Is daily single dosage of diazepam as effective as chlordiazepoxide in divided doses in alcohol withdrawal--a pilot study

We report on a pilot double-blind study on the effectivenessof divided doses of chlordiazepoxide and a single daily doseof diazepam in the treatment of the alcohol-withdrawal syndrome.While a variety of drugs (chlormethiazole, propranolol and clonidine)have been used for treatment of alcohol-withdrawal symptoms,benzodiazepines remain the drugs of choice for alcohol detoxification(Mayo-Smith, 1997). Diazepam and chlordiazepoxide are both . . . [Full Text of this Article]APPENDIXFOOTNOTESREFERENCES     

Determination of ethyl glucuronide in hair samples

Ethyl glucuronide (EtG) is a non-volatile, water-soluble, stable-upon-storage,direct metabolite of ethanol and can be detected in body fluidsand tissues (and also in post-mortem material) for an extendedtime period after the complete elimination of alcohol from thebody (Alt et al., 1997; Schmitt et al., 1997; Seidl et al.,1998; Wurst et al., 1999a,b). The aim of the present Letteris to emphasize . . . [Full Text of this Article]FOOTNOTESREFERENCES     

Alcohol exposure in utero and breast cancer risk later in life

Since the pioneering work of Hiatt and Bawol (1984), there hasamassed a considerable amount of evidence that moderate-to-heavyalcohol consumption increases risk of breast cancer in women(Willett et al., 1987; Longnecker, 1999). A plausible mechanismis by alcohol's effects on circulating hormone levels. Alcoholadministration has been reported to increase circulating oestradiollevels in pre-menopausal women (Reichman et al., 1993); theevidence is mixed in . . . [Full Text of this Article]FOOTNOTESREFERENCES     

The volume of the liver in patients correlates to body weight and alcohol consumption

The measurement of liver volume has gained practical use inrelation to liver transplantation (Kawasaki et al., 1993). Livervolume may also relate to the many metabolic processes in whichthe liver is engaged (Homeida et al., 1979; Marchesini et al.,1988; Murry et al., 1995; Reichel et al., 1997; Kwo et al.,1998; Andersen et al., 1999). The present study was undertakento measure liver . . . [Full Text of this Article]FOOTNOTESREFERENCES     

Reversal of ethanol-induced hepatic steatosis and lipid peroxidation by taurine: a study in rats

We read with interest the study reported by Kerai et al. inthe July–August (1999) issue of Alcohol and Alcoholism.The authors concluded that hepatic steatosis and lipid peroxidationcaused by chronic alcohol consumption in rats can be reversedby administration of taurine. Furthermore, . . . [Full Text of this Article]FOOTNOTESREFERENCES     

Alcohol-dependent patients with neuroendocrine evidence for reduced dopamine d(2) receptor function have decreased platelet monoamine oxidase-B activity

This letter is a report of a re-evaluation of the results obtainedin an earlier study of ours (Balldin et al., 1994) of plateletmonoamine oxidase (MAO)-B activity in alcoholics with reduceddopamine (DA) D₂ receptor function, as assessed by the growthhormone (GH) response to the D₁/D₂ agonist apomorphine (APO),which was published in this journal. The reason for the re-evaluationof the results in our study is a Letter to the Editors of thisjournal by Farren and Dinan (1996) reporting on platelet MAO-Bactivity in alcoholics with reduced DA D₂ receptor function,as assessed by the GH response to the DA D₂ receptor agonistbromocriptine. In the report by Farren and Dinan (1996), fourof eight alcoholics had no increase in GH above baseline, whereasall eight subjects in the control group had the expected GH. . . [Full Text of this Article]FOOTNOTESREFERENCES     

The value of oral thiamine

Cook (2000) advocated parental replacement of thiamine as aroutine accompaniment to in-patient alcohol detoxification.The justification is . . . [Full Text of this Article]REFERENCES     

ON INTRACELLULAR FORMATION OF ETHANOL AND ITS POSSIBLE ROLE IN ENERGY METABOLISM

Despite a great number of papers devoted to studies of the influenceof alcohol on man's health, very few of them discuss the issueof the presence of ethanol in the human body not connected withalcohol consumption. Such ethanol is commonly called endogenous.It is believed to originate from the microbial fermentationof the carbohydrates in the gastro-intestinal tract (Krebs andPerkins, . . . [Full Text of this Article]REFERENCES     

Translation problems of the Spanish version of the Readiness to Change Questionnaire

The Readiness to Change Questionnaire instrument by Rollnicket al. (1992) has become a standard in assessing stages of changeamong substance users. It has found such widespread acceptancethat recently it has been translated into Spanish by Rodriguez-Martoset al. (2000). . . . [Full Text of this Article]FOOTNOTESREFERENCES     

Secondary depression in weaned alcoholics: implications of Lesch's typology of chronic alcoholism

Schuckit (1983) described two types of alcohol-related depression:(1) the common type, in which secondary depression disappearswithout treatment within the first few weeks of abstinence;(2) a less frequent type, primary depression, requiring specifictreatment. It is difficult to anticipate whether an alcoholicpatient needs antidepressive treatment or whether depressionwill remit spontaneously. A potential guide to differentiatedepressed alcoholic patients who might need specific treatmentfor depression could be the typology of Lesch et al. (1990).Based on . . . [Full Text of this Article]ConclusionFOOTNOTESREFERENCES     

Introduction to personality-biological interactions in alcoholism: 'The Markku Linnoila Memorial Symposium'.

