Search results for category: Alcohol and Health Effects

Research On Why Two Drinks Help The Heart

Clues to Why Drinking Can Protect Heart
Alcohol 'Preconditions' Laboratory Guinea Pigs

By Charles Petit, Chronicle Science Writer

SF Chronicle Copywrite

San Francisco scientists are reporting today the first solid clues -- gleaned from feeding alcohol to guinea pigs -- to why moderate drinking reduces the risk of heart attacks.

For years, doctors have reported evidence that people who have one or two drinks a day reduce their chance of heart attacks by as much as a third, and significantly reduce the severity of heart attacks that do occur.

Heavier drinking leads to increased risk of heart disease as well as liver problems.

"It's a U-shaped risk distribution," said Dr. Vincent Figueredo, a cardiologist at San Francisco General Hospital and assistant professor of medicine at the University of California at San Francisco. "Alcoholics, and people who don't drink at all, are worse off than people who regularly drink a little."

Figueredo is the lead author of a study published today in the journal Proceedings of the National Academy of Sciences. It reports experiments that he, post-doctoral fellow Masami Mayamae, and three other colleagues performed on the hearts of laboratory guinea pigs to try to find out what alcohol does to allay heart attacks.

Alcohol, the scientists concluded, serves to "precondition" the animals' heart muscle to withstand a heart attack.

Its effect is identical to that of established laboratory methods used to toughen the hearts of lab animals against severe loss of oxygen. Such preconditioning is done by subjecting the animals' hearts to brief, but harmless episodes of low oxygen. Then, when the equivalent of a full heart attack is caused in such preconditioned animals, their survival goes up dramatically.

The new study of the hearts of guinea pigs revealed that alcohol increases levels of a natural substance called adenosine in the fluids surrounding the heart muscle cells. Adenosine is critically important to a cell's use of energy it gets from nutrients in the blood. Muscle cells also release large quantities of adenosine when they are cut off from oxygen, as in a heart attack.

Now, it looks as though alcohol causes heart muscles to prepare for an emergency in somewhat the same way as does a sudden drop in oxygen levels. So, if a heart attack occurs, with its prolonged lack of oxygen to parts of the heart, muscle cells there have already begun to get ready for hard times. "Maybe there is something about adenosine that causes the heart muscle to start hoarding energy," Figueredo said.

The next step toward helping hearts to protect themselves is to look for medications that might cause the same effect on adenosine levels and on the substances in the cells that react to adenosine -- but without the side effects of alcohol. In addition, further research is needed to learn exactly what changes occur inside a cell in response to higher levels of adenosine.

"The bottom line is that if you consume alcohol on a regular basis in moderation, you are more likely to survive a heart attack," Figueredo said. "What this paper is doing is to suggest a mechanism." Turning that mechanism into a useful medical procedure -- other than to recommend light drinking for people at risk of heart disease and with no history of alcoholism -- may take several years.

Tags: Alcohol and Health Effects

Teen Dies with Toxic Mix of Aspirin

TEEN DIES AFTER TAKING PAINKILLER-ASPIRIN MIX

Friday, July 12, 1996
Section: Local
Page: 2B

By: By KATHERINE CONRAD, Mercury News Staff Writer

A 16-year-old Mountain View boy died early Thursday morning after swallowing a toxic mix of at least six painkillers, 10 aspirin and then washing it all down with beer.

Almost immediately, he fell into a coma for 11 days, according to Mountain View police Lt. Patrick Langner.

The teen's friends said he took the drugs after complaining of a headache and back pain June 29. After swallowing the deadly mixture, he said he felt ill and went to the bathroom. There he began convulsing and then turned blue. His friends called 911 and began administering CPR, but the boy never regained consciousness.

One of the boy's friends mixed herself the same toxic cocktail, but didn't take quite as many pills, Langner said. She was treated for nausea and dizziness and released from El Camino Hospital.

Langner identified the painkiller the teens took as propoxyphene, from which Darvon is derived.

Paula Hekimian of the San Mateo County Drug and Alcohol Program said that this type of incident happens often with teen-agers.

''It's all part and parcel of kids believing they are invincible and not knowing the ramifications of mixing different substances. These kids think nothing will kill them,'' Hekimian said.

She urged parents to talk to their children about drugs.

''This is a nightmare that could have happened to anybody's child. These kids come from good families. They look like you, they look like me, these are not quote, unquote bad kids,'' she said. ''We're not seeing an upswing in overdose deaths, but it's still happening.''

Langner said police will investigate the case further.

SAN JOSE MERCURY NEWS

Tags: Alcohol and Health Effects

Relationship Between Sweets and Alcoholism

Study Links Alcohol, Sweet Cravings

UPI Science News

CHAPEL HILL, N.C., Feb. 3 (UPI) -- University of North Carolina researchers say a strong desire for sweets may be a clue that someone has a tendency to become an alcoholic.

The February issue of the American Journal of Psychiatry found alcoholics are much more likely to prefer strongly sweet tastes than non-alcoholics. "In animal studies consumption of sweets has been the best predictor of propensity to drink alcohol," Dr. Alexey B. Kampov-Polevoy, of the University of North Carolina at Chapel Hill says today (Monday). "Now we have begun to see similar results in humans."

In animals predisposed to drink alcohol, scientists have found two characteristics: the inability to control urges to consume sweets and the preference for stronger concentrations of sweetness. One of three UNC researchers who authored the paper, Kampov says the new study is the first published based upon human research. It seems to confirm humans also prefer stronger concentrations.

Twenty alcoholic men and 37 non-alcoholic men were asked to taste five sugar solutions ranging from not sweet to very sweet. The strongest solution tasted twice as sweet as Coca-Cola Classic.

