Effects of short-term abstinence from alcohol on subsequent drinking patterns of social drinkers

Previous research with both animals and humans has suggested that short-term abstinence from alcohol temporarily may increase subsequent alcohol consumption. To study this issue further, the present investigation evaluated the effect of voluntary, short-term abstinence on the subsequent drinking patterns of female social drinkers. Thirty-six subjects provided a baseline assessment of drinking patterns and then were assigned randomly to either a control group, which drank as usual, or to an experimental group, which abstained from alcohol for 3 weeks. All subjects monitored the frequency and quantity of their subsequent drinking for a 3-week follow-up period. The results showed that voluntary abstinence neither increased nor decreased subsequent alcohol consumption. This finding is discussed in relation to previous research.     

Effects of heavy alcohol consumption on the cardiovascular system may be mediated in part by the influence of alcohol-induced depression on the immune system

The harmful effects of heavy alcohol use are well-documented and wide-ranging. Heavy drinking may cause or exacerbate cardiovascular disorders. The author suggests that effects of heavy alcohol consumption on the cardiovascular system may be mediated in part by the influence of alcohol-induced depression on the immune system. This hypothesis is based on the following data: (1) alcohol misuse may cause or exacerbate depression; (2) depressive disorders are associated with increased incidence, morbidity, and mortality of cardiovascular disorders; (3) the immune system may mediate effects of depressive disorders on the cardiovascular system. Further studies are needed to clarify the etiopathogenesis of alcohol-related disorders and develop new treatment modalities.     

Moderate alcohol intake is related to increased heart rate variability in young adults: Implications for health and well‐being

Epidemiological literature indicates that the relationship between alcohol consumption and health outcomes reflects a J‐shaped curve such that moderate alcohol consumption confers a protective effect in comparison to abstinence, while heavy consumption is associated with poorer health. While heart rate variability (HRV) may underpin the relationship between drinking and poor health in heavy drinkers, it is unclear whether HRV is increased in moderate, habitual drinkers relative to nonhabitual drinkers. HRV and drinking habits were assessed in 47 volunteers. Results supported hypotheses suggesting that moderate, habitual drinking increases HRV. Although not supported by a significant interaction between drinking group and sex, planned follow‐up analysis also revealed that these findings may be specific to males. Regardless, results highlight HRV as a candidate mechanism for the findings reported in the epidemiological literature.     

Alcohol abuse and postoperative morbidity

Patients who drink too much have more complications after surgery. The aim of this thesis was to evaluate the evidence, possible mechanisms, and prevention of the increased postoperative morbidity in alcohol abusers, defined by a consumption of at least five drinks per day. The literature could be criticised for several methodological flaws. Nevertheless, the results are in agreement showing moderate to strong evidence of increased postoperative morbidity after surgical procedures on alcohol abusers. There is weak to moderate evidence of increased postoperative mortality, hospital stay, and re-operation. The personal and economic consequences are tremendous. The incidence of alcohol abusers undergoing surgery was 7% to 49%, according to gender and diagnosis. They have been identified by a self-reported alcohol intake, which implies the possibility of underestimation. Alcohol markers could be used for a more precise identification of alcohol abuse. However, the inability of the questionnaires to detect short-term changes in intake and abuse without dependence, the inconsistent predictive values of the biological markers, and the lack of evidence of an association to postoperative morbidity reduces their usefulness. A detailed alcohol history is therefore recommended. The pathophysiology may include alcohol-induced organ dysfunctions. We demonstrated that subclinical cardiac insufficiency, immune incompetence, and haemostatic imbalance were already present preoperatively. A relation between the various lesions remains to be investigated. The surgical stress response was greater in alcohol abusers, which may further compromise the already dysfunctioning organs, thus leading to the documented increase in postoperative morbidity. Withdrawal from alcohol reverses organic dysfunction in non-surgical patients. Haemostasis normalises after one to four weeks, cardiac function after one month, immune function after two months, and response to external stress after three months. Accordingly, our small randomised investigation has shown that one month of abstinence before surgery improves several organic dysfunctions and reduces postoperative morbidity. We have demonstrated that prevention before surgery is possible. The study has methodological flaws, so further studies are required before final recommendations can be given. However, in the meantime clinical guidelines for alcohol abusers undergoing surgery should include up-to-date patient information and four weeks of abstinence before surgery, in accordance with the evidence-based association, the potential prevention attained by preoperative abstinence, and the best clinical practice. Implementation should be monitored in the clinical databases. In future, all patients admitted to surgery should be offered a health promoting dialogue with the surgeon, anaesthesiologist, general practitioner, or other health professionals, which focuses on alcohol among other risk factors in relation to the operative treatment, diagnosis and prognosis. A beneficial effect attainable from this multi-modal prevention and fast track surgery should be investigated among the alcohol abusers.     

