Alcohol consumption/alcoholism abuse

Alcohol abuse Alcohol-preferring rat Decreases alcohol consumption [60]... 

Specific concomitant medications or consumptions (check specific statin package insert for warnings) fibrates (especially gemfibrozil, but other fibrates too), nicotinic acid (rarely), cyclosporine, azole antifungals such as itraconazole and ketoconazole, macrolide antibiotics such as erythromycin and clarithromycin, protease inhibitors used to treat Acquired Immune Deficiency Syndrome, nefazodone (antidepressant), verapamil, amiodarone, large quantities of grapefruit juice (usually more than 1 quart per day), and alcohol abuse (independently predisposes to myopathy)... 

Alcohol consumption is very difficult to assess. There is widespread belief that individuals underreport their intake and there are no reliable laboratory tests available for definitive diagnosis of alcohol abuse. A combination of abnormalities in the plasma activity of gamma-glutamyl transferase (GGT or yGT), AST and reduction in erythrocyte mean cell volume (MCV) maybe useful and all are routine lab. tests. A potential marker of interest is carbohydrate-deficient transferrin (CDT) which is an abnormal isoform of serum transferrin arising due to defects in the attachment of carbohydrate chains to the protein core. Unfortunately, CDT is a somewhat specialized test, not performed by most laboratories. Other markers which have attracted some research interest are ethyl sulphate and ethyl glucuronide. Excretion in the urine of these metabolites occurs for up to 50 hours after binge drinking so they offer a useful index of recent heavy alcohol intake. 

Toxicologists nowadays take a broad view of developmental toxicity they consider not only structural but also functional abnormalities to qualify as adverse, as long as they were produced as a result of exposures incurred in utero. Thus, for example, the developmental effects of chronic alcohol abuse by pregnant women, known as fetal alcohol syndrome (FAS), are characterized not only by the presence of certain craniofacial abnormalities, but also by a variety of disabilities such as shortened attention span, speech disorders, and restlessness. Although fully expressed physical deformities included in FAS are associated with heavy drinking, debate continues on the level of alcohol consumption, if any, that is without these more subtle effects on behavior. 

Alcohol abuse is associated with many psychiatric complications, starting with those involving acute consumption or withdrawal ... 

Liver disease is the most common medical complication of alcohol abuse an estimated 15-30% of chronic heavy drinkers eventually develop severe liver disease. Alcoholic fatty liver, a reversible condition, may progress to alcoholic hepatitis and finally to cirrhosis and liver failure. In the United States, chronic alcohol abuse is the leading cause of liver cirrhosis and of the need for liver transplantation. The risk of developing liver disease is related both to the average amount of daily consumption and to the duration of alcohol abuse. Women appear to be more susceptible to alcohol hepatotoxicity than men. Concurrent infection with hepatitis or C virus increases the risk of severe liver disease. 

Abrupt alcohol withdrawal leads to a characteristic syndrome of motor agitation, anxiety, insomnia, and reduction of seizure threshold. The severity of the syndrome is usually proportionate to the degree and duration of alcohol abuse. However, this can be greatly modified by the use of other sedatives as well as by associated factors (eg, diabetes, injury). In its mildest form, the alcohol withdrawal syndrome of tremor, anxiety, and insomnia occurs 6-8 hours after alcohol consumption is stopped (Figure 23-2). These effects usually abate in 1-2 days. In some patients, more severe withdrawal reactions occur, with patients at risk of hallucinations or generalized seizures during the first 1-3 days of withdrawal. Alcohol withdrawal is one of the most common causes of seizures in adults. Several days later, individuals can develop the syndrome of delirium tremens, which is characterized by total disorientation, hallucinations, and marked abnormalities of vital signs. 

Alcohol consumption Moderate consumption of alcohol (for example, two drinks a day) decreases the risk of coronary heart disease, because there is a positive correlation between moderate alcohol consumption and the plasma concentration of HDLs. However, because of the potential dangers of alcohol abuse, health professionals are reluctant to recommend increased alcohol consumption to their patients. Red wine may provide cardioprotective benefits in addition to those resulting from its alcohol content, for example, red wine contains phenolic compounds that inhibit lipoprotein oxidation (see p. 233). [Note These antioxidants are also present in raisins and grape juice.]... 