Two-thirds of the alcoholics in the study preferred the sweetest solution compared to only 16 percent of non-alcoholics. Adding further confirmation to the published results, Kampov told United Press International the published work has already been replicated in a similar study he and his colleagues recently conducted in Indiana.

Ultimately, the researchers hope to develop a test to predict alcoholism. Kampov says that, combined with other factors such as impulsiveness and novelty seeking, a desire for highly-concentrated sweets could eventually become an effectve pre-screen for the disease.

Copyright 1997

Tags: Alcohol and Health Effects

Kudzu and Sobriety

Kudzu and Sobriety

The ancient herb kudz may help alcoholics get sober, UPI reported April 17.

A kudzu-based Chinese herbal medicine reduces the urge to drink and mitigates the negative effects of alcohol, according to researchers at the university of North Carolina at Chapel Hill. Rats fed kudzu drank less and were less intoxicated; researchers said kudzu reduces craving by 40 percent.

People in China have long held that kudzu eases the pain of hangovers.

The findings were published in the journal of Alcoholism Clinical and Experimental Research.

Tags: Alcohol and Health Effects

Red Wine in Cancer Research

Red Wine Polyphenols in Cancer Research
by Dr. Erik Skovenborg

In the eyes of science all alcoholic beverages are created equal, however, some drinks may be more equal than others. Red wine may be one of those beverages offering a dual action of alcohol and antioxidants. The name of the game is Red Wine Polyphenols (RWP) - compounds derived from grape tannins and anthocyanin pigments that belong to the most powerful antioxidants in the world. As we absorb polyphenols, they change the properties of blood lipids making LDL-cholesterol more resistant to the sort of oxidation that can trigger atherosclerosis and coronary heart disease. From Coronary Heart Disease to Cancer

For many years the overwhelming evidence that light-to-moderate alcohol use lowers the risk of coronary heart disease has been in focus. In 2000 Morten Grønbæk with a study of data from 257,859 person-years of follow-up (the Copenhagen Centre for Population Studies) was able to conclude that not only did wine drinkers have significantly lower mortality from coronary heart disease; with a consumption of 1-3 glasses a day wine drinkers also reduced their risk of cancer by 20 percent compared with non-drinkers. As the number of global cancer deaths are rising there is an urgent need of efficient methods of cancer prevention and cancer cure. Earlier studies have found a strong protective effect of intake of fruits and vegetables against cancer. The potential role of red wine polyphenols in cancer prevention may turn out to be one of the most exciting areas of current cancer research.

RWP in cancer prevention

In 2000 Elias Castanas, professor of experimental endocrinology at the University of Crete’s School of Medicine in Iráklion, published important papers on the inhibitory action of Red Wine Polyphenols on human breast cancer cells and human prostate cancer cells. In collaboration with Joseph Vercauteren, professor of pharmacology at the Université Victor Segalen in Bordeaux and expert in polyphenols, Elias Castanas added polyphenols derived from from de-alcoholized red wine to cultures of breast cancer and prostate cancer cells. The RWP had an antiproliferative effect on the cancer cell lines in test tube experiments in the laboratory. During a short stay in Crete in the lovely September weather we had the opportunity to ask professor Castanas some questions about his important cancer research.

Assisted cancer cell suicide

To professor Castanas one of the most intriguing discoveries of his laboratory tests is the very low concentrations of polyphenols needed to inhibit cancer cell growth. Traditional chemotherapy is based on a group of cell poisons the success of which depend on whether the poisons kill the cancer cells before they kill the patient. Polyphenols are non toxic compounds; as a matter of fact it looks as if the RWP have very few side effects. So if the polyphenols do not poison the cancer cells, how do they manage to inhibit and eventually kill them? Castanas has an idea that includes the phenomenon of apoptosis: programmed cell death. The general purpose of apoptosis is to have any cell that suffers from irreparable DNA damage kill itself. Maybe the action of RWP on cancer cells can be described as "assisted suicide". Elias Castanas and his colleagues are working hard to find the answers. His laboratory is doing some preliminary animal (mice) studies that seems to back his test tube research on cancer cells. No studies with cancer patients has yet been performed as far as Castanas knows, and besides he warns that such studies are premature. "Science is five years away from proving whether wine’s antioxidant polyphenols do kill breast and prostate cancer cells in humans".

Other polyphenols to look for

In his tests professor Castanas has used several different polyphenols such as quercetin against cancer cell lines. However, an extract of total RWP is what he favours for his experiments. So far more than 200 polyphenols have been identified in red wine, and Castanas has the opinion that the combined group of polyphenols is more active than the single compounds by themselves.

Professor Castanas has conducted some experiments with tea polyphenols and the results were more or less the same as for RWP. He has not yet had the opportunity to work with beer polyphenols, however, Castanas is familiar with some of the polyphenols in beer. In his opinion there is no substantial mechanistic difference between the polyphenols in wine, beer and tea, however, based on his experience RWP millimol per millimol have a higher antioxidant capacity than other polyphenols.

Bioavailability of polyphenols

The question of bioavailability is a crucial question: if you drink a bottle of full-bodied red wine you consume about 2 grams of RWP; what part of these healthy compounds is absorbed during the process of digestion to become available to target tissues like the endothelial cells of blood vessels or the nerve tissue of the brain? Professor Castanas has good news to wine drinkers: alcohol protects the RWP, so a glass of Cabernet Sauvignon is a good vehicle for polyphenols. For those who want a steak on the plate to go with their Cabernet here is more good news: proteins have a dual action protecting the RWP from oxidation and increasing the bioavailability of the healthy compounds. That added bonus leads directly to Elias Castanas’ favourite advice concerning a sufficient daily intake of polyphenols: eat a normal meal with a variety of foods like fruit, vegetables, legumes, olive oil, bread and fish accompanied by moderate consumption of wine.