Although a number of specific personality disorders, includinganti-social personality, passive-dependent personality, andexplosive personality, have been associated with the diagnosisof alcoholism, studies of the relationship of underlying personalityand/or temperament to the nature, phenomenology, psychobiology,prognosis, and treatment of alcoholism have occurred much lessfrequently. However, there is a growing body of evidence thatcore or underlying personality and temperament are . . . [Full Text of this Article]FOOTNOTES     

Alcohol and hypertension: an old relationship revisited

The American comedian Henny Youngman (1906–1998) oncesaid, ‘When I read about the evils of drinking, I gaveup reading.’ Ironic, but interestingly as though witha sense of foresight, he did not speak of giving up drinking!It is despite the fact that alcohol is responsible for increasedillness, being causally related to more than 60 different medicalconditions (Rehm et al., 2003). Around 4% of the global diseaseburden is also thought to be alcohol related, which is comparablewith that attributed to the effects of tobacco (4.1%) and highblood pressure (4.4%) (Ezzati et al., 2002; WHO, 2002). For most diseases related to alcohol consumption, a dose–responserelationship exists with risk of the disease increasing withgreater amounts of alcohol intake, with cardiovascular     

Screening for alcohol misuse

Aira et al.'s constructive paper¹ identifies seven categoriesinfluencing the physician:patient dialogue for alcohol consumption.We recently have completed a study of Senior House Officer (SHO)attitudes to screening for alcohol misuse in Accident and Emergency(A&E) (127 SHOs over 5 years)². Briefly, we compare theexperiences of GPs and A&E staff under the headings identified. Sensitive nature of alcohol drinking     

Separate and Joint Effects of Alcohol and Smoking on the Risks of Cirrhosis and Gallbladder Disease in Middle-aged Women

The separate and joint effects of alcohol and smoking on incidencesof liver cirrhosis and gallbladder disease were examined ina prospective study of 1,290,413 United Kingdom women (meanage, 56 years) recruited during 1996–2001. After a meanfollow-up of 6.1 years (1996–2005), incidence rates ofcirrhosis and gallbladder disease were 1.3 per 1,000 persons(n = 2,105) and 15 per 1,000 persons (n = 23,989), respectively,over 5 years. Cirrhosis risk increased with increasing alcoholconsumption, while the risk of gallbladder disease decreased(P_trend < 0.0001 for each). Comparing women who drank 15units/week with those who drank 1–2 units/week, the relativerisk was 4.32 (95% confidence interval (CI): 3.71, 5.03)) forcirrhosis and 0.59 (95% CI: 0.55, 0.64) for gallbladder disease.Increasing numbers of cigarettes smoked daily increased therisk of both conditions (P_trend < 0.0001 for each). Comparingcurrent smokers of 20 cigarettes/day with never smokers, therelative risk was 3.76 (95% CI: 3.25, 4.34) for cirrhosis and1.29 (95% CI: 1.22, 1.37) for gallbladder disease. Effects ofalcohol and smoking were more than multiplicative for cirrhosis(P_interaction = 0.02) but not for gallbladder disease (P_interaction= 0.4). Findings indicate that alcohol and smoking affect therisks of the 2 conditions in different ways. For cirrhosis,alcohol and smoking separately increase risk, and their jointeffects are particularly hazardous. For gallbladder disease,alcohol reduces risk and smoking results in a small risk increase. alcohol drinking; gallbladder diseases; liver cirrhosis; liver diseases, alcoholic; prospective studies; smoking     

Pragmatic trials and the ARES study

The ARES study (Kiritzé-Topor et al., 2004) addressesan important issue of the use of acamprosate in general practicepatients with alcohol dependence. The paper gives a stronglyargued advocacy for pragmatic trials in alcohol dependence.The authors have tried to ensure that the study closely mimicsclinical practice in almost all possible ways, thus increasingthe     

Prevalence of asthma in schoolchildren under-represents those from socially deprived areas

We were interested to read the excellent study by McCann etal. in the February edition of Health Education Research (McCannet al., 2002). We have recently conducted a similar, but smaller,study that sheds some light upon their results. Our study aimedto assess the impact of our local asthma health promotion schemefor schools [Asthma Friendly Schools (AFS) Initiative], whichhad been in place for 5 years and had been adopted by abouthalf of all Portsmouth schools. We     

Disulfiram, cocaine, and alcohol: two outcomes for the price of one?

