5.12汶川地震灾后酒依赖流行病学调查研究

目的:了解5.12汶川地震灾后酒依赖的患病率及其相关因素,为灾后心理康复提供科学依据。方法:整群抽样,在具有代表性的极重灾区都江堰、北川、青川三地,以自编一般情况调查表及一般健康问卷12项(GHQ-12)为筛选工具,以SCID-I/P定式检查问卷为调查诊断工具,依据DSM-Ⅳ诊断标准,对成年地震亲历人群(≥15a)进行调查,并通过单因素和多因素的分析方法,计算这些因素对灾后酒依赖的作用强度。结果:共纳入14208例调查对象,总酒依赖时点患病率为0.80%,比1993年调查结果(0.68‰)高11.76倍。相关因素有男性、年龄较大者、受教育年限较少者、婚姻不稳定者、震中丧失亲人、震前居住地在城镇的、亲眼看到他人死亡者等。结论:酒依赖是震后主要的精神疾病之一,大量饮酒者及酒依赖患者是灾后精神卫生防治的重点人群。     

酒依赖者认知功能障碍的事件相关电位研究

目的··:就酒依赖者与非酒依赖者事件相关电位听觉P300 进行对照研究 ,以了解酒依赖者认知功能状况。方法·· :使用NicoletCA -IV型诱发电位仪 ,对完成脱酒治疗的33例酒依赖者和30例非酒依赖者诱发电位P300 的变化进行对照研究 ,并就早发酒依赖和晚发酒依赖者的P300 进行比较。结果··:酒依赖组P300 靶刺激中P3 波幅较非依赖者明显降低,P3 波幅增宽 ,潜伏期延长 ,与对照组比较有显著性差异。晚发酒依赖组 (发病年龄>28a)较早发酒依赖组(发病年龄≤28a)P3 波幅下降更为明显。结论·· :酒依赖者P3 波幅下降 ,潜伏期延长 ,提示认知功能受损。晚发酒依赖组较早发酒依赖组P3 波幅下降更为明显     

1142例海洛因依赖者对艾滋病防卫意识与行为研究

目的:通过评价海洛因依赖者对艾滋病病毒的认知行为,依从性及防护行为的研究,从而为控制艾滋病在一般人群中传播提供参考依据.方法:对自愿住院的戒毒病人和亲近的健康人群进行HIV防护知识的调查,同时对自愿住院的戒毒病人进行依从性和防护状况调查.结果:健康人群和吸毒者HIV防护知识得分无显著性差异(P＞0.05).吸毒病人防护知识得分和防护状况得分有显著性差异(P＜0.05).吸毒病人的防护状况与年龄、学习年限及防护知识之间呈中度相关(γ＞0.5).结论:当前应对低年龄、低学历及低健康知识人群的三低人群重点进行预防艾滋病的教育.     

Fischer和Lewis两种品系的大鼠可作为研究药物成瘾易感性的遗传背景实验材料

药物滥用的流行病学资料显示,大约70%阿片类依赖者亲属产生药物依赖性的危险性比对照人群(非依赖者亲属)高8倍。酒精成瘾者的亲属产生酒依赖的危险性比一般人群高。研究遗传因素在药物成瘾易感性中的作用正成为研究药物成瘾的神经生物学的内容之一。Fischer大鼠和Lewis大鼠是遗     

金平莽族人饮酒状况调查

目的:了解莽人的饮酒情况及危害程度.方法:通过自拟饮酒调查表了解莽人饮酒情况,并用酒精使用障碍识别测验(AUDIT)筛查危害饮酒,对诊断酒依赖者用饮酒问卷(ADS)评定其依赖程度.结果:莽人饮酒人数占15岁以上人群的62.3%,危害饮酒占15岁以上人群的45.9%,酒依赖占15岁以上人群的29.18%o,酒精所致精神障碍占15岁以上人群的7.96‰.饮酒方式为群聚取乐为主,醉酒现象普遍,占饮酒人数的65.1%,年平均醉酒次数31.45±60.27次,醉酒者没有明显的攻击倾向.结论:莽人危害饮酒现象突出,原因可能与御寒、生活方式简单枯燥和回避行为有关,值得关注.     

