Alcohol Symptoms Research Articles

Evidence of linkage in subtypes of alcoholism.

We believed that subtyping alcoholism might be an efficient strategy for mapping susceptibility genes. Cluster analysis is one of the possible statistical techniques for such a purpose. We required that, ideally, the variables to be used in cluster analysis should be: 1) related to alcoholism, 2) related to the severity of alcoholism, and 3) familial, i.e., correlated within families. Only three variables met all three conditions. Those included age of onset of ALDX1, smoking, and TPQ-HA. A global score of symptoms of alcoholism was systematically introduced as one of the variables composing a subset for cluster analysis, although this score did not show any familial aggregation. Our strategy led to a strong evidence of linkage at D15S230 in only 20 families whose members are mainly characterized by heavy smoking.

Familial risk for alcoholism and hangover symptoms

Previous work suggests sons of alcoholics (SOAs) report greater hangover symptoms than do sons of nonalcoholics (SONAs) (Newlin & Pretorious, 1990; McCaul, Turkkan, Svilis, & Bigelow, 1991). This study sought to replicate this work and examine the relation between personality risk for alcoholism and hangover. Twenty SOAs and 20 SONAs completed the MacAndrew scale as an index of personality risk for alcoholism. They also completed the McCaul et al. (1991) and Newlin and Pretorious (1990) assessments of hangover after consuming a placebo in one session and alcohol (0.5 g/kg) in two subsequent consecutive sessions. The MacAndrew scale did not covary with hangover. Data revealed main effects for familial risk for both hangover questionnaires. SOAs reported significantly greater hangover symptoms than did SONAs. Individuals at elevated familial risk for alcoholism reportedly experienced more acute withdrawal and hangover, which might contribute to the development of problem drinking.

DIAGNOSIS AND MANAGEMENT OF ALCOHOL PROBLEMS

Approximately 14 million Americans suffer from alcohol abuse and dependen~e,’~ and drinking remains the most common cause of liver-related mortality in the United States. Forty-four percent of the 26,000 annual deaths from liver cirrhosis are attributed to alcohol use. Even this is likely to be an underestimate because certifying physicians may not be familiar with the decedent’s drinking history or may desire to protect the family from the stigma of a family member being an alcoholic.10 Alcoholic liver disease is also an important cause of morbidity. It has been estimated that between 15% and 30% of heavy drinkers develop advanced liver disease.I9 In 1990, cirrhosis was listed as a diagnosis on approximately 1% of discharges from nonfederal short-stay hospitals for those 15 years and older and was the principal diagnosis for 0.2% of the discharges. Underestimation of alcoholic liver disease on hospital discharge records may exceed that for death certificate^.^^ Because of the adverse effects of alcohol on the liver, alcoholdependent and alcohol-abusing patients commonly are seen in many hepatologists’ practices. Although findings on the physical examination and laboratory tests may provide clues, the diagnosis of alcoholism depends on the history provided by patients and their relatives. The two most commonly employed sets of criteria are the American Psychiatric Association‘s Diagnostic and Statistical Manual of Mental Disorders, ed 4 (DSM-IV)’ and in the World Health Organization’s International Classification of Diseases, 10th rev (ICD-10).36 Both are based on symptoms of alcohol dependence and abuse rather than specific thresholds of drinking frequency, quantity, or patterns. The term alcoholism has been dropped in favor of two distinct categoriesalcokol abuse and alcohol dependence. Alcoholic liver

Underemployment and alcohol misuse in the National Longitudinal Survey of Youth.

This study measured the impact of unemployment and underemployment on alcohol misuse. A panel of respondents from the National Longitudinal Survey of Youth was studied in 1984-85 and 1988-89. In each pair of years, the effect of employment change (e.g., becoming underemployed) on alcohol misuse was assessed controlling for misuse in the first year. Alcohol misuse was operationalized in two ways: elevated symptoms and heavy drinking. Three samples were analyzed: a core sample of 2,441 who were available in both pairs of years (approximately 65% male) and two extended samples that included everyone available in one pair of years but not the other (n = 4,183 in 1984-85 and n = 3,926 in 1988-89). The 1984-85 analyses revealed a significant association of adverse change in employment with both elevated alcohol symptoms and heavy drinking (the latter moderated by prior heavy drinking). The 1988-89 analyses found no relationship between adverse change in employment and heavy drinking in the core sample and no main effect of adverse change in employment on symptoms, but they did reveal interactions involving prior symptoms (core sample) and marital status (extended sample). Several explanations for these decreasing effects over time were considered including changes in measurement reliability, statistical power, economic environment and respondents' maturity. These results confirm previous findings that job loss can increase the risk of alcohol misuse, provide new evidence that two types of underemployment (involuntary part-time and poverty-level wage) can also increase this risk and suggest that these effects vary over time.