The concurrent abuse of cocaine and alcohol is a common phenomenon,and is increasingly recognized as a difficult clinical issue.Several effective pharmacotherapies for substance dependencedisorders have been identified, though the search for an effectivepharmacotherapy for cocaine dependence has proved difficult.However, it has been suggested that disulfiram may offer a promisingtreatment option. The randomized, placebo-controlled study of Carroll et al. (2004)provides some of the strongest evidence to date regarding theeffectiveness of disulfiram treatment in reducing cocaine use.In a large     

Detection times for urinary ethyl glucuronide and ethyl sulfate in heavy drinkers during alcohol detoxification

Aims: Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are conjugatedethanol metabolites formed in low amounts after alcohol consumption.Compared with ethanol, EtG and EtS are excreted in urine fora prolonged time, making them useful as sensitive alcohol biomarkers.This study determined the detection times for EtG and EtS inalcoholic patients undergoing alcohol detoxification. Methods:Alcohol-dependent patients (n = 32) with an initial alcoholconcentration 1 g/L based on breath testing were followed duringdetoxification. Urine samples for determination of EtG, EtS,ethanol and creatinine were collected on admission to the hospitaland thereafter once daily for several days. EtG and EtS measurementswere performed by liquid chromatography-mass spectrometry (LC-MS)and EtG also using an immunochemical assay (DRI-EtG EIA, ThermoFisher/Microgenics).Results: The detection time for urinary EtG was weakly correlated(r = 0.434, P = 0.013) with the initial alcohol concentration(range 1.0–3.4 g/L). For EtG, the individual time rangeuntil return to below the applied cut-off limit (<0.5 mg/L)was 40–130 h (median 78) with a similar time course observedfor EtS. After correction for urine dilution, the time untilan EtG/creatinine ratio <0.5 mg/g was 40– 90 h (median65). The detection times after an estimated zero ethanol concentrationwere 30–110 h (median 66) for EtG and 30– 70 h (median56) for EtG/creatinine. The EtG results by LC-MS and the immunoassaywere in good agreement. Conclusions: During alcohol detoxification,EtG and EtS remained detectable in urine for several days. Thedetection times showed wide inter-individual variations, alsoafter adjusting values for urine dilution and to the estimatedtimes for a completed ethanol elimination.     

EFFECTS OF VARIOUS CYTOCHROME P-450 INDUCERS ON TESTOSTERONE METABOLISM AND SEVERAL MONOOXYGENASE ACTIVITIES IN SPRAGUEDAWLEY (SpD), HIGH ALCOHOL SENSITIVITY (HAS) AND LOW ALCOHOL SENSITIVITY (LAS) RATS

Hydroxylation of testosterone (TST) has been shown to be regio-and stereo-specific for a number of cytochrome P-450 isoenzymes.Three rat lines [Sprague-Dawley (SpD), high alcohol sensitivity(HAS) and low alcohol sensitivity (LAS)] were tested for thisenzymatic specificity after treatment with phenobarbital, clofibrate,3-methylcholanthrene and pregnenolone-16-carbonitrile. Thesecompounds are known to induce cytochrome P-450 2B, 4A, 1A and3A1. respectively, in the rat. Induction efficiency was establishedby using the usual enzyme activities specific for these P-450s(pentoxyresorufin, lauric acid, ethoxyresorufin and nifedipineoxidase). Five mono hydroxylated TST metabolites were separatedusing a sensitive HPLC procedure. The hydroxylation of TST wasfound to be significantly different between the lines even inthe uninduced state. The formation of the metabolites of TST,hydroxylated on 2 or 7 or 16 positions and oxidated on carbon17 (4), was found to be significantly increased in SpD ratswhen compared with the HAS-LAS lines (P < 0.0001 in eachcase). When the HAS-LAS lines were compared, the quantity of2 and 16 hydroxylated metabolites was found to be significantlylower in LAS rats (P < 0.05). These differences persisted,although in the opposite direction, after 3-methylcholanthrene(P < 0.01 for both 2 and 16) and phenobarbital induction(P < 0.01 for 2). In conclusion, large differences in TSThydroxylation were found between the SpD and HAS-LAS rats whilemore subtle differences were found between the more closelyrelated HAS-LAS lines especially after phenobarbital and 3-methylcholanthreneadministration as confirmed by our enzyme activity results.The above differences in steroid metabolism between HAS andLAS rats may help to explain their contrasting sensitivitiesto alcohol.     

Reply to the commentary by Kari Poikolainen on evaluation of the effect of treatment of alcohol and drug problems by the Swedish Council on Technology Assessment in Health Care (SBU)

We appreciate the careful reading and evaluation of the SwedishCouncil on Technology Assessment in Health Care (SBU, 2001)report by Dr Poikolainen (SBU, 2002). Poikolainen discussesseveral important issues, not only related to the report butalso to systematic reviews in general. First, we shall commenton the SBU methodology. SBU METHODOLOGY It is important to stress that the methodology applied is basicallya series of systematic reviews of the available literature.The use of meta-analytical procedures depends on the characterof the studies on the different topics. In most previous SBUreports meta-analytical techniques have not been applied. Inour opinion, the development of meta-analytical methodologyand the availability of effective software for performing meta-analyticalcalculations have made this