Polyphenols on the table or in a capsule?

Who wants to spend hours in the kitchen scraping carrots, cleaning fish and peeling fruit? Why not relax in the sun with an exciting book washing down a capsule of RWP with Dry Martini? No, says the Cretan professor, the antioxidant activity of extracts of polyphenols is poor compared to the antioxidant power of polyphenols from natural fruits and vegetables. Besides there is always the problem of protecting the extracted polyphenols from oxidation. With an ample supply of antioxidants from various sources like fruit, vegetables, vegetable oils and wine you arm the cells of your body with heavy antioxidant artillery to face any oxidant threat.

Professor Castanas is a founder member of the Greek academy of taste. As a bon vivant with an intimate knowledge of the best restaurants on the island of Crete the choice between a RWP-capsule and the fine cuisine of Crete is easy. Raising a glass of fragrant Mirambelo, a red wine from the grape varieties Kotsifali and Mandilaria picked from the mountain vineyards of Peza, Castanas toasts the conclusion from the landmark article on wine and health by St. Leger and A. Cochrane (Lancet 1979;i:1017-21): "If wine is ever found to contain a constituent protective agent against I.H.D. then we consider it almost a sacrilege that this consituent should be isolated. The medicine is already in a highly palatable form".

Dr. Erik Skovenborg is a founder member of the Scandanavian Medical Alcohol Board, a specialist in alcohol and health and a member of the AIM Editorial Board.

Tags: Alcohol and Health Effects

Cancer Prevention and Red Wine

Red wine is a rich source of biologically active phytochemicals, chemicals found in plants. Particular compounds called polyphenols found in red wine, such as catechins and resveratrol, are thought to have anti oxidant or anti cancer properties.

What are polyphenols and how do they prevent cancer?

Polyphenols are antioxidant compounds found in the skin and seeds of grapes. When wine is made from these grapes, the alcohol produced by the fermentation process dissolves the polyphenols contained in the skin and seeds. Red wine contains more polyphenols than white wine because the making of white wine requires the removal of the skins after the grapes are crushed. The phenols in red wine include catechin, gallic acid, and epicatechin.

Polyphenols have been found to have antioxidant properties. Antioxidants are substances that protect cells from oxidative damage caused by molecules called free radicals. These chemicals can damage important parts of cells, including proteins, membranes, and DNA. Cellular damage caused by free radicals has been implicated in the development of cancer. Research on the antioxidants found in red wine has shown that they may help inhibit the development of certain cancers. What is resveratrol and how does it prevent cancer?

Resveratrol is a type of polyphenol called a phytoalexin, a class of compounds produced as part of a plant's defense system against disease. It is produced in the plant in response to an invading fungus, stress, injury, infection, or ultraviolet irradiation. Red wine contains high levels of resveratrol, as do grapes, raspberries, peanuts, and other plants.

Resveratrol has been shown to reduce tumor incidence in animals by affecting one or more stages of cancer development. It has been shown to inhibit growth of many types of cancer cells in culture. Evidence also exists that it can reduce inflammation. It also reduces activation of NF kappa B, a protein produced by the body's immune system when it is under attack. This protein affects cancer cell growth and metastasis. Resveratrol is also an antioxidant.

What have red wine studies found?

The cell and animal studies of red wine have examined effects in several cancers including leukemia, skin , breast, and prostate cancers . Scientists are studying resveratrol to learn more about its cancer preventive activities. Recent evidence from animal studies suggests this anti-inflammatory compound may be an effective chemopreventive agent in three stages of the cancer process: initiation, promotion, and progression.

However, studies of the association between red wine consumption and cancer in humans are in their initial stages. Although consumption of large amounts of alcoholic beverages may increase the risk of some cancers, there is growing evidence that the health benefits of red wine are related to its nonalcoholic components.

Tags: Alcohol and Health Effects

Drinking and the Liver

National Institute on Alcohol Abuse and Alcoholism

No. 19 PH 329 January 1993

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Alcohol and the Liver

Alcoholic liver disease is one of the most serious medical consequences of chronic alcohol use. Moreover, chronic excessive alcohol use is the single most important cause of illness and death from liver disease (alcoholic hepatitis and cirrhosis) in the United States (1).

The Normal Liver

Normal liver function is essential to life. The liver is the largest organ of the body, located in the upper right section of the abdomen. It filters circulating blood, removing and destroying toxic substances; it secretes bile into the small intestine to help digest and absorb fats; and it is involved in many of the metabolic systems of the body. Digested food substances are carried from the intestine directly to the liver for further processing. The liver stores vitamins; synthesizes cholesterol; metabolizes or stores sugars; processes fats; and assembles amino acids into various proteins, some for use within the liver and some for export. The liver controls blood fluidity and regulates blood-clotting mechanisms. It also converts the products of protein metabolism into urea for excretion by the kidneys.

Alcoholic Liver Disease

The three alcohol-induced liver conditions are fatty liver, alcoholic hepatitis, and cirrhosis.

Some degree of fat deposition usually occurs in the liver after short-term excessive use of alcohol. However, fatty liver rarely causes illness (2).

In some heavy drinkers, alcohol consumption leads to severe alcoholic hepatitis, an inflammation of the liver characterized by fever, jaundice, and abdominal pain (3). Severe alcoholic hepatitis can be confused with many serious abdominal conditions, such as cholecystitis (inflammation of the gall bladder), appendicitis, and pancreatitis. It is important to be aware of this potential confusion because some of these other conditions require surgery, and surgery is contraindicated in patients with alcoholic hepatitis. These patients have a high death rate following surgery.