An evaluation of Cloninger's typology of alcohol abuse.

To evaluate Cloninger's typology of "alcoholism" using the Alcohol Symptom Scale (Gilligan et al., 1987). A sample of 300 Australian men and women with a life-time diagnosis of DSM-III-R alcohol abuse/dependence. The Alcohol Dependence Scale, the Short Alcoholism Screening Test, the Composite International Diagnostic Interview (CIDI) Substance Abuse Module, the Brief Symptom Inventory, the CIDI core modules, the Family History Questionnaire and the Sensation Seeking Scale. The Alcohol Symptom Scale classified only 18% of the sample into either type 1 or type 2. There was mixed support for the hypothesized differences between type 1 and type 2 problem drinkers in pattern of alcohol abuse, gender, personality characteristics and familial aggregation of alcohol abuse. More women than men were classified as type 1 (19% vs. 6%) but, contrary to expectations, similar numbers were classified as type 2 problem drinkers (7% vs. 4%). As predicted, type 2 problem drinkers had more symptoms of antisocial personality disorder, more social consequences of drinking and higher sensation-seeking scores than type 1 problem drinkers. Cloninger's typology failed to classify two types of problem drinkers and it did not predict gender differences in symptoms of alcohol dependence, family history or personality. Schuckit, Irwin & Mahler's (1990) hypothesis that type 2 problem drinkers are more likely to have primary ASPD was supported.

Effect of Fetal Alcohol Exposure on Adult Symptoms of Nicotine, Alcohol, and Drug Dependence

The objective of this study is to examine the effect of fetal alcohol exposure on later substance dependence using an adoption study method. One hundred ninety-seven adoptees were interviewed for substance abuse disorders, including nicotine, alcohol, and drug dependence. Twenty-one adoptees had mothers who drank during pregnancy. Adoptees with fetal alcohol exposure were compared with those without fetal alcohol exposure for symptoms of adult nicotine, alcohol, and drug dependence. Adoptee symptom counts for alcohol, drug, and nicotine dependence were higher for those exposed to alcohol in utero. The effect of fetal alcohol exposure remained after controlling for gender, biological parent alcohol dependence diagnosis, birth weight, gestational age and other environmental variables. Fetal alcohol exposure may produce increased risk for later nicotine, alcohol, and drug dependence. Possible effects of fetal alcohol exposure on development of adult substance use patterns needs attention in genetic studies of substance abuse.

Effect of Fetal Alcohol Exposure on Adult Symptoms of Nicotine, Alcohol, and Drug Dependence

Effect of Fetal Alcohol Exposure on Adult Symptoms of Nicotine, Alcohol, and Drug Dependence

Long-term reliability and validity of alcoholism diagnoses and symptoms in a large national telephone interview survey.

The long-term reliability and validity of telephone lay interview assessments of alcoholism were examined in the context of a large national community-based survey of over 8,000 male Vietnam era veterans. A subsample of 146 men was interviewed twice by telephone using the same structured interview an average of 15 months apart to evaluate the long-term reliability of alcoholism symptoms and diagnoses. In addition, a search of Department of Veterans Affairs patient treatment files of inpatient hospitalizations between 1970 and 1993 yielded a subsample of 89 interviewed men with a past discharge diagnosis of alcohol dependence. The test-retest reliability of alcohol abuse and alcohol dependence diagnoses was good, with kappa coefficients of 0.74 and 0.61, respectively. The reliability of individual alcoholism symptoms was fair to good, with kappas of 0.46 to 0.67. Ninety-six percent of individuals identified by Department of Veterans Affairs patient treatment files as having an alcohol dependence diagnosis were correctly diagnosed by the telephone interview. The results of the present study provide additional evidence for the long-term reliability and validity of lifetime alcoholism diagnoses, and suggest that the reliability and validity of telephone interview assessments of alcoholism are as good as that of an in-person interview. Telephone administration of structured psychiatric interviews appears to be an attractive alternative to in-person interviewing for gathering information about alcoholism and alcohol-related problems.

