Pharmacokinetics of zimeldine in male alcoholics

The pharmacokinetics of zimeldine, a 5-HT reuptake blocker with antidepressive effects, was studied after a single oral dose and after multiple oral administration in 19 alcoholic males, 10 with and 9 without chronic liver damage. The average plasma concentration of zimeldine as assessed by the AUC values (area under the plasma concentration-time curve) was significantly higher in the chronically liver damaged patients than in the patients without chronic liver damage. The plasma half-life of zimeldine was also significantly longer in the chronically liver damaged patients. There were no differences in the obtained pharmacokinetic parameters between the patients having nonchronic liver damage and healthy control subjects. The pharmacokinetics of the active metabolite norzimeldine (resulting from N-demethylation of zimeldine) showed no differences between the two groups of alcoholics and the healthy controls. The IgA values were significantly correlated to both the AUC and plasma half-life of zimeldine. No other correlation between clinical chemistry parameters and pharmacokinetic parameters of zimeldine and norzimeldine were found.     

Derivation and validation of neuropsychological clusters among men alcoholics

Scores from 13 cognitive-neuropsychological tests administered to 245 men alcoholics were subjected to an average linkage cluster analysis. Six subtypes were derived but three were eliminated from further analyses because they had samples of less than 10. The remaining clusters appeared to reflect differing levels and patterns of neuropsychological functioning. Subsequent analyses indicated that the clusters were related to age but were independent of most other demographic and pretreatment alcohol-related variables. Significant associations were found between cluster membership and the likelihood of abstinence, completion of aftercare therapy and employment status over a 9-month follow-up period. Although this relationship to outcome is encouraging, neuropsychological status accounted for only a limited amount of the variance. The findings suggest the need to broaden the base of assessment, using multiple domains, in future attempts to derive meaningful subtypes within an alcoholic population.     

Changes in anxiety among abstinent male alcoholics

Symptoms of anxiety are prevalent features of alcoholics seeking treatment. In the present study levels of state anxiety among male primary alcoholics (with no preexisting major psychiatric disorders) were examined 3 times per week during inpatient treatment for alcoholism and again at 3 months following treatment. The 171 male alcoholics also completed the trait scale of the State Trait Anxiety Inventory upon admission to an inpatient program and at 3 months following treatment. Results indicate that recently detoxified males experience multiple anxiety symptoms, with 40% reporting significantly elevated levels of state anxiety at admission (greater than or equal to 75th percentile). By the second week of treatment state anxiety scores typically returned to the normal range although symptoms continued to decrease significantly with each week of continued abstinence. Elevated levels of anxiety symptoms were more common among primary alcoholics with a history of panic episodes or generalized anxiety disorder symptoms. While abstainers and relapsers did not differ in level of anxiety observed during treatment, the relapsers report significantly higher state and trait anxiety scores at follow-up.     

Risk factors for alcohol hepatotoxicity among male alcoholics

Alcoholic liver cirrhosis is a leading cause of morbidity and mortality in alcohol dependence. A common precursor to cirrhosis is alcoholic hepatotoxicity evident clinically by elevated serum liver enzymes. In this study 50 male patients with significant (greater than two times upper limits of normal) elevation of liver enzymes attending a veterans inpatient alcohol treatment center were matched by age and time since last drink to 50 male veterans without elevated liver enzymes. Patients with elevated liver enzymes were found to be more likely to be daily drinkers, less likely to indulge in binge drinking patterns or have alcoholic blackouts, and showed a trend towards a less severe pattern of alcoholism. Significant gamma glutamyl transferase (GGT) elevations were found in patients consuming an average of 7 beers/day for 5 years, and significant aspartate aminotransferase (AST) elevations were found in patients consuming a threshold of 12 beers/day for 10 years. These findings are consistent with current research suggesting alcoholic cirrhosis is a result of a threshold exposure to alcohol in alcoholics with an additional environmental or genetic risk factor.     

Older and younger male alcoholics in outpatient treatment

In the coming decades, the proportion of the older age groups in the total population, and, therefore, in the alcoholic population, will be increasing. The aim of the study is to assess to what extent older alcoholics form a distinct group within the problem-drinking population. Alcoholics in outpatient treatment of over 50 years of age (n = 52) are compared with those from the modal age group (ages 35-44, n = 55). Results indicate that problems with alcohol are less severe among older alcoholics. Contrary to expectation, older alcoholics did not report more health problems. No differences were observed in the duration of the treatment career. It is concluded that older alcoholics show the same types of problems, but less so than younger alcoholics. Further research is indicated regarding late onset, older alcoholics with multiple diagnosis, and drinking problems in the age group over 70.     

Neuropsychological efficiency measures in male and female alcoholics.

The role of time in performance on many neuropsychological tests has been relatively neglected in the literature to date. Neuropsychological functioning in 90 male and female alcoholics and 65 peer controls was examined using both accuracy and time measures for four basic types of neuropsychological functioning: verbal skills, learning and memory, problem-solving and abstracting, and perceptual-motor skills. Alcoholics had significantly lower efficiency ratios (accuracy/time) than controls in each of the four areas, and had significantly lower overall accuracy and time scores. There were no significant Group x Gender interactions for efficiency, speed or accuracy scores, indicating that male and female alcoholics have similar deficits as a result of chronic alcoholism. The study is the first to apply systematically an empirical measure of neuropsychological efficiency to different areas of cognitive function; the results have implications for neuropsychological testing procedures.     

Persistence and problem-solving skills in young male alcoholics.

This study compares the level of persistence between 31 inpatient alcoholic males and 31 abstinent or light social drinking males matched on age, education, socioeconomic status and estimated premorbid IQ. An unsolvable anagram and diagram were selected as measures of persistence. Results indicated that alcoholics persisted for significantly shorter periods of time on both measures than their matched controls. However, there were no significant group differences on two measures from the Wisconsin Card Sorting Test (set shifting and set maintenance). Persistence measures from the unsolvable tasks were not significantly correlated with the set maintenance score of the Wisconsin Card Sorting Test. Possible explanations are considered for these findings of persistence deficits without problem-solving impairments among young alcoholics.     

Mortality in male alcoholics after ten to fourteen years

OBJECTIVE: Alcoholics frequently die prematurely. The purpose of this study was to determine: (1) whether subjects in a sample of 360 male alcoholics, followed over a period of 10-14 years, died prematurely: (2) if so, from what causes; and (3) whether such deaths are predictable from characteristics present at initial assessment. METHOD: Subjects were male veterans (N = 360) with a diagnosis of alcoholism admitted to an inpatient substance abuse treatment program at the Kansas City Veterans Affairs (VA) Medical Center during 1980-1984 who consented to participate in intake evaluations and subsequent follow-ups at 1 year and 10-14 years later. Of the 357 (99.2%) men located at the 10-14 year follow-up, 96 (26.6%) were confirmed as deceased, 255 survivors agreed to be reassessed and 6 subjects refused reassessment. Information regarding cause of death was obtained from death certificates, VA records and other sources. RESULTS: At intake, the subsequently deceased men were older, had less education, lower psychosocial functioning, more medical problems and greater psychiatric severity. Their overall death rate was 2.5 times greater than that of a reference group of men. Men in the 35-44 year age group were 5.5 times as likely to die. A statistical model utilizing measures of alcohol dependence to predict mortality from intake to 10-14 year follow-up indicated that alcoholics who limited drinking were half as likely to die whereas those who engaged in morning drinking were 2.5 times more likely to die. CONCLUSIONS: Alcoholic men, especially those in the group aged 35 to 44 years, have a significantly higher risk of premature death than a reference group of men. Men who engaged in morning drinking and could not limit drinking appeared to be at higher risk of mortality 10 years later.     

Relationships between neuropsychological and psychopathological dimensions in male alcoholics

A study was conducted of the relationships between psychopathology and neuropsychological deficit in chronic alcoholic patients who had received the Minnesota Multiphasic Personality Inventory (MMPI), the Halstead-Reitan Neuropsychological Test Battery, and the Wechsler Adult Intelligence Scale (WAIS). Classification of the MMPIs by code type resulted in the formation of groups of 10 subjects with normal MMPIs, 19 subjects with MMPI profiles suggestive of depression, and 10 subjects with profiles suggestive of psychosis. Analysis of covariance was performed for various Halstead-Reitan scores; the only significant findings emerged for several of the verbal subtests of the WAIS. The group with psychotic MMPIs did substantially more poorly on these measures than the other groups. It was concluded that depressed alcoholics do not show greater neuropsychological deficit than do individuals with no significant psychopathology other than alcoholism. However, alcoholics with MMPI profiles that suggest psychosis differ from the other groups studied with regard to certain verbal abilities.     

Factors associated with motor vehicle accidents among male alcoholics

Male alcoholics (N = 260) presenting for inpatient treatment were given a structured psychiatric interview that included questions about previous motor vehicle accidents while intoxicated. The histories of 57 patients who reported personal injury accidents were compared with those of 131 patients who did not report accidents. Patients reporting accidents were more severely ill and had an earlier onset of heavy drinking. Also, more patients with accidents belonged to a subgroup of alcoholics with antisocial personality. The identification of high-risk alcoholics may contribute to motor vehicle accident prevention.     

A comparison among some measures of depression in male alcoholics

The efficacy of three depression scales--the Dysthymic scale of the Millon Clinical Multiaxial Inventory, the Beck Depression Inventory and the Geriatric Depression Scale (GDS)--in assessing depressive symptoms in 67 male alcoholic patients was compared. The criterion of depression was the patient's score on the Depression scale of the Minnesota Multiphasic Personality Inventory. In addition, the effects of age on the test results were explored as it was believed that the GDS would be less affected by age than the other two scales. The findings disclosed that all three depression scales are comparable in assessing depressive symptoms and that age is not a factor in any of the scales.     

Discharge patterns of residents from halfway houses for male alcoholics

Length of stay (LOS) data for male alcoholics discharged from eight halfway houses were examined in the light of the hypothesis that the rate of discharge would be a linear function of time. In general, the hypothesis was confirmed, although the rate of discharge for four houses was significantly accelerated during the first two weeks of residence. Further analysis showed that both resident characteristics and house structure (defined in terms of the number of hours of formal activities each week) contributed significantly to LOS. Resident characteristics accounted for 5.3% of the variance in LOS when house structure was controlled, and structure accounted for 1.6% of variance when resident characteristics were controlled. No significant interaction effects were detected. Implications of these results are discussed.     

Alcohol cue reactivity and private self-consciousness among male alcoholics.

Recent alcohol cue exposure studies have noted that not all alcoholics demonstrate increased reactivity when presented with alcohol-related cues. This study examined the relationship of private self-consciousness (PSC) to subjective, self-report measures of reactivity and measures of negative mood states that involve a focus on internal processes. These subjective measures of reactivity were contrasted with salivary reactivity, an objective measure of reactivity which does not require individual self-report or awareness. A cue reactivity assessment was administered to 47 men meeting DSM-III-R criteria for a diagnosis of alcohol dependence. Our hypothesis, that PSC would predict urge reactivity status and greater levels of negative mood states, was supported. Urge reactors were more likely to be high in PSC, while the proportions of salivary reactors and nonreactors were not significantly different between the high and low PSC groups. Although regression analyses indicated that PSC did not significantly predict urge to drink alcohol, it did predict angry/frustrated mood and sad/depressed mood at the first alcohol trial. These results suggest that individuals high in PSC may benefit more from cue exposure-based treatment, as they are more likely to be urge reactors and to evidence negative mood reactivity. Low PSC individuals may be at higher risk for relapse given they are less able to recognize internal reactions signaling the presence of a high-risk alcohol use situation, and therefore less likely to mobilize coping responses.     

Behavioral marital therapy couples groups for male alcoholics and their wives

This article presents in detail the clinical procedures for a behavioral marital therapy (BMT) couples group for male alcoholics. Methods used to recruit and prepare couples for therapy are presented. In the BMT couples group, therapists use behavioral rehearsal and weekly homework assignments to help couples (a) decrease drinking and alcohol-related interactions by making an Antabuse Contract and discussing relapse prevention; (b) plan shared recreational activities; (c) notice, acknowledge, and initiate daily caring behaviors; (d) learn communication skills of listening, expressing feelings directly, and the use of planned communication sessions; and (e) negotiate desired changes using positive specific requests, compromise, and written agreements. Methods for dealing with resistance and noncompliance in the group are also described. Finally, modifications in the BMT treatment package presented here that may be helpful in other settings are described.     

Parental alcoholism: an examination of male and female alcoholics in treatment

This study investigated the implications of parental alcoholism in 639 male and female alcoholics who were in treatment. In comparison with persons who did not report a parental history of alcoholism (PA-), the 264 offspring of alcoholics (PA+) were characterized by higher levels of alcohol dependency and alcohol-related consequences, increased reports of use of other drugs and higher levels of MMPI-measured psychopathology. Comparisons of PA+ patients with PA- patients with the same age of onset of problematic alcohol use suggested that PA+ persons are characterized more by an early onset of alcoholism than by a more severe form of the disorder. Results with female PA+ alcoholics were similar to those obtained with their male counterparts, although PA+ women exhibited very high levels of MMPI-measured psychopathology in comparison to both PA+ men and PA- women.