Alcohol and Alcoholism - Advance Access

Preliminary Evaluation of Phosphatidylethanol and Alcohol Consumption in Patients with Liver Disease and Hypertension

2009-06-17

Aims: The goal of this preliminary study was to evaluate the relationship between blood phosphatidylethanol (PEth) and recent drinking in patients with liver disease and hypertension. Methods: Twenty-one patients with liver disease and 21 patients with essential hypertension were recruited at an academic medical center. Alcohol consumption was estimated using validated self-report methods, and blood PEth was measured by HPLC-MS/MS at a contracted laboratory. Nonparametric comparisons were made between abstainers/light drinkers, moderate drinkers consuming between 1 and 3 drinks per day, and those drinking above this level. Regression methods were used to estimate the effects of liver disease, gender, and age on the relationship between PEth and alcohol use, and to estimate the strength of the linear relationship between PEth and drinking. Results: PEth differed significantly between the three drinking groups (P < 0.001). The relationship between PEth and alcohol did not differ between hypertension and liver disease patients (P = 0.696), nor by gender and age. While there was substantial variability between subjects in the PEth concentration given a similar level of reported drinking, the amount of ethanol consumed was strongly associated with the PEth concentration (P < 0.001). Conclusion: Results support PEth measurement by HPLC-MS/MS as a promising marker of past 1- to 2-week moderate to heavy alcohol consumption in patients with and without liver disease. PEth appears useful for differentiating abstinence or light drinking from moderate to heavy consumption, but may have limited utility for differentiating moderate from heavy alcohol use.

Osteopenia in Alcoholics: Effect of Alcohol Abstinence

2009-06-17

Aims: The aims of this study were to assess bone mineral density (BMD) and content (BMC), osteocalcin, serum telopeptide, PTH and vitamin D in alcoholics, and to determine if a 6-month period of abstinence leads to changes in these parameters. Methods: Serum osteocalcin, insulin-like growth factor 1 (IGF-1), telopeptide (40 patients) and 1,25 dihydroxyvitamin D, were measured in 28 controls and 77 alcoholic patients, 48 of whom were evaluated again 6 months later. All patients underwent whole-body assessment of BMD by a Hologic QDR-2000 (Waltham, MA, USA) bone densitometer, at the beginning of the study and 6 months later. Results: Patients showed higher serum telopeptide levels (0.59 ± 0.40 versus 0.19 ± 0.10 nmol/100 ml, P < 0.001), lower IGF-1 [median = 49, interquartile range (IQR) = 31–121 ng/ml versus 135, IQR = 116–237 ng/ml, P < 0.001], vitamin D [26.5, IQR = 17.0–37.8 pg/ml versus 82.4 (IQR = 60.9–107.4 pg/ml, P < 0.001] and osteocalcin (2.1, IQR = 1.1–3.6 ng/ml versus 6.65, IQR = 4.9–8.8 ng/ml, P < 0.001) than those in controls. Patients also showed lower BMD values, Z- and T-scores at many levels of the skeleton and reduced total BMC. After 6 months, those who continued drinking showed a loss of bone mass, whereas those who abstained showed either no change or increase, differences being especially marked at pelvis, right arm and total BMD and BMC. Simultaneously, abstainers showed a significant increase in osteocalcin (versus a decrease among those who continued drinking). Serum telopeptide increased in both groups. Conclusion: Ethanol consumption leads to osteopenia, and decreased serum osteocalcin, which improve with abstinence, whereas those who continue drinking show a worsening of both parameters.

Impaired Emotional Facial Expression Decoding in Alcoholism is Also Present for Emotional Prosody and Body Postures

2009-06-17

Aims: Emotional facial expression (EFE) decoding impairment has been repeatedly reported in alcoholism (e.g. Philippot et al., 1999). Nevertheless, several questions are still under debate concerning this alteration, notably its generalization to other emotional stimuli and its variation according to the emotional valence of stimuli. Methods: Eighteen recently detoxified alcoholic subjects and 18 matched controls performed a decoding test consisting in emotional intensity ratings on various stimuli (faces, voices, body postures and written scenarios) depicting different emotions (anger, fear, happiness, neutral, sadness). Perceived threat and difficulty were also assessed for each stimulus. Results: Alcoholic individuals had a preserved decoding performance for happiness stimuli, but alcoholism was associated with an underestimation of sadness and fear, and with a general overestimation of anger. More importantly, these decoding impairments were observed for faces, voices and postures but not for written scenarios. Conclusions: We observed for the first time a generalized emotional decoding impairment in alcoholism, as this impairment is present not only for faces but also for other visual (i.e. body postures) and auditory stimuli. Moreover, we report that this alteration (1) is mainly indexed by an overestimation of anger and (2) cannot be explained by an ‘affect labelling’ impairment, as the semantic comprehension of written emotional scenarios is preserved. Fundamental and clinical implications are discussed.

Contrasts in Alcohol-Related Mortality in Estonia: Education and Ethnicity

Rahu, K., Parna, K., Palo, E., Rahu, M. — 2009-06-08

Aims: The aims of this study were to examine socio-demographic differences in alcohol-related mortality in Estonia, and how they changed over time. Methods: Individual death records (age at death 25–64) in Estonia from the late Soviet era (1983–1991) to Estonian re-independence (1992–2005) were analysed using a case-control design. Cases were deaths from alcohol-related causes (7981 deaths). Controls were deaths (13,820) from those neoplasms that are considered not to show variation in death risk according to the socio-demographic variables (that is, excluding cancer of the upper aero-digestive tract, lung, stomach, colon and female breast). Differences in alcohol-related mortality between socio-demographic groups were measured by mortality odds ratio. Results: In the study period as a whole, in both genders, an inverse relationship between the educational level and risk of alcohol-related death was apparent. Non-Estonians were more likely to die from alcohol-related causes than Estonians. Risk of alcohol-related death varied over time, being lowest just before Estonia regained its independence, and highest in the most recent period. In men, the educational gradient in the mortality odds ratio almost disappeared in 1988–1991, but reappeared in the transition period, while the impact of ethnicity remained stable over time. In women, educational contrasts in the risk of death existed throughout all subperiods, and ethnical inequalities widened in the re-independence period. Conclusion: Rapid societal changes had profound effects on alcohol-related mortality. Strategies to prevent alcohol misuse should include all sections in society, paying special attention to less educated and non-Estonians.

The Cure for Alcoholism. Drink Your Way Sober without Willpower, Abstinence or Discomfort. By Roy Eskapa

Beaglehole, A. — 2009-03-09

Cultural Analysis as a Perspective for Gender-Informed Alcohol Treatment Research in a Swedish Context

DeMarinis, V., Scheffel-Birath, C., Hansagi, H. — 2009-01-19

Aim: An exploratory study to investigate the role of culture in women's drinking at a clinic for women with alcohol problems in a Swedish treatment context. Methods: A content analysis of the case journal material of 20 consecutive female patients at the EWA clinic (Early treatment of Women with Alcohol addiction) in Stockholm, Sweden, was conducted using an original instrument informed by the field of cultural psychiatry and emerging from recurrent themes in the case journals. Results: The patients perceived themselves as having a sub-group status. A trajectory of ritualized actions around drinking, especially private drinking rituals, was identified. Existential components of patients’ struggles with addiction in a highly secularized cultural context were identified. Multiple, contradictory explanatory frameworks for understanding drinking problems were creating cognitive dissonance. Conclusion: Using cultural analysis as a perspective for gaining gendered information may allow for identifying new patterns within specific cultural and subgroup contexts. It may contribute new information to the following treatment research areas: gender-appropriate measurement issues; service integration; gender-appropriate services for women; and, drinking rituals and patterns.

Alcohol Use and Patterns of Delinquent Behaviour in Male and Female Adolescents

Eklund, J. M., Klinteberg, B. a. — 2009-01-09

Aims: The overall aim was to study patterns of delinquent behaviour in relation to adolescent alcohol use. The more specific aims were to examine whether alcohol use varied between groups of adolescents with different patterns of delinquent behaviour, and to explore whether the association between delinquent behaviour patterns and alcohol use was similar for males and females. Methods: The participants were male (n = 406) and female (n = 532) adolescents in the eighth grade (age 14 years) in a medium-sized city of Sweden. We used information about self-rated alcohol use and different types of delinquent behaviour. Results: The results revealed that the occurrence of excessive alcohol use and drunkenness varied between groups of adolescents with different delinquency patterns, and that the associations between alcohol use and patterns of delinquent behaviours were relatively similar for males and females. Adolescents with patterns characterized by more serious non-violent delinquency or by violent delinquency reported the highest occurrence of alcohol use and frequency of drunkenness. Adolescents with well-adjusted behaviour or occasional minor delinquency were less likely to report drinking large amounts of alcohol or to the point of feeling drunk. Conclusions: The present results further emphasize the importance of distinguishing between different offender groups when examining the relationship between delinquent behaviour and associated problems, such as excessive alcohol use.