Family thinking in prevention of alcoholism.

Prevention of alcoholism is considered through family therapy interfering with the transgenerational transmission. A theoretical structure is offered which argues that unless alcoholism is a strictly constitutional trait, genetically transmitted (for which there is inconclusive evidence), then intervention in the family through treatment offers a potential for breaking the chain.Evidence that alcoholism is familial is reviewed in terms of physiologic predisposition and family structure. The history and theoretical base for family thinking and family therapy are presented. The way in which these concepts apply to alcoholic families and the way alcoholic families reflect and reinforce symptoms of alcoholism are described.How intervention in family process can interrupt the continuation of alcohol abuse and change unhealthy patterns that promote alcohol abuse is described in terms of actual experience as well as theory. It is recommended that family thinking be introduced and encouraged in treatment programs, alcohol education, and public information about alcoholism.     

Stress-related neuropeptides and alcoholism: CRH, NPY, and beyond

This article summarizes the proceedings of a symposium held at the conference on “Alcoholism and Stress: A Framework for Future Treatment Strategies” in Volterra, Italy, May 6-9, 2008. Chaired by Markus Heilig and Roberto Ciccocioppo, this symposium offered a forum for the presentation of recent data linking neuropetidergic neurotransmission to the regulation of different alcohol-related behaviors in animals and in humans. Dr. Donald Gehlert described the development of a new corticotrophin-releasing factor receptor 1 antagonist and showed its efficacy in reducing alcohol consumption and stress-induced relapse in different animal models of alcohol abuse. Dr. Andrey Ryabinin reviewed recent findings in his laboratory, indicating a role of the urocortin 1 receptor system in the regulation of alcohol intake. Dr. Annika Thorsell showed data supporting the significance of the neuropeptide Y receptor system in the modulation of behaviors associated with a history of ethanol intoxication. Dr. Roberto Ciccocioppo focused his presentation on the nociceptin/orphanin FQ (N/OFQ) receptors as treatment targets for alcoholism. Finally, Dr. Markus Heilig showed recent preclinical and clinical evidence suggesting that neurokinin 1 antagonism may represent a promising new treatment for alcoholism. Collectively, these investigators highlighted the significance of neuropeptidergic neurotransmission in the regulation of neurobiological mechanisms of alcohol addiction. Data also revealed the importance of these systems as treatment targets for the development of new medication for alcoholism.     

Carbohydrate deficient transferrin in alcoholic liver disease: mechanisms and clinical implications.

Carbohydrate-deficient transferrin (CDT) is now considered to be the most sensitive and specific biological marker of alcohol abuse. The mechanism by which chronic alcohol consumption causes an elevation of CDT levels in serum is discussed. The sensitivity and specificity of various test procedures are compared, with special emphasis on the impact of liver disease. Clinical applications are reviewed, including the utility of CDT as a marker of relapse in alcoholic patients, and the use of CDT for the systematic screening of drinking in vulnerable populations as part of a public health approach to alcoholism.     

Disordered sleep, nocturnal cytokines, and immunity: interactions between alcohol dependence and African-American ethnicity.

Sleep disturbance is one of the most prominent complaints of alcohol-dependent patients. In view of recent evidence that the immune system is integrated with other homeostatic processes ultimately regulated by the brain, the influence of sleep on host defense mechanisms and the expression of proinflammatory and T helper cell cytokines deserves attention in alcohol dependence. Although not all immune alterations found in alcohol-dependent persons are related to disordered sleep, it is exceedingly important to know whether sleep influences immunity in alcoholism because of the recognized impact of disordered sleep on infectious disease risk. Conversely, feedback systems are also operating between the brain and the immune system, and abnormalities in the expression of cytokines might contribute to sleep disturbances in alcohol-dependent persons. In this review, we identify the immune alterations found in association with alcohol dependence and discuss the implications of these findings for infectious disease risk, with particular attention to the interaction between African-American ethnicity and alcoholism in contributing to this risk. We provide evidence that sleep disruption occurs in association with alcohol dependence and that African-American alcohol-dependent persons show greater abnormalities in sleep and sleep regulatory processes than shown by Euro-American alcohol-dependent persons. The relations among alcoholism, sleep, and immunity are discussed, with an emphasis on understanding how the cytokine network is altered during sleep in the African-American alcohol-dependent populations. The potential is to use cytokine agonists or antagonists to determine whether physiologic changes in cytokines have a role in the homeostatic regulation of sleep in human beings, which has tremendous implications for the development of novel treatments of alcohol-related sleep disorders.     

