CORRELATION OF ALCOHOL CONSUMPTION WITH LIVER DAMAGE IN MEN AND WOMEN

In Canterbury with the establishment of a service for alcohol-relatedproblems, 161 alcohol abusers were admitted to the Kent andCanterbury Hospital in the five-year perid 1973–1978. This study showed that women consuming less than 100 units ofalchohol but more than 70 units per week were more likely todevelop hepatitis than men drinking the same amount. No othersex differences in susceptibility to liver damage were observed.Abnormal mean corpuscular volume (MCV) was found to be a betterindicator of the presence of liver damage in women (90% withliver damage had abnormal MCV) than men (65% with liver damagehad abnormal MCV).     

The natural history of psychosomatic symptoms and their association with psychological symptoms: Observations from the Population Study of Women in Gothenburg

Objective: To study the prevalence of subjective unspecified psychological symptoms (UPS) in a cohort of middle-aged women and the development of psychosomatic symptoms over 24 years. Methods: In 1968–1969, 1462 randomly selected women, aged 38, 46, 50, 54 and 60, were recruited. A 24-year follow-up was performed in 1992–1993 (n=836). The same structured interview concerning psychological and psychosomatic symptoms was used on both occasions. Results: The prevalence of UPS was 28% in 1968–1969 and 20% in 1992–1993. Women with UPS in 1968–1969 were significantly more likely to have asthma/obstructive symptoms (34% vs 26%), headache (38% vs 22%) and abdominal symptoms (40% vs 21%), but not hypertension/high blood pressure (28% vs 28%), than women who did not report UPS. In 1992–1993, women with UPS in 1968–1969 were significantly still more likely to have asthmatic (25% vs 18%) and abdominal symptoms (44% vs 33%). Sixty-one per cent of women with UPS in 1968–1969 did not report such symptoms in 1992–1993, compared to 86% of women without UPS in 1968–1969 (p<0.001).

Conclusion: Women reporting UPS seemed to have a higher frequency of simultaneous psychosomatic symptoms than women not reporting UPS. However, having UPS was apparently unassociated with the development of psychosomatic symptoms over time. Psychosomatic symptoms in women seem to be self-limiting and decrease with time.     

ARE ALCOHOLIC WOMEN MORE LIKELY TO DRINK PREMENSTRUALLY?

A retrospective questionnaire study of alcoholic women attendinga clinic for abstaining alcoholics, a voluntary agency and adrop-in centre for people with alcohol problems was conductedover a 2-year period. The women were asked whether they experiencedpremenstrual symptoms based on Halbreich et al. s PremenstrualAssessment Form (PAF) [Halbreich et al. (1982) Acta PsychiatricaScandinavica 65. 46–65] and were also administered theseverity of Alcohol Dependence Questionnaire (SADQ) The resultsshowed that one-third of women drank more premenstrually thanat other times of the month. It is concluded that knowledgeof high-risk times of the month can aid counselling for thisgroup of women.     

ALCOHOLIC WOMEN: INHIBITION OF PROTEIN SYNTHESIS IN THE PLACENTA

[4,5,³H]L-Leucine incorporation into proteins in placental slicesof alcoholic and normal women was measured in the first andsecond trimesters of pregnancy, and on the day of birth. Inthis study, alcoholic women were defined as women who drinkdaily at least 150 ml, calculated as 100% ethanol. Leucine incorporationinto proteins was significantly decreased in alcoholic womencompared with normal placentas: 72% in the first, 70% in thesecond trimester, and 82% in term placenta. The data indicatethat not only can chronic maternal alcohol consumption inducedefects in protein synthesis, but also that heavy alcohol ingestion,even during the beginning of pregnancy, could be toxic for thehuman placenta and development of the fetus.     

