Archive for September, 2010

Stress hormone impacts on alcohol recovery

Scientists at the University of Liverpool have found that high levels of a stress hormone in recovering alcoholics could increase the risk of relapse.

The study showed that cortisol, a hormone produced by the adrenal gland in response to stress, is found in high levels in chronic alcoholics, as well as those recovering from the condition. Researchers found that this could result in impaired memory, attention and decision-making functions, which could decrease the patient’s ability to engage with treatment.

Chronic alcoholism is a disabling addictive disorder, characterised by compulsive and uncontrolled consumption of alcohol despite the negative effects it has on health, relationships and social standing. Alcohol damages almost every organ of the body including the brain where it causes memory loss and impairs decision-making and attention span.

Cortisol and Recovery

Cortisol plays an important role in the regulation of emotion, learning, attention, energy utilization, and the immune system. The research showed that high levels of this hormone are present in alcoholic patients and continue to be elevated during withdrawal from alcohol and after long periods of abstinence.

Dr Abi Rose (lead author of the review), in the School of Psychology, Health and Society at the University of Liverpool, said: “Both drinking and withdrawal from alcohol can affect cortisol function in humans. Cortisol dysfunction, including the high levels of cortisol observed during alcohol withdrawal, may contribute to the high rates of relapse reported in alcohol dependence, even after many months of abstinence. Drugs targeting the effects of cortisol in the brain might reduce the chances of relapse and reduce the cognitive impairments that interfere with treatment.”

September 27th, 2010  in Alcoholism No Comments »

Just 2 drinks slow reactions in older people

Blood alcohol levels below the current legal limit for driving have a significant negative effect on a person’s dexterity. Researchers writing in the open access journal BMC Research Notes found that just two single vodka and orange drinks were enough to make senior volunteers struggle at an obstacle avoidance test while walking.

Judith Hegeman worked with a team of researchers from Sint Maartenskliniek, Nijmegen, The Netherlands, to carry out the tests in 13 healthy men and women (average age 61.5yrs or 62yrs). She said, “The results clearly show that even with low blood alcohol concentrations, reactions to sudden gait perturbations are seriously affected. After ingestion of 2 alcoholic drinks, obstacles were hit twice as often, response times were delayed and response amplitudes were reduced. These changes were most obvious in situations with little available response time.”

Alcohol Hampers Reaction Times

To carry out the test, the volunteers first started to walk on a treadmill. Once they had attained a steady walking pace, a thin wooden block was placed at the far end of the belt and allowed to move towards the volunteer. Hegeman and her colleagues measured the effects of alcohol on how capable the subjects were of stepping over this obstacle.

She said, “We found that alcohol levels, considered to be safe for driving, seriously hamper the ability to successfully avoid sudden obstacles in the travel path. A possible limitation of this study is the relatively small sample size, however even with the small number, it yielded an unequivocal outcome.”

September 23rd, 2010  in Alcohol, Drunk Driving No Comments »

Acamprosate prevents relapse to drinking in alcoholism

Acamprosate reduces the number of patients being treated for alcoholism who return to drinking, according to a new Cochrane Systematic Review. The drug showed moderate benefits in trials when used in addition to non-drug treatments.

Drinking too much alcohol increases the risk of ill health. According to the World Health Organization, alcohol misuse is at the root of around a quarter of all cases of oesophageal cancer, liver disease and epilepsy, as well as road accidents and homicides. Acamprosate and naltrexone are drugs used alongside psychosocial methods to help prevent relapse in alcoholics who are trying to stop drinking.

Lower Risk of Relapse

The researchers reviewed data from 24 randomized controlled trials, considered the gold standard for clinical studies. Altogether these trials involved 6,915 alcohol dependent patients who were also undergoing psychosocial therapies. Acamprosate prevented relapse in one in every nine patients who had stopped drinking and increased the number of days patients spent not drinking by an average of three days a month. The researchers showed that the risk of a patient on acamprosate returning to drinking was 86% of that of a patient who took a placebo instead. Diarrhoea was the only side effect that was more frequently reported under acamprosate than placebo.

“Acamprosate is certainly no magic bullet, but it is a safe and effective treatment for patients who are trying to stop drinking,” said lead researcher Susanne Rösner of the Psychiatric Hospital at the University of Munich, Germany. “The benefits we have seen in these trials are small. However, we must remember that these are additional benefits on top of those from other non-drug therapies.”