18例酒依赖再次住院患者社会心理学问题

目的:了解酒依赖者存在的社会心理学状况,为解决酒依赖者复发问题提供部分依据。方法:利用自行设计的调查表,对2所精神病专科医院2次以上住院的酒依赖患者共计18例进行了社会心理问题调查。结果:调查发现这些患者的社会心理问题主要是食欲差、性欲或性快感丧失、失眠、自身健康评估错误、难以完成工作任务、精力不足、责怪别人制造麻烦、饮酒不影响健康、与家人关系紧张等。结论:酒依赖者存在严重的社会心理学问题。提示应对酒依赖者综合治疗,即认知-行为治疗、心理治疗与家庭支持,建议采用"动机启发性交谈"。     

酒依赖住院患者血清钾浓度变化分析

目的:了解酒依赖住院患者在不同时段中血清钾浓度变化情况及发生低血钾的相关危险因素。方法:应用XD-684电解质分析仪,对符合CCMD-3诊断标准酒依赖的住院患者183例,分别于新入院、入院一周、入院一个月测定其血清钾浓度,并与120例健康者组成的对照组进行比较。结果:在183例酒依赖患者中,入院时查出低血钾症者51例(27.9%),低血钾发生率显著高于正常对照组(P<0.01)。住院一周时酒依赖患者血清钾平均浓度仍显著低于正常对照组(P<0.01);住院一周及住院一个月酒依赖患者血清钾平均浓度与新入院患者比较,差异有统计学意义(P<0.01);住院一个月与住院一周酒依赖患者血清钾平均浓度比较,差异有统计学意义(P<0.01);住院一个月酒依赖患者血清钾浓度基本恢复正常,与正常对照组比较,差异无统计学意义(P>0.05)。年龄≥45 a的酒依赖患者中低血钾发生率显著高于<45 a酒依赖患者(P<0.01);伴随有躯体疾病的酒依赖患者中,低血钾发生率显著高于未伴随有躯体疾病的酒依赖患者(P<0.01);进食状况较差的酒依赖患者中,低血钾发生率显著高于进食状况较好的酒依赖患者(P<0.01);平均日饮酒量≥500 g的酒依赖患者中,低血钾发生率显著高于平均日饮酒量<500 g的酒依赖患者(P<0.01);饮酒史≥15 a的酒依赖患者中,低血钾发生率显著高于饮酒史<15 a的酒依赖患者(P<0.01)。结论:酒依赖患者低血钾发生率显著高于正常人,酒依赖患者在住院的不同时段中血清钾浓度有不同程度的变化。年龄大、伴随有躯体疾病、进食状况较差、日饮酒量大及饮酒时间长的酒依赖患者发生低血钾的危险性增加。因此,酒依赖患者应常规进行血清钾浓度的检测,早诊断,早治疗。     

酒依赖者与正常对照人群酒精敏感性的比较研究及乙醛脱氢酶表现型的测定

<正> 本文对酒依赖者与正常人群对酒精敏感性作对照研究。共112人,皆为男性,其中酒依赖者42人,来自上海市精神卫生中心的住院病例或现已出院的“酒依赖”或“酒中毒”患者。在排除其它严重躯体疾患后,按     

