The role of alcohol abuse in working disability in patients with low back pain

The prevalence of alcohol problems was investigated in 50 patients with chronic low back pain, and compared to an age, sex, civil status, and income matched control group. Alcohol abuse was significantly more frequent among the male low back patients. Within the patient group the use of analgesics and sedatives was not related to the degree of alcohol consumption. Alcohol problems were not found to influence the rehabilitation process negatively, probably because the rehabilitation programme was not directed to the back only. Such problems therefore should not discriminate against inclusion in a rehabilitation programme.     

Alcohol,the elderly,and motor vehicle crashes

To document the prevalence of alcohol or drug use among elderly drivers admitted to a Level 1 trauma center after motor vehicle crashes, charts from 180 drivers age 60 years or older who were admitted to an urban Level 1 trauma center after motor vehicle crashes were retrospectively reviewed. Overall, 14% of the patients had a positive blood alcohol screen; among men, 21% had a positive screen. Only 55% of the patients were discharged to home. Only one patient (<1%) had a toxicology screen positive for another drug of abuse. Alcohol/drug abuse counselling was offered to only one patient. These results suggest a relatively high prevalence of alcohol use in elderly drivers involved in motor vehicle crashes, particularly men. However, abuse of other drugs was uncommon. Physicians treating intoxicated drivers should consider referral for alcohol counselling.     

Cardiovascular Disease in Alcohol Abusers

Moderate alcohol use (two or fewer drinks daily) may offer some degree of protection from coronary artery disease and stroke. Any potential benefit must be weighed against an individual's risk profile for alcohol abuse or dependence and the associated health and social consequences. Health costs of alcohol abuse are well into the billions. Heavy alcohol consumption is associated with cardiomyopathy, arrhythmias, hypertension, stroke, and sudden death. Alcohol is the major cause of nonischemic cardiomyopathy in the Western world. In any health care setting, education about the potential risks and benefits of alcohol use must be provided with health promotion and maintenance strategies tailored to the individual.     

Possible interaction between ethanol and drugs and their significance for drug therapy in the elderly]

Even though alcohol dependence is not often found in the elderly, alcohol consumption and alcohol abuse are both common. As the elderly also often take medication on a regular basis, this group is at particularly high risk for problems resulting from the concurrent use of these substances. Physical changes as a result of the aging process (e.g. reduction of body water, decrease of hepatic blood flow) and alcohol related diseases can influence the pharmacokinetics and pharmacodynamics of both ethanol as well as other drugs. Alcohol dehydrogenase (ADH), acetaldehydede hydrogenase (ALDH) and cytochrome P450 2E1 are the enzymes responsible for the metabolism of ethanol. These enzymes are also the sites of direct pharmacological interaction between ethanol and other drugs, however, altered effects of medication can also be caused by ethanol adding to or reducing the drug's effect. Although some of these effects result from heavy use of alcohol, others can also occur with moderate use. Interactions have most frequently been described for analgetics, psychopharmacologically active drugs, antihistamines, anticoagulants antihypertensive drugs and antibiotics.     

Health issues in men: Part II. Common psychosocial disorders

During screening examinations and, when appropriate, other health-related visits, family physicians should be alert for signs and symptoms of common psychosocial disorders in men. Health issues of concern include alcohol and substance abuse, domestic violence, midlife crisis and depression. Alcohol remains the most abused drug in America. The highest rates of alcohol abuse are in men 25 to 39 years of age, although alcoholism is also a considerable problem after 65 years of age. Disulfiram and the opioid antagonist naltrexone are the two medications currently labeled by the U.S. Food and Drug Administration for the treatment of chronic alcohol dependence. Like alcohol abuse, domestic violence is a sign of psychosocial distress in men. Domestic violence may be a problem in up to 16 percent of marriages. Most men move through the midlife period without difficulty. Major depressive illness occurs in about 1 percent of elderly men, whereas minor depression or subsyndromal depression affects 13 to 27 percent of older men. Selective serotonin reuptake inhibitors have become first-line therapy for depression.     