Pharmacogenetic strategies for studying alcohol dependence

The importance of genotypic differences in the determination of sensitivity to ethanol, tolerance development and physical dependence susceptibility is achieving ever greater recognition. It is now generally accepted by investigators studying the biochemical and physiological bases for alcoholism that genotype can influence all these different aspects of sensitivity to the effects of ethanol. Although there is convincing evidence that susceptibility to alcoholism is inherited in man, we have no idea what it is that is inherited [2, 7, 19, 24, 31]. By examining a family history for a particular individual, we can identify individuals at familial risk for developing problems with alcohol abuse. However, environmental as well as genetic factors are important in determining who does and who does not become an alcoholic [4]. Thus, one critical need is for a genetic marker for alcoholism. Since the search for such markers in human research is both expensive and time-consuming, this has led to the use of animal models for alcoholism. Animal models are particularly helpful for genetic research since their genetics are well understood and can be specifically tooled to the task at hand. The goal of this paper is to illustrate the principal genetic methodologies that have been employed to study the human and animal pharmacogenetics of alcohol, and to identify future directions in this area.     

Genetics and biological markers of risk for alcoholism

Substantial scientific evidence has accumulated that both genetic and environmental factors predispose the development of alcoholism in certain individuals. Evidence has accumulated to indicate that alcoholism is a heterogeneous entity arising from multiple etiologies. The demonstrated role of genetics in increasing the risk of alcoholism has promoted the search for biological markers that could objectively identify individuals who are genetically predisposed to alcoholism. Identifying such markers could allow for early diagnosis, focused prevention, and differential and type-specific treatment of alcoholism. Promising markers have been provided by research in electrophysiology, endocrinology, and biochemistry. Recent advances in molecular genetics are offering prospects for direct analysis of the human genome to determine elements that provide predisposition to, and protection from, alcoholism. Recent advances in research and new knowledge gained by the alcoholism treatment community and the lay public are helping to diminish the societal damage caused by alcohol abuse and alcoholism and to change prevailing attitudes about them.     

Women and cross-dependence

Most scientific researches on drug abuse and dependence suffer from "gender bias" being male dominated with the assumption that men are the main users of drugs. In reality, women use mind-altering drugs in the same way as men. This paper focus on alcohol, drugs use/abuse and dependence amongst females on public treatment Services, on recreational settings as well as at school. Problem related to alcohol and cocaine are discussed the most. Findings on aggressive behavior, psychological aspects, younger age of abuse, traumatic events, patterns of use, subset of gender specific symptoms manifestation (depression, mood swings, paranoia) the vicious circle of anxiety and alcoholism, the cross-dependence on legal and illegal drugs, comorbidity between drug abuse and psychiatric syndromes are treated in relation to academic literature.     

Gamma-hydroxybutyric acid Efficacy, potential abuse, and dependence in the treatment of alcohol addiction

The main objective in alcoholism therapy is to achieve and maintain abstinence and to prevent relapse. Pharmacotherapy may be necessary in treating persons who are not helped by group or psychosocial support alone. Among the substances experimented with in the past few years, gamma-hydroxybutyric acid has been effective in preventing alcohol withdrawal syndrome and in inducing a reduction in craving and an increase in the abstinence rate in treated alcoholics, in view of the alcohol-mimicking effects of the drug on the central nervous system. However, a possible development of craving for the drug and the risk of abuse and physical dependence have been reported in subjects who used gamma-hydroxybutyric acid for different reasons, including alcoholism therapy. The present review updates the existing differences in drug abuse behavior, side effects, and poisoning in the use of gamma-hydroxybutyric acid in a treatment alcoholism program and in self nonclinical illicit use.     