The contributions of sex and drinking history to the CT brain scan changes in alcoholics

Consecutive series of male and female alcoholics, Alcoholic Anonymous (AA) members and controls were examined by interview and with a CT brain scan. Male controls were shown to have larger CT brain parameters than healthy females of the same age. Female alcoholics revealed equivalent CT scan abnormalities, apart from less sulcal widening, after a markedly shorter drinking history and at a lower estimated peak alcohol consumption than male alcoholics. The CT scan findings persisted after accounting for body weight and after matching for age and length of drinking history. The CT scan parameters of female AA members approached control values more completely and after briefer abstinence than did those of male AA members. Methodological problems and sex differences in selection and other processes are discussed. The findings are consistent with sex differences in the vulnerability of the brain to alcohol toxicity, and in its recovery with abstinence.     

Alcoholics anonymous and relapse prevention as maintenance strategies after conjoint behavioral alcohol treatment for men: 18-month outcomes

Ninety men with alcohol problems and their female partners were randomly assigned to 1 of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses.     

Treating alcohol problems with couple therapy

Couple therapy for treating alcohol use disorders (AUDs) results in less drinking and greater relationship stability and satisfaction in both men and women with AUDs. The theoretical tenets, treatment methods, and research evidence for Alcohol Behavioral Couple Therapy (ABCT) are summarized. The application of ABCT is illustrated through the treatment of a 42‐year‐old woman with an AUD and her 56‐year‐old husband. During 12 sessions over a 6‐month period, the woman attained abstinence from alcohol and learned cognitive and behavioral coping skills to deal with drinking antecedents. Her husband learned to support her abstinence by stopping drinking himself, helping her cope with drinking urges, and reinforcing her successes. The couple increased positive pleasurable activities that did not involve alcohol and improved their communication skills. Challenges in the treatment included her ambivalence about abstaining, their complicated work and travel schedules, and other life stressors.     

Effects of chronic intermittent ethanol exposure on orbitofrontal and medial prefrontal cortex-dependent behaviors in mice

In humans, stroke or trauma-induced damage to the orbitofrontal cortex (OFC) or medial prefrontal cortex (mPFC) results in impaired cognitive flexibility. Alcoholics also exhibit similar deficits in cognitive flexibility, suggesting that the OFC and mPFC are susceptible to alcohol-induced dysfunction. The present experiments investigated this issue using an attention set-shifting assay in ethanol dependent adult male C57BL/6J mice. Ethanol dependence was induced by exposing mice to repeated cycles of chronic intermittent ethanol (CIE) vapor inhalation. Behavioral testing was conducted 72 hours or 10 days following CIE exposure to determine whether ethanol-induced changes in OFC-dependent (reversal learning) and mPFC-dependent (set-shifting) behaviors are long lasting. During early ethanol abstinence (72 hrs), CIE mice showed reduced reversal learning performance as compared to controls. Reversal learning deficits were revealed as greater number of trials to criterion, more errors made, and a greater difficulty in performing a reversal learning task relative to baseline performance. Furthermore, the magnitude of the impairment was greater during reversal of a simple discrimination rather than reversal of an intra-dimensional shift. Reversal learning deficits were no longer present when mice were tested 10 days after CIE exposure, suggesting that ethanol-induced changes in OFC function can recover. Unexpectedly, performance on the set-shifting task was not impaired during abstinence from ethanol. These data suggest reversal learning, but not attention set-shifting, is transiently disrupted during short-term abstinence from CIE. Given that reversal learning requires an intact OFC, these findings support the idea that the OFC may be vulnerable to the cognitive impairing actions of ethanol.     

Gender differences in risk factors and consequences for alcohol use and problems

Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.     

Clinical pathology of alcohol.

There is good though not conclusive evidence that a small to modest average daily intake of alcohol--that is, 20-30 g/day is associated with increased longevity due mainly to a reduction in death from cardiovascular disease. Larger average daily alcohol intakes--especially those in excess of 60 g/day for men and 40 g/day for women--are associated with gradually increasing morbidity and mortality rates from a variety of diseases. Alcohol may be unrecognised as the cause of somatic disease, which can occur without overt psychosocial evidence of alcohol abuse, unless the index of suspicion is high and a thorough drink history obtained. Laboratory tests for the detection and/or confirmation of alcohol abuse are useful but subject to serious limitations being neither as sensitive nor specific as sometimes believed. The value of random blood and/or breath alcohol measurements, in outpatients, as an aid to diagnosis of alcohol-induced organic disease is probably not sufficiently appreciated and, though relatively insensitive, is highly specific.     

Facilitation of aggressive and sexual behaviors by saccharin deprivation in rats

The 'deprivation effect' (DE) phenomenon is expressed as an increase in the level of free choice consumption of drugs, alcohol, or saccharin following a period of forced abstinence in humans and in several species of laboratory animals. The DE may reflect relapse-like drinking and be relevant for modeling addictive behaviors. In humans, drug or alcohol abstinence is commonly associated with the increased physical and sexual abuse. The present study aimed to study whether aggressive and sexual behaviors are affected by the conditions known to result in the DE. Adult male Wistar rats had unlimited free choice access to water and saccharin-containing solution (0.1%, w/v). After the preference for saccharin was established, animals underwent repeated 7-day-long episodes of saccharin deprivation. It was found that (i) aggressive and sexual behaviors were facilitated after 7 days of saccharin deprivation, and (ii) DE was significantly reduced in animals that were allowed to interact with the nonaggressive male or receptive female conspecifics during the last day of deprivation exposure. These results suggest that the saccharin deprivation exposures may facilitate aggressive and sexual behaviors. Alternative behavioral strategy may serve as a mechanism of coping with the deprivation state.     

健康教育路径在酒依赖厌恶治疗中的对照研究

目的 探讨路径健康教育在酒依赖厌恶治疗中的作用及效果.方法 将酒依赖住院患者随机分为两组,实验组在厌恶治疗基础上,按健康教育路径进行宣教,而对照组予以常规健康教育.两组分别于4周末,采用自行设计的护理服务满意度调查袁及健康教育知识测试卷进行评定;随访12周末对出院后的累加戒酒时间和复饮率进行评定.结果 实施健康教育4周...     

Longitudinal changes in cognition, gait, and balance in abstinent and relapsed alcoholic men: relationships to changes in brain structure

Chronic alcoholism is associated with cognitive and motor deficits, and there is evidence for reversibility with sobriety. Alcoholic men were examined after 1 month of sobriety and 2 to 12 months later with cognitive and motor tests and magnetic resonance imaging. In this naturalistic study, 20 alcoholic participants had abstained and 22 had resumed drinking at retesting. Abstainers sustained greater improvement than relapsers on tests of delayed recall of drawings, visuospatial function, attention, gait, and balance. Shrinkage in 3rd ventricle volume across all participants significantly correlated with improvement in nonverbal short-term memory. Additional brain structure-function relationships, most involving short-term memory, were observed when analyses were restricted to alcoholic men who had maintained complete abstinence, were light relapsers for at least 3 months, or had consumed no more than 10 drinks prior to follow-up testing. Thus, alcoholic men who maintain abstinence can show substantial functional improvement that is related to improvement in brain structure condition.     

