue and Vasquez, 2002 Rich-Edwards et al., 2001 Rowley, 1994, 2001 Rowley et al., 1993). In particular, attention is being directed to the role of racism and discrimination in health outcomes in general (Krieger, 2000) and in pregnancy outcomes specifically (Collins et al., 2000, 2004). Racism is defined as racially motivated interpersonal and institutional discrimination (Krieger, 2000). Several research teams have developed self-report measures of racism, and these measures have been used in a handful of case-control and prospective studies of pregnancy. Collins and colleagues (2000) published the first study on this issue with a sample of low-income African-American women in Chicago who delivered very-low-birth-weight infants (n 25), all of which were...
The history of support groups in modern times begins with the formation of the Oxford Group in 1908 and the subsequent development of Alcoholics Anonymous. For the participants, support groups reduce feelings of isolation, offer information, instill hope, provide feedback and social support, and teach new social skills. At the opening of the twenty-first century, support groups exist for persons suffering from all kinds of medical and psychological conditions to support for victims of violent crime.
A number of conditions in the prenatal environment may increase the likelihood that a child will be born with the potential for a developmental disability. Fetal alcohol syndrome, for example, is completely preventable if pregnant women do not drink alcohol. Women who have sufficient amounts of folic acid in their diets reduce the risk of having a child with a neural tube defect that can result in a developmental disability.
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