The most advanced form of alcoholic liver injury is alcoholic cirrhosis. This condition is marked by progressive development of scar tissue that chokes off blood vessels and distorts the normal architecture of the liver (2).

A patient may have only one of the three alcohol-induced conditions or any combination of them. Traditionally, they have been considered sequentially related, progressing from fatty liver to alcoholic hepatitis to cirrhosis. However, some studies have demonstrated that alcoholics may progress to cirrhosis without passing through any visible stage resembling hepatitis. Thus, alcoholic cirrhosis can appear insidiously, with little warning (4).

Fatty liver is reversible with abstinence. Alcoholic hepatitis may be fatal but can be reversible with abstinence (5). While alcoholic cirrhosis is often progressive and fatal, it can stabilize with abstinence (3).

Complications of advanced liver disease include severe bleeding from distended veins in the esophagus, brain disorders (hepatic encephalopathy), accumulation of fluid in the abdomen (ascites), and kidney failure (6).

Not all liver disease that may occur in alcoholics is caused by alcohol. In addition, when alcohol-induced liver disease does occur, it may be accompanied by other conditions, not related to alcohol, that also can cause liver failure. These include nonalcoholic hepatitis and exposure to drugs and occupational chemicals (see below).

Extent of the Problem

Alcohol-related cirrhosis is know n to be underreported. However, about 44 percent of all deaths caused by cirrhosis in North America are reportedly alcohol related (7).

Up to 100 percent of heavy drinkers show evidence of fatty liver, an estimated 10 to 35 percent develop alcoholic hepatitis, and 10 to 20 percent develop cirrhosis (1).

Daily drinkers are at a higher risk of developing alcoholic cirrhosis than are binge drinkers (8). In general, patients with alcoholic cirrhosis have been drinking heavily for 10 to 20 years (8-10).

Mortality from cirrhosis in the United States varies significantly with gender, race, and age. In 1988, the highest mortality from cirrhosis occurred in nonwhite males, followed by white males, nonwhite females, and white females (11). Most of the deaths from alcoholic cirrhosis occur in people ages 40-65 (11). Thus, alcoholic cirrhosis kills people in what should be their most productive years.

How Does Alcohol Damage the Liver?

Currently we do not know how alcohol causes cirrhosis. However, there are many mechanisms by which alcohol injures the liver. Many of these mechanisms are poorly understood, in part because no simple animal model has been developed for cirrhosis. In addition, there is considerable variation among individuals in susceptibility to alcoholic liver disease, so that among people drinking similar amounts, only some develop cirrhosis.

Diet. Before the 1970's, alcoholic cirrhosis was believed to arise from nutritional deficiencies common among heavy drinkers. Overwhelming evidence subsequently proved that alcohol itself is toxic to the liver, even when nutrition is adequate. Today, it is believed that nutritional effects and direct alcohol toxicity interact in such complex ways that the influence of the two cannot be separated (12).

Genetics. Genetic differences might explain why some heavy drinkers develop cirrhosis while others do not. The scar tissue that forms in the cirrhotic liver is composed of the protein collagen. It has been suggested that stimulation of collagen synthesis resulting from activation of the collagen gene may promote liver scarring (13). In that case, it might be speculated that differences in genes for collagen among individual drinkers may be associated with differences in the development of alcoholic cirrhosis.

Free radicals and acetaldehyde. Much of the cell damage that occurs during liver degeneration is believed to be caused by free radicals, highly reactive molecular fragments, liberated during alcohol metabolism. The damage caused by free radicals can include the destruction of essential components of cell membranes. The cell's natural defenses against free radicals include the natural chemicals glutathione (GSH) and vitamin E.

The function of GSH and vitamin E is impaired in alcoholics. For example, chronic alcohol ingestion decreased GSH levels in baboons and humans (14). Similarly, chronic alcohol feeding significantly increased damage caused by free radicals in liver cells of rats maintained on a diet low in vitamin E (15).

Acetaldehyde, the primary metabolic product of alcohol in the liver, appears to be a key generator of free radicals. Because of its reactivity, acetaldehyde can promote membrane damage and can stimulate the synthesis of collagen to form scar tissue (16-18).

Nonalcoholic hepatitis. The increased prevalence of hepatitis C viral infection in alcoholics might explain some of the variation in individual susceptibility to alcoholic liver disease (19). In addition, chronic hepatitis C infection is significantly correlated with the severity of alcoholic cirrhosis (20) and may influence the progression of alcoholic liver disease in some patients (21,22).

The immune system. The immune system responds or contributes to liver cell damage in alcohol-induced liver disease in complex ways, although a causal relationship is unclear. Acetaldehyde has been shown to attach chemically to liver proteins. The altered proteins may then trigger various immune responses (23). Cellular toxins are released, causing cell damage; certain proteins are deposited along the liver's small blood-carrying channels; and specific white blood cells are activated (24-27).

Liver metabolism. Chronic alcohol administration has been found to increase the rate of oxygen metabolism by the liver. In addition, a series of studies by Israel and colleagues (28) demonstrated similarities in the effects of alcohol and thyroid hormone on liver cells. They called these effects the "liver hypermetabolic state." As a result of these studies, propylthio-uracil, a drug used to treat excessive production of thyroid hormone, has been tested for the treatment of alcoholic liver disease (see Treatment below).

Gender. Current evidence suggests that women may be more susceptible than men to alcoholic liver disease; more research is necessary to validate this hypothesis (8,19).