Oral baclofen has also been used to reduce alcohol consumption in people who are chronic alcohol abusers.21,22 Apparently, relatively low doses of baclofen can reduce the cravings and desire for alcohol consumption via the effects of this drug on CNS GABA receptors.21 Future studies will help clarify the role of this drug in treating chronic alcoholism. 

People who continue to drink alcohol in spite of adverse medical or social consequences related directly to their alcohol consumption suffer from alcoholism, a complex disorder that appears to have genetic as well as environmental determinants. The societal and medical costs of alcohol abuse are staggering. It is estimated that about 30% of all people admitted to hospitals have coexisting alcohol problems. Once in the hospital, people with chronic alcoholism generally have poorer outcomes. In addition, each year thousands of children are born in the USA with morphologic and functional defects resulting from prenatal exposure to ethanol. Despite the investment of many resources and much basic research, alcoholism remains a common chronic disease that is difficult to treat. 

Alcohol abuse and addiction (alcoholism) in America affects 5% to 10% of the population. The consumption of alcohol has become a status symbol among the business class, students, and high society. People always look for an occasion to celebrate with drinks and ultimately may become the victims of alcohol addiction.10-15... 

Since prehistoric times, ethanol-containing beverages have enjoyed widespread use as a recreational luxury. What applies to any medicinal substance also holds for alcohol the dose alone makes the poison (see p. 2). Excessive, long-term consumption of alcoholic drinks, or alcohol abuse, is harmful to the affected individual. Alcoholism must be considered a grave disorder that plays a major role in terms of numbers alone for instance, in Germany 1 000 000 people are affected by this self-inflicted illness. 

A kind of (low-dose) dependence may also develop when alcohol is consumed daily, albeit in minor quantities. As a rule of thumb, alcohol always makes people dependent when consumed on a regular basis — no matter what the dose may be. Alcohol addiction comprises (1.) physical dependence including increased tolerance as well as the withdrawal syndrome and (2.) psychological dependence with an uncontrollable desire for permanent or intermittent alcohol consumption, reduced self-control as well as changes in behaviour, (s. tab. 28.1) Alcohol abuse includes addiction without actually being identical to it. Neither the brain s reward system (A. Herz et af, 1989) nor the addiction memory (X Boning, 1992) are stimulated by occasional alcohol consumption. Another explanation for this... 

The effect of alcohol abuse, one of the most common aggravating factors in vitamin A toxicity, has been elucidated. Vitamin A toxicity was potentiated in patients who took 10 000 lU/day for sexual dysfunction, and this effect was attributed to excess alcohol consumption (95). In animals, potentiation of vitamin A toxicity by ethanol resulted in striking hepatic inflammation and necrosis accompanied by a rise in serum glutamate dehydrogenase and aspartate transaminase (96). 

This section on the chronic effects of heavy alcohol consumption has highlighted the idea of alcohol as a double-edged sword. On the one side, as we showed you in Chapter 1, the economic costs of alcohol abuse to the United States are tremendous and come from many sources. The cftects of chronic, heavy alcohol use on the body result in major health care expenses. Furthermore, if you consider some of the social consequences that contribute to the costs, they may become even more real to you. We already discussed how alcohol is implicated... 

Americans (7.4% of the population) meet the diagnostic criteria for alcohol abuse or alcoholism. More than one-half of American adults have a close family member who has or has had alcoholism. Almost 2.7 million violent crimes and 16000 traffic crashes can be directly linked to alcohol. Alcohol consumption has consequences for the health and well-being of those who drink and, by extension, the lives of those around them. Because alcoholism... 

There is no question that alcohol abuse contributes significantly to liver-related morbidity and mortality in the United States. Long-term alcohol use is the leading cause of illness and death from liver disease. There are three phases of alcohol-induced liver damage, alcoholic fatty liver, which is usually reversible with abstinence alcoholic hepatitis or inflammation and alcoholic cirrhosis or scarring of the liver. Patients with both alcoholic cirrhosis and hepatitis have a death rate of more than 60% over a 4-year period. The prognosis is bleaker than the outlook for many types of cancers. As many as 900 000 people in the United States suffer from cirrhosis and some 26 000 of these die each year. The risk for liver disease is related to how much a person drinks the risk is low at levels of alcohol consumption but steeply increases with higher levels of consumption. Because effects of alcohol are dose-related and because of the steepness at which the adverse effects are... 

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