Alcohol Detoxification Program Research Articles

Effectiveness of Reducing Craving in Alcohol Use Disorder Using a Serious Game (SALIENCE): Randomized Controlled Trial.

Alcohol use disorder (AUD) has become a major global health problem. Therapy for this condition is still a great challenge. Recently, it has become increasingly evident that computer-based training is a valuable addition to the treatment of addictive disorders. This study aims to evaluate the web-based serious game SALIENCE (Stop Alcohol in Everyday Life-New Choices and Evaluations) as an add-on therapy for AUD. It combines the cue-exposure therapy approach with elements of decision-making training, enhanced by interactive panoramic images. The effects of SALIENCE training on levels of craving, attention, and cognitive bias are investigated. In a randomized controlled trial, 62 participants with AUD undergoing 3 weeks of an extended alcohol detoxification program were randomly allocated to an intervention and a control group. A total of 49 individuals (mean age 44.04 y; 17/49, 35% female) completed all sessions and were included in the analysis. Only pretreatment data were available from the other 13 patients. Participants answered questionnaires related to alcohol consumption and craving and completed neuropsychological tasks at the beginning of the study and 2 weeks later to evaluate levels of attention and cognitive biases. During the 2-week period, 27 of the participants additionally performed the SALIENCE training for 30 minutes 3 times a week, for a total of 6 sessions. We observed a significant decrease in craving in both groups: the control group (mean 15.59, SD 8.02 on the first examination day vs mean 13.18, SD 8.38 on the second examination day) and the intervention group (mean 15.19, SD 6.71 on the first examination day vs mean 13.30, SD 8.47 on the second examination day; F1,47=4.31; P=.04), whereas the interaction effect was not statistically significant (F1,47=0.06; P=.80). Results of the multiple linear regression controlling for individual differences between participants indicated a significantly greater decrease in craving (β=4.12; t36=2.34; P=.03) with the SALIENCE intervention. Participants with lower drinking in negative situations reduced their craving (β=.38; t36=3.01; P=.005) more than people with higher drinking in negative situations. The general effectiveness of SALIENCE training as an add-on therapy in reducing alcohol craving was not confirmed. Nevertheless, taking into account individual differences (gender, duration of dependence, stress, anxiety, and drinking behavior in different situations), it was shown that SALIENCE training resulted in a larger reduction in craving than without. Notably, individuals who rarely consume alcohol due to negative affect profited the most from SALIENCE training. In addition to the beneficial effect of SALIENCE training, these findings highlight the relevance of individualized therapy for AUD, adapted to personal circumstances such as drinking motivation. ClinicalTrials.gov NCT03765476; https://clinicaltrials.gov/show/NCT03765476.

Gender Differences in Anxiety and Depression before and after Alcohol Detoxification: Anxiety and Depression as Gender-Related Predictors of Relapse

Background/Aims: The aim of this prospective study was to estimate gender differences in anxiety, depression, and alcohol use severity among patients with alcohol use disorder (AUD) before and after detoxification program and within 12 months after discharge. Methods: AUD severity, state and trait anxiety, and depression were assessed in 187 patients entering an inpatient alcohol detoxification program. Follow-up assessments were performed at 6 and 12 months after discharge. A between- and within-subjects analyses explored gender differences. The predictive value of anxiety and depression for alcohol relapse was analyzed by logistic and linear regression in both genders. Results: Females had higher levels of anxiety and depression than males both at admission and after discharge. Trait anxiety and depression significantly increased 6 months after discharge in males and females respectively. Both state and trait anxiety levels at the 6-month follow-up predicted alcohol relapse at the 12-month follow-up in males. Conversely, in females, depression level at the 6-month follow-up was a predictor of relapse at the 12-month follow-up. Conclusions: In both genders, the psychopathological dimension that showed the most significant worsening at 6-month follow-up (i.e., anxiety in males and depression in females) was found to be a significant predictor of relapse at the 12-month follow-up.