Environmental factors. Chronic alcohol consumption markedly increases the liver toxicity of various industrial solvents, anesthetics, medications, and vitamins (29,30). For example, acetaminophen (Tylenol and others), a widely used over-the-counter pain reliever, is generally safe when taken in recommended doses. However, excessive use of acetaminophen has been associated with liver toxicity in people drinking heavily (30-32). Alcohol also enhances the toxicity of excess vitamin A, so care must be taken when treating an alcoholic with a vitamin A deficiency (33).

Treatment

Alcoholic hepatitis. Mortality from alcoholic hepatitis during the early weeks of treatment is very high. Although the evidence is inconsistent, corticosteroid therapy may improve survival during the early stages of the disease in patients with severe alcoholic hepatitis (34-38). Supplemental amino acids may improve a patient's nutrition but not the chances of survival or progression to cirrhosis (39).

Orrego and colleagues (40) reported that the drug propylthiouracil (PTU) improved survival of patients with all types of alcoholic liver disease. However, other studies have demonstrated no benefit from this therapy in patients with alcoholic hepatitis (41,42).

Abstinence is the cornerstone of therapy for patients with prolonged alcoholic hepatitis. Also important are careful control of diet with correction of vitamin deficiencies, and management of medical complications (38).

If the patient with alcoholic hepatitis lives to leave the hospital, abstinence is essential for long-term survival. Alexander and coworkers (43) found that more than 80 percent of those who abstained or markedly reduced their drinking were alive 7 years later, whereas only 50 percent who continued to drink were alive 7 years later.

Alcoholic cirrhosis. Treatment for cirrhosis is directed at symptoms and complications, with abstinence a requirement. For terminally ill patients, liver transplantation is the only effective treatment. This procedure in alcoholic cirrhotic patients has demonstrated success and survival rates equal to those for nonalcoholic cirrhotic patients (44).

Future directions in cirrhosis therapy are suggested by a study showing that lecithin protects against the development of alcohol-induced liver scarring in baboons (45). This therapy has not yet been studied in humans.

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Alcohol and the Liver--A Commentary by
NIAAA Director Enoch Gordis, M.D.

Abstinence from alcohol is the single most important component of treatmen t for alcoholic liver disease. Continued drinking will worsen the condition of patients with this disease and greatly increase their risk for death. Physicians who treat alcoholic liver disease, no matter how competently, and who do not address their patients' drinking are practicing bad medicine, akin to treating an iron-deficiency anemia and disregarding the colon cancer that is causing it.

Because many alcohol abusers and most alcoholics require some form of treatment to remain abstinent, simply giving advice to "quit" drinking often is not sufficient. Physicians who choose not to manage their patients' alcohol problems may refer these patients to specialized alcohol treatment providers for evaluation and appropriate treatment. In referring a patient to appropriate alcohol treatment, physicians should keep informed of their patients' progress, as relapse may further complicate management of the alcoholic liver disease.

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ACKNOWLEDGMENT: The National Institute on Alcohol Abuse and Alcoholism wishes to acknowledge the valuable contributions of Marcus A. Rothschild, M.D., editor of Alcohol: Clinical and Experimental Research, to the development of this Alcohol Alert.

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All material contained in the Alcohol Alert is in the public domain and may be used or reproduced without permission from NIAAA. Citation of the source is appreciated.

Copies of the Alcohol Alert are available free of charge from the Scientific Communications Branch, Office of Scientific Affairs, NIAAA, 5600 Fishers Lane, Room 16C-14, Rockville, MD 20857. Telephone: 301-443-3860.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service * National Institutes of Health

Tags: Alcohol and Health Effects

Study Says Health Insurance to Rise 30%

NCPA: MANDATES INCREASE COST OF HEALTH INSURANCE BY 30%

08/13 1148

NEW ORLEANS, Aug. 13 /PRNewswire/ -- Mandates are increasing the cost of health insurance by as much as 30 percent, according to a National Center for Policy Analysis report released today at the annual meeting of the American Legislative Exchange Council. The analysis, prepared by the actuarial firm Milliman & Robertson, estimated the costs of 12 of the most common mandates and found that added together, those 12 mandates can increase the cost of a family health insurance policy by as much as $700 to $1,050 a year.

"Based on the Milliman & Robertson estimates, a small business that employs 25 people, with a standard mix of 40 percent single coverage and 60 percent family coverage, could see its premiums rise by $20,000 a year," said Dr. Merrill Matthews, NCPA Vice President for Domestic Policy.

The study analyzed the cost of health care policies when minimum stay maternity, speech therapy benefits, drug abuse treatment benefits, mammography screening, well child care, podiatry, pap smears, vision exams, chiropractic care, alcoholism treatment, infertility treatment and mental health care were included.

Assuming that a mandate-free, basic health insurance policy costs a family about $3,500 a year, the Milliman & Robertson study found:

Several of the mandates increase the cost of a policy by less than $35 each.

Infertility treatment can increase the cost of a policy from anywhere between $105 and $175 a year.

Mental health parity, which requires insurers to treat mental illnesses the same as physical illnesses, adds between $175 and $350 to the cost of a policy.

While employees tend to like health insurance mandates regardless of cost, Matthews believes that's because the costs are hidden, while the benefits are apparent.

"What people need to realize is that while mandates provide more options for those with health insurance, they also mean fewer people end up being insured," Matthews said. "A poll of employers who have canceled their employees' health insurance policies found it was because the price was no longer affordable."

