摘要:

Until two decades ago, dietary deficiencies were considered to be the only reason for alcoholics to develop liver disease. As the overall nutrition of the population improved, more emphasis was placed on secondary malnutrition and direct hepatotoxic effects of ethanol were established. Ethanol is hepatotoxic through redox changes produced by the NADH generated in its oxidation via the alcohol dehydrogenase pathway, which in turn affects the metabolism of lipids, carbohydrates, proteins, and purines. Ethanol is also oxidized in liver microsomes by an ethanol‐inducible cytochrome P‐450 (P‐45011E1) that contributes to ethanol metabolism and tolerance, and activates xenobiotics to toxic radicals thereby explaining increased vulnerability of the heavy drinker to industrial solvents, anesthetic agents, commonly prescribed drugs, over‐the‐counter analgesics, chemical carcinogens, and even nutritional factors such as vitamin A. In addition, ethanol depresses hepatic levels of vitamin A, even when administered with diets containing large amounts of the vitamin, reflecting, in part, accelerated microsomal degradation through newly discovered microsomal pathways of retinol metabolism, inducible by either ethanol or drug administration. The hepatic depletion of vitamin A is strikingly exacerbated when ethanol and other drugs were given together, mimicking a common clinical occurrence. Microsomal induction also results in increased production of acetaldehyde. Acetaldehyde, in turn, causes injury through the formation of protein adducts, resulting in antibody production, enzyme inactivation, decreased DNA repair, and alterations in microtubules, plasma membranes and mitochondria with a striking impairment of oxygen utilization. Acetaldehyde also causes glutathione depletion and lipid peroxidation, and stimulates hepatic collagen production by the vitamin A storing cells (lipocytes) and myofibroblasts. Experimentally, liver injury and even fibrosis can be attenuated by some “supernutrients,” such as S‐adenosyl‐l‐methionine or polyunsaturated lecithin. Thus, the classic dichotomy between nutritional and toxic effects of ethanol h

ISSN:0145-6008    

DOI:10.1111/j.1530-0277.1991.tb00563.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0145-6008    

DOI:10.1111/j.1530-0277.1991.tb00564.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The relationship between family history of alcoholism and risk for benzodiazepine abuse was examined by assessing the reinforcing and subjective effects of diazepam (DZ; 4‐28 mg) in 14 normal (i.e., nonalcoholic) males with a first‐degree alcoholic relative (family history positive; FHP) and in 13 control subjects without alcoholic relatives (FHN). Reinforcing effects were measured using a double‐blind preference procedure in which subjects first sampled DZ and placebo (PL) and then chose the substance they preferred. Subjects were also allowed to select the dose of drug they preferred on each choice session. The subjective effects of DZ were assessed using standardized self‐report questionnaires. Neither group chose the DZ more often than PL. The FHP group chose DZ slightly (but not significantly) more often than the FHN group (mean choices FHP 1.42 vs. FHN 1.15 out of 3 choice options), and they chose slightly (but not significantly) more doses of DZ within sessions (FHP 25 mg vs. FHN 18 mg). The groups did not differ in their responses to DZ on other measures (e.g., subjective drug effects or drug liking). To the extent that laboratory procedures such as the one used here provide a model for assessing the abuse liability of drugs, these results do not provide strong evidence that males with a family history of alcoholism have an elevated risk for developing benzodiazepine abuse or dep

ISSN:0145-6008    

DOI:10.1111/j.1530-0277.1991.tb00565.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0145-6008    

DOI:10.1111/j.1530-0277.1991.tb00566.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

This study investigated whether male and female alcoholics and controls differed in their ability to solve an ecologically valid measure of abstraction. Ninety‐one alcoholics (39 females, 52 males) and 61 community controls (36 females, 26 males) completed a battery of abstraction tasks including a Piagetian‐type task, the Plant Task. The Plant Task demands that subjects predict the outcome of an unseen plant given a specific treatment regime. No group differences in the ability to correctly predict the unseen plant's outcome were obtained. Alcoholics were significantly poorer than controls in isolating the relevant variable (χ2(1) = 8.24, p = 0.004). There were no sex differences in the ability to isolate the relevant variable. However, there was a sex effect in the number of irrelevant explanations (χ2(3) = 15.58, p = 0.001) with females producing more than males and female alcoholics more than any of the other three cells. These data suggest that (1) alcoholics may exhibit subtle abstraction deficits most readily observed in tasks examining process as opposed to final performance, (2) males and females differ in their response patterns regarding irrelevant material, and (3) further empirical study of the Plant Task may support its use in experimental and clinical set