Long-Term Reliability and Validity of Alcoholism Diagnoses and Symptoms in a Large National Telephone Interview Survey

Long-Term Reliability and Validity of Alcoholism Diagnoses and Symptoms in a Large National Telephone Interview Survey

Modification of alcohol withdrawal by the A9 allele of the dopamine transporter gene.

Determinants of individual vulnerability to alcohol withdrawal symptoms are largely unknown. Because of the substantial role of monoaminergic transporters in limiting time and space effects of synaptic neurotransmission, the dopamine transporter gene (DAT1; locus symbol: SLC6A3) was studied as a candidate gene possibly related to symptoms of uncomplicated alcohol withdrawal. In 48 chronically intoxicated alcoholics (diagnosed according to ICD-10), withdrawal symptoms were examined and the presence of a variable-number tandem repeat in the 3' untranslated region of the DAT1 gene was determined. Withdrawal syndromes were more pronounced in the 22 patients carrying the nine-copy repeat than in the 26 patients without this variant. Multiple regression analysis revealed that 4% of the variance of withdrawal was explained by this genotype, whereas 16% was due to the amount of alcohol the patients reported having consumed in the month before detoxification. The A9 allele of the dopamine transporter gene is associated with more severe effects of alcohol withdrawal, possibly because of modifications of the brain's capacity to compensate for long-term effects of ethanol on cerebral function.

Reply to Lilienfeld: Why Alcoholism is a Disease

Lilenfeld's attack on my conceptual examination of the disease concept of alcoholism suffers from erroneous interpretations, fallacious reasoning, and a lack of fam iliarity with relevant alcoholism research. He offers an alternative nominalist interpretation of the disease concept of alcoholism based on a fuzzy boundary between disease and well ness. He fails to recognize that the basic issue between nominalist and realist accounts of a lower-order concept such as alcoholism is the presence or absence of general principles that may account for the observed signs and symptoms characterizing a specific disease entity, not fuzzy boundaries between higherorder categories. Extensive evidence (which Lilienfeld ignores) of biological bases for the pathognomic signs and symptoms of alcoholism, particularly loss of control, demonstrates that the disease concept of alcoholism refers to a disease entity that has a biological basis. It is not a “mental construct.”

Family Variables in Substance-Misusing Male Adolescents: The Importance of Maternal Disorder

Selected family variables, especially maternal behaviors, were studied as predictors of alcohol and drug misuse in severely disturbed adolescent boys from largely father-absent homes. The families of 50 male youths (mean age 15.8 years) in a residential center for alcohol and substance misuse were compared with the families of a community control group (mean age 16.3 years). Within-subject group comparisons also were made. Family structure, interactive processes, maternal and paternal alcohol and substance use, and criminality were assessed through direct interview and/or self-report. The families of alcohol- and substancemisusing boys were markedly disadvantaged or impaired on numerous family structure, process, and substance-misusing behavioral variables in comparison with community controls. Within the alcohol- and substance-misusing group itself, family process variables, maternal alcohol symptoms, and maternal criminality differentiated boys with more vs. less severe drug-dependence symptoms. Maternal alcohol problems and criminality were more important than family process variables. Paternal alcohol or substance misuse or criminality did not differentiate proband symptom severity. We concluded that maternal alcohol symptoms and criminality differentiate severity of drug dependence in severely disturbed, substance-misusing adolescent males from largely father-absent homes. Maternal substance misuse should be evaluated carefully in adolescent substance abuse treatment settings.

Substance abuse and homelessness: social selection or social adaptation?

Although substance abuse has for many years been documented as a serious problem among homeless populations, there is as yet no clear understanding of the nature of the relationship between substance abuse and homelessness. We evaluate alternative social selection and social adaptation models of this process. Using data from a random probability sample, the substance abuse and homeless experiences of 303 homeless people and people at risk of homelessness in Cook County, Illinois, were investigated. Proportional hazards regression models were employed to assess both social selection and social adaptation models. Drug but not alcohol abuse was associated with first homeless episode. Prior homeless experiences were found to be predictive of first symptoms of both alcohol and drug abuse. Other variables, including the availability of social and economic resources, were also associated with each of these outcomes. Models of both selection and adaptation processes are necessary to account for the association between homelessness and substance abuse, indicating that a multi-directional model is more appropriate. In addition findings suggest that, in recent years, drugs may have displaced alcohol as an important precursor of homelessness for many individuals.