Determinants of Blood Brain-Derived Neurotrophic Factor Blood Levels in Patients with Alcohol Use Disorder.

Blood brain-derived neurotrophic factor (BDNF) levels are influenced by both addiction and mood disorders, as well as somatic conditions, gender, and genetic polymorphisms, leading to widely varying results. Depressive symptoms and episodes are frequently observed in patients with alcohol use disorder, and vary widely over time, making it a challenge to determine which aspects are specifically involved in variations of serum BDNF levels in this population. We assessed 227 patients with alcohol dependence involved in a detoxification program, at baseline and after a follow-up of 6months, for the Alcohol Use Disorders Identification Test score, the length of alcohol dependence, and the number of past detoxification programs. The Beck Depression Inventory and information on current tobacco and alcohol use, suicidal ideation, body mass index, age, gender, and psychotropic treatments were also collected. Serum BDNF (ELISA) and 2 genetic polymorphisms of the BDNF gene (Val33Met and rs962369) were analyzed. The presence of the Metallele, 2 markers of the history of alcohol dependence (gamma glutamyl transferase and the number of past treatments in detoxification programs), and the presence of a depressive episode (but not depressive score) were significantly associated with the 2 blood levels of BDNF at baseline and after 6months. After controlling for baseline BDNF levels, the presence of the Metallele and an ongoing depressive episode were the only variables associated with changes in BNDF levels after 6months. Low serum BDNF levels are associated with characteristics related to alcohol consumption and mood disorders, and variants of the BDNF gene in alcohol use disorder patients. The factors that most strongly influenced changes in serum BDNF levels following treatment in an alcohol detoxification program were variants of the BDNF gene and ongoing depression.

Differential cytokine levels between early withdrawal and remission states in patients with alcohol dependence

Alcohol dependence (AD) leads to altered innate and adaptive immune responses, and frequently co-occurs with inflammation. Therefore, inflammatory cytokines potentially play a crucial role in the development of alcohol-related illnesses. This study evaluated changes in plasma cytokine concentrations, liver function, cravings, depression severity, and cognitive function in male patients with AD, during the course of an alcohol-detoxification program. A total of 78 male patients with AD were recruited for a conservative detoxification program; and cytokine levels, depressive score, and cognitive impairment applying the Trail Making Test (TMT) were evaluated during early withdrawal (baseline) and after 4 weeks of abstinence from alcohol. Healthy volunteers (86 males) were also recruited as controls. Inflammatory cytokine expression in all participants was assessed by multiplex magnetic bead assay. AD patients during early withdrawal demonstrated higher cytokine levels than the healthy controls (P≤0.001 for all cytokines). However, the levels of cytokine expression were significantly lower after 4 weeks of abstinence from alcohol (P≤0.001, except for IL-1β and IL-5). Higher liver function marker levels, depressive severity, and TMT times were observed in patients at the beginning of the detoxification program than in healthy controls. Fortunately, these functions significantly ameliorated after 4 weeks of abstinence. (P≤0.001). Levels of circulating cytokines, liver function, and cognitive function may markers of alcohol use disorder.

Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences

BackgroundEthyl glucuronide (EtG) is a minor alcohol metabolite that accumulates in hair and is proposed as a stable marker for the detection of chronic and excessive alcohol consumption above a cut-off level of 30pg/mg hair. A correlation between drinking behavior and EtG hair concentrations is observed, but large variability exists. AimsTo investigate the correlation between alcohol consumption and hair EtG concentrations in alcohol dependent patients, and the effect of gender differences as a factor for the variability on this correlation. MethodsEtG was measured by gas chromatography coupled to mass spectrometry in the hairs (first 3cm) of 36 alcohol dependent patients (25 males/11 females) starting and alcohol detoxification program. Factors that possibly influence EtG content in hair (except age and gender) were excluded. Detailed retrospective alcohol consumption was obtained over the last 3 months using the Timeline Follow Back interview. ResultsMedian total alcohol consumption over 3 months was 13,050g pure alcohol (range 60–650g/day). Hair EtG concentrations varied between 32 and 662pg/mg. There was a statistically significant linear and positive correlation between hair EtG and amounts of alcohol consumed (Pearson r=0.83; p<0.001), in both males (Pearson r=0.83; p<0.001) and females (Pearson r=0.76; p=0.007). ConclusionsThere is a linear correlation, with no significant effect of gender, between hair EtG concentrations and amounts of alcohol consumed in alcohol-dependent individuals. Analysis of EtG in hair can be applied to estimate retrospective alcohol consumption in both male and female alcohol dependent subjects using the same cut-off.

O14: Alcohol consumption vs. hair EtG concentration in alcohol dependent individuals: Role of gender differences

Introduction Ethyl glucuronide (EtG), a minor alcohol metabolite, accumulates in hair and is proposed as a stable marker for the detection of excessive alcohol consumption above a cut-off level of 30 pg/mg hair. A correlation between drinking behavior and EtG hair concentrations is observed, but variability exists, which could partially be explained by gender differences. Aims To investigate (1) the correlation between alcohol consumption and hair EtG in alcohol dependent patients, and (2) the effect of gender differences on this correlation. Methods The first 0–3 cm hair segments were analyzed using gas chromatography mass spectrometry (GC-MS) in negative ion chemical ionization (NICI) mode. Detailed retrospective alcohol consumption was obtained on a day per day basis over the last 3 months using the Timeline Follow Back Interview in alcohol dependent individuals starting an alcohol detoxification program. Results Thirty-six Caucasian alcohol dependent individuals (25 males/11 females; mean age 45 ± 8 years; mean BMI 25 ± 6) participated. Median alcohol consumption over the last three months (90 days) was 13050 g alcohol (range 65 – 650 g alcohol/ day). Hair EtG concentrations varied between 32 pg/mg hair and 662 pg/mg hair. There was a good linear and positive correlation between hair EtG and the amounts of alcohol consumed (Pearson r = 0.83; p r = 0.82; p r = 0.78; p = 0.005). Conclusions Our data confirm the good linear correlation between hair EtG and amounts of alcohol consumed, extending findings to alcohol dependent individuals. Additionally, we show that gender differences do not play a crucial role in the interpretation of hair EtG values for evaluating the amounts of alcohol consumed. As a result, no separate cut-off values are necessary for male and female alcohol abusers. These findings should be replicated in recreational alcohol consumers to assess possible gender differences in the interpretation of lower hair EtG values.

Alcohol-dependent patients receiving specialised outpatient care: an overview of gender issues

OBJECTIVE: The objective of the present study, with focus on gender, was aimed at evaluating alcohol-dependent individual in terms of socio-demographic variables related to alcohol consumption and therapeutic interventions. METHODS: This is a retrospective cross-sectional study of 1,051 patients (833 men and 218 women), with diagnosis of alcohol dependence syndrome, according to ICD-10 criteria, who had sought treatment for the first time at a specialised health centre between 2000 and 2006. RESULTS: The results showed that women, compared to men, are more likely to be unemployed and without partner, in addition to having higher educational level, latter age of alcohol initiation, needing less outpatient alcohol detoxification program, consuming more fermented beverage, presenting less psychiatric comorbidities, and using less coadjutant medications during treatment. CONCLUSION: We can state that some peculiarities exist permeating both gender and alcohol consumption. A further focus on the characteristics of each population is needed to facilitate the adequate use of therapeutic interventions according to gender specificities.

A Seizure Attributed to Ofloxacine in a Woman Undergoing Detoxification for Alcohol Dependence

Objective. To report one case of seizure following administration of ofloxacin. Case Summary. A 38-year-old woman with alcohol dependence but no prior history of seizure disorder admitted in our inpatient alcohol detoxification program was prescribed ofloxacin four days after admission for a lower urinary tract infection. She was currently prescribed diazepam 30 mg per day. This treatment was continued without modification following admission. Forty eight hours after starting ofloxacin and after receiving five doses of oral ofloxacin, the patient experienced a seizure. Ofloxacin treatment was stopped and no further seizures occurred. Neurological examination of the patient, laboratory tests, computerized tomography with contrast enhancement and electroencephalography did not detect any abnormalities. Up to the last consultation, six months after admission, the patient has reported no recurrence of the seizure. Discussion. Quinolone antibiotics vary in their ability to induce seizures, with ofloxacin having one of the least potentials. In the present case, the seizure could be attributed in all probability to taking ofloxacin; since she had no previous history of seizures, she did not present an alcohol withdrawal syndrome, benzodiazepine treatment was not modified, the seizure occurred 48 h after taking ofloxacin, but seven days after stopping drinking, no alternative aetiologies for the seizure could be identified and no seizure recurrence was reported over the following seven months. Of reported cases of seizures in patients treated with fluoroquinolones, none concerned patients with alcohol dependence or patients treated with benzodiazepines. Conclusions. The present case alerts us to the possibility that seizures may occur in alcohol dependent patients treated with benzodiazepines who concomitantly prescribed a fluoroquinolone. These widely-used antibiotics should thus be prescribed with caution to patients undergoing detoxification for alcohol dependence, particularly if they are also taking benzodiazepines, irrespective of whether they have a previous history of seizures or not.

Varenicline, Appetite, and Weight Reduction

Varenicline, Appetite, and Weight Reduction

Varenicline, Appetite, and Weight Reduction

was normal (2.3 ng/ml), whereas serum prolactin level was suppressed to 1.3 ng/ml. His pathological hypersexuality completely disappeared 2 weeks after discontinuation of bromocriptine. After 4 weeks, pramipexole (0.125 mg b.i.d.), another dopamine receptor agonist, was added instead of bromocriptine since his motor performance deteriorated. After 1 week of pramipexole, all the hypersexual symptoms reemerged. At this point, his serum prolactin level was 2.2 ng/ml. His pathological hypersexuality completely disappeared again just by discontinuing pramipexole. Then we titrated madopar up to 125 mg t.i.d. instead of adding other dopamine receptor agonist. After 3 weeks, his motor performance improved with partial reemergence of hypersexual symptoms (penile erection, facial flushing, sexually suggestive remarks, touching). However, the severity of the reemerged symptoms was much more tolerable than those induced by dopamine receptor agonist. At this point, his serum prolactin level was not suppressed (13.3 ng/ml).

Rauchreduktion bei Alkoholkranken im Rahmen einer stationären Alkohol-Entzugsbehandlung

Health care professionals tend to advise alcohol dependent patients to quit tobacco consumption only after longer periods of alcohol abstinence. This recommendation reflects concerns that smoking intervention programs may adversely interfere with the outcome of ongoing alcohol detoxification and rehabilitation treatment. However, the issue of appropriate time windows for initiating changes of smoking behaviour in alcoholic patients is still in need of empirical evaluation. Thus the aim of the present study is to investigate whether alcohol dependent smokers may be able to reduce cigarette consumption very early during alcohol detoxification and rehabilitation treatment. We performed a non-randomized controlled clinical pilot trial with 56 female and male alcohol dependent smokers in an inpatient setting providing a 3-weeks alcohol detoxification program. 28 individuals received a smoking reduction program consisting of a 6-sessions approach in a group format following behavioural principles. For the control group of 28 individuals the program was not available. Tobacco consumption was assessed daily by staff members. Alcohol dependent patients participating in the smoking reduction program reduced their daily cigarette consumption rates significantly, whereas the control group showed a tendency to increase tobacco consumption. According to the tentative findings of this pilot study early smoking interventions already during alcohol detoxification appear to be a feasible approach.

Mirtazapine Improves Alcohol Detoxification

The objective of the present study was to determine whether a combined psychotherapeutic-psychopharmacological (with mirtazapine) treatment of collateral anxiety and depressive symptomatology during the post-withdrawal phase of alcoholism facilitates the process of alcohol detoxification, which is a decisive stage in the treatment of alcohol-dependent individuals. For that purpose, the rate of remission of anxiety and depressive symptoms over a 4-week detoxification period was evaluated between two groups: the first group followed a standard detoxification protocol (n = 33) and the second group was assigned to mirtazapine in addition to standard treatment (n= 35). A marked reduction of anxiety and depressive symptoms was demonstrated in both groups. However, patients on mirtazapine improved more and at a faster rate compared to controls. Thus, mirtazapine, used adjunctively to short-term psychotherapy, may help the detoxification process by minimizing physical and subjective discomfort. Consequently, it may improve patient compliance in alcohol detoxification programs and facilitate the initial phase treatment of alcohol abuse dependence.

The antinociceptive effect of trazodone in mice is mediated through both μ-opioid and serotonergic mechanisms

The antinociceptive effects of trazodone (a triazolopyridine derivative with antidepressant activity) and its interaction with various opioid, noradrenaline and serotonin receptor subtypes were evaluated. Mice were tested with a hotplate analgesia meter. Trazodone induced a dose-dependent antinociceptive effect following i.p. administration. The ED 50 for mice in the hotplate assay for trazodone was 24.8 mg/kg (9.8; 67.4; 95% CL). The effect of opioid, adrenergic and serotonergic receptor antagonists was examined as to their ability to block trazodone antinociception. Trazodone-induced antinociception was significantly inhibited by naloxone, β-FNA and naloxonazine, but not by nor-BNI or naltrindole, implying involvement of μ1- and μ2-opioid mechanisms. When adrenergic and serotonergic antagonists were used, metergoline ( p<0.05) but not phentolamine or yohimbine, decreased antinociception elicited by trazodone, implying a clear 5-HT mechanism of antinociception. When trazodone was administered together with various agonists of the opioid receptor subtypes, it significantly potentiated antinociception mediated by μ1- and μ2- opioid receptor subtypes. Summing up these results, we conclude that the antinociceptive effect of trazodone is mainly influenced by the μ1- +μ2-opioid receptor subtype combined with the serotonergic receptor. These results explain the diffuse clinical use of trazodone in the management of some pain syndromes, and in opioid- and alcohol-detoxification programs, but raise questions regarding a possible ‘indirect’ opioid-dependence induced by trazodone itself.

The Role of the Psychiatric Clinical Nurses Specialist in Primary Mental Health Alcohol Detoxification Programs

(1999). The Role of the Psychiatric Clinical Nurses Specialist in Primary Mental Health Alcohol Detoxification Programs. Journal of Addictions Nursing: Vol. 11, No. 1, pp. 35-36.

Demonstration of a mixed social/medical model detoxification program for homeless alcohol abusers