酒依赖患者的非理性信念特点及与酒依赖严重程度的关系

目的:研究酒依赖患者非理性信念的特点,并分析其与酒依赖程度、饮酒方式的关系。方法:采用非理性信念量表(IBS)和密西根酒精依赖调查表(MAST)对35例住院酒依赖患者进行评定,并与36例正常对照。结果:(1)酒依赖组IBS总分高于对照组,且差异有显著统计学意义(P=0.007)。因子分低挫折耐受(LFT)和概括化评论(GE)评分酒依赖组均高于对照组,且具有显著统计学意义(P均=0.005);(2)IBS总分与MAST评分呈正相关(r=0.359,P=0.037)。低挫折耐受(LFT)、概括化评论(GT)、绝对化要求(AD)评分与MAST评分无显著相关(P均>0.05)。结论:酒依赖患者存在非理性信念,主要是低挫折耐受和概括化评论。酒依赖患者的非理性信念与酒依赖严重程度有关,但是与开始饮酒时间和酒依赖时间及每日饮酒量无关。     

79例酒依赖者戒断治疗中血压升高的临床分析

目的:观察79例酒依赖者戒断治疗中血压的变化并加以分析。方法:对2004年6月-2006年6月住院的79例酒依赖者在初入院尚未进行戒断治疗之前测首次平卧位血压,开始戒断治疗第1-3天连续监测3次不同时间的平卧位血压。治疗后血压与初入院时血压用t检验进行比较。结果:79例酒依赖者开始戒断治疗时平卧位血压,有非常显著的差异性(P<0.01),开始戒断治疗后的血压呈现明显的上升趋向,其中62例出现不同程度的血压升高,占79%。结论:酒依赖者在戒断治疗中血压升高。     

Does marital status predict long-term drinking? Five-year observations of dependent and problem drinkers

OBJECTIVE: Married individuals have lower rates of problem drinking, but little is known about this relationship in the context of other factors. This longitudinal analysis examines marital status with other individual predisposing, problem severity and social predisposing characteristics to understand its strength in predicting alcohol consumption over 5 years. METHOD: A probability sample of dependent (n = 600) and problem (n = 992) drinkers was recruited through consecutive adult intakes from a Northern California county's alcohol and drug treatment programs and through a general population survey. Annual volume of drinks consumed over a 5-year period-measured at baseline, and at 1, 3 and 5 years later-was estimated in four nested models using maximum likelihood estimation via PROC MIXED. RESULTS: In simpler models that examined only marital status, married individuals drank significantly less than those never married (p < .01 for problem drinkers and p < .05 for dependent drinkers); however, when our models added individual predisposing, problem severity and social predisposing characteristics, marital status was no longer significant in predicting a trajectory of decreased drinking. For problem drinkers, the following characteristics were more important than marital status in predicting alcohol consumption over the 5 years: individual predisposing characteristics (age, p < .001; income, p < .001; education, p < .001; and age of initiation of regular alcohol use, p < .001), problem severity (number of alcohol dependence symptoms, p < .001; number of alcohol-related social consequences, p < .001; and higher drug severity, p < .05) and social predisposing characteristics (family member with an alcohol problem, p < .05; the size of heavy alcohol- and drug-using social network, p < .05; and chemical dependency treatment in the prior year, p < .001). For those who were alcohol dependent, income (p < .05), number of alcohol dependence symptoms (p < .001), higher drug severity (p < .05) and a heavy alcohol- and drug-using social network (p < .05 ) were more important than marital status in predicting consumption. CONCLUSIONS: In longitudinal models, individual predisposing, problem severity and social predisposing characteristics are more important than marital status in predicting alcohol consumption.     

Associations of alcohol use disorder,alcohol use,housing, and service use in a homeless sample of 255 individuals followed over 2 years