Concurrent and separate effects of body mass index and waist-to-hip ratio on 24-year mortality in the Population Study of Women in Gothenburg: Evidence of age-dependency

Obesity is generally assumed to be an important risk factor for death and morbidity. However, the association between excess body weight and all-cause mortality among younger and older women and the impact of body mass index (BMI) and waist-to-hip ratio (WHR) concurrently is not fully understood. In 1968–1969 we initiated a prospective study comprising a population sample of 1,462 women from Gothenburg, Sweden. During a 24 year period, until 1992–1993, 265 women had died. A multivariable Cox Proportional Hazards Regression model was used to estimate the relative risk of death in relation to BMI and WHR, with age and other covariates of age-specific interest as smoking, physical activity at work and leisure time and serum triglyceride concentration, at start of the study. BMI and WHR were analyzed as independent variables. Younger women (38 and 46 years at baseline) presented a statistically significant non-linear (U-shaped) relation between BMI and mortality. Among older women (50, 54 and 60 years at baseline), a significant negative linear relationship with decreasing mortality in relation to increasing BMI values was seen. For all women a higher WHR was related to an increased risk of death. The lowest risk of death among younger women corresponded to a low WHR and a BMI within the middle range. For older women the highest survival was observed for those with lowest WHR and highest BMI. Thus, in older women a high BMI seems not to be an increased risk as long as adiposity is not centrally located.     

PLASMA LIPIDS AND ALCOHOL CONSUMPTION IN ALCOHOLIC MEN: EFFECT OF WITHDRAWAL

This study examines the effect of alcohol withdrawal on plasmalipids and particularly on HDL-cholesterol subfractions, in18 middle-aged, clinically healthy but chronically drinkingmen, institutionalized for withdrawal therapy. Plasma lipids,total HDL and HDL₃-cholesterol, Apo A-I and Apo B were assayedbefore and after 30–86 days of abstinence. A 38% decreasein mean total HDL-cholesterol levels was observed after withdrawaltherapy (P = 0.0002), and this was due mainly to a drop in HDL₃-cholesterolconcentrations (–43%, P = 0.0002). The decrease in HDL₂-cholesterolconcentrations was also significant (–21%, P < 0.005)but less marked. These results were not dependent on quantitiesof alcohol ingested before therapy, on duration of hospitalizationand on changes in dietary fat intake or smoking habits. ApoA-I levels decreased (–39%, P = 0.0002) and the magnitudeof the decrease after alcohol withdrawal was positively relatedto the duration of hospitalization. Apo B levels increased (+24%,P < 0.005). Among the anthropometric parameters, arm musclearea was significantly higher after alcohol withdrawal. Theenergy and macronutrient intakes did not significantly changeduring hospitalization. It is concluded that the modificationsof HDL-cholesterol, HDL₃-cholestercol, HDL₂-cholesterol ApoA-I and Apo B values were induced by alcohol withdrawal in thispopulation of chronic French alcoholics.     

DRINKING AND SMOKING PATTERNS AMONGST WOMEN ATTENDING AN ANTENATAL CLINIC--II. DURING PREGNANCY

This paper describes smoking and drinking patterns during pregnancyamongst a cohort of 2266 women who enrolled at a London antenatalclinic 1982–1983. Only 12% of mothers were non-drinkersbefore pregnancy, but 44% abstained in the first trimester,38% in the second and 50% in the third. Before pregnancy 20%of mothers were drinking more than the recommended 10 unitsof alcohol per week. This dropped to 6% during pregnancy. Meanconsumption at each of the three stages of pregnancy was highestamongst those mothers who were the heaviest drinkers beforepregnancy. The heaviest pre-pregnancy drinkers were also theleast likely to abstain at any point in pregnancy. Of thosemothers who were drinking less than 10 units of alcohol perweek before pregnancy, 3% increased during pregnancy. Wine wasthe most popular beverage choice but heavier drinkers were morelikely to drink beers and spirits in addition. Before pregnancy 29% of mothers smoked. This dropped to 23%in pregnancy. Consumption levels fell amongst those who continuedsmoking. The heaviest pre-pregnancy smokers were the most likelyto reduce but the least likely to stop. Smoking was positivelyassociated with the level of both pre-pregnancy and pregnancydrinking. The most commonly cited reasons for changes in drinking andsmoking habits in pregnancy were concern for the child, concernfor self or concern for both. Feeling sick or ill was a morecommonly stated reason for reduction of drinking than smoking.Social pressures were important in reducing smoking, but themass media were quoted as a more important influence in reducingdrinking. Mothers who drank more than 10 units of alcohol per week duringpregnancy were more likely to be older, of higher social statusand primiparous. In contrast those who smoked in pregnancy weremore likely to be younger, of lower social status and multiparous.This has important implications for planning antenatal healtheducation.     