Substance abuse and homelessness: social selection or social adaptation?

Although substance abuse has for many years been documented as a serious problem among homeless populations, there is as yet no clear understanding of the nature of the relationship between substance abuse and homelessness. We evaluate alternative social selection and social adaptation models of this process. Using data from a random probability sample, the substance abuse and homeless experiences of 303 homeless people and people at risk of homelessness in Cook County, Illinois, were investigated. Proportional hazards regression models were employed to assess both social selection and social adaptation models. Drug but not alcohol abuse was associated with first homeless episode. Prior homeless experiences were found to be predictive of first symptoms of both alcohol and drug abuse. Other variables, including the availability of social and economic resources, were also associated with each of these outcomes. Models of both selection and adaptation processes are necessary to account for the association between homelessness and substance abuse, indicating that a multi-directional model is more appropriate. In addition findings suggest that, in recent years, drugs may have displaced alcohol as an important precursor of homelessness for many individuals.

A Personality typology of smokers

The study of smoker's personality has a long and controversial history. Smokers tend to be more extroverted, tense, and anxious and have more antisocial characteristics than nonsmokers. However, some of the data is contradictory, and the strength of the relationship between personality and smoking is weak, probably because smokers are not a homogeneous group. To test this possibility, we used cluster analysis to identify types of smokers in a general population sample. Using Ward's heirarchical clustering algorithm, two clusters were identified from the scores on 10 personality measures in 346 smokers. The smaller cluster (28.8% of the smokers) was higher on neuroticism-related characteristics. The clusters were not different on extroversion-related measures, but people in the smaller cluster were more likely to have symptoms of alcoholism and to have more drinking-related problems (although they didn't actually drink more). They were also younger, had lower income, and were antisocial. The pattern of results suggests that there is a subpopulation of smokers who are more anxious than other smokers and who have strong antisocial tendencies.

A new pharmacological and physiological aspects of L-amino acids

Taste preferences are altered to reflect physiological needs and to support the recovery from nutritional disorders. The central mechanism both recognition for and adaptation to a deficient essential nutrient, i.e. L-lysine, have been unveiled that the feeding center in the hypothalamus is a primary center nucleus to induce a neuronal plasticity responding to dietary intake of deficient nutrient in the brain and peripherally, such as sense of taste and its concentration change. Changing preferences may act as an alarm, signaling protein malnutrition or metabolic adult disease, such as hypertension for saltiness, diabetes for sweetness, etc. In addition, our consumption of alcohol beverage is still increasing despite of one of candidate to induce the hepatic disorders, because pharmacological function of alcohol in the brain is welcome for people enjoying meal or being relieved from stresses. Preference for both L-alanine and L-glutamine was observed when alcoholic rats fell in the hepatic disorder. Acute alcohol loading induced suppression of motor activity and the hepatic dysfunction, but both amino acids did obviously protect these alcoholic symptoms. People should have to require a little bit more specific L-amino acid physiologically and pharmacologically depending upon different states among aging, lifestyle, metabolic diseases and various stresses.

The relationship between alcohol symptoms and consumption among older drinkers.

The present study assessed the relationship between current alcohol symptoms and consumption levels in a heterogeneous sample of older adults. The sample consisted of 443 participants over age 55 who reported drinking within the past year, including social drinkers, alcoholics in treatment, and alcoholics not in treatment. Symptoms for the past year were assessed using the Diagnostic interview Schedule (DIS-III-R) alcohol section, and subjects were subsequently assigned to two groups (symptom-free and symptomatic), depending on whether they experienced any DSM-III-R alcohol symptoms in the last year. For both men and women, average daily consumption and the frequency of heavy drinking contributed to whether participants had experienced any alcohol symptoms. The results indicate that the consumption levels of men and women differed only for symptomatic drinkers. The findings support recommendations that consumption limits for older adults should be lower than those recommended in the literature for younger adults. Furthermore, the results suggest that, in addition to limiting average daily consumption to no more than one drink per day, eliminating episodes of heavy drinking (consuming five or more drinks) could further reduce the risk of alcohol-related symptoms for older adults.

Estimating genetic and environmental effects of alcohol use and dependence from a national survey: a "quasi-adoption" study.

A growing number of studies have examined the role of genetic and environmental influences on various aspects of alcohol use and abuse for women and men. We briefly review relevant twin and adoption studies; overall, these studies suggest: (1) both genetic and environmental factors play a role in the development of various alcohol-related problems, (2) these factors affect both males and females, and (3) genetic factors may be more significant for males than females. This study is the first to address the question of genetic and environmental effects using data from a nationally representative probability sample, the National Health Interview Survey, 1988 Alcohol Supplement (NHIS-88A). We model the effects of biological family history of alcoholism (FHB) and environmental exposure to alcoholism during childhood (FHE) on (1) whether the respondent ever drank (current/former drinker), and, given that the respondent is a current drinker, (2) whether he or she developed DSM-III-R symptoms of alcohol dependence. Results suggest (1) main effects of FHB and FHE on both current/former drinker and alcohol dependence and (2) evidence of greater FHB effects among males. No other gender differences were detected, and no gene by environment interaction effects were found, either for all respondents or by gender. Results are consistent with previous research showing a greater effect of genetic risk factors among men than women, yet important effects of both environment and genetic factors for both sexes. The study design appears to provide an alternative to standard twin and adoption studies as a way to separate genetic and environmental risk factors, with both advantages and disadvantages compared to such designs. Some of these disadvantages might be addressed in questionnaire construction, but some are probably inherent.

Staging in the onset of DSM-IV alcohol symptoms in adolescents: survival/ hazard analyses.

This research examined staging in the time to onset of DSM-IV alcohol symptoms in adolescents. Consistent staging in the onset of symptoms provides important tests of the construct validity of diagnostic systems, and aids the development of early case identification strategies. The Structured Clinical Interview for the DSM (SCID), adapted to assess DSM-IV alcohol abuse and dependence symptoms, was used to determine time to symptom onset in 102 male and 97 female adolescent drinkers with and without alcohol use disorders. The sample provided a broad range of drinking practices and alcohol-related problems. Symptom onset patterns were examined using survival-hazard analyses. Survival and hazard data suggested three stages of alcohol problems distinguished by time to onset: heavy and heedless drinking with associated social and role obligation problems, psychological dependence, and withdrawal. This three-stage model fit both the male and female data, and described staging patterns in 70% of the subjects. The symptom onset model suggested a first stage of adolescent alcohol symptoms characterized by heavy and heedless drinking with associated interpersonal and role obligation problems. The data did not support the construct validity of DSM-IV alcohol abuse when applied to adolescents, and suggested staging among DSM-IV alcohol dependence symptoms. Implications for the diagnosis and early identification of adolescent alcohol problems are discussed.

Role of salivary and seric epidermal growth factor in pathogenesis of reflux esophagitis in chronic alcoholics and nondrinkers.

Our objective was to investigate the putative role of epidermal growth factor (EGF) in esophagitis pathogenesis in both nondrinkers and chronic alcoholics. We studied the EGF serum level, the EGF salivary concentration, and the esophageal EGF receptor expression in different groups of patients with esophagitis: nondrinkers with typical symptoms of gastroesophageal reflux (N = 12) and chronic alcoholics (N = 12), and in controls: chronic alcoholics without esophagitis (N = 16) and healthy nondrinkers (N = 12). All patients had an endoscopy with esophageal biopsies, 24-hr esophageal pH-metry, and esophageal manometry. EGF serum levels and EGF salivary concentrations were determined by radioimmunoassay. EGF receptor expression was determined by immunohistochemistry. Both the EGF serum level and the EGF salivary concentration remained constant, 328 +/- 21 pg/ml and 305 +/- 48 pg/ml, respectively, regardless of alcohol intake and the presence or absence of esophagitis. In addition, the presence of esophagitis did not affect the EGF receptor expression. These results suggest that seric and salivary EGF is not involved in the pathogenesis of reflux esophagitis in nondrinkers and in chronic alcoholics.