Background: Homeless individuals with alcohol use disorders have multiple comorbidities and therefore various service needs. Despite need for services, homeless individuals face numerous barriers to treatment. Little is known about the associations of specific services in relation to homelessness in the context of alcohol problems. The current study analyzed 2-year prospective longitudinal data on a homeless sample, examining relationships between alcohol use disorder, alcohol use, housing status, and service use over time. Methods: Two hundred fifty-five of 400 individuals recruited systematically from shelters and street locations completed 3 annual assessments (69% completion). Data on lifetime and current psychiatric disorders, housing status, and past-year service use were obtained and merged with service use data gathered from local agencies. Generalized estimating equation (GEE) models were created to predict dependent outcome variables of stable housing, alcohol use, and service use in both follow-up years. Results: Lifetime alcohol use disorder was positively associated with substance and medical service use. Alcohol problems did not hinder attainment of stable housing, and placement in housing did not necessarily increase risk for alcohol use. Stable housing was negatively associated with psychiatric and substance service use. In the second year, when alcohol use was finally associated with receiving substance services, it appears that these services provided a gateway to psychiatric services. The psychiatric services in turn appeared to provide a gateway to medical services. Conclusions: Alcohol use behaved differently compared with lifetime alcohol use disorder in relation to service use. Lack of association between alcohol use and housing supports Housing First policy. Obtaining housing may have ameliorative effects on mental health, diminishing perceived need for psychiatric services. Services may also be more accessible during homelessness. Obtaining substance treatment may provide a gateway for those who use alcohol after becoming homeless to connect with psychiatric and medical services, informing policy and practice.     

Marital status, alcohol dependence, and GABRA2: evidence for gene-environment correlation and interaction

OBJECTIVE: The gene GABRA2 has been associated with the risk for alcohol dependence in independent samples. This article explores how this genetic risk factor interacts with marital status, another factor previously shown to be associated with the risk for alcohol dependence. METHOD: Data from more than 1,900 male and female subjects from the Collaborative Study of the Genetics of Alcoholism (COGA) sample were analyzed. Subjects were recruited based on membership in a family with multiple individuals with alcoholism. A series of analyses was performed to evaluate the relationship between the following: (1) GABRA2 and alcohol dependence, (2) marital status and alcohol dependence, (3) GABRA2 and marital status, and (4) interactions between GABRA2 and marital status on the development of alcohol dependence in the high-risk COGA sample. Additional analyses were carried out in a sample of approximately 900 individuals from control families to test the generalizability of results. RESULTS: Both GABRA2 and marital status contributed independently to the development of alcohol dependence in the COGA sample. The high-risk genotype at GABRA2 was also related to a decreased likelihood of marrying and an increased likelihood of divorce, which appeared to be mediated in part by personality characteristics. There was also differential risk associated with the GABRA2 genotype according to marital status. CONCLUSIONS: These analyses provide evidence of both gene-environment correlation and gene-environment interaction associated with GABRA2, marital status, and alcohol dependence. They illustrate the complex pathways by which genotype and environmental risk factors act and interact to influence alcohol dependence and challenge traditional conceptualizations of "environmental" risk factors.     

Patterns of illegal drug use among an adult alcohol dependent population: Results from the National Survey on Drug Use and Health

The use of illegal drugs is common in alcohol dependence and significant psychological and social consequences are associated with the concurrent use of alcohol and illegal drugs. However, little literature has examined the patterns of concurrent-drug use in alcohol dependent individuals. A latent class analysis (LCA) was used to determine whether patterns of past year illegal drug use existed in a national sample of 6059 alcohol dependent respondents of the combined 2005, 2006 and 2007 National Survey on Drug Use and Health. Multinomial logistic regression was then used to determine whether demographic variables, mental health disturbance and social consequences were predictive of drug use classes. Results of the LCA demonstrated a 5-class solution with optimal fit deduced by Bayesian Information Criterion minima. The five classes included: a close to zero probability of illegal drug use (class 1: 65%), medium marijuana, medium sedatives/tranquilizers and high analgesics (class 2: 7%), high marijuana, medium cocaine use (class 3: 21%), high probabilities of marijuana, cocaine, sedatives and analgesic use (class 4: 6%) and a high concurrent-drug use except other hallucinogens (class 5: 1%). Regression results suggest that younger age, comorbidity, engaging in deviant behaviors, sexually transmitted infection and incarceration are associated with concurrent illegal drug use in alcohol dependent individuals. Findings advocate that more intense psychiatric and drug dependence treatment resources may be needed for concurrent-drug using alcohol dependent populations and provide evidence for targeted prevention and treatment interventions.     