Geriatric trauma in the State of Illinois: substance use and injury patterns.

As the elderly population increases and they lead more active and healthy lifestyles, their exposure to the threats of injury multiply. Undoubtedly, the geriatric population will comprise a growing percentage of trauma patients. The role of alcohol and drug use in geriatric trauma has not been clearly defined. The purpose of this study is to determine the incidence of alcohol and illicit drug use in association with mechanism of injury in all elderly trauma patients presenting to level I and II trauma centers in the State of Illinois over 3 years. A retrospective analysis was performed on 3 years of data (January 1, 1994 to December 31, 1996), provided by the Illinois Department of Public Health as the Illinois Trauma Registry, which describes consecutive trauma patients presenting to level I and II trauma facilities in the State of Illinois. During the study period, there were a total of 134,846 trauma patient entries. Of these 32,382 (24.0%) were for patients 65 years of age or older. In those patients 65 and older, 1699 (5.2%) were tested for the presence of alcohol and 845 (49.7%) tested positive. Of the elderly patients who tested positive for alcohol, 71.8% were considered intoxicated (BAC >80 mg/dL). Urine toxicology screens were performed on 1785 (5.5%) elderly trauma patients, and 208 (11.6%) were positive. Besides alcohol, benzodiazipines and opiates were the most frequently detected drugs. For elderly patients under the influence of alcohol falls (49.5%) and motor vehicle crashes (36.7%) were the most common mechanism of injury. For geriatric patients testing negative for alcohol, motor vehicle crashes were a much more common mechanism of injury than falls (65.0% v 25.1%). Falls were a much more common cause of injury in elderly patients using alcohol than in those not using alcohol. Alcohol and substance abuse are possibly significant factors in geriatric trauma. Although only 5% of elderly trauma patients were tested for alcohol, nearly half had alcohol present on presentation to a trauma center, and the majority of these patients were intoxicated. Prospective studies are needed to determine the true incidence of alcohol use/abuse in the geriatric trauma population and the need for routine alcohol screening of these patients. Detection of alcohol abuse in elderly trauma patients could help identify individuals in need of counseling and rehabilitative treatment. It may also reduce future injuries in these patients.     

The Pharmacology of Alcohol Withdrawal Syndrome Treatment Reviewed: Efficacy, Cost, and Safety

Alcohol continues to be one of the most common drugs of abuse. The morbidity and mortality associated with alcohol withdrawal has decreased significantly with the advent of pharmacologic intervention. However, the best method for the treatment of alcohol withdrawal syndrome remains controversial. With chronic use, alcohol can disturb the function and balance of several neurotransmitter systems such as excitatory amino acids, GABA, serotonin, and acetylcholine. Compensatory mechanisms in these pathways appear to predominate during chronic use but may become pathologic during withdrawal. As the understanding of alcohol-induced cellular changes increases, treatment of chronic abuse and withdrawal can be refined. Several groups of drugs are efficacious as either primary or adjunct agents in the treatment of alcohol withdrawal. This review describes the current theories on the etiology and treatment of alcohol withdrawal syndrome with emphasis on efficacy, cost, pharmacokinetic parameters, and safety considerations. A proposed withdrawal regimen is also described. Benzodiazepines appear to be the safest and most efficacious choice. With a wide variety of pharmacokinetic parameters and low cost of treatment, they remain the drugs of choice for withdrawal. Ethanol, barbiturates, antiseizure medications, and sympatholytic and sympathomimetic drugs are also reviewed. Newer agents that may have a future role in withdrawal are discussed as well.     

Identifying and managing acute alcohol withdrawal in the elderly

In the elderly population, alcohol-related problems may be misinterpreted as normal consequences of aging. However, alcohol is a commonly abused substance among older adults, and age-related changes predispose these patients to a greater sensitivity to its effects. All older patients should be screened for alcohol dependence and abuse on admission to an acute care facility. If identified, the plan of care must include close observation for acute alcohol withdrawal and prompt intervention if it occurs.     