Chronic alcohol excess is associated with selective but reversible injury to type 2B muscle fibres

Patients drinking more than 100 g alcohol/day for longer than three years develop atrophy of striated muscle fibres. This predominantly affects type 2B fibres which are dependent on anaerobic glycolytic metabolism. Atrophy of type 1 and type 2A fibres, which in addition use aerobic mitochondrial respiration, only occurs in the most severe cases and then only to a lesser degree. Abstention from alcohol reverses the changes in muscle which slowly return to normal. Selective injury to type 2B fibres indicates that search should be made for an alcohol-induced biochemical lesion affecting the anaerobic glycolytic pathways of the muscle fibre.     

Hybrid Mice as Genetic Models of High Alcohol Consumption

We showed that F1 hybrid genotypes may provide a broader variety of ethanol drinking phenotypes than the inbred progenitor strains used to create the hybrids (Blednov et al. in Alcohol Clin Exp Res 29:1949–1958, 2005). To extend this work, we characterized alcohol consumption as well as intake of other tastants (saccharin, quinine and sodium chloride) in five inbred strains of mice (FVB, SJL, B6, BUB, NZB) and in their reciprocal F1 hybrids with B6 (FVBxB6; B6xFVB; NZBxB6; B6xNZB; BUBxB6; B6xBUB; SJLxB6; B6xSJL). We also compared ethanol intake in these mice for several concentrations before and after two periods of abstinence. F1 hybrid mice derived from the crosses of B6 and FVB and also B6 and SJL drank higher levels of ethanol than their progenitor strains, demonstrating overdominance for two-bottle choice drinking test. The B6 and NZB hybrid showed additivity in two-bottle choice drinking, whereas the hybrid of B6 and BUB demonstrated full or complete dominance. Genealogical origin, as well as non-alcohol taste preferences (sodium chloride), predicted ethanol consumption. Mice derived from the crosses of B6 and FVB showed high sustained alcohol preference and the B6 and NZB hybrids showed reduced alcohol preference after periods of abstinence. These new genetic models offer some advantages over inbred strains because they provide high, sustained, alcohol intake, and should allow mapping of loci important for the genetic architecture of these traits.     

Drinking patterns in general practice patients

Patients from 47 group practices recruited from the Medical Research Council's general practice research framework participated in a study involving the collection of information about smoking, drinking, exercise and dieting and weight. This paper is concerned with the data on alcohol consumption obtained in the first stage of the study in which a self-administered questionnaire, the health survey questionnaire, was distributed by hand or by post to patients registered with the participating practices.

Of the 25496 men who completed the questionnaire, 83.6% stated that they had been drinking in the previous three months compared with 69.2% of the 36657 women. For both sexes, abstinence rates were significantly lower in the younger age groups (P<O.001). Of the men, 7.6% admitted to a weekly alcohol consumption of 35 units or more and 2.7% women were drinking 21 units per week or more.

Of the 1948 male excessive drinkers 45.9% expressed concern about their drinking through a positive CAGE response and/or self assessment of a drinking problem, while for the 989 female excessive drinkers the figure was 44.1%. A positive response to these questions was strongly related to alcohol consumption and was more frequent among women than men at most levels of consumption.

     

Analysis of carbohydrate deficient transferrin serum levels during abstinence

An alcohol-associated change in the serum transferrin glycoform pattern, carbohydrate-deficient transferrin (CDT), is used as a biomarker of chronic moderate to heavy alcohol consumption. Furthermore, CDT is employed as a marker of abstinence. Here, we analyzed CDT in patients with chronic excessive alcohol abuse at the beginning and during abstinence. Twenty-nine alcohol dependent patients were recruited from an in-patient abstention program. Reported drinking levels were at least 100 g/d (range up to 450 g/d; mean: 248.9±94.7 g/d) within the last month before study entry. Blood samples were drawn at the beginning and during the abstention program and the relative concentration (%CDT) of CDT was determined using ion exchange followed by immunodetermination of CDT. At study entry, 25/29 patients had a %CDT level above the established cutoff. Although CDT levels declined during abstinence in most patients, in ten patients with %CDT levels just above the cutoff at the start of the program, the CDT values remained elevated 6 weeks after cessation of drinking. Our data indicate that %CDT levels below the cutoff cannot even rule out long lasting excessive alcohol abuse. Further, measurement of %CDT should be interpreted with special care when used as a marker of alcohol abstinence.     

