Regional Brain Metabolic Response to Lorazepam in Alcoholics during Early and Late Alcohol Detoxification

Changes in GABA function have been postulated to be involved in alcohol tolerance, withdrawal and addiction. In this study we measured regional brain metabolic responses to lorazepam, to indirectly assess GABA function (benzodiazepines facilitate GABAergic neurotransmission), in alcoholics during early and late withdrawal. Brain metabolism was measured using PET and 2-deoxy-2[¹⁸F]fluoro-D-glucose after placebo (baseline) and after lorazepam (30 μg/kg intravenously) in 10 alcoholics and 16 controls. In the alcoholics evaluations were performed 2 to 3 weeks after detoxification and were repeated 6 to 8 weeks later. Controls were also evaluated twice at a 6 to 8 weeks interval. While during the initial evaluation metabolism was significantly lower for most brain regions in the alcoholics than in controls in the repeated evaluation the only significant differences were in cingulate and orbitofrontal cortex. Lorazepam-induced decrements in metabolism did not change with protracted alcohol withdrawal and the magnitude of these changes were similar in controls and alcoholics except for a trend towards a blunted response to lorazepam in orbitofrontal cortex in alcoholics during the second evaluation. Abnormalities in orbitofrontal cortex and cingulate gyms in alcoholics are unlikely to be due to withdrawal since they persist 8 to 11 weeks after detoxification. The fact that there was only a trend of significance for an abnormal response to lorazepam in orbitofrontal cortex indicates that mechanisms other than GABA are involved in the brain metabolic abnormalities observed in alcoholic subjects.     

Children of Alcoholics:

This article reports results of a study designed to determine differences among three populations: college-aged children of alcoholics seeking treatment; college-aged children of alcoholics not seeking treatment; and a control group of college-aged non-children of alcoholics. Further, outcome data was gathered with regard to the children of alcoholics treatment groups populated by subjects of this study. Significant differences were determined among the three groups studied, and support was determined for the therapeutic value of group treatment with children of alcoholics.     

Children of Alcoholics:

Children of alcoholics are now seen as a special population of persons who are at risk for a host of medical, psychological and social problems. Because of genetic predisposition, these children are at increased risk for the development of alcoholism. Alcohol's impact upon the developing fetus may result in fetal alcohol syndrome or fetal alcohol effects. The psychological and social impact of alcoholism on the family may result in personality problems of various kinds. Progress in this area of investigation will depend upon development of typology of alcoholic families, alcoholics, and drinking patterns since variation in all of these is likely to result in varying impact upon children. Treatment of children of alcoholics must avoid stereotypes, follow from careful individualized assessments of the family, and involve many modalities and varied strategies.     

Multiple Substance Use by Alcoholics

Use of drugs by 1,340 alcoholic clients of 17 New York alcoholism rehabilitation units was assessed for pre-treatment and three and eight month post-treatment periods. Drug use was reported by 44% of the clients before treatment and about 30% after treatment. Clients who were drinking greater amounts of ethanol before treatment tended to be drug users after treatment. Only a slight substitution of drug use for alcohol use was found from before to after treatment. Alcoholic substance users were more likely to be behaviourally and physiologically impaired than were alcohol users. Greater impairment for alcoholic and substance users was found both before and after treatment. Special categories of pre-treatment drug use showed differential predictive relationship with alcohol use after treatment. Drug use by alcoholics was shown to be related to a number of dysfunctional behaviours indicating a need for improved assessment and treatment of substance users in alcoholism rehabilitation programmes.     

Personalized Best: Toward Improving Care in Ulcerative Colitis

Digestive Diseases and Sciences -     

Improving CKD Therapies and Care: A National Dialogue

The Kidney Research National Dialogue, supported by the National Institute of Diabetes and Digestive and Kidney Diseases, asked the research and clinical communities to formulate and prioritize research objectives that would improve our understanding of kidney function and diseases. This commentary outlines the high-priority research objectives for CKD. The goal of these research objectives is to enhance knowledge to improve outcomes in people with CKD. Basic and translational research, longitudinal observations, and epidemiologic studies can each point to targets for intervention. Future interventions must be informed by data from well designed, large representative observational studies that include collection of genetic and phenotypic data as well as biospecimens. Interaction of genetic and environmental factors must be part of the analysis, including the influence of diet, comorbid conditions, and medication. The focus should be not only on slowing or preventing progression of CKD, but also on regression of disease to the greatest extent possible.     

Treatment Outcome for Hospitalized Alcoholics:

Treatment outcome for hospitalized alcoholics was assessed two years after their first hospitalization for alcholism. Results indicated hospitalization to have been an effective mode of treatment in terms of relapse to the hospital, patient's perception of treatment, and patient's functioning at home and at work. Eighty-seven percent of the patients did not relapse during the first six months; 79% did not relapse after one year; 75% did not relapse after 18 months; and 72% did not relapse two years after hospitaliztion. Nearly three-fourths of the patients indicated that their lives had improved since hospitalization.     

A Follow-up of Alcoholics Treated by Multimodal Therapy

A general hospital sponsored program foi the psychotherapeutic treatment of alcoholism is described. In this context a multimodal approach, emphasizing methods derived from principles of learning, is applied to training the individual in new life-style skills for the management of alcoholism. Demographic characteristics of the population served by the program are of a predominantly blue collar clientele, mostly employed (72%), married (61%), and from urban centers (95%). Attrition as a major problem in evaluating results at the follow-up stage is identified and a method of reporting follow-up results taking this factor into account is presented. This method showed that under the most stringent conditions for reporting results, 36.64% of a sample of 131 alcoholics were showing improvement at 12 months, while under the least stringent condition 84% were showing some improvement over the same period.