ACUTE ETHANOL INTOXICATION DOES NOT INFLUENCE GONADOTROPIN SECRETION IN POSTMENOPAUSAL WOMEN

Acute effects of ethanol ingestion (1.0 g per kg body weight)on the serum levels of LH, FSH and prolactin were studied in10 postmenopausal women. Ethanol was administered during thefirst 3 hr of the experiment and the hormone concentrationswere monitored for 10 hr. Each subject served as her own controlin an identical experiment without ethanol. Blood alcohol concentrationreached its maximum 1.18 ± 0.02 g/l (mean ± S.E.M.)3hr after the start of the drinking. No changes were found inthe levels of LH and FSH during the experimental period. Theincrease of 80% in the mean concentration of prolactin at 4hrafter the start of drinking was not statistically significant.On the basis of these and previous results we conclude thatalcohol has no acute effects on the secretion of gonadotropinsin women.     

ALCOHOL DECREASES INSULIN SENSITIVITY IN HEALTHY SUBJECTS

To study the effect of alcohol on glucose and insulin metabolism,a simultaneous infusion of glucose and insulin was given for150 min to healthy volunteers, once during alcohol and onceduring calorie-free gingerale (control) ingestion. During alcoholintake, the average steady-state (between 100 and 150 min) glucoseof 5.44±0.39 mmol/1. and the average steady-state insulinof 6.3±1.1 ng/ml were significantly higher than those(4.0±0.39 mmol/1. of glucose and 4.4±0.6 ng/mlof insulin) observed during the control state. Despite the highersteady-state insulin concentrations, the glucose metabolismwas significantly less during alcohol ingestion. These findingssuggest alcohol-induced impairment in glucose metabolism iscaused by a decreased tissue sensitivity to insulin.     

AGE-RELATED DIFFERENCES IN THE EFFECTS OF ETHANOL ON PERFORMANCE AND BEHAVIOUR IN HEALTHY MEN

Four age groups of healthy men; 20–29, 30–39, 40–49,and 50–59 years (N = 12 per group), drank 0.68 g of ethanol/kgbody weight as neat whisky in the morning after an overnight(10 hr) fast. The concentration of ethanol in fingertip blood,various signs and symptoms of intoxication, body-sway (openand closed eyes), hand-tremor, positional alcohol nystagmus(PAN) and roving ocular movements (ROM) were measured at 30–60min intervals after drinking. Body-sway and hand-tremor increasedwith advancing age in tests made before the ingestion of alcohol(P < 0.05). After drinking alcohol, body-sway and hand-tremorincreased in the four age groups (P < 0.05), being most pronouncedat or near the time of reaching the peak blood alcohol concentration(BAC). The initial impairment subsided when the post-absorptivephase of ethanol kinetics commenced. At 60 min post-drinking,body-sway was most pronounced in men aged 40–49 yearswhen their eyes were closed (P < 0.05). Otheiwise, age-relateddifferences in alcohol impairment in the other age groups werenot statistically significant. Positional alcohol nystagmus(PAN) developed mainly during the acute phase of intoxication,decreasing in intensity as the time after drinking progressed.Roving ocular movements (ROM) were most apparent during thepost-absorptive phase (120–420 min). We conclude thatthe acute effects of a moderate dose of ethanol on sensory andmotor functions are not much different in men aged between 20and 59 years.     

HEAVY ALCOHOL DRINKING AND RELATED SYMPTOMS IN A POPULATION STUDY OF URBAN MEN

An age-stratified random sample of 228 men was selected fromthe urban districts of Solna and Sundbyberg in Stockholm. Twohundred of these men (90%) underwent a health survey comprisinga general medical examination, taking of a medical and socialhistory, blood and urine tests, roentgenography of the heartand lungs, ECG, electroneurography and computed tomography ofthe brain. The purpose of the present study was to determinealcohol consumption levels and their correlation with symptomsof heavy drinking and with age. The subjects were collectedaccording to a rectangular age distribution, with age rangesof 20–29, 30–39,40–49, 50–59 and 60–65years. Quartiles were used in order to obtain homogeneous strataand to group the sample concerning alcohol consumption. Twomeasures of alcohol consumption were used–the amount ofalcohol consumed in the previous week in g of absolute alcoholper day, and the typical peak consumption in the last six months.Three symptoms related to heavy drinking were studied: (1) inabilityto cut down or stop drinking, referred to here as subjective,relative loss of control over drinking; (2) morning shakes andmalaise relieved by drinking, termed morning drinks; (3) amnesiainduced by alcohol, referred to as blackouts. Ten per cent ofthe men had all three alcohol symptoms and 52% had no alcoholsymptoms at all. Twenty-nine per cent had lost control overthe amount they drank. Blackouts were noted for 33% and morningdrinks for 25%. Three groups of participants with different degrees of exposureto alcohol were distinguished: 41 low consumers without alcoholsymptoms; an intermediate group of 106 participants; and a heavy-drinkinggroup of 53 men with high consumption and two or more symptoms.There was no significant age difference between any of the groupsI–III. Twenty-seven per cent belonged to the heavy-drinkinggroup in this sample from the general population.     

