Alcohol dependence

The aim of this study is to deliver representative epidemiological data about the prevalence of alcohol abuse and dependence in general practices in an urban area. In 12 general practices at Luebeck, a Northern German city with 220,000 inhabitants, a total of 929 patients (aged between 14 and 75 years) were screened using the CAGE and the Short Michigan Alcoholism Screening Test. If one of these screening questionnaires or the General Practitioners' assessment of the patient indicated an alcohol problem, the patient underwent a standardized diagnostic interview using the alcohol section of the Schedules for Clinical Assessment in Neuropsychiatry. The prevalence rates according to ICD-10 or DSM-III-R were 3.5% for alcohol abuse and 7.2% for alcohol dependence, the sex ratio was 1:2.8 (female:male). These results are compared with previous findings, and general epidemiological implications of this study are discussed.

The effect of osmotic dehydration on the volatile fraction of kiwi fruit was studied, as well as the effect of freezing and frozen storage. Osmotic treatments were carried out in sucrose solutions until the kiwi fruit reached 30°Brix, at atmospheric pressure (OD) and by applying a vacuum pulse (PVOD), by using 45 and 65°Brix sucrose. Volatile compounds of fresh, dehydrated

This study was designed to confirm our previous findings that nonalcoholic offspring from families with alcohol-dependent individuals have greater hypothalamic-pituitary-adrenal axis activation induced by opioid blockade compared with nonalcoholic subjects without a family history of alcohol dependence. Sixty-four nonalcoholic subjects aged 18 to 25 years were enrolled in the protocol. Twenty-seven subjects were offspring from families with alcohol dependence and were designated as family history-positive subjects (FHP). Thirty-seven subjects were biological offspring of non-alcohol-dependent parents and were designated as family history-negative subjects (FHN). Subjects received naloxone hydrochloride (0, 50, 125, 375, and 500 microg/kg) in double-blind, randomized order; adrenocorticotropin (ACTH) and cortisol were monitored over 120 min. No hormone differences at baseline or during placebo administration were identified between FHP and FHN subjects. FHP subjects had greater ACTH and cortisol response to opioid receptor blockade induced by naloxone hydrochloride compared with FHN subjects. These observations confirm previous findings that differences in ACTH and cortisol dynamics between FHP and FHN subjects can be unmasked by opioid receptor blockade.

In a department of hepatology and gastroenterology, a significant number of patients are hospitalized for alcohol withdrawal. The aim of this retrospective study was to identify factors predictive of severe or complicated alcohol withdrawal in order to improve patient management.Between June 2002 and June 2005, 182 patients admitted for alcohol dependence according to the DSM-IV classification were enrolled in this study. A unique management protocol for alcohol withdrawal was applied for all patients. The Cushman score was recorded on day 1, 2 and 3 to assess the severity of alcohol withdrawal. We searched for correlations between epidemiological, clinical and biological data and the Cushman score.The study population included 136 (74.7%) men and 46 (25.3%) women, mean age 47.6 ± 10.1 years. One hundred and eighteen patients (64.8%) were referred from a specialized outpatient clinic and 64 (35.2%) patients were referred from the emergency unit. The mean and median Cushman scores on day 1, 2 and 3 were: 5.1 and 5; 3.9 and 4; 2.3 and 2, respectively. Twenty patients (11.0%) and five patients (2.7%) had scores greater than or equal to 8 and greater than 12, respectively. The proportion of patients with Cushman score greater than or equal to 8 on day 1 was significantly greater in patients referred from the emergency unit than in those referred from a specialized outpatient clinic (p = 0.002). Mean alanine aminotransferase level on day 1 was significantly higher in patients with a score greater than or equal to 8 than in those who had a score less than 8 (112.1 ± 44.4 UI/L versus 78.4 ± 11.8 UI/L; p = 0.046). Referral via an emergency unit as well as an alanine aminotransferase level greater than 1.5 fold the upper limit of the normal range were independent predictive factors for a Cushman score greater than or equal to 8.In conclusion, severe alcohol withdrawal (Cushman score ≥ 8) is significantly associated with initial management in an emergency unit and serum alanine aminotransferase level greater than 1.5 fold the upper limit of the normal range. These predictors should be monitored in order to appropriately adapt the therapeutic schedule.Le nombre d’hospitalisations dans un service d’hépatogastroentérologie pour le sevrage d’une alcoolo-dépendance est important. Le but de cette étude, retrospective, était de déterminer les facteurs prédictifs d’un sevrage alcoolique sévère ou compliqué afin d’améliorer la prise en charge de ces malades. De juin 2002 à juin 2005, 182 malades ayant une alcoolo-dépendance selon la classification DSM-IV pris en charge dans le service pour sevrage ont été inclus dans cette étude. Tous les malades recevaient un protocole de sevrage identique. La gravité du sevrage alcoolique était évaluée par le score de Cushman à j1, j2 et j3. Les paramètres épidémiologiques et biologiques ont été comparés avec les valeurs du score de Cushman. Cent trente-six hommes (74,7 %) et 46 femmes (25,3 %) d’âge moyen 47,6 ± 10,1 ans ont été inclus. L’hospitalisation a été réalisée à partir d’une consultation d’alcoologie pour 118 malades (64,8 %) et par le biais des urgences pour 64 d’entre eux (35,2 %). La moyenne et la médiane du score de Cushman étaient à j1, j2 et j3, respectivement, de 5,1 et 5 ; 3,9 et 4 ; 2,3 et 2. Vingt malades (11,0 %) et cinq malades (2,7 %) avaient un score, respectivement, supérieur à 8 et supérieur ou égale à 12 à j1. La proportion de malades ayant un score supérieur ou égale à 8 à j1 était supérieure chez les malades venant des urgences que chez ceux issus de la consultation d’alcoologie (p = 0,002). Les malades dont le score était supérieur ou égale à 8 avaient un taux sérique moyen de l’alanine aminotransférase significativement plus élevé à j1 que ceux qui avaient un score inférieur à 8 (respectivement, 112,1 ± 44,4 UI/L versus 78,4 ± 11,8 UI/L ; p = 0,046). L’admission par le biais des urgences ainsi qu’un taux sérique de l’alanine aminotransférase supérieur à 1,5 fois la limite supérieure de la normale étaient les deux variables indépendantes prédictives d’un score de Cushman supérieur ou égale à 8. En conclusion, un syndrome de sevrage sévère lors d’une alcoolo-dépendance est significativement plus associé à une hospitalisation directe par le biais des urgences et à un taux sérique de l’alanine aminotransférase supérieur à 1,5 fois la limite supérieure de la normale. La présence de ces facteurs à l’admission du malade nécessite une surveillance accrue et une éventuelle adaptation de la prise en charge thérapeutique.