Giving Patients a Choice

The researchers stress the need to respect a patient’s right to choose by providing all the necessary information about the benefits and drawbacks of the drugs when recommending a therapeutic strategy. “Patients’ doubts and reservations against a strategy that uses one substance to treat dependency on another should be taken seriously, while interventions that have been shown to work should not kept back from patients,” said Rösner.

September 14th, 2010  in Alcoholism No Comments »

Women beer drinkers more likely to have psoriasis

Regular beer—but not light beer or other types of alcohol—appears to be associated with an increased risk of developing psoriasis, according to a report posted online today that will be published in the December print issue of Archives of Dermatology, one of the JAMA/Archives journals.

“Psoriasis is a common immune-mediated skin disease,” the authors write as background information in the article. “The association between alcohol consumption and increased risk of psoriasis onset and psoriasis worsening has long been suspected. For example, individuals with psoriasis drink more alcohol than individuals without psoriasis, and alcohol intake may exacerbate psoriasis severity.”

Diagnosis of Psoriasis

For other diseases, type of alcoholic beverage has been shown to influence risk—for instance, beer confers a larger risk for gout than wine or spirits. To evaluate the association between different types of alcohol and psoriasis risk, Abrar A. Qureshi, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, Boston, assessed data from 82,869 women who were age 27 to 44 years in 1991. The women, participants in the Nurses’ Health Study II, reported the amount and type of alcohol they consumed on biennial questionnaires. They also reported whether they had received a diagnosis of psoriasis.

Through 2005, 1,150 cases of psoriasis developed, 1,069 of which were used for analysis. Compared with women who did not drink alcohol, the risk of psoriasis was 72 percent greater among women who had an average of 2.3 drinks per week or more. When beverages were assessed by type, there was an association between non-light beer drinking and psoriasis, such that women who drank five or more beers per week had a risk for the condition that was 1.8 times higher. Light beer, red wine, white wine and liquor were not associated with psoriasis risk.

When only confirmed psoriasis cases—those in which women provided more details about their condition on a seven-item self-assessment—were considered, the risk for psoriasis was 2.3 times higher for women who drank five or more beers per week than women who did not drink beer.

Only Regular Beer Increased Risk

“Non-light beer was the only alcoholic beverage that increased the risk for psoriasis, suggesting that certain non-alcoholic components of beer, which are not found in wine or liquor, may play an important role in new-onset psoriasis,” the authors write. “One of these components may be the starch source used in making beer. Beer is one of the few non-distilled alcoholic beverages that use a starch source for fermentation, which is commonly barley.” Barley and other starches contain gluten, to which some individuals with psoriasis show a sensitivity. Lower amounts of grain are used to make light beer as compared with non-light beer, potentially explaining why light beer was not associated with psoriasis risk, they note.

“Women with a high risk of psoriasis may consider avoiding higher intake of non-light beer,” the authors conclude. “We suggest conducting further investigations into the potential mechanisms of non-light beer inducing new-onset psoriasis.”

September 5th, 2010  in Alcohol No Comments »

Alcoholic liver disease is more aggressive

Many diagnostic and treatment options have been developed for chronic liver disease during the last 40 years, yet their influence on survival remain unclear. A new study of the prognosis for patients hospitalized for liver diseases between 1969 and 2006, and of differences in mortality and complications between patients with alcoholic and non-alcoholic liver diseases, has found that the general prognosis for patients hospitalized with chronic liver diseases has not improved.

“The most effective changes in treatment for chronic liver disease during the last 40 years are, in my opinion, combination treatment for hepatitis C and treatment with prednisolone and azathioprine for autoimmune hepatitis,” said Knut Stokkeland, an instructor in the department of medicine at Visby Hospital in Sweden and corresponding author for the study. “In addition, new diagnostic tools such as endoscopic examinations, computed tomography, MRI, and ultrasound have probably increased our possibilities to detect early disease and the development of cirrhosis.”

Alcohol Dependence Increases Risks

Stokkeland added that the key difference between alcoholic and non-alcoholic liver disease is alcohol dependence (AD), which almost all patients with alcoholic liver disease have. “AD increases the risks of social problems, being a smoker, and severe psychiatric diseases,” he said. “It also inhibits staying sober, which may stop disease progression.”