PREVALENCE OF ALCOHOL PROBLEMS AMONG ADULT SOMATIC IN-PATIENTS IN NAPLES

The aim of this cross-sectional study was to determine the prevalenceof alcohol problems among adult somatic in-patients in urbanhospitals of Naples. The patients were screened with a structuredquestionnaire regarding life style. After discharge, the patientrecords were examined and the hospital discharge diagnoses wereregistered. A patient was considered having an alcohol problemif one or more of the following criteria were fulfilled: (1)a Michigan Alcoholism Screening Test score at or above five;(2) a self-reported daily consumption for at least 2 years ofat least 60g of ethanol for males and 36g for females; (3) analcohol-related discharge diagnosis. The prevalence of patientswith alcohol problems was significantly (P < 0.01) higheramong male (43.8%, 95% confidence limits. 37.6–50.2%)than among female patients (14.8%, 95% confidence limits. 9.6–21.4%).There were no significant differences among the different typesof somatic departments regarding the prevalence of alcohol problemswhen gender was considered. Patients with alcohol problems differedsignificantly from those without alcohol problems regardinga number of variables: the former drank significantly more alcohol,smoked for more years, and had a higher prevalence of alcoholproblems in the family. It is concluded that alcohol problemsamong in-patients are as prevalent in Naples as in other industrializedcountries, that it is often not registered among discharge diagnoses,and that the problems are more prevalent in males than in females,irrespective of the type of department.     

PREVALENCE OF ALCOHOL PROBLEMS IN GENERAL PRACTICE: AN EXPERIENCE FROM SOUTHERN ITALY

The Michigan Alcoholism Screening Test (MAST) and the responseto a question about heavy alcohol consumption were used to assessthe prevalence of alcohol problems in consecutive patients (77males and 46 females) consulting a general practitioner in anurban area in the South of Italy (Castellammare di Stabia).Alcohol problems, which were defined by a cut-off score of 5on the MAST and/or by heavy alcohol consumption (correspondingto at least 60 g of ethanol daily for males and 36 g of ethanoldaily for females for at least 2 years), were identified in54 patients [43.9%: 95% confidence interval (CI) 35.0–53.1%].45 males (58.4%. 95% Cl 46.6–69.6%) and nine females (19.6%.95% CI 9.4–33.9%). The prevalence of MAST positive patientswas 32.5% (95% CI 24. 4–41.6%) in the total patient sample.45.5% (95% CI 34.1–57.2%) among males and 10.9% (95% CI3.6–23.6%) among females. The question about heavy alcoholconsumption had a predictive negative value of 97.2% (95% CI90.2–99.7%) and a predictive positive value of 73.1 %(95% CI 59.0–84.4%) in relation to MAST positive patients.It is suggested that general practitioners should incorporatethis question about heavy alcohol consumption as a screeningquestion in order to detect alcohol problems and give adviceregarding reduction of alcohol consumption.     