Alcohol abuse in the elderly

Alcoholism is often difficult to recognize in the elderly. Information about alcoholic behavior cannot always be accurately extrapolated to older drinkers. Consequences of alcohol abuse and responses to treatment may be quite different in young and elderly alcoholics. Treatment must focus on such day-to-day problems as loneliness, loss of independence and declining health. Gentle persistence is required in guiding the patient to an awareness of the problem.     

Alcohol abuse in adolescents.

Alcohol abuse among teenagers is an increasing problem with serious physical and social consequences. Early diagnosis of adolescent alcoholism may be delayed for two reasons: the physical indicators of alcohol abuse seen in adults are often not identifiable in teenagers, and alcoholism is generally believed to be an adult problem. If the history is taken carefully, with respect and confidentiality, it can help the family physician determine the extent of a young person's alcohol abuse and begin the process of treatment for both the adolescent patient and the family.     

Bone and the ‘Comforts of Life’

Coffee drinking, smoking and especially alcohol abuse are considered to be risk factors for fractures and osteoporosis. Caffeine causes acute increase in urinary calcium excretion, but epidemiological evidence for the effects of coffee consumption on the risk of fractures is contradictory. Many, (but not all) studies point to decreased bone mass or increased fracture risk in smokers. Alcohol abuse is associated with deleterious changes in bone structure detected by histomorphometry, and with a decrease in bone mineral density (BMD). These changes may also be produced by factors commonly associated with alcohol abuse, e.g. nutritional deficiencies, liver damage and hypogonadism. Alcohol, however, has clear-cut direct effects on bone and mineral metabolism. Acute alcohol intoxication causes transitory hypoparathyroidism with resultant hypocalcaemia and hypercalciuria. As assessed by serum osteocalcin levels, prolonged moderate drinking decreases the function of osteoblasts, the bone-forming cells. In addition, chronic alcoholics are characterized by low serum levels of vitamin D metabolites. Thus, alcohol seems to have a direct toxic effect on bone and mineral metabolism. In contrast, it has recently been reported that moderate alcohol consumption by postmenopausal women may have a beneficial effect on bone.     

Alcohol use: from childhood through adolescence

Alcohol use is often overlooked and more importantly unsuspected in young children 3-11 years of age. Alcohol use in preteens is commonly overlooked when there is growing evidence to suggest that the age at which one begins drinking can be predictive of future problem drinking and other substance abuse. There is a need for health care professionals and elementary school educators to be aware of the real and growing problem of alcohol use from childhood through adolescence. It is sometimes difficult to recognize because many of the effects of alcohol mimic routine presentations seen in children. This article focuses on the significance, contributing factors, effects on the body, comorbidities, and social and psychological effects of alcohol use on children through adolescence. It also examines diagnostic screening for alcohol use in adolescence and the detrimental role of the nurse in assisting with identifying and preventing the problem of alcohol use in childhood through adolescence.     

Alcohol abuse and brain infarction

Recent findings on the relation between alcohol abuse and ischaemic brain infarction are reviewed. Much of the association has hitherto been explained by the effects of confounding factors such as smoking. Alcohol increases blood pressure in both hypertensive and normotensive subjects and alcohol induced hypertension enhances the risk of both hemorrhagic and ischaemic strokes. Analysis of case histories shows that alcohol abuse has precipitated cerebral embolism in conjunction with cardiac diseases including alcoholic cardiomyopathy and paradoxical embolism due to deep vein thrombosis via atrial septal defect. Among young adults, falling when intoxicated with alcohol has caused traumatic dissection of the carotid artery and consequent brain infarction. Alcohol may predispose individuals to cerebral embolism, thrombosis and ischaemia via its effects on the coagulation cascade, platelet count and function and contractility of the cerebral vessels. Further studies are needed to prove that these mechanisms are significant and to identify any other mechanisms which may mediate the risk associated with alcohol abuse. On the basis of current data, alcohol should be considered as an independent risk factor for ischaemic cerebral infarction in young adults.     