A biobehavioral research perspective on alcohol abuse and alcoholism

An empirical biobehavioral research approach to the conditions generally identified as alcohol abuse and alcoholism emphasizes the temporal ordering of participating biochemical, physiological, and behavioral events that provide an operational basis for characterizing the functional aspects of this complex disorder and identifying distinguishable features of the alcohol abuse and dependence process. The available evidence suggests that alcoholism is a condition determined by a host of continuous variables rather than an entity possessing static qualities that imply intractability. The challenge for biobehavioral research is to determine the details of how chronic and excessive alcohol drinking is generated as well as the conditions under which such overindulgence can be attenuated and prevented. Environmental context, for example, can dramatically alter the frequency and amount of alcohol intake. Such contextual malleability is suggested as an important key to at least some of the inconsistencies in the literature with regard to the conditions under which chronic and excessive alcohol intake occurs. Excessive and chronic alcohol ingestion would seem most parsimoniously viewed as a set of behaviors for which others might have been substituted, and intermittently do, rather than as a highly specific disorder or disease. Though current etiological, preventive, and therapeutic orientations emphasize the role of physical dependence and favor genetic influences as strong determinants of alcohol-related disorders, it is important to recognize that troubled drinking is malleable, waxing and then entering periods of remission, with alcohol drinking even in severely dependent individuals remaining susceptible to control by both antecedent and consequating environmental events.     

Alcohol dependency prevention and early intervention

Current data on efforts to prevent alcoholism indicate that we are better able to prevent some of the consequences of alcohol misuse, such as alcohol-related car crashes and fetal alcohol syndrome, than chronic alcohol dependence itself. A review of data on outcomes of treatment for long-term alcohol dependence indicates that 9 of 10 alcohol dependent persons receive no treatment for the disorder in any given year. When treatment is provided for long-term alcohol dependent persons, it has only slightly positive results. As a result, many clinicians and researchers have concluded that rather than exclusive preoccupation with long-term alcoholics, early intervention with persons who are just beginning to abuse alcohol may be a more effective use of resources.     

Alcoholism research: delivering on the promise

Prospects for research advances in alcoholism are very promising, because of the explosion in the neurosciences and advances in epidemiology and typology of the disorder. For example, the field is now ready for molecular genetics studies of the early onset form of alcoholism that is transmitted from father to son with high penetrance. Leading neuroscientists are being recruited into alcoholism research. Paradoxically, this time of new hope coincides with challenges to the scientific enterprise, such as the animal rights movement and impatience with the scientific process in the face of the public health emergencies represented by acquired immunodeficiency syndrome (AIDS) and drug abuse. The emergence of genetically based subtypes of alcoholism suggests that at least two discrete illness processes are involved. Mounting evidence from spinal fluid studies has rekindled interest in a key role for serotonin in the early onset form of alcoholism. One hypothesis now being explored is that genetically low brain serotonin function may be part of the predisposition to this form of alcoholism. It is known that acute alcohol intake transiently increases brain serotonin turnover. Thus, drinking might be viewed as an attempt to correct a deficit, only to produce further serotonin depletion as the drug's effect wears off, setting up a vicious cycle of repeated attempts to self-medicate. Impulsive, violent, and suicidal behavior as well as alcohol abuse are associated with the low brain serotonin activity. Persons with these problems suffer from circadian rhythm and glucose metabolism disturbances that may also be mediated by serotonin. New pharmacological probes are now available to tease out the mechanisms of altered serotonin function.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ethnicity, alcohol, and acculturation

In the social and behavioral sciences there is a strong correlation alleged between alcohol abuse and ethnonational origins. Changes in drinking patterns and problem drinking among immigrants to the United States are often mistakenly attributed to acculturation, just as the etiology of alcohol abuse and alcoholism is often erroneously traced to the 'ethnic origins' of these men and women. In addition, and for the same reasons, researchers and practitioners may have thus unwittingly influenced the perceptions and understandings of this population with respect to the relationship between particular ethnic groups and alcohol consumption. This paper summarizes how the term acculturation has been employed recently in alcohol studies. Preliminary findings are reported from ethnographic fieldwork with Latin America-born men in the San Francisco Bay Area.     