Cocaine abusers with and without alcohol dependence respond equally well to contingency management treatments

Contingency management (CM) treatments are efficacious in treating cocaine abuse. Despite high prevalence rates of alcohol dependence (AD) among individuals with cocaine use disorders, relatively little data are available regarding whether comorbid AD is associated with poorer treatment outcomes in general, or in response to CM in particular. Using data from 3 randomized trials of CM for cocaine abuse, we compared cocaine abusers (N = 393) with and without AD in terms of abstinence and psychosocial problems during treatment and follow-up. Alcohol dependent participants had more lifetime years of cocaine and alcohol use and greater severity of alcohol and psychiatric problems. CM was positively and significantly associated with longer durations of abstinence, regardless of AD status. Although not significantly associated with abstinence, the presence of AD was related to improvement in medical and alcohol-related problems during treatment, and these gains were maintained posttreatment. The results suggest that cocaine abusers benefit equally well from CM treatments, regardless of AD status. Further, alcohol dependent participants are able to offset greater baseline severity in psychosocial functioning and maintain these improvements with CM.     

Neuropsychological performance of individuals dependent on crack-cocaine, or crack-cocaine and alcohol, at 6 weeks and 6 months of abstinence

BACKGROUND: Little data exist on the neuropsychological effects of crack-cocaine dependence or crack-cocaine and alcohol dependence. This study examined cognitive function in abstinent crack dependent and crack and alcohol dependent individuals at 6 weeks and 6 months abstinence. METHODS: a comprehensive neuropsychological battery, including the MicroCog computerized assessment, was administered to 20 abstinent crack dependent subjects, 37 abstinent crack and alcohol dependent subjects, and 29 normal controls. Depression was examined as a covariate, and the association between substance use variables and neuropsychological performance was examined. RESULTS: the two substance dependent groups had similar neuropsychological profiles at 6 weeks abstinent, with both groups exhibiting significant cognitive impairment in a wide range of functions compared to controls. The substance dependent groups were still impaired significantly at 6 months of abstinence. Only mild effects of depression on neuropsychological performance were observed. CONCLUSIONS: crack dependence and crack and alcohol dependence may lead to severe and persistent neuropsychological deficits over a wide range of domains. The strongest predictor of brain damage associated with substance dependence in this sample was dose (particularly quantity and duration of peak dose).     

fMRI BOLD response to alcohol stimuli in alcohol dependent young women

BACKGROUND: Cue reactivity in alcohol dependent adults has revealed autonomic, cognitive, and neural responses to alcohol-related stimuli that differ from those of nonabusers. Cue reactivity and craving responses have not been studied in youth. METHOD: Alcohol-dependent young women (n=8) and female light social drinkers (n=9) ages 18-24 were administered an alcohol cue reactivity task during functional magnetic resonance imaging (fMRI) to examine brain response to alcohol-related words. RESULTS: Alcohol dependent young women demonstrated significantly more blood oxygen level dependent (BOLD) response than nonabusers during alcohol word presentation trials relative to neutral word trials in subcallosal, anterior cingulate, left prefrontal, and bilateral insular regions (P<.025). However, controls showed greater response to alcohol words in some right hemisphere cortical regions. Increased craving after cue exposure correlated with increased subcallosal cortex BOLD response to alcohol cues (r=.87) among alcohol dependent subjects. CONCLUSIONS: This pilot study corroborates previous reports of increased limbic and frontal response to substance cues and extends these findings to young alcohol dependent women. This limbic reaction may underlie the elevated physiological response and altered cognitive reactions to alcohol stimuli that are observed in alcohol dependent individuals.     