The goal of this study was to compare five scales of adult recall of childhood psychological maltreatment. The internal consistency, mean levels, intercorrelations, and associations with demographic variables were examined. Also examined was whether respondents were less likely to endorse items that were general and value laden as opposed to descriptive of specific behaviors. Results revealed high internal consistency, high

Driving under the influence is a devastating problem in the United States, killing almost 17,000 people in 2005. The present article describes a cognitive treatment program aimed at repeat drinking and driving offenders. Sixty-three participants were court mandated to the four-month outpatient treatment program. Before entering and after completing treatment, participants were administered self-report instruments measuring alcohol problems, readiness to

À l'aide du modèle multidimensionnel de l' « Ouverture émotionnelle » nous explorons les hypothèses suivantes : les patients souffrant d'un Trouble de la dépendance ou d'un Trouble de la personnalité présentent une diminution a) de la « représentation cognitive et conceptuelle » de leurs états affectifs ; b) de leur « régulation émotionnelle » et c) de la « communication et expression » de leurs émotions, mais une augmentation d) de la « perception des indicateurs corporels internes » ; e) des interventions psychologiques appropriées améliorent ces patterns problématiques. Les résultats avec le questionnaire factoriel DOE (« Dimensions de l'Ouverture Émotionnelle ») – dans deux études comparant des patients (n = 71) avec des sujets non cliniques (n = 101) – confirment les déficits marqués selon les hypothèses, en particulier chez les patients avec un double diagnostic qui présentent des déficits encore plus importants en « représentation cognitive » et en « régulation des émotions ». En revanche, des comparaisons pré- post-traitement montrent une amélioration du profil DOE. Des implications du dysfonctionnement émotionnel pour la psychothérapie sont discutées.Emotion processing is supposed to play an important role in psychological dysfunctions in alcohol and drug dependency disorders (DD), as well as in personality disorders (PD). The model of “Emotional Openness” (“Ouverture émotionnelle”) provides a multidimensional framework to analyze problematic patterns of emotion processing. Within this framework, it is suggested that drug- and alcohol-dependent patients as well as borderline and antisocial patients show reduced a) “cognitive/conceptual representation” of affective states; b) “emotion regulation”; and c) “expression and communication of emotion”; but d) increased “awareness of body internal indicators” of affectivity; and e) appropriate psychological treatment is supposed to improve these patterns. Drug-dependent patients with PD comorbidity (in particular borderline or antisocial) are supposed to present even stronger deficits in (a) and (b). The hypotheses are tested with the 36-item DOE questionnaire (“Dimensions of Openness to Emotional experiences”, trait version; [19]), assessing six main dimensions of emotion processing as represented by the subject (French and Italian version). The instrument presents satisfying reliability coefficients (mean alphas of the scales in two recent studies (N = 251; N = 435) vary between 0.74 and 0.82) and good factorial validity (6-factor PCA solutions with varimax rotation solutions in the two samples are highly coherent; the mean of Tucker's congruence coefficients is 0.93). Results of two clinical studies are presented, comparing N = 71 patients (21 drug-dependent without personality disorder; 30 drug-dependent with borderline or antisocial personality; 20 dependent in-patients receiving psychological therapy) with normal control subjects (N = 51 matched; N = 50 reference group), including one pre-post treatment comparison. Results confirm marked deficits of DD patients concerning “conceptual representation” and “emotion regulation”, as well as a reduction of “communication/expression of emotion” but an increased “awareness of body internal indicators” of affectivity. Differences of patients with a double diagnosis