DETERMINATIONS OF ETHANOL, ACETALDEHYDE AND ACETATE IN BLOOD AND URINE DURING ALCOHOL OXIDATION IN MAN

Blood and urine samples were analyzed for ethanol, acetaldehydeand acetate during alcohol oxidation in Japanese men by headspace gas chromatography, following the consumption of 16 ml/kgof beer during a 20 min period. The maximum level of blood/urineethanol was found to be 15–17 mM (20–22 mM), whilethat of acetaldehyde in a flusher and in non-flushers was 20µM (52 µM) and 2–5 µM (10–13 µM),respectively. Acetate levels in these groups ranged from 0.2mM (0.1 mM) to 0.8 mM (1.0 mM). Blood ethanol levels were dosedependent, whereas acetaldehyde and acetate levels reflectedindividual metabolic rates. The relative concentrations of ethanoland acetaldehyde in blood and that of acetate in alcohol metabolismcould be summarized as follows: 7500 (15 mM): 1–3 (2–5µM); 250–400 (0.5–0.8 mM) for non-flushers;and 7500 (15 mM): 5–10 (10–20 µM): 250–400(0.5–0.8 mM) for a flusher.     

RECIDIVISM AMONG DRUNKEN AND DRUGGED DRIVERS IN NORWAY

The prevalence of re-arrest among drunken drivers in relationto different blood alcohol concentrations (BAC) at the timeof the offences was studied. Between 38 and 50% of arresteddrunk drivers were re-arrested for similar offences The frequencyof re-arrests was, however, reduced during 1992 compared with1986, but only significantly for those with a low BAC interval(60–90 mg/dl). We conclude that drivers with high re-arrestrates have a careless attitude to the Road Traffic Act and requirea different treatment and follow-up programme.     

Health factors and longevity in men and women: a 26-year follow-up study

Health factors have the power to prevent and postpone diseases and death; however, studies using the same methodology in both men and women are sparse. We aimed to study the ability of health factors to prevent mortality in a population-based, 26-year follow-up of Swedish men and women. During 1969–70, a health-screening programme was offered to a stratified sample of 3,064 individuals aged 18–64 years to estimate health-care needs. Missing data (largely according to protocol) for physical fitness, BMI, and smoking habits left 935 subjects, 463 men and 472 women. Alcohol consumption in grams per week and BMI was calculated. Tobacco smoking was recorded as yes/no. Multivariate analysis was performed by Cox regression with age adjusted hazard ratios (HR) and 95% confidence interval (CI). Moderate alcohol consumption did not lead to any decrease in mortality. Having two health factors halved the mortality risk in men and women (hazard ratio (HR) 0.52, confidence interval (CI) 0.39–0.70). A further risk reduction was seen in men with three health factors (HR 0.17, CI 0.074–0.41). Men had about 70 per cent higher risk of mortality compared with women after adjustments for all health factors (HR 1.67, CI 1.26–2.23). Men compared to women had greater benefit of all three health factors. This in combination with the overall higher mortality risk in men makes a healthy lifestyle more important for them. The benefit of moderate alcohol consumption could not be detected in this study, and may be explained by an unhealthy drinking pattern in Sweden.     

PERSISTENCE OF DEFECTIVE SEROTONERGIC AND GABAERGIC CONTROLS OF GROWTH HORMONE SECRETION IN LONG-TERM ABSTINENT ALCOHOLICS

In order to establish whether long-term abstinence from alcoholreverses the defective serotonergk and GABAergic controls ofgrowth hormone (GH) secretion affecting alcoholic patients,the 5-HT1D serotonergic receptor agonist sumatriptan and theGABAergic agent gamma-hydroxybutyric acid (GHB) were administeredto 12 normal men (32–49 years) and 22 non-depressed malealcoholic subjects (38–52 years) after 1–2 yearsof abstinence from alcohol. All subjects were also tested withplacebos. Furthermore, tests with GH-releasing hormone (GHRH)and L-arginine (which releases GH from somatostatin inhibition)were performed to determine whether GH secretion in responseto its major determinants is preserved in alcoholics. Administrationof placebo did not change plasma GH levels in any subject. SimilarGH responses were observed in normal controls and alcoholicsubjects when GHRH or arginine were administered. A significantGH increase was observed in normal controls after sumatriptanor GHB injection; in contrast, GH secretion was not modifiedby sumatriptan or GHB administration in alcoholic patients.These data show a persistent selective loss of 5-HT1D receptorand GHB-mediated neurotransmissions in alcoholics that a long-termabstinence from alcohol is unable to restore.     