Stokkeland and his colleagues used data from the Swedish Hospital Discharge Register and Cause of Death Register between 1969 and 2006 to both identify and follow up with a cohort of 36,462 patients hospitalized with alcoholic liver diseases and 95,842 patients hospitalized with non-alcoholic liver diseases.

“The main finding of Dr. Stokkeland’s study is the much increased mortality risk of having an alcohol- versus a non-alcohol-related liver disease,” observed Johan Franck, a professor of clinical addiction research at Karolinska Institutet in Sweden. “Thus, patients with alcohol-induced liver diseases should receive more attention, and they should routinely be offered treatment for their alcohol-use disorder. Presumably, the various treatment systems involved – such as hepatology versus substance-abuse care – may not be very well coordinated and this may present an area for improvement.”

Must Focus on Treating Alcoholism

Stokkeland agreed. “This may be caused by the fact that hospitalized patients with [alcoholic] liver disease have such a severe liver disease that no effort may change their prognosis,” he said. “I hope this study will motivate clinicians and scientists in the field of hepatology and gastroenterology to design clinical studies to see if any changes in care-taking of our patients with alcoholic liver disease may change their severe prognosis. We must also focus on treating their AD so that they may stop drinking.”

“Given that alcohol doubles the risk of having a serious liver disease,” added Franck, “efforts to reduce alcohol drinking will likely have a positive impact on the disease’s outcome.”

Results will be published in the November 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

September 5th, 2010  in Alcoholism No Comments »

Hispanic kids show greater risk of substance use

Hispanic middle school students may be more likely to smoke, drink or use marijuana than their peers of other races and ethnicities, whereas Asian students seem to have the lowest risk, according to new research in the September issue of the Journal of Studies on Alcohol and Drugs.

The study, of 5,500 seventh- and eighth-graders at 16 California schools, found that young Hispanic adolescents were more likely than other students to have ever used alcohol, cigarettes or marijuana. Asian students, meanwhile, had the lowest rates of substance use compared with Hispanic, white and African American students.

Race a Factor in Substance Abuse?

Moreover, the study found that some of the factors that seemed to influence kids’ odds of substance use also varied by race and ethnicity.

Among Hispanic youth, it was personal factors that were linked to the risk of substance use — including their confidence in their ability to “say no” and whether they believed drinking, smoking and drug use had more negative consequences.

In contrast, a wider range of factors was linked to Asian teens’ relatively low rates of substance use — not only those same personal-level factors but also respect for their parents and lower rates of substance use among their older siblings and peers.

The findings point to some important issues that could be addressed in substance-use prevention programs for middle school students, according to Regina A. Shih, Ph.D., and colleagues at the research organization RAND Corporation.

Culturally Appropriate Interventions

“Most interventions haven’t really been tailored to be culturally appropriate,” Shih explained. For example, “skills training,” where kids learn how to resist pressure to smoke, drink or use drugs, could help address one of the personal factors that was connected to Hispanic students’ higher rates of substance use.

Similarly, interventions that encourage positive parent-child communication and boost kids’ sense of responsibility to their parents might help maintain lower rates of substance use — and could be particularly effective for young Asian teens.

Shih said, however, that the researchers are not suggesting that such targeted efforts only be offered to students of certain ethnicities — but that they could be widely applied in prevention programs to help the broadest range of kids possible. Many existing interventions target these types of personal factors and address adolescent and parent communication. “It is important for parents to be aware that many youth initiate substance use during the middle school years, and parents can help their teen make healthier choices by monitoring their activities and talking with them about these issues,” Shih said.

Of all students in the study, 22 percent said they had ever used alcohol, 10 percent admitted to smoking at some point, and 7 percent reported marijuana use. In general, the odds of substance use were highest among Hispanic students, lowest among Asians and not statistically different between white and African American students.

Hispanic Students at Greater Risk

When it came to drinking, for example, 26 percent of Hispanic students said they had ever tried alcohol, versus 21 percent of black students, 18 percent of whites and just below 10 percent of Asians.

When the researchers accounted for several other factors — including gender and students’ family structures — Hispanic middle schoolers still had a higher probability, and Asian students still had a lower probability, of ever using cigarettes, alcohol or marijuana, compared with white students.

Using this large longitudinal sample, Shih’s team will be able to continue to follow young adolescents over time to see which personal, family and school factors seem to predict the initiation or worsening of teens’ smoking, drinking or drug use.

September 5th, 2010  in Substance Abuse, Tobacco No Comments »