Improving the old, embracing the new: implications of alcohol research for future practice.

Alcohol research has two important goals. The first of these is to evaluate existing therapies for treating alcoholism. The second, more long term goal is to increase understanding of the biology of alcoholism. The second, more long term goal is to increase understanding of the biology of alcoholism and to use this understanding to develop new targeted medications to prevent alcohol use problems and to improve treatment outcome. Considerable research progress has been made over the past three decades toward achieving each goal. The careful study of existing therapies and the development of both behavioral strategies and medications, such as naltrexone, have helped improve treatment success. New neuroscience techniques have led to an increased understanding of how alcohol's actions in the brain are related to the phenomenon of addiction, and new imaging techniques have permitted scientists to study alcohol's effects on the brain and to link these effects to behavior in ways not even possible just a few years ago. Finally, genetics researchers are using both animal and human genetics techniques to identify the genes that confer vulnerability to alcoholism and developing ways to apply this information to clinical populations. As a result of increased understanding of the biology of alcohol dependence, future clinicians will need to understand not just the traditional behavioral nuances of alcoholism treatment, but the biology of alcohol dependence as well.     

Neurobiology and treatment in alcoholism--recent findings regarding Lesch's typology of alcohol dependence

Subtyping in alcohol dependence has become an important issue as studies have proposed different neurobiological mechanisms in alcoholism in the recent years. Studies have shown that alcohol dependence reflects a wide range of different phenotypes, including psychological, social, and neurobiological factors. Different ways of subtyping have been proposed in the last decades, one of them being Lesch's typology of alcohol dependence. Recent investigations have shown that different subtypes of Lesch's typology are associated with specific neurobiological factors which may have important implications for clinical practice. This applies in particular for genetic and neuroendocrinological factors, differences in the regulation of NMDA receptor-mediated glutamatergic neurotransmission, and in response to acamprosate and naltrexone treatment.     

Estimating prevalence of alcohol abuse and dependence in one general hospital: an approach to reduce sample selection bias.

Prevalence estimates of alcohol abuse or dependence in general hospitals are often limited to single wards, small data collecting periods or insufficient diagnostic procedures. Therefore, the present study aimed to ascertain alcohol abuse or dependence in one general hospital, to compare prevalence data for all the 11 wards and 6 intake months, to establish if screening is sufficient or if a two-step diagnostic procedure is needed, and to determine whether information for an alcohol diagnosis on suspicion is available. A sample of 1309 medical or surgical in-patients were screened by questionnaires or medication for withdrawal, and, if screening-positive, were interviewed with the alcohol section of a standardized psychiatric interview. In screening-negative patients, a diagnosis on suspicion was given if medication to treat withdrawal had been used, or if there was evidence of single criteria of alcohol dependence, somatic disorders from alcohol drinking, raised laboratory parameters on grounds of alcohol drinking or of self-reported high alcohol consumption. Of the medical and surgical in-patients, 20.7 and 16.0% respectively were alcohol abusers or dependents, with a range of prevalence rates of alcohol abuse or dependence among wards of 11.1-32.9% and among intake months between 11.3 and 28.7%. Of the medical department in-patients, 1.9%, and of the surgical in-patients, 2.1%, were screened as false-positive cases. In addition, 5.5% of the medical and 12.0% of the surgical patients were given a diagnosis on suspicion. It is concluded that all general wards and different intake months should be taken into account when estimating prevalence of alcohol abuse or dependence in a general hospital.     