correspond to effect sizes of d = –1.33 for cognitive/conceptual representation of emotions and d = –1.25 for emotion regulation; differences in emotion communication and expression are also significant but less important d = –0.44. Awareness of body internal emotion indicators is increased (d = +0.27) but does not differ significantly from the control group. As supposed, patients with a double diagnosis (DD and PD) described significantly stronger deficits in conceptual representation and emotion regulation than the patients with dependency disorder only. In the second study, a group of DD patients receiving multi-component treatment, including individual and group therapeutic intervention, according to the client-centered approach, and working on emotion processing, showed marked differences from the reference group at the beginning of the treatment (d = –0.91 for cognitive/conceptual representation, d = –0.82 for emotion regulation and d = +0.46 for awareness of bodily internal indicators). As supposed, pre-post comparisons indicate improvement with change effect sizes of d = 0.99 for conceptual representation, d = 0.97 for emotion regulation, as well as d = 0.88 for emotion communication and expression. Furthermore, the changes following treatment are highly significant and substantial, except for the awareness of internal bodily indicators, which only slightly decreased. Patients “normalize” their emotion processing following treatment, describing increased conceptual representation and emotion regulation, as well as emotion communication and expression. Results underline the importance of dysfunctional modes of emotion processing in both pathologies, and underline the validity of applying the model and the DOE instrument. They are discussed with reference to the model of alexithymia.

In contrast to many years of important research and clinical attention to the pathological effects of alcohol (ethanol) abuse, the past several decades have seen the publication of a number of peer-reviewed studies indicating the beneficial effects of light-moderate, nonbinge consumption of varied alcoholic beverages, as well as experimental demonstrations that moderate alcohol exposure can initiate typically cytoprotective mechanisms. A considerable body of epidemiology associates moderate alcohol consumption with significantly reduced risks of coronary heart disease and, albeit currently a less robust relationship, cerebrovascular (ischemic) stroke. Experimental studies with experimental rodent models and cultures (cardiac myocytes, endothelial cells) indicate that moderate alcohol exposure can promote anti-inflammatory processes involving adenosine receptors, protein kinase C (PKC), nitric oxide synthase, heat shock proteins, and others which could underlie cardioprotection. Also, brain functional comparisons between older moderate alcohol consumers and nondrinkers have received more recent epidemiological study. In over half of nearly 45 reports since the early 1990s, significantly reduced risks of cognitive loss or dementia in moderate, nonbinge consumers of alcohol (wine, beer, liquor) have been observed, whereas increased risk has been seen only in a few studies. Physiological explanations for the apparent CNS benefits of moderate consumption have invoked alcohol’s cardiovascular and/or hematological effects, but there is also experimental evidence that moderate alcohol levels can exert direct “neuroprotective” actions—pertinent are several studies in vivo and rat brain organotypic cultures, in which antecedent or preconditioning exposure to moderate alcohol neuroprotects against ischemia, endotoxin, β-amyloid, a toxic protein intimately associated with Alzheimer’s, or gp120, the neuroinflammatory HIV-1 envelope protein. The alcohol-dependent neuroprotected state appears linked to activation of signal transduction processes potentially involving reactive oxygen species, several key protein kinases, and increased heat shock proteins. Thus to a certain extent, moderate alcohol exposure appears to trigger analogous mild stress-associated, anti-inflammatory mechanisms in the heart, vasculature, and brain that tend to promote cellular survival pathways.