Matthews predicts problems with mandates will only get worse. In 1965 there were only seven state-mandated health insurance benefits. Today there are nearly 1,000. In addition, the federal government recently joined the states by imposing two mandates of its own, a ban on "drive-through" baby deliveries and a requirement that any cap on mental health benefits be the same as the cap on physical health benefit.

"One or two federal mandates may not increase the cost of health insurance significantly, but, as the states have proven, it's almost impossible to stop with a few mandates," Matthews said. "When the dust settles, policies will cost more, employers and individuals will be canceling their polices and Congress will have to face an even bigger uninsured 'crisis.'" For a copy of the brief analysis "The Cost of Health Insurance Mandates" visit the NCPA Web site at http://www.ncpa.org or contact the NCPA.

The National Center for Policy Analysis is a public policy research institute founded in 1983 and internationally known for its studies on public policy issues. The NCPA is headquartered in Dallas, Texas, with an office in Washington, D.C. Internet: http://www.ncpa.org/

SOURCE National Center for Policy Analysis -0- 08/13/97 /CONTACT: Katy Meaker Menges, Dallas, 972-386-6272, or Joan Kirby, Washington, 202-628-6671, both of the National Center for Policy Analysis/ CO: National Center for Policy Analysis ST: Louisiana IN: HEA SU:

Tags: Alcohol and Health Effects

Some Companies Refuse DUI's Health Insurance

No Health Insurance For DUI's

Drunken drivers may find insurance won't pay the bills for their injuries

BYLINE: Lee, Louise
EST. PAGES: 1
DATE: 07/06/95
DOCID: WSAB159782
SOURCE: WALL STREET JOURNAL ABSTRACTS; WSAB
COPYRIGHT: (Copyright 1995 UMI, Wall Street Journal Abstracts)
PAGE: B, 1:3
CATEGORY: News

A growing number of companies are adding drunken-driving injuries to the list of exclusions in their health plans, including Chief Auto Parts Inc, Monfort Inc and Electronic Data Systems Corp. Companies that won't cover drunken-driving injuries are often self-insured.

REFERENCE: ISSN: 0099-9660
DESCRIPTORS: DRUNK DRIVING / HEALTH INSURANCE / INCENTIVES / EMPLOYEE BENEFITS ; LAW ENFORCEMENT; LABOR PERSONNEL ISSUES
ORGANIZATION: CHIEF AUTO PARTS INC / MONFORT OF COLORADO INC / ELECTRONIC DATA
SYSTEMS CORP
INDUSTRY: INSURANCE
OTHER TERMS: DOCN: 03415715

Tags: Alcohol and Health Effects

Physicians Guide to Assessing Alcohol Dependence

THE PHYSICIANS' GUIDE TO HELPING PATIENTS WITH ALCOHOL PROBLEMS

CONTENTS

FOREWORD

LETTER FROM NIAAA DIRECTOR

WHAT YOUR PATIENTS SHOULD KNOW ABOUT ALCOHOL USE

RECOMMENDATIONS TO PATIENTS FOR LOW-RISK DRINKING

SCREENING AND BRIEF INTERVENTION PROCEDURES

Step I. Ask About Alcohol Use
Step II. Assess for Alcohol-Related Problems
Step III. Advise Appropriate Action
Step IV. Monitor Patient Progress

WHAT TO DO ABOUT PATIENTS WHO ARE NOT READY TO CHANGE THEIR DRINKING BEHAVIOR

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FOREWORD

This Guide was developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in conjunction with an interdisciplinary working group of alcohol researchers and health professionals. The clinical recommendations in this Guide are based on the findings of more than a decade of research on the health risks associated with alcohol use and on the effectiveness of alcohol screening and interven- tion methods. NIAAA plans to update this Guide periodically to reflect continuing advances in research.

NIAAA would like to acknowledge the contributions of members of the Working Group on Screening and Brief Intervention, including the following: John Allen, Ph.D.; Peter Anderson, M.D.; Thomas Babor, Ph.D.; Kendall Bryant, Ph.D.; David Buchsbaum, M.D.; Jonathan Chick, M.D.; Frances Cotter, M.A., M.P.H.; Michael Fleming, M.D., M.P.H.; Richard K. Fuller, M.D.; Nick Heather, Ph.D.; Yedy Israel, Ph.D.; Cherry Lowman, Ph.D.; William R. Miller, Ph.D.; Judith Ockene, Ph.D.; and Allen Zweben, D.S.W.

NIAAA also would like to thank other collaborators, including the following: Michael Fleming, M.D., M.P.H., and Frances Cotter, M.A., M.P.H., for their leadership in writing this Guide; the College of Family Physicians of Canada Alcohol Risk Assessment and Intervention (ARAI) Project Steering Committee for sharing their expertise and early drafts of brief intervention materials; and Eve Shapiro and colleagues at CSR, Incorporated, for their expertise in editing and designing this Guide.

Up to Table of Contents.

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Letter from NIAAA Director

Dear Colleagues: As a primary care physician, you are in an excellent position to identify and manage patients at risk for alcohol-related problems. Alcohol-related problems are common in primary care practice: An estimated 25 percent of adults in the United States either report drinking patterns that put them at risk for developing problems or currently have alcohol-related problems, including alcohol abuse or dependence.1 Primary care physicians are the entry point into the health-care system for many individuals. Furthermore, because you are concerned with the overall health of an individual, you generally see patients more frequently than do other health-care professionals.

Primary care physicians are busy. Yet you want to practice good medicine and are willing to take time to address your patients' alcohol problems. This Guide, prepared by the National Institute on Alcohol Abuse and Alcoholism, provides you with a step-by-step approach to identifying and managing these problems and offers practical advice on making alcohol screening, assessment, and brief intervention procedures a routine part of your clinical practice. There are important reasons for doing so. Untreated alcohol- ism results in a variety of social, economic, and medical consequences. Alcohol use can complicate treatment for medical problems, interfere with prescribed medications, or lead to adverse side effects. Most importantly, left untreated, alcohol abuse and alcoholism often result in severe or fatal outcomes.