ISSN:0145-6008    

DOI:10.1111/j.1530-0277.1991.tb00567.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Short‐ and long‐latency auditory evoked potentials (SAEPs and LAEPs), visual‐evoked potentials (VEPs), and contingent negative variation (CNV) were studied in 32 chronic alcoholics and their age‐, sex‐, and education‐matched control subjects. The alcoholics exhibited a delayed SAEP peak V and an increase in the III‐V and I‐V intervals, increased VEP P100 latency, increased LAEP N2 and P3 latencies and increased LAEP N1‐P2 amplitude. The analysis of the anomalies at a clinical level indicates a differential sensitivity of the event‐related potentials. The parameters most sensitive to chronic alcohol consumption were (in descending order) P3 latency, peak V latency, the I‐V and III‐V inte

ISSN:0145-6008    

DOI:10.1111/j.1530-0277.1991.tb00568.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The speed and accuracy of neuropsychological performance in alcoholics and nonalcoholics were assessed for each item within a four‐test computerized battery. Subjects were randomly assigned to one of three instructional conditions: Speed‐emphasis instructions, Accuracy‐emphasis instructions, orTypicalinstructions emphasizing speed and accuracy equally. Across conditions, alcoholics were less accurate and took longer to perform than controls. Examining speed and accuracy components separately within each condition, as predicted, the greatest differences in accuracy scores between alcoholics and controls appeared in the Speed‐emphasis condition, while the greatest group differences in speed scores appeared in the Accuracy‐emphasis condition. The results indicate that the relationships between speed and accuracy are dissimilar between alcoholics and controls; alcoholics exhibit speed/accuracy tradeoffs in that they are unable to adjust performance to meet speed or accuracy demands without suffering substantial compromise in the other aspect of performance. These results have implications for future studies concerning methodological approaches to speed and accuracy assessment and provide support for an information‐processing deficit associated with chronic al

ISSN:0145-6008    

DOI:10.1111/j.1530-0277.1991.tb00569.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The past 10 years have witnessed important advances in research on pharmacotherapy for alcoholism. Promising drugs are discussed under six headings: agents to treat alcohol withdrawal; anticraving agents; agents that make drinking an aversive experience; agents to alleviate concomitant psychiatric problems; agents to treat concurrent drug abuse; and amethystic (“sobering‐up”) agents. Research on the drug classes is summarized and clinical issues surrounding specific agents and alcoholism pharmacotherapy in general are discussed. Finally, long‐range therapeutic implications of recent findings on the actions of alcohol on basic mechanisms of the brain are

ISSN:0145-6008    

DOI:10.1111/j.1530-0277.1991.tb00570.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

A mathematical model of alcohol consumption, which characterizes individual drinking in terms of frequency of consumption and subsequent loss of control drinking once consumption has been initiated, is introduced. The model provides a conceptual link between behavioral indices of alcohol consumption patterns and theoretical models of the role of loss of control drinking in the genesis of alcohol dependence and alcoholism. Based on data from a large sample of first offender drunk drivers, it is shown that specific measures of consumption patterns can be used to provide individual estimates of parameters of the model. These estimates are shown to be strongly related to one measure of alcohol dependence and to introspective reports of loss of control drinking.

ISSN:0145-6008    

DOI:10.1111/j.1530-0277.1991.tb00571.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The importance of psychiatric symptomatology for the treatment course of alcoholics was analyzed in a long‐term outpatient treatment study. Seventy‐two patients, 60 men and 12 women, were personally interviewed during treatment and after 3 years. Before treatment psychiatric symptoms were rated according to the Comprehensive Psychopathological Rating Scale (CPRS). Women had significantly higher scores than men. Men with many symptoms and women had more psychological benefits from drinking and a more impaired personality structure than men with few symptoms. Men with many symptoms also had a lower level of social functioning. The severity of abuse did not differ between the three groups. Men with many symptoms had a less favorable outcome between 25 and 36 months after start of treatment than men with few symptoms and women. Among men who completed treatment, those with many symptoms showed a less successful course after 6 months and during the 3rd year after start of treatment, while differences after 3 months and during later stages of treatment were less pronounced. It is suggested that before start of treatment a psychiatric evaluation should be performed including psychiatric diagnosis, personality analysis, and an assessment of psychological benefits from drink

ISSN:0145-6008    

DOI:10.1111/j.1530-0277.1991.tb00572.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY