Longitudinal Characteristics of Hospital Use Before and After Alcoholism Treatment

The frequency of inpatient hospital care for three years before and three years after alcoholism treatment was evaluated for a group of 255 patients of predominantly lower socioeconomic status treated for alcoholism at a rural midwestern medical center in 1983. Subjects were interviewed while in treatment to obtain information regarding alcoholism history and demographics. Hospital care was ascertained from an electronic data file of discharges from 172 acute care hospitals throughout the United States and Puerto Rico. One-third of the sample was never hospitalized for an alcohol-related condition in the years prior to or after alcoholism treatment, and 23% of the sample experienced no hospitalizations at all other than the treatment episode when interviewed. The majority of hospital stays before and after treatment were attributed to alcohol abuse. The frequency and total hospital length of stay for alcohol-related admissions increased yearly before treatment, peaked in the year after treatment, and then declined, but not to earliest pretreatment levels. Subjects experienced significantly more hospitalizations and length of stay after alcoholism treatment than before when comparing both the two three-year periods and the immediate 12 months before and after treatment. More frequent hospital care was also significantly associated with higher levels of daily alcohol consumption and drinking duration but not with sociodemographic indicators.     

A Longitudinal Examination of the Relationships Among Stress, Coping Strategies, and Problems Associated with Alcohol Use

This study examined the longitudinal relationships among family history of alcoholism (FH+), stress levels, utilization of coping methods, and alcohol-related problems. Data used in this study were obtained from a nonclinical sample of subjects who were originally interviewed when they were 12, 15, or 18 years of age and followed-up twice more at 3-year intervals for a longitudinal sample size of 1270. Although a greater percentage of females in this sample reported a FH+ background as well as higher levels of stress, they tended to utilize positive coping strategies more often and reported fewer numbers of alcohol problems than males. In general, younger subjects who reported high levels of stress experienced more alcohol-related problems regardless of coping method chosen. In older subjects, the effect of stress on problems appeared to be buffered when coupled with the use of support seeking. Subjects whose stress preceded problems exhibited no significant difference from subjects whose problems preceded stress and symptom-free and "stressed-only" subjects were not significantly different from each other in number of problems at time 3, suggesting that a direct effect of stress alone on alcohol-related problems is questionable.     

Court-Ordered Alcohol Treatment for Patients With Medical Problems

The authors performed a retrospective analysis of medical records and death certificates for 99 consecutive patients who had an alcohol-related medical problem that prompted a petition for court-ordered alcohol treatment. Ninety percent voluntarily participated in initial evaluation. Two appeared to be alcoholfree 6 months after treatment. The number of alcohol-related hospital visits was not different before and after intervention. Death certificates revealed that at least 12% of the patients had died within 2 years of the petition. Court-ordered alcohol treatment for patients for serious medical sequelae of alcoholism does not appear to be successful.     

Is Alcohol-Related Flushing a Protective Factor for Alcoholism in Caucasians?

Although alcohol-related flushing seems to be a genetically influenced protective factor for alcoholism in some Asian groups, little is known about whether this is true for Caucasians. The evidence for alcohol-related flushing as a protective factor for the development of alcoholism was examined in a sample of 5831 Australian twins (2041 men, 3790 women) who were administered a structured psychiatric interview. Twin correlations for self-reported adverse alcohol reactions (e.g., "flushing or blushing" and "feeling very sleepy" after drinking 1 or 2 drinks) were modest, suggesting minimal contribution of genetic factors, but when corrected for reliability of measurement, were consistent with moderate heritabilities. In accord with studies examining Asian samples, we found that individuals who experienced adverse reactions after drinking small amounts of alcohol drank less often and slightly less per drinking occasion than those who did not experience adverse reactions. However, those who experienced adverse reactions were more likely to have symptoms of alcoholism and to report a parental history of alcohol problems. We conclude that self-reported alcohol-related flushing is not a protective factor for alcoholism in Caucasians and may be a risk factor.     