Your patients look to you for advice about the risks and benefits associated with drinking. Research, in fact, demonstrates that simply dis- cussing your concerns about alcohol use can be effective in changing many patients' drinking behavior before problems become chronic.

We commend this Guide to your attention and hope that you will make it an integral part of your practice.

Enoch Gordis, M.D.
Director
National Institute on Alcohol Abuse and Alcoholism

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WHAT YOUR PATIENTS SHOULD KNOW ABOUT ALCOHOL USE

Most adults who drink alcohol drink in moderation and are at low risk for developing problems related to their drinking. However, all drinkers, including low-risk drinkers, should be aware of the health risks associated with alcohol consumption. Provide your patients with information and advice about the risks of drinking.

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RECOMMENDATIONS TO PATIENTS FOR LOW-RISK DRINKING

Advise those patients who currently drink to drink in moderation.

Moderate drinking is defined as follows:

• Men--no more than two drinks per day
• Women--no more than one drink per day
• Over 65--no more than one drink per day

Note: A standard drink is 12 grams of pure alcohol, which is equal to one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.

Advise patients to abstain from alcohol under certain conditions:

• when pregnant or considering pregnancy
• when taking a medication that interacts with alcohol
• if alcohol dependent
• if a contraindicated medical condition is present (e.g., ulcer, liver disease)

If a patient is at risk for coronary heart disease, discuss the potential benefits and risks of alcohol use:

• Light to moderate drinking is associated with lower rates of coronary heart disease in certain populations (e.g., men over 45, postmenopausal women). Infrequent or nondrinkers are not advised to begin a regimen of light to moderate drinking to reduce the risk of coronary heart disease because vulnerability to alcohol-related problems cannot always be predicted. Similar protective effects can likely be achieved through proper diet and exercise.

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Clinical Notes

• Women and the elderly have smaller amounts of body water than men; therefore, they achieve a higher blood alcohol concentration than men after drinking the same amount of alcohol.
• Exposing a fetus to alcohol can cause a broad range of birth defects referred to as fetal alcohol syndrome (FAS) or alcohol-related birth defects (ARBD). Although FAS/ARBD is associated with excessive alcohol consumption during pregnancy, studies also have reported neurobehavioral deficits in infants born to mothers reporting drinking an average of one drink per day during pregnancy.
• Studies indicate that heavier episodic drinking (i.e., the consumption of more than four drinks per occasion by men and more than three drinks per occasion by women) impairs cognitive and psychomotor functions and increases the risk of alcohol-related problems, including accidents and injuries.

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SCREENING AND BRIEF INTERVENTION PROCEDURES

Recommended screening and brief intervention procedures include four steps:

• Step I. ASK about alcohol use.
• Step II. ASSESS for alcohol-related problems.
• Step III. ADVISE appropriate action (i.e., set a drinking goal, abstain, or obtain alcohol treatment).
• Step IV. MONITOR patient progress.

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Ask all patients:

• Do you drink alcohol, including beer, wine, or distilled spirits?

Ask current drinkers about alcohol consumption:

• On average, how many days per week do you drink alcohol?
• On a typical day when you drink, how many drinks do you have?
• What is the maximum number of drinks you had on any given occasion during the last month?

Ask current drinkers the CAGE questions:

• Have you ever felt that you should Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you ever felt bad or Guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye opener)?

If there is a positive response to any of these questions:

• ASK: Has this occurred during the past year?

A patient may be at risk for alcohol-related problems IF:

• alcohol consumption is:
  Men:
  > 14 drinks per week or
  > 4 drinks per occasion
  Women:
  > 7 drinks per week or
  > 3 drinks per occasion

or

• one or more positive responses to the CAGE that have occurred in the past year

When is screening for alcohol problems appropriate?

• as part of a routine health examination
• before prescribing a medication that interacts with alcohol
• in response to presenting problems that may be alcohol-related

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Patients who screen positive should be assessed to determine the nature and extent of their alcohol-related problems. Use the assessment procedures described below to determine problem severity, as follows: (l) at increased risk for developing alcohol-related problems, (2) currently experiencing alcohol-related problems, or (3) may be alcohol dependent.

1. At Increased Risk for Developing Alcohol-Related Problems

Indicators

• drinking above recommended low-risk consumption levels or in high-risk situations
• personal or family history of alcohol-related problems

Assessment procedures

• Ask about typical drinking patterns:
  How long have you been drinking this amount? How many times in a week (or month) do you have four or more drinks on one occasion? What is the most you have consumed on one occasion during the past year?
• Ask about personal and family history:
  Have you or anyone in your immediate family ever had a drinking problem?

Note: For many conditions, there is a dose-response relationship between alcohol consumption and risk. This applies to cirrhosis of the liver; cancers of the oropharynx, larynx, liver, and breast; hypertension; and stroke.

2. Currently Experiencing Alcohol-Related Problems

Indicators

• one or two positive responses to the CAGE that have occurred in the past year
• evidence of alcohol-related medical or behavioral problems

Assessment procedures

• Review your patient's medical history for evidence of alcohol-related medical problems, such as:
  blackouts
  chronic abdominal pain
  depression
  liver dysfunction
  hypertension
  sexual dysfunction
  trauma
  sleep disorders

Note: Chronic heavy use of alcohol (i.e., three or more drinks per day) may be associated with elevations in serum gamma-glutamyltransferase (GGT). This can be an indicator of excessive drinking.