Adverse childhood exposures and alcohol dependence among seven Native American tribes

BACKGROUND: Alcohol abuse and alcoholism are leading causes of death among Native Americans. Little is known about the impact of negative childhood exposures, including parental alcoholism, childhood maltreatment, and out-of-home placement, on risk of lifetime DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) diagnosis of alcohol dependence in this population. METHODS: Face-to-face interviews were conducted with 1660 individuals from seven Native American tribes from 1998 to 2001. Logistic regression was used to estimate the impact of specific types and number of different adverse childhood experiences on alcohol dependence. Relationships between tribe-specific cultural characteristics and alcohol dependence were also examined. RESULTS: There were significant tribal differences in rates of alcohol dependence and several adverse childhood exposures. Lifetime prevalence of alcohol dependence was high among all tribes (men: 21%-56%, women: 17%-30%), but one (men: 1%, women: 2%). High prevalence rates were documented for one or more types of adverse childhood experiences (men: 74%-100%; women: 83%-93%). For men, combined physical and sexual abuse significantly increased the likelihood of subsequent alcohol dependence (odds ratio [OR]=1.58; 95% confidence interval [CI], 1.10-2.27). For women, sexual abuse (OR=1.79; 95% CI, 1.21-2.66) and boarding school attendance increased the odds of alcohol dependence (OR=1.57; 95% CI, 1.03-2.40). Two separate patterns of dose-response relationships were observed for men and women. Significant inter-tribal differences in rates of alcohol dependence remained after accounting for tribe-specific cultural factors and geographic region. CONCLUSIONS: Effects of childhood exposures on high-risk behaviors emphasize screening for violence in medical settings and development of social and educational programs for parents and children living on and near tribal reservations.     

Scheduled access alcohol drinking by alcohol-preferring (P) and high-alcohol-drinking (HAD) rats: Modeling adolescent and adult binge-like drinking

Binge alcohol drinking continues to be a public health concern among today's youth and young adults. Moreover, an early onset of alcohol use, which usually takes the form of binge drinking, is associated with a greater risk for developing alcohol use disorders. Given this, it is important to examine this behavior in rat models of alcohol abuse and dependence. Toward that end, the objective of this article is to review findings on binge-like drinking by selectively bred alcohol-preferring (P) and high-alcohol-drinking (HAD) lines of rats. As reviewed elsewhere in this special issue, the P line meets all, and the HAD line meets most, of the proposed criteria for an animal model of alcoholism. One model of binge drinking is scheduled ethanol access during the dark cycle, which has been used by our laboratory for over 20 years. Our laboratory has also adopted a protocol involving the concurrent presentation of multiple ethanol concentrations. When this protocol is combined with limited access, ethanol intake is maximized yielding blood ethanol levels (BELs) in excess, sometimes greatly in excess, of 80 mg%. By extending these procedures to include multiple scheduled ethanol access sessions during the dark cycle for 5 consecutive days/week, P and HAD rats consume in 3 or 4 h as much as, if not more than, the amount usually consumed in a 24 h period. Under certain conditions, using the multiple scheduled access procedure, BELs exceeding 200 mg% can be achieved on a daily basis. An overview of findings from studies with other selectively bred, inbred, and outbred rats places these findings in the context of the existing literature. Overall, the findings support the use of P and HAD rats as animal models to study binge-like alcohol drinking and reveal that scheduled access procedures will significantly increase ethanol intake by other rat lines and strains as well.     

Diagnosis of alcoholism in a simulated patient encounter by primary care physicians

Although early detection and treatment of alcoholism have been shown to be efficacious, it is widely accepted that primary care physicians often fail to diagnose alcoholism. In this study, a computerized, simulated encounter with an alcoholic patient was used to assess the performance of a randomly selected sample of primary care physicians in diagnosing alcoholism. Of 95 physicians in this study, only 32 percent diagnosed alcoholism with maximal certainty. There was great variability among physicians in the threshold of information needed to diagnose alcoholism. One third of subjects misinterpreted symptoms of alcoholism and erroneously made other psychiatric diagnoses, chiefly anxiety or depression. Results of this pilot study were not associated with the physicians' age, sex, specialty, duration of training, or reported personal impact of alcoholism. This study provides further evidence of the need for additional education of primary care physicians if such physicians are to succeed in reducing the dramatic impact of alcoholism and alcohol abuse on public health.