Using virtual reality to investigate complex and contextual cue reactivity in nicotine dependent problem drinkers

Alcohol and cigarette smoking frequently co-occur among adults in the U.S., resulting in a myriad of deleterious health outcomes. Cue reactivity has been posited as one factor that precludes individuals from overcoming alcohol and nicotine dependency. While cue reactivity studies have focused on the impact of proximal cues on cue reactivity, much less is known about the unique impact of complex and contextual cues. This pilot study compares nicotine and alcohol cue reactivity among a sample of nicotine dependent, daily drinkers (N=21) across neutral, party, and office courtyard virtual reality (VR) contexts embedded with proximal smoking cues to: 1) explore and compare the effects of complex nicotine cues on alcohol cross-cue reactivity between nicotine/alcohol dependent drinkers and nicotine dependent/non-alcohol dependent daily drinkers, and 2) assess the effectiveness of VR for eliciting cue-induced nicotine craving responses using complex nicotine cues. Nicotine dependent/non-alcohol dependent drinkers had significantly lower craving for alcohol in the non-alcohol congruent office courtyard VR scene and there was no difference in the alcohol-congruent party scene when compared to the alcohol dependent group, suggesting that the non-alcohol dependent daily drinking group was more likely to react to contextual cues. Consistent with prior cue reactivity studies, dependent smokers experienced significantly higher craving for nicotine in the VR smoking congruent contexts compared to the neutral contexts; however, nicotine/alcohol dependent participants did not return to baseline craving after exposure to smoking cues. These results suggest substantive differences in the ways that nicotine-dependent, daily alcohol drinkers and nicotine/alcohol dependent drinkers experience craving, whether cross-cue or traditional.     

Interrelationship of hepatic function, thyroid activity and mood status in alcohol-dependent individuals

BACKGROUND: Alcohol-induced changes in thyroid function may contribute to the development of mood disorders such as depression and anxiety that almost invariably coexist in alcohol-dependent individuals. The aim of the present study was to investigate the severity of liver dysfunction and thyroid activity in correlation with anxiety and depressive-like symptomatology before and after a detoxification period. PATIENTS AND METHODS: In a sample of 100 alcohol-abusing/dependent subjects treated on an in-patient basis according to a standard detoxification protocol, measurements of the serum levels of hepatic enzymes (ASAT, ALAT, gammaGT) and thyroid hormones (T3, T4, TSH) as well as measures of anxiety, depression and global functioning were obtained at baseline and at weekly intervals over the period of 4-5 weeks. RESULTS: After completion of the alcohol detoxification, most measurements returned to normal levels and correlations were observed between the levels of hepatic enzymes and thyroid hormones. Additionally, a significant correlation was obtained between the levels of thyroid hormones and the mood status scales. CONCLUSION: Our results indicated a dysfunction of the hypothalamic-pituitary-thyroid axis in alcohol dependence with possible implications in the diagnosis and treatment of mood disorders associated with alcohol abuse.     

DSM-IV alcohol dependence and sustained reduction in drinking: investigation in a community sample

OBJECTIVE: A common clinical conception of alcohol dependence is that it is chronic, and the idea of impaired control figures prominently in an influential definition of alcohol dependence. We investigated the meaning of a diagnosis of DSM-IV alcohol dependence in untreated individuals. METHOD: Household residents screened for elevated drinking were assessed for DSM-IV alcohol dependence and re-interviewed 1 year later. We report on 115 subjects with and 460 subjects without current DSM-IV alcohol dependence at baseline. Follow-up drinking indicators included a measure of sustained reduction in drinking. RESULTS: No support was found for a lower probability of sustained reduction in drinking at follow-up among the group with baseline DSM-IV alcohol dependence. Significant group differences indicated that the dependent group was more likely to reduce drinking. CONCLUSIONS: A diagnosis of DSM-IV alcohol dependence among untreated individuals implies a prognosis that is different from that for the same diagnosis among those seen in treatment settings. This does not necessarily indicate that the diagnosis is invalid, but rather suggests that risk factors for chronic course are more applicable to cases of DSM-IV alcohol dependence seen in treatment settings.