Typically, insurance carriers and the federal government (through Medicare and Medicaid) have paid for alcohol detoxification only in hospital settings. This approach, known as the medical or the clinical model, controls detoxification almost exclusively through medication and with medically trained professional staff (DenHartog, 1982). Yet the far less expensive, already widespread for alcohol detoxification may be a viable alternative. Since the early 1970s, studies have documented the safety and efficiency with which most patients can undergo alcohol withdrawal without the use of medications (Whitfield, 1978). Social detoxification also has been demonstrated to be much less costly than medical detoxification (Shaw and Borkman, 1990). Non-medical alcohol detoxification programs have become accepted in the western U.S., especially in California (Sadd and Young, 1986). In 1986, about one-third of persons using detoxification services for alcohol withdrawal received them in residential programs labeled social model programs (Sadd and Young, 1986). However, there have been no published studies of such detoxification programs specifically designed for homeless persons with alcohol-related disorders. The has been described as viewing alcoholism as correctable through behavioral change (Shaw and Borkman, 1990). Distinctions between staff and participants are minimized, and shared responsibility is maximized (Shaw, 1990). There is ample use of reassurance, orientation to the here and now, frequent monitoring of signs and symptoms, and general supportive care (Wartenberg et al., 1990). In practice, most detoxification programs in operation today, such as the one described in the present report, are mixedmodel programs, combining elements of both and medical models. For example, programs may require patients to undergo a medical examination before they can be admitted. The present paper describes and evaluates a mixed social/ medical detoxification facility instituted in a metropolitan area as part of a national research demonstration program for homeless urban alcoholics (Conrad et al., 1993). We describe our experience regarding the safety of medicationfree detoxification of urban homeless alcoholics and discuss the implications of our findings with respect to the establishment of similar programs in other localities. Methods The medical approach treats patients almost exclusively through medication and uses medically trained professional staff (DenHartog, 1982). Treatment of alcohol withdrawal includes abstinence from alcohol, the use of benzodiazepines and/or other medications to treat withdrawal symptoms and vitamin supplements to improve nutritional status, medical surveillance, and treatment of co-morbid medical illnesses (Klerman, 1989). The model, on the other hand, proposes detoxifying in a non-medical setting, does not utilize medications for treating alcohol withdrawal symptoms, and uses medical services only if needed. Such programs are characterized by the following (Wright, 1990): 1. First-hand knowledge and experience are valued as much as knowledge gained through formal education. 2. The relationship between the individual and the program is emphasized. 3. Participants not only receive help but also give it. 4. An AA framework is utilized. 5. Great importance is given to the program's positive, alcoholfree environment. 6. Alcoholism is seen as pertaining not just to the individual, but to his or her relationships as well. The Albuquerque project was one of 13 National Institute on Alcohol Abuse and Alcoholism (NIAAA)-funded demonstration programs for treating homeless alcohol abusers located in metropolitan areas throughout the U.S. (Conrad et al., 1993). Clients were recruited into the Housing and Alcohol Research Team Project (Project H&ART) by staff of a day shelter for homeless persons, by outreach or clinic staff of Albuquerque Health Care for the Homeless (HCH), and by other local agencies that provide services to homeless clients. …

Visuospatial information processing in intoxicated, recently detoxified, and long-term abstinent alcoholics.

Visuospatial information processing has been shown to be particularly sensitive to acute alcohol intoxication and chronic alcohol abuse. This study extended previous studies by determining if recently detoxified alcoholics recover visuospatial processing after long-term abstinence. If visuospatial function returns to the level displayed by intoxicated alcoholics, then the deficit displayed by recently detoxified alcoholics may represent a short-term adjustment due to the removal of alcohol. However, if the visuospatial deficit remains in long-term abstinent alcoholics, then the superior processing of the intoxicated alcoholic could reflect a normalization of processing produced by alcohol ingestion. Twenty active and 40 recovering alcoholic male volunteers participated. The active alcoholics were seen intoxicated at the time of admission into a 21-day alcohol detoxification and treatment program. Of the recovering alcoholics, 20 were designated as recently detoxified alcoholics and had just completed the same treatment program. The remaining 20 long-term abstinent alcoholics had completed alcohol treatment several years previously with no relapse. Participants selected were similar in general demographic status, alcohol treatment histories, and psychomotor ability. Two main effects emerged from the results: First, the intoxicated alcoholics displayed visuospatial learning that was superior to the learning of alcoholics recently detoxified or abstinent for several years; a second principal finding was nearly identical visuospatial learning displayed by recently detoxified and long-term abstinent alcoholics.

THE KINDLING HYPOTHESIS: FURTHER EVIDENCE FROM A U.S. NATIONAL STUDY OF ALCOHOLIC MEN&lt;xref ref-type="fn" rid="fn1"&gt;&lt;sup&gt;*&lt;/sup&gt;&lt;/xref&gt;

A sample of 6818 alcoholic men participating in a short in-patient detoxification episode was studied to examine the kindling effect of repeated prior alcohol withdrawals on occurrence of seizures or severe withdrawal problems observed during the hospitalization. Subjects studied were hospitalized in one of 172 U.S. Department of Veterans Affairs medical centers. Patients with seizures and withdrawal problems had more prior detoxifications and other alcohol-specific hospitalizations. They were also more likely to be later readmitted for an alcoholism diagnosis. Patients with withdrawal problems during the detoxification episode studied were more likely to have such problems again as well as seizures during the readmission; those with seizures during the index detoxification were more likely to have repeated seizures during the readmission. These results confirm the kindling effect in a large, multi-site patient sample and suggest that alcohol detoxification programs may need to consider anticonvulsant therapy in patients with many prior detoxifications or withdrawals.

Peripheral mechanical loading and the mechanism of the tremor of chronic alcoholism.

The tremor of chronic alcoholism, although clinically similar to essential tremor, has been considered a distinct syndrome. Its underlying mechanism was analyzed in five patients (none in the acute stages of alcohol withdrawal) hospitalized in an alcohol detoxification program. All five patients performed tracking tasks in which they pursued a linearly moving "target" light with a response light that they controlled by flexion-extension activity of the wrist. Stationary and dynamic targets were used with both isometric and unconstrained wrist mechanical interfaces. Frequency, torque, and displacement tremor characteristics were examined under varying inertial loading or isometric voluntary torque conditions. Two simultaneous tremor components were present in all patients: a prominent 4- to 7-Hz low-frequency peak and a smaller-amplitude 9.4- to 9.6-Hz high-frequency peak. As the inertia of the hand was augmented during unconstrained tasks, the low-frequency peak decreased, while the high-frequency peak was unaffected. As required voluntary effort was increased during isometric testing, the amplitude of the low-frequency peak increased. These findings suggest that the low-frequency peak represents the significant pathologic component of the tremor of chronic alcoholism and that it has a biomechanical reflex mechanism similar to that of the lower-amplitude normal physiologic tremor.

Erythrocyte aldehyde dehydrogenase: assay of a potential biochemical marker of alcohol abuse.

Erythrocyte aldehyde dehydrogenase (ALDH; EC 1.2.1.3) may be a new biochemical indicator of alcohol abuse. An improved assay for it is described and characterized. We found that expression of erythrocyte ALDH activity in terms of hemoglobin was valid, and preferable to expression in terms of erythrocyte volume. A normal reference interval was determined from results for 375 healthy subjects (236 men, 139 women). We compared these data with results for 109 men admitted to our alcohol detoxification program. The mean erythrocyte ALDH of the alcohol abusers was 30% lower than our mean value for men (p less than 0.001). Values did not change between the time the patient presented for admission and greater than 48 h later (when blood-ethanol concentration was zero). Other variables that affect erythrocyte ALDH activities--changes in pH, temperature, other assay conditions, and drug treatments such as disulfiram and nitrate anti-anginals--are discussed.

Lipoprotein cholesterol, vitamin A, and vitamin E in an alcoholic population.

Elevated alcohol consumption is associated with an increased risk of cancer. Reasons for this association are not well established but may relate to alterations in cholesterol, vitamin A (carotene and retinol), and vitamin E metabolism, since low levels of these factors have been linked to risk of cancer. Blood levels of cholesterol, carotene, retinol, and vitamin E were determined in 192 male alcoholics entering into an alcohol detoxification program. Compared to nonalcoholic populations, their cholesterol (187 mg/dl) and carotene (94 micrograms/dl) concentrations were markedly reduced at entrance; however, abstinence of 33 days returned both to normal levels. In contrast, the retinol and vitamin E levels were within the normal range at baseline and remained relatively stable throughout rehabilitation. Of particular interest was that the low density lipoprotein cholesterol was highly correlated with carotene (r = +0.40, whites, r = +0.54, blacks). The results suggest that alterations in the metabolism of cholesterol and carotene, due to alcohol intake, may partially account for the relationship of alcohol to increased cancer risk.