Archive for category Alcohol'

Posttraumatic Stress Disorder in World War II and Korean Combat Veterans with Alcohol Dependency

Our country was confronted with the problems of postcombat adjustment while the Vietnam conflict was still winding down. Concerns centered on the disruptive impact of returning drug-dependent veterans, the overall problems of readjustment, and assessment of public attitudes. As is the case with each major conflict, health-care-delivery systems were forced to assess and react to the aftermath of combat. This took place within the framework of the disciplines of program evaluation, quality assurance, and clinically applied research. Out of this has evolved a determined attempt to understand the interaction between combat and psychiatric disorders including alcoholism. This chapter demonstrates the existence of a posttraumatic stress syndrome compounded by alcoholism in World War II and Korean Conflict veterans. These comorbidities have resulted in chronic maladjustment over a prolonged period of time. Recommendations suggest early detection and triage of a posttraumatic syndrome and co-related substance use disorder in people who experience any catastrophic stressor. In 1971 top management at Coatesville Veterans Administration Medical Center committed itself to the development of an aggressive treatment network that Read more […]

Posttraumatic Stress Disorder in Older Alcoholic Combat Veterans

SATU at the Veterans Administration Medical Center comprises 102 beds across five inpatient programs and is a part of a large, 1300-bed psychiatric hospital. SATU programs include medical detoxification, 45-day alcohol and 45-day drug therapeutic communities, a 45-day therapeutic community for older veterans or veterans with serious psychiatric disorders, and one 14-day skills-training, relapse prevention program. SATU has been in existence since 1975. Our patients’ average age is 40 years, with a range of 19-69 years. The racial mix of admitted patients is approximately 65% white, 32% black, and 3% Hispanic. Over a given year, SATU discharges approximately 1200 patients. These patients seek services for alcohol and other substance abuse/ dependence disorders. Patients with a primary diagnosis of alcohol dependence, with other drug use, account for approximately 40% of our case mix. Patients who are principally drug dependent, with or without other alcohol/ drug use, account for approximately 60% of our case mix. Of our admissions, just less than 50% undergo formal detoxification using therapeutic medications (e.g., Librium, methadone). Typically, when a veteran comes in for substance abuse treatment, he enters Read more […]

Alcohol: Brain Evoked Potentials as Predictors of Risk

Sensory evoked potentials are capable of demonstrating brain sensory and cognitive function. These measures of brain activity can be used to demonstrate genetic influences in alcoholism. Auditory evoked potentials have been used successfully to demonstrate inherited differences in alcohol sensitivity. As in animal models, these inherited differences are limited to particular neuronal mechanisms and are not a general property of all neurons. The P300 wave, which is elicited in particular paradigms in which the subject is required to attend to specific stimuli, is smaller in subjects who are at high risk for alcoholism by virtue of having an alcoholic father. These subjects at risk for alcoholism show lower P300 amplitudes in paradigms in which they are given small doses of alcohol. P300 is also small in younger high-risk subjects who have never been exposed to alcohol. The evoked potential data are in general agreement with earlier electroencephalographic data that suggested the presence of electrophysiological abnormalities in the children of alcoholics. Sensory evoked potentials have been used extensively over the past decade to characterize abnormalities in brain function. This chapter describes their use in studies Read more […]

Treatment of Alcohol Use Disorders

In general, treatment for substance dependence involves a combination of several psychosocial interventions, which can be combined with pharmacological interventions. Treatment of AUDs can be preceded by a detoxification, depending on severity of alcohol dependence. Personality and Substance Misuse and Pharmacotherapy of Addiction are discussed in depth in site. A short description and discussion of psychological and pharmacological interventions in AUDs are presented below. Detoxification: Symptoms, Medication The first stage of treatment for alcohol dependence often consists of alcohol detoxification, in order to prevent complications during detoxification, and to diminish symptoms and adverse effects associated with detoxification. Symptoms can develop within several hours after last alcohol use, and usually show a peak 24–36 h after abstinence. Symptoms that can be experienced during alcohol detoxification are anxiety, restlessness, sleeplessness, sweating, nausea, vomiting, tremors, heightened blood pressure, and an increased heart rate. Alcohol detoxification is estimated to take a week, although sleep disturbances and psychological withdrawal symptoms can persist much longer. Monitoring of alcohol-dependent Read more […]

Effects of Alcohol Abuse on Reproductive Function in Women

 Alcohol abuse and alcoholism are associated with disorders of reproductive function in both men and women. Amenorrhea, anovulation, and luteal phase dysfunction may occur in alcohol-dependent women and alcohol abusers. Yet there has been relatively little research on the consequences of alcohol abuse for female reproductive function. Recent clinical and survey studies of alcohol effects on pituitary gonadotropins and gonadal steroid hormones in women are reviewed. Experimental studies of the acute and chronic effects of alcohol on the hypothalamic-pituitary-gonadal axis in normal women and in animal models are also described. Recent studies of the acute effects of alcohol on opioid antagonist and synthetic LHRH-stimulated pituitary gonadotropins are summarized. Possible mechanisms underlying alcohol-induced disruptions of menstrual cycle regularity are discussed. The adverse effects of alcohol on reproductive function in men are well documented. Impotence and diminished sexual interest are common clinical complaints among alcohol-dependent men. Testicular atrophy, low testosterone levels, and gynecomastia are often associated with chronic alcohol abuse (). There is now considerable evidence that alcohol inhibits Read more […]

Studies of Acute Alcohol Effects in Women and Animal Models

Alcohol Effects on Basal Hormone Levels Another approach to examination of alcohol’s toxic effects on reproductive function is to administer a single acute dose of alcohol to a normal healthy woman or experimental animal and measure the effects on pituitary and ovarian steroid hormones. Through a systematic manipulation of alcohol dose and changes in hormone levels, it should be possible to establish whether alcohol primarily disrupts hypothalamic, pituitary, or ovarian function. Surprisingly, studies of acute alcohol administration have shown that alcohol has minimal effects on basal hormone levels. Alcohol did not significantly suppress LH or estradiol in normal women or in female macaque monkeys. These data suggest that a single episode of intoxication is probably not sufficient to suppress normal basal hormone levels and that repeated episodes of intoxication are required to produce the hormonal correlates of amenorrhea, anovulation, and luteal phase dysfunction observed in clinical studies. One procedural difficulty affecting all investigations of acute alcohol effects on basal hormone levels is that studies have usually been conducted during the early follicular or luteal phase of the menstrual cycle, when basal Read more […]

Clinical Studies of Reproductive System Dysfunctions in Alcoholic Women

Alcoholic women may have several disorders of menstrual cycle function, including amenorrhea, luteal phase dysfunction, anovulation, and, in some instances, early menopause. Most available information about alcohol effects on reproductive function has been derived from clinical studies of alcoholic women during sobriety. Evidence of menstrual cycle dysfunctions is based on clinical history information and endocrine evaluations at the time of admission for treatment of alcohol-related medical problems. Disorders such as liver disease and pancreatitis, often complicated by malnutrition or other infectious disorders, are observed clinically. Since these medical disorders can also contribute to reproductive system dysfunctions, it is not possible to attribute abnormal menstrual cycles to alcohol alone. However, recent replications of these reproductive disorders in animal models under controlled conditions and in healthy social drinkers increase confidence in the validity of the clinical observations. Amenorrhea Amenorrhea refers to the complete cessation of menses. Amenorrhea has been consistently reported by alcoholic women, and this condition may persist for several months or for many years. Data from two clinical Read more […]

Women, Alcohol, and Sexuality

Alcohol consumption increases subjective sexual desire, arousal, and pleasure for many women, although it lowers physiological arousal. Despite the general belief that alcohol disinhibits female sexual behaviors, alcohol leads to changes in sexual behavior only for a minority of women. Expectancies about the effects of alcohol on sexual behavior may be important mediators of the alcohol–sexual behavior linkage. There also is a relationship between overall alcohol consumption and risky sexual behavior for women, but when alcohol use at or preceding individual instances of sexual activity is examined, there is no association in the majority of studies. Alcohol use by both perpetrators and victims has been implicated in instances of sexual victimization. Heavy alcohol consumption and alcohol problems in women are associated with heightened risk of childhood incest, sexual assault, and sexual dysfunction. The last ten years have witnessed a dramatic increase in some areas of research involving alcohol and sexual behavior in women, while other areas have remained dormant. Most notably, the devastating scourge of AIDS since the early 1980s and the recent rise in the United States in the percentage of AIDS cases involving Read more […]

Sexual Violence against Women

Before 1980, there were few published data on alcohol use and abuse as a precursor, concomitant, or consequence of sexual violence toward women. In the last 10–15 years the extent to which many women suffer sexual abuse and violence at the hands of a drinking perpetrator has been recognized, and researchers have attempted to understand the complex relationships between alcohol use and violence against women. Most theories consider alcohol consumption or alcohol abuse in victim or perpetrator as an antecedent or contributor to sexual abuse. Incest and Childhood Sexual Abuse The first national study of childhood sexual victimization reported a rate of 27% for women. Moreover, these estimates are probably low due to underreporting. There are only occasional references in the literature on childhood incest (or other childhood sexual abuse) to its role in the development of alcohol abuse in women, and studies of women alcohol abusers that examine history of childhood incest or other sexual abuse are still rare. The literature in this area suggests a strong association between childhood incest and sexual abuse and the development of alcohol abuse. The prevalence rates for a history of incest among alcoholic women range Read more […]

Alcohol Use and Sexual Dysfunction

Despite some alcoholic women’s beliefs about the positive effects of alcohol consumption on female sexual functioning, there is a “dark side” of the effects of alcohol on women’s sexual and reproductive functioning. Alcoholic women are often characterized as having sexual problems including “frigidity,” anorgasmia, dyspareunia, and vaginismus. Most of the evidence supporting this view has been gleaned from clinical studies that lack adequate controls. There are, however, a number of studies involving nonalcoholic or other psychiatric control groups. For the most part, the present analysis only touches on the earlier clinical studies that lack control groups, focusing instead on the control group and recent national survey results. Types of female sexual dysfunction include low sexual desire, difficulties in sexual arousal, primary organismic disorder, secondary organismic disorder, vaginismus (contractions of the vagina that interfere with intercourse and can make it impossible to achieve intercourse), and dyspareunia (painful intercourse). Clinical studies suggest that lack of sexual interest and sexual inhibition in alcoholic women ranges between 23 and 100%. Rates of primary and secondary organismic dysfunction Read more […]