IRREVERSIBILITY OF KINDLED ALCOHOL-WITHDRAWAL BEHAVIOUR IN RATS

In order to investigate whether alcohol-withdrawal kindlingis an irreversible process, male Wistar rats were exposed to12 episodes, each consisting of 2 days of severe alcohol intoxicationand 5 days of alcohol withdrawal. Spontaneous withdrawal seizureswere found in 15% of the animals during episodes 10–12.After an alcohol-free period of 26 days, the animals were subjectedto three more episodes of alcohol dependence (i.e. episodes13–15) in which 12% of the animals developed spontaneouswithdrawal seizures. Based on several statistical tests, weconcluded that there was no true difference between the seizureactivity in episodes 10–12 and episodes 13–15, indicatingthat alcohol-withdrawal kindling is a long-lasting and perhapsirreversible process. In a second experiment, an alcohol-withdrawalkindled group was first exposed to seven episodes of alcoholdependence. A diazepam group went through the same alcohol regimen,but each withdrawal reaction was blocked by diazepam treatment.Finally, a single episode group was included which was fed isocaloricallywith the kindled animals. After an alcohol-free period of 11days, all three groups were subjected to 4 days of severe alcoholintoxication. During the subsequent withdrawal reaction seizureswere observed in 22–26% of the animals with no significantdifferences across the groups. These results call for a modificationof the kindling hypothesis of alcohol withdrawal and suggestthat kindling-induced alterations may be overlooked if convulsivebehaviour is tested during a relatively strong withdrawal reaction.     

SCREENING FOR PSYCHIATRIC COMORBIDITY AMONG FEMALE ALCOHOLICS: THE USE OF A QUESTIONNAIRE (SCL-90) AMONG WOMEN EARLY IN THEIR TREATMENT PROGRAMME

The use of a questionnaire, Symptom Check List-90 (SCL-90),as a screening instrument for psychiatric disorders was studiedin 60 women attending their first treatment for alcohol abusein Stockholm, Sweden. A global SCL-90 index, the General SymptomaticIndex (GSI), measuring the total level of recent self-reportedpsychological distress, showed a high efficacy in distinguishing‘psychiatric cases’ from ‘non-cases’in the present sample. Psychiatric cases were defined as subjectssatisfying the criteria for any current DSM-III-R disorder otherthan substance abuse. The psychiatric diagnoses were obtainedindependently by use of the Structured Clinical Interview forDSM-III-R (SCID-I). Psychiatric disorders, especially depressionand anxiety disorders, frequently antecede or develop secondaryto alcohol abuse among women. The use of structured interviewsto diagnose these disorders is, however, time-consuming. Findingsfrom the present study indicate that SCL-90 can be used to detectpsychiatric comorbidity among female alcoholics, thus enablingclinicians to be aware of concomitant psychiatric disordersamong a subgroup of patients.     

PREVALENCE OF ALCOHOL PROBLEMS AMONG ADULT SOMATIC IN-PATIENTS OF A COPENHAGEN HOSPITAL

The adult patients of somatic departments of a Copenhagen hospitalwere screened on a randomly selected day during a 14 day periodby interviewers who examined them using a stnictured questionnaireregarding life-style. A patient was considered having an alcoholproblem if one or more of the following criteria was fulfilled:(1) a self-reported daily alcohol consumption for at least 2years of at least 60 g of ethanol in men and 36 g in women,(2) a Michigan Alcoholism Screening Test (MAST) score of orabove 5, (3) an alcohol-related discharge diagnosis. In total,692 patients fulfilled the enny critena, but 181 patients (26.2%)had to be excluded owing to predeflned exclusion criteria (terminalillness, dementia, etc.), and 74 patients (14.5%) refused toparticipate. Among the 437 interviewed patients, 125 patients(28.6%; 95%-confidence limits 24.4–33.1%) fulfilled oneor more of the diagnostic criteria for an alcohol problem. Only14 patients (3.2%; 95%-confidence limits 1.8–5.3%) hadan alcohol-related discharge diagnosis. The prevalence of patientswith alcohol problems was significantly (P < 0.05) higheramong male patients (82 of 171 men (48.0%; 95%-confidence limits40.3–55.7%)) than among female patients (43 of 266 women(16.2%; 95%-confidence limits 12.0–21.2%)). The prevalenceof patients with alcohol problems was 32.4% (95%-confidencelimits 25.5–39.8%) in internal medicine departments, 28.5%(95%-confidence limits 21.3–36.6%) in surgical departments,and of female patients 22.2% (95%-confidence limits 13.7–32.8%)in the department of gynaecology and obstetrics.