Increased total serum IgE in alcoholics

Total serum IgE concentrations were measured in 106 male alcoholics with current alcohol abstinence of varying duration. The influence of smoking habits and clinical atopy on IgE levels was considered. The majority (91%) of the alcoholics were smokers and 26% suffered from possible clinical atopy. The geometric mean IgE in non-atopic, smoking alcoholics was 42 kU/l and significantly higher than the mean IgE level, 19 kU/l, in age-matched, smoking, non-atopic male participants in a general health survey (p less than 0.001). The IgE levels declined with the length of the alcohol abstinence period. Alcoholics, serially followed after a heavy drinking spree, showed a uniform pattern of declining IgE levels during a fortnight of abstinence (p less than 0.001). No link was noted between total IgE levels and the extent of liver affection as estimated by various serum variables (bilirubin, aminotransferases, gamma-GT, IgG, IgA and IgM) or galactose tolerance test. The increased IgE levels in alcoholics are suggested to reflect an influence of ethanol on T lymphocytes regulating the IgE synthesis. Such a proposed effect of ethanol on cellular immunity may contribute to certain organic alcohol diseases, but does not appear to influence the frequency of clinical atopy, being similar in our patient group and in the general population of the same geographic area.     

Critical periods for the effects of alcohol exposure on learning in rats

Critical periods for alcohol-induced deficits in spatial navigation and passive avoidance learning were investigated with a rat model of fetal alcohol syndrome. Rats were exposed to alcohol prenatally (Gestational Days 1-10 or 11-22) or postnatally (Postnatal Days 2-10) or throughout all 3 periods. Offspring were tested in either a spatial navigation or an avoidance task as juveniles or adults. As juveniles, the combined exposure group took longer to learn the spatial navigation task compared with all other groups. This effect was not seen in adults. Passive avoidance performance was not affected. These results suggest that long-term exposure to alcohol during development has adverse effects on spatial learning. The lack of differences in the short-term exposure groups implies that there may not be 1 critical period of alcohol exposure, but that the adverse effects of alcohol during development may be cumulative on some behaviors.     

RXRalpha-regulated liver SAMe and GSH levels influence susceptibility to alcohol-induced hepatotoxicity

Retinoids influence the pathogenesis of alcohol liver disease (ALD). To analyze the impact of retinoid X receptor alpha (RXRalpha) on ALD, alcohol-induced hepatotoxicity was studied using mice fed ethanol intragastrically for 25 days. Alcohol-induced microvesicular fat around the central vein and drug-induced morphological changes (loss of rough endoplasmic reticulum, pinkish cytoplasm, and enlarged hepatocyte) in the pericentral area were observed in the liver of wild-type mice. In the hepatocyte RXRalpha-deficient mouse liver, alcohol induced fat accumulation, mitosis, acute inflammation, and necrosis. The histology score after alcohol treatment was significantly higher in mutant mice than in wild-type mice. However, drug-induced morphological changes were not apparent in alcohol-treated hepatocyte RXRalpha-deficient mice. Northern analysis showed that the basal and alcohol-induced CYP2B, CYP2A, and CYP3A mRNA levels were lower in hepatocyte RXRalpha-deficient mice than in wild-type mice, which in turn may protect mutant mice from morphological changes. Compared with wild-type mice, hepatocyte RXRalpha-deficient mice have significant lower levels of S-adenosylmethionine and glutathione, which is further reduced after alcohol treatment, and that may account for severe liver injury induced by alcohol. The overall result suggests an important role of RXRalpha in preventing alcohol-induced liver injury.