Alcoholism Diagnoses for Convicted Drinking Drivers Referred for Alcoholism Evaluation

The types and extent of alcohol-related problems were determined for a sample of 461 convicted drinking drivers who were referred to an alcoholism treatment facility for evaluation and possible treatment. Using responses to questionnaire and structured interview questions on alcohol-related problems, DSM III diagnoses are constructed; approximately three-quarters of the sample are diagnosed with sufficient severity for a DSM III diagnosis of abuse or dependence. Self-reported consumption levels and drinking/driving incidents increase as the level of the alcohol problem increases; persons in the Alcohol Abuse category are heavier consumers and drive more frequently after drinking than are persons who are not diagnosed by the DSM III as having an alcohol problem. Persons in the Alcohol Dependence category are heavier consumers than either the Alcohol Abuse or Undiagnosed Problem categories and report more drinking/driving incidents. The DSM III provides useful subcategories of convicted drinking drivers referred for alcoholism evaluation and distinguishes groups differing in quality, frequency, and self-reported DWI measures, independent of basic demographics. These analyses suggest that drinking/driving countermeasures should include intervention efforts to address alcohol-related problems. Serious alcohol problems exist among some drinking drivers, and drinking/driving incidents are more frequent among these individuals.     

An Investigation of an Alcoholism Rehabilitation Halfway House: I. Types of Client and Modes of Discharge

Each member of a sample of 59 men admitted to one London alcoholism halfway house was interviewed concerning the details of his social and drinking history. Analysis suggested the existence of two major dimensions of individual variation: degree of chronic alcohol dependence, and late-uncomplicated versus early-complicated alcohol dependence. Observation of the lengths of residence and manners of discharge of members of the sample suggested two varieties of failure; premature discharge (length of stay less than two months) and irregular discharge (drinking at discharge and/or discharge to an unknown or unsatisfactory destination). There was a significant tendency for early-complicated alcoholism to be associated with premature discharge.     

Increase in Alcohol-Related Hospitalizations in Finland 1969–1975

Alcohol consumption increased 2.2-fold in Finland in 1968-1974. Have alcohol-related diseases become at the same time more common? This was studied by scrutinizing hospitalizations with alcoholism, alcohol psychosis, alcohol poisoning, liver cirrhosis and pancreatitis as the principal diagnosis. During the years 1969–1975, the male admission rate for alcohol psychosis increased 2.1-fold, the rate for pancreatitis increased 2-fold, that for alcoholism increased 1.7-fold and that for liver cirrhosis increased 1.2-fold. At the same time, the increases in female admission rates were 2.4-fold for alcoholism, 2.3-fold for alcohol psychosis, 1.9-fold for alcohol poisoning and 1.4-foldfor pancreatitis. The increase in admission rates seemed to be closely associated with the increase in alcohol consumption.     

Alcohol-related problems among Aboriginal drinkers in the Kimberley region of Western Australia

This paper reports on the prevalence of alcohol-related problems among drinkers in a stratified random sample of the adult Aboriginal population of the Kimberley region of Western Australia. Subjects were 265 current drinkers who were identified in the total sample of 516 Kimberley Aboriginal men and women over the age of 15 years. Participants' reports were obtained on their frequency and quantity of alcohol consumption, and their lifetime experience of 16 alcohol-related problems. The majority of Aboriginal drinkers in the Kimberley consumed harmful amounts of alcohol, and there was a high prevalence of the 16 alcohol-related problems which showed a high degree of internal coherence, with the first principal component accounting for 45% of the total variance. The number of alcohol-related problems which respondents reported was strongly related to the quantity and frequency of self-reported alcohol consumption.     

Hospital morbidity of alcohol use disorders in the center of France

BACKGROUND: The Auvergne region of central France has the third highest mortality rate in the country for alcohol-related disorders and the highest level of alcohol consumption among young people. METHODS: An exhaustive cross-sectional study of regional hospital morbidity related to alcohol was undertaken on a single day in May 1998, including 9,552 hospital beds. All inpatients age 16 and older in the Departments of Medicine, Surgery, Obstetrics and Gynecology, Psychiatry, and Medium-Stay Services were studied. The aim was to define alcohol-related behavior patterns (by using the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] criteria of abuse and dependence and the CAGE questionnaire) and to measure the proportion of nonsomatic alcohol-related care dispensed in hospital. RESULTS AND CONCLUSIONS: The prevalence of alcohol use disorders in all wards was 20%. Half of these patients were alcohol dependent, a quarter were diagnosed as alcohol abusers, and a quarter had an alcohol-related problem that was not identified during the stay. Alcohol use disorders were more common in male inpatients (34% vs. 8% in female inpatients) and in certain age groups. One male subject in two and one female subject in five between 34 and 45 years had an alcohol-related problem. Almost 25% of male inpatients studied between the ages of 16 and 20 years had an alcohol-related problem, but only half had been diagnosed previously. Hospital care for alcohol-related health problems was seriously inadequate. On average, 38% of patients diagnosed with an alcohol use disorder received relevant nonsomatic alcohol care, of which 13% were alcohol abusers and 50% were alcohol-dependent patients. Significance: This exhaustive study demonstrates the degree of alcohol-related morbidity among hospitalized patients, which is particularly high in men, in the Auvergne region of France. The study emphasizes the lack of diagnosis, particularly for the young, and the apparent deficiencies in the hospital management of these patients.     

Behavioral and Cognitive Measurements Predict Scores on the MAST: A 3-Year Prospective Study

This experiment examined the ability of neuropsychological and behavioral tests of anterior brain functioning to predict changes in alcohol-related behaviors 3 years after the initial evaluation. One hundred four young adult subjects, sixty-six of whom had a positive family history of alcoholism, filled out the Michigan Alcoholism Screening Test (MAST), self-rated the frequency with which they consumed alcohol, and completed a retrospective test of childhood hyperactivity/impulsivity/conduct problems (Wender Behavioral Checklist). Eighty-three of the subjects also completed a neuropsychological battery consisting of cognitive tests of executive functioning (i.e., Trails, Categories Test, Similarities) and motor tests (i.e., TPT, hand dynamometer, finger tapping). Subjects returned to complete the alcohol-related measures during a second testing session 3 years later. Changes in MAST scores, and in alcohol consumption, between the first and second test session were computed, and median splits classified subjects into "high" versus "low" change groups. After factor analysis of the cognitive and behavioral data, hierarchical logistic regression equations assessed the ability of the cognitive and behavioral variables, as well as the presence of a positive family history of alcoholism, to predict future changes in the alcohol outcome measures. Scores from the WENDER behavioral checklist predicted future changes in the MAST scores (p = 0.0026), with more impaired scores associated with higher MAST scores. Tests of executive functioning, in subjects with a positive family history of alcoholism, predicted alcohol consumption (p = 0.033). None of the other predictor variables showed any relationship to the alcohol-related outcome measures.     

Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter

Many patients received in emergency units (EU) of hospitals present alcohol-related problems. Most are alcohol dependent or abusers and enter for drunkenness, stay a few hours and return home. To assess the effectiveness of a letter referring these patients to an outpatient alcoholism treatment clinic, we performed a randomized study. For 6 months, all the patients who had been diagnosed as alcoholic, who had an address and who had not consulted a physician for alcoholism in the 6 previous months were selected from the records of the EU of a French university hospital. At hast 2 days after their stay in the EU, we sent a letter to 181 patients of an experimental group (group E) suggesting they make an appointment with a physician specializing in alcoholism. No letter was sent to 181 patients in a control group (group C). Six months later, 21 patients (11.2%) of group E had called the outpatient alcoholism treatment clinic to make an appointment and came to a consultation. Two of the 181 patients of group C came to the consultation. The effectiveness of this method for referring alcoholics to a clinic had been controlled by another prospective study. We concluded that sending a letter 2 days after the passage of an alcoholic to an EU for drunkenness is a useful method of referral to an outpatient alcoholism treatment clinic.     

RESEARCH REPORT Clinical significance of Cloninger's classification in a sample of alcoholic Spanish men

Abstract Aims. To evaluate Cloninger's classification in a sample of alcoholic Spanish men. Design. A crosssectional study was carried out on subjects diagnosed as alcoholics. Setting. Out-patient units specializing in the treatment of alcoholics and the psychiatry unit of a general hospital. Participants. One hundred and ninety-eight males diagnosed as alcoholics. The mean age was 44.4 11.6 years and 98% were from urban areas. Measurements. Participants were interviewed using the Structured Clinical Interview for DSMIII-R(SCID). They were classified using type 1 and type 2 criteria of Cloninger's classification. Findings. Only one-third of our sample could be classified by Cloninger's type 1 and type 2 criteria. Patients classified as belonging to type 2 had an earlier onset of regular drinking compared to type 1 patients. Type 2 subjects presented a higher percentage of alcohol-related problems as well as problems related to drugs other than alcohol and they also presented a higher percentage of antisocial personality disorder. No differences in alcoholism family history were found between the groups. Criteria showing the poorest discriminative ability between both groups were "failure to keep abstinent" and "benders lasting at least two days". Conclusions. Our results do not support Cloninger's etiological hypotheses for alcoholism. Cultural differences may be responsible for the different drinking patterns observed.     

Drinking patterns and problems: a comparison of two black primary care samples in two regions

This paper explores the effect of regional ("wet" vs. "dry") variation in drinking patterns and problems on the prevalence of alcohol-related problems among those seeking care in primary care settings. A sample of black primary care patients interviewed in Hinds County, MS (n = 740) and in Contra Costa County, CA (n = 93) are compared on quantity and frequency of usual drinking, drunkenness, consequences of drinking, and alcohol dependence. Controlling for demographic differences in logistic regression analysis, drinkers in Contra Costa, while no more likely to report heavy drinking, were four times more likely to report alcohol-related consequences, more than five times more likely to report alcohol dependence experiences, and more than nine and a half times more likely to report ever having had treatment for an alcohol problem than those in Hinds County. Data suggest that regional variations in drinking patterns may be reflected in alcohol involvement in primary care caseloads, and that the large variation in the prevalence of alcohol-related problems found in primary care settings may, in part, be attributable to this. All primary care settings do not appear to hold equal promise for screening for and intervening with problem drinking, and further research is needed in determining those settings that provide the greatest potential for targeting prevention efforts.     

Multidisciplinary Heart Failure Care Program: An Experience From Colombia

The prevalence of Heart Failure is growing alarmingly; its treatment consumes health resources and affects the quality of life of patients. To describe the changes in NYHA functional Class, ejection fraction, hospitalizations, and mortality after 8 years of follow up in a multidisciplinary heart failure program in Colombia as a model for lower and middle income countries. An observational study was performed with the retrospective analysis of the information. 1757 patients were included, The NYHA functional class at the beginning of the program was: NYHA I 23.5%, NYHA II 50.3%, NYHA class Improvement was observed at the end of the follow-up with an increase in the percentage of patients in Functional Class NYHA I and II. The reduction in hospitalizations were 35% less (mean: 0.68 ± 0.95, P < 0.0001), a reduction in the length of stay in the hospital was 13.2% (before: 4.46 ± 7.16, after 3.87 ± 8.1 days, P < 0.001). The total mortality after eight years of follow-up was 6.6 % (n = 116). Multidisciplinary follow-up in Heart Failure (HF) programs improves Functional Class and EF, decreases hospital admissions as well as hospitalization and the length of stay. This is a very simple and successful model of care for this disease that can be implemented for countries of lower- and middle-income countries.     

Alcoholism as a risk factor in methadone maintenance: A randomized controlled trial

A randomized controlled trial of 625 addicts on methadone maintenance identified 105 (17 percent) as active alcoholics, 47 (8 percent) as inactive alcoholics, and 473 (75 percent) as nonalcoholics. Subjects were followed for up to 29 months (mean 53.7 weeks) to assess the influence of alcoholism on the rehabilitative process. During the study, alcohol consumption significantly decreased (p < 0.001) in active alcoholics. Indexes of productive activity on entry or during follow-up revealed no significant differences between active alcoholics and other patients with the exception of alcohol-related hospitalizations (p < 0.001). Behavioral indexes consistently improved with treatment in all patients, being greatest among active alcoholics (p < 0.01). During the study, 28 (7 percent) of 399 nonalcoholics were recategorized as active alcoholics, and remission from alcoholism was noted in 28 (27 percent) of patients who were initially classified as alcoholic. These findings suggest that alcoholism does not significantly affect rehabilitation from narcotic use and therefore should not be cause for detoxification from methadone maintenance.     

Hepatitis C and hospital outcomes in patients admitted with alcohol-related problems

BACKGROUND/AIMS: Alcohol is known to act synergistically with chronic hepatitis C virus (HCV) infection to cause liver disease; however, their combined effect on outcomes in acutely hospitalized patients is less clear. We examined the impact of HCV infection on hospital mortality and length of stay among hospitalized patients with alcohol abuse problems. METHODS: We retrospectively identified 6354 admissions to an urban, public hospital between July 1996 and January 2002 with discharge diagnoses related to alcohol dependence or abuse. Hepatitis C diagnosis and other information were extracted from a clinical database and tested for associations with death and length of hospital stay using multivariable regression techniques. RESULTS: The prevalence of diagnosed HCV infection in this sample of patients with alcohol abuse was 15%. Patients with HCV were about twice as likely to die during hospital admission (4.4 vs. 2.4%; P-value < 0.01), and there appeared to be a trend toward increased mortality even after adjustment for demographics, medical service, homelessness and comorbidities (fully adjusted OR 1.41; 95% CI: 0.97-2.04). Length of stay was significantly longer for patients with HCV (19% longer; 95% CI: 12-27% after adjustment) than those without. CONCLUSIONS: Patients admitted to the hospital with alcohol-related diagnoses have longer hospital stays and are more likely to die in hospital if they have a diagnosis of HCV.     

Hospital Treatment of Alcoholism: A Profile of Middle Income Americans

3,411 first admissions for alcoholism treatment to nine proprietary hospitals were studied with standardized questionnaire and diagnostic instruments. Despite the patients' relative economic and social stability, severe patterns of addictive alcohol use had developed and persisted for many years with a high incidence of alcohol-related and intercurrent medical disorders which required prompt medical intervention. Although most patients had a personal physician, less than 9% of referrals for hospital treatment for alcoholism were made by physicians; most patients responded to television outreach programs, recommendations by former patients or were self or family referred. This survey shows that persons who are neither socially disadvantaged nor economically deprived may have severe alcohol-related problems. Such patients constitute a significant challenge to the medical profession to develop strategies for early intervention and more efficacious treatment.     

Alcoholism in males with antisocial personality disorder

Two hundred and sixty men entering an inpatient program for alcohol and drug treatment were interviewed and tested for cognitive disturbances and hepatic function. When the treatment group was separated by the presence or absence of antisocial personality disorder, the antisocial group was distinguished by several factors. Antisocial alcoholics were more likely to have an early onset of alcoholism and to be involved with other illicit drugs, and showed evidence of more problems with control of their drinking. They reported more alcohol-related problems as defined in DSM-III. Despite histories of a more severe form of alcoholism, the antisocials were no more likely to develop alcohol dependence or show signs of cognitive or hepatic toxicity.     

β-Carbolines in Chronic Alcoholics Undergoing Elective Tumor Resection

The prevalence of chronic alcoholism in patients with carcinomas of the upper digestive tract exceeds 60%. The patient's history and laboratory markers, preoperatively, are often not sensitive or specific enough to detect alcohol-dependent patients, preoperatively, who are at risk of developing alcohol withdrawal syndrome (AWS) during their postoperative intensive care unit (ICU) stay. Previously, it was found that plasma norharman was elevated in chronic alcoholics, suggesting marker characteristics for chronic ethanol misuse and possibly alcohol dependence. We investigated whether β-carbolines (i.e., harman and norharman) were different between chronic alcoholics and nonalcoholics with carcinoma, and how the levels change in alcohol-dependent patients during their hospital stay. Ninety-seven patients with oral, pharyngeal, laryngeal, or esophageal carcinomas were evaluated regarding their drinking habits. Sixty patients were transferred to the ICU following tumor resection. Chronic alcoholics met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use. The daily ethanol intake in chronic alcoholics was ≥60 g. Blood samples were collected on admission to the hospital, preoperatively, on admission to the ICU and on days 2, 4, and 7 in the ICU. Harman and norharman were determined by HPLC. Elevated norharman was found in chronic alcoholics on admission to the hospital, whereas harman did not differ between groups. On admission, the area under the receiver operating characteristics curve was significantly larger for carbohydrate-deficient transferrin and preoperatively for norharman. The preoperative norharman levels were significantly correlated with the period of mechanical ventilation and the length of ICU stay. Postoperatively, norharman decreased in all patients, except a group of 11 alcohol-dependent patients who developed AWS during their ICU stay. The finding that elevated norharman levels were found in chronic alcoholics on admission to the hospital and preoperatively supports the view of a specific marker for alcoholism. Preoperative norharman was superior to carbohydrate-deficient transferrin and was associated with a prolonged ICU stay and a prolonged period of mechanical ventilation. Further studies are required to determine whether norhaman aids in the preoperative diagnosis of chronic alcohol misuse with respect to the prevention of postoperative complications.     

Laboratory Markers as Compared to Drinking Measures before and after Inpatient Treatment for Alcoholism

A study group, consisting of 60 male and 13 female alcohol-dependent patients, participated in an inpatient treatment for alcoholism. They were interviewed about their alcohol use before the treatment period and bimonthly for 8 months after it. It was found that the correlations between laboratory markers and average daily alcohol intake are very low (range, -0.01-0.23) in alcoholics with high alcoholic intake level (before the treatment period). It was also found that the correlations between the laboratory tests and the drinking measures after the initial assessment undergo large changes. The correlation between GGT and average daily alcohol intake before the treatment period was 0.07 (p = NS) and 2 months after the treatment period 0.55 (p less than 0.001). The long period of abstinence, the change to a lower level of alcohol consumption, and improved accuracy of reporting alcohol intake were probably causative in this change. GGT proved to have the highest correlations with the drinking measures during the follow-up and MCV before the treatment period. The frequency measure, number of drinking days, gave consistently higher correlations with the laboratory markers than the measure of drinking amount, average daily alcohol intake. Laboratory markers, GGT and MCV, are well suited for outcome evaluation of drinking behavior of alcoholics after inpatient treatment for alcoholism or other comparative periods of abstinence.