• Ask about interpersonal or work-related problems:
  Has your drinking ever caused you problems, such as problems with your family, problems with your work (or school) performance, or accidents/injuries?

3. May Be Alcohol Dependent

Indicators

• three or four positive responses to the CAGE that have occurred in the past year
• evidence of one or more of the following symptoms: 2
  Compulsion to drink--preoccupation with drinking
  Impaired control--unable to stop drinking once started
  Relief drinking--drinking to avoid withdrawal symptoms
  Withdrawal--evidence of tremor, nausea, sweats, or mood disturbance
  Increased tolerance--takes more alcohol than before to get "high"

Assessment procedures

• Ask the following questions:
  -- Are there times when you are unable to stop drinking once you have started?
  -- Does it take more drinks than before to get "high"?
  -- Do you feel a strong urge to drink?
  -- Do you change your plans so that you can have a drink?
  -- Do you ever drink in the morning to relieve the shakes?

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State your medical concern:

• Be specific about your patient's drinking patterns and related health risks.
• ASK: How do you feel about your drinking?

Advise to abstain or cut down:

• Advise to abstain if:
  -- evidence of alcohol dependence
  -- history of repeated failed attempts to cut down
  -- pregnant or trying to conceive
  -- contraindicated medical condition or medication
• Advise to cut down if:
  -- drinking above recommended low-risk drinking amounts and no evidence of alcohol dependence

Agree upon a plan of action:

• ASK: Are you ready to try to cut down or abstain?

Talk with patients who are ready to make a change in their drinking about a specific plan of action.

For patients who are not alcohol dependent:

• Recommend low-risk consumption limits for your patient based upon the low-risk drinking recommendations and your patient's health history (See Recommendations to patients for low-risk drinking).
• Ask your patient to set a specific drinking goal:
  Are you ready to set a drinking goal? Some patients choose to abstain for a period of time or for good; others prefer to limit the amount they drink. What do you think will work best for you?
• Provide patient education materials and tell your patient:
  It helps to think about your reasons for wanting to cut down and examine what situations trigger unhealthy drinking patterns. These materials will give you some useful tips on how to maintain your drinking goal.

For patients with evidence of alcohol dependence:

• Refer for additional diagnostic evaluation or treatment.
• Procedures for patient referral are as follows:
  -- Involve your patient in making referral decisions.
  -- Discuss available alcohol treatment services.
  -- Schedule a referral appointment while the patient is in the office.

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SOME PATIENT COUNSELING TIPS

• Use an empathic, nonconfrontational style.
• Offer your patient some choices about how to effect change.
• Emphasize your patient's responsibility for changing drinking behavior.
• Convey confidence in your patient's ability to change drinking behavior.

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Monitor patient progress in the same way you manage other chronic medical problems, such as hypertension or diabetes. Recognize that behavior change is an incremental process that often involves trial and error. Patient management strategies include the following:

• Indicate that you (or designated staff) are available to provide ongoing assistance and support.
• Support your patient's efforts to cut down or abstain at each subsequent visit by:
  -- reviewing progress to date
  -- commending your patient for efforts made
  -- reinforcing positive change
  -- assessing continued motivation
• Consider scheduling a separate followup visit or telephone call, as appropriate, if the patient needs additional support.
• Consider referring a selected patient whose counseling needs exceed the services provided in a primary care setting.

For patients who have been advised to abstain or have been referred for alcohol treatment:

• Ask to receive periodic updates from the treatment specialist on your patient's treatment plan and prognosis.
• Monitor symptoms of depression and anxiety. Such symptoms may occur, but they often decrease or disappear after 2 to 4 weeks of abstinence.
• Monitor GGT levels, when appropriate, as a means of assessing alcohol treatment compliance.

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WHAT TO DO ABOUT PATIENTS WHO ARE NOT READY TO CHANGE THEIR DRINKING BEHAVIOR

Do not be discouraged if patients are not ready to take action immediately. Decisions to change behavior often involve fluctuating motivation and feelings of ambivalence. By offering your advice, you have prompted your patients to think more seriously about their drinking behavior. In many cases, continued reinforcement is the key to a patient's decision to take action. Offer the following guidance to patients who are not ready to take action:

• Restate your concern for your patient's health.
• Reinforce your willingness to help when the patient is ready.
• Continue to monitor alcohol use at subsequent office visits.

For patients who may be alcohol dependent, you may want to consider some additional strategies:

• Encourage your patient to consult an alcohol specialist.
• Ask your patient to discuss your recommendation with family members and schedule a followup visit that includes family members/significant others.
• Recommend a trial period of abstinence, monitor for withdrawal symptoms, and review progress in a followup visit.

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WHERE TO GO FOR ADDITIONAL INFORMATION

The National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Office of Scientific Affairs
Willco Building
6000 Executive Boulevard, Suite 409
Bethesda, MD 20892-7003
301-443-3860

American Society of Addiction Medicine (ASAM)
4601 North Park Avenue
Suite 101, Upper Arcade
Chevy Chase, MD 20815
301-656-3920

National Council on Alcoholism and Drug Dependence (NCADD)
12 West 21st Street
New York, NY 10010
212-206-6770

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NOTES

1 Seven percent of the U.S. population--approximately 14 million adults--meet the diagnostic criteria for alcohol abuse or dependence.

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2 This selective listing of dependence symptoms is offered as an initial assessment procedure and not for the purpose of making a diagnosis. For a diagnostic evaluation, refer your patients to a specialist or use the diagnostic procedures outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

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Prepared: January 1996

Tags: Alcohol and Health Effects