International Perspectives The Educational Experiences and Previous Orientation of Undergraduate Nursing Students in Alcohol and Drug: The English Context

Several international and national reports have identified the need for nurses, including primary health care workers and staff in the prison health system, to receive adequate training in substance abuse education. The reports highlight the need for a systematic approach to education and training on substance abuse and the principles that underpin quality education and training. However, education about drugs and alcohol and their impact on health still find insufficient space within the nursing curriculum. The purpose of the study was to examine the previous orientation of alcohol and drug education and explore the personal and professional experiences of undergraduate nursing students. A sample of 110 undergraduate nursing students completed a questionnaire. The results showed that the majority of the participants did not receive any instruction on alcohol and other drugs. Alcohol seemed to be the major health problem, compared to other drug problems, encountered by the students in their personal life. The results of this study are congruent with previous findings of the lack of adequate educational preparation of undergraduate nursing students in alcohol and other drugs.     

Prevalence of problem drinking and characteristics of a single-question screen

Hazardous drinking and alcohol use disorders (i.e, abuse and dependence) are common in Emergency Departments (EDs). This study examined 1) the prevalence of these conditions among ED patients and 2) characteristics of a single screening question (having consumed at least five drinks for males or four for females during a single day). Data from the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Logistic regression for clustered data was used to estimate the relative risk for past-year ED use associated with hazardous drinking, abuse, and dependence. Contingency tables were analyzed to estimate the sensitivity and specificity of the single-question screen for detecting these conditions. Hazardous drinking was not associated with ED utilization. Alcohol abuse was associated with a relative risk of 1.3 (95% confidence interval [CI] 1.1-1.5) and alcohol dependence with a relative risk of 1.9 (95% CI 1.6-2.2). For current drinkers, the single question screen was 0.96, 0.85, and 0.90 sensitive for hazardous drinking, alcohol abuse, and alcohol dependence, respectively. Individuals with a positive screen in the past year were considered at least hazardous drinkers, and specificity was 0.80, 0.64, and 0.65 for hazardous drinking, abuse, and dependence, respectively. Specificity was modestly increased in women. Most problem drinkers were hazardous drinkers, but only severe alcohol use disorders were particularly prevalent in the ED. The single heavy-drinking-day item appears sensitive for problem drinking. Positive tests must be followed by additional assessment to differentiate hazardous drinking from alcohol use disorders.     

Anorexia and weight loss in the elderly. Causes range from loose dentures to debilitating illness

Differentiating between anorexia (loss of appetite) and weight loss (documented loss of pounds) can be difficult, but the same causes and treatments apply to both. Gastrointestinal and metabolic disorders, cardiopulmonary disease, the presence of a neoplasm or infection, and use of certain drugs are possible medical causes. Inadequate nutritional intake can result from the inability to obtain and prepare foods, dietary restrictions, intolerance to certain foods, and poor oral and dental health. Social factors that can greatly reduce an elderly person's interest in food include loneliness, depression, isolation, and self-consciousness because of hearing and visual impairments. Some problems, such as alcohol abuse or inappropriate use of certain medications, may be revealed only with difficulty, and some of the problems mentioned may overlap. Although the physician may find assessment of anorexia or weight loss in the elderly a challenge, it usually responds well to corrective measures.     

Substance abuse and the hospitalized elderly

Health care professionals frequently fail to recognize and address the misuse and abuse of alcohol and drugs in the elderly. Estimates of alcohol abuse in the older adult population range from 4% to 20% in the community dwelling elderly and up to approximately 25% among hospitalized older adults (Adams & Cox, 1995; Adams & Kinney, 1995; Beresford et al., 1990). In addition, the present population of older adults consumes 2-3 times more psychoactive medications than younger age groups (Sheahan et al., 1995). The effects of alcohol and substance abuse in older adults are influenced by physical, developmental, and psychosocial changes that occur with aging. Identification of alcohol and substance abuse presents a challenge for health care providers as older adults often present with atypical symptoms. Accurate diagnosis allows for the initiation of interventions for both immediate and long-term treatment.