Recognizing the alcohol patient

[Illustration by George Bates / www.georgebatesstudio.com]

Recognizing the alcoholic patient

Patients who struggle with alcohol can be difficult to spot. Better training, starting as early as medical school, can ensure these patients get needed treatment.

By Carolyne Krupa, amednews staff. Posted Oct. 15, 2012.

 

Some are easier to spot than others.

It may be as obvious as encountering an intoxicated patient in the emergency room. Or as subtle as noting a hypertensive patient who seems otherwise healthy but has mysteriously missed his or her last few appointments.

Alcoholism presents itself through a variety of signs, symptoms and severities, said Jeffrey Samet, MD, MPH, chief of general internal medicine at Boston Medical Center, professor of medicine at Boston University School of Medicine and professor of community health sciences at Boston University School of Public Health. He is president of the American Board of Addiction Medicine.

“They come in a whole spectrum of obviousness,” he said. “It’s not necessarily going to hit you over the head. It can be highly, highly challenging.”

Primary care physicians can feel ill-equipped to identify and care for such patients, but they play a crucial role in ensuring that individuals get treatment, said Raye Litten, PhD, associate director of the National Institute on Alcohol Abuse and Alcoholism’s Division of Treatment and Recovery Research. Most people who have problems with alcohol use don’t seek care from a specialist.

Most doctors are not sufficiently trained to identify or diagnose substance abuse.

 

“Usually, the primary care physician may be the only medical professional that people with alcohol problems will see, and maybe not for the alcohol, but for whatever other problems it is causing,” Litten said.

For that reason, it’s important that primary care physicians be able to identify those patients and get involved to help ensure they are treated to control their drinking, he said.

“In many cases, if the doctor doesn’t get involved, the patient dies,” said Nicholas Pace, MD, clinical associate professor at New York University Langone Medical Center.

A June report by the National Center on Addiction and Substance Abuse at Columbia University in New York found that most health professionals are not sufficiently trained to identify or diagnose substance abuse. They often are unfamiliar with the signs and symptoms of addiction, and they don’t know the best treatment options for patients. As a result, many of those who do provide treatment for addiction are not medical professionals and lack the knowledge and skills to provide the full range of available evidence-based treatments, the report said.

About one in seven Americans 12 and older (40.3 million people) meets the clinical criteria for substance abuse addiction. Seven percent of Americans have an addiction involving alcohol, either to alcohol alone or to alcohol and one or more other substances, said Susan E. Foster, vice president and director of the Columbia center’s Division of Policy Research and Analysis and principal investigator on the report. The high prevalence of the disease makes it something that primary care physicians encounter on a regular basis, she said.

“You can’t practice primary care without seeing patients with current or past alcohol problems every day,” said Patrick G. O’Connor, MD, MPH, professor of medicine and chief of general internal medicine at Yale School of Medicine in Connecticut.

Beyond full-blown alcoholism, many more people are involved in risky levels of drinking. The National Institute on Alcohol Abuse and Alcoholism defines risky drinking as more than four drinks on any single day and no more than 14 drinks per week for men. For women, such drinking means no more than three drinks on any single day and no more than seven drinks per week. An estimated 18 million Americans have an alcohol use disorder and 40 million are high-risk drinkers, Litten said.

Obstacles to care

Primary care physicians face several challenges in identifying patients who have problems with alcohol. Many patients may not be comfortable talking with doctors about drinking, and doctors have a limited time to meet with each patient, Dr. Samet said.

“With primary care, if you’re seeing a patient in a usual clinic, there are so many issues on the table that this one may be lost in the shuffle,” he said.

18 million Americans have an alcohol-use disorder.

 

Depending on their training, physicians may not recognize that a patient is addicted to alcohol, Dr. O’Connor said. Historically, medical schools have not provided much training on treating people with alcohol problems, and that lack of training often continues into graduate medical education training, he said.

One issue is that medical schools have a lot of competing subjects to cover in four years. Even so, educating students about alcoholism should be a priority, Dr. O’Connor said.

“There are knowledge barriers in how to identify them, as well as what to do with them when you have them,” he said. “Given that alcohol use disorders are so common in medical populations, it’s ridiculous to think that it’s ignored as much as it is.”

In caring for these patients, there are other barriers, such as the availability of services, the patients’ willingness to undergo treatment and insurance coverage for addiction services, O’Connor said.
Then there is the question of the doctor’s attitude. Despite research proving that alcohol addiction is a disease with serious physiological consequences, some physicians still blame the patient, said Dennis H. Novack, MD, professor of medicine and associate dean of medical education at Drexel University College of Medicine in Philadelphia.

“There is a lot of misunderstanding and bias, even among physicians,” Dr. Novack said. “Until physicians see alcoholism as a chronic disease for which there is no cure, you can’t help the patient.”
Instituting some type of standardized screening process can make a difference, Dr. Pace said. The Alcohol Use Disorders Identification Test can help physicians identify patients with alcohol issues. It involves asking patients questions about how much they drink, what they drink and when they drink.

40 million Americans are high-risk drinkers.

 

“Alcoholism is the big masquerader,” Dr. Pace said. “If the patient has several issues and a physician can’t figure out what’s really wrong, they should really think about alcohol and alcoholism. You have to keep in mind that you see the whole spectrum of the disease. It comes in all sizes, shapes and colors and really mimics so many other problems.”

Patients struggling with alcohol use may display a variety of symptoms, including indigestion, hypertension and liver problems, Dr. O’Connor said. Physicians should routinely screen patients for alcohol use, he said.

In talking with patients, physicians should make it clear that their discussions are confidential, Dr. O’Connor said. They also should discuss what could happen if the patient pursues treatment. Alcohol counseling can be brief, similar to discussions on other health issues such as diabetes and hypertension.

“If you don’t address those issues, they will make other medical issues worse,” Dr. O’Connor said.
Excessive alcohol use raises blood pressure and can contribute to a litany of medical problems, Dr. O’Connor said. Hypertension can lead to cardiac arrhythmia; problems with the gastrointestinal system, liver and pancreas; and neurological problems such as dementia.

The NIAAA provides resources for physicians and the public. Its guide for doctors recommends asking patients how many times in the past year they have had more than five drinks at a time. Asking that single question can help physicians identify up to 82% of people who have alcohol problems, Litten said.

It’s important that physicians not be reproachful or judgmental of patients, but express concern for their health and welfare, said David Bronson, MD, a general internist and president of the American College of Physicians. If doctors immediately ask a patient about drinking, the patient may feel attacked. It’s important to frame the question as a series of other general health questions that the doctor would ask of all patients.

“You have to make them feel comfortable about it,” Dr. Bronson said. “It should be a routine for all of your patients.”

Educating young doctors about alcohol

Some medical schools are working to make sure students are exposed to the issues of alcohol addiction early in their training. For example, first-year students at Drexel University College of Medicine are required to attend an Alcoholics Anonymous meeting. Two AA members also come to the school to talk with students about their experiences in small group sessions.

“We want our students to understand and see AA as a resource, but we also want our students to understand what people with this disease are going through,” Dr. Novack said. “They have gone through hell and back, and they have a lot that they can share that I think can help break some of the biases of our students.”

At the GME level, Dr. Pace has been leading a course for first-year internal medicine residents on alcoholism and substance abuse for about 10 years. The four-day course is offered once a month to residents at four New York hospitals.

As part of the course, AA members meet one on one with residents. They tell their stories, and residents present those to the class at the end of the course. Students also attend an AA meeting and work with trained actors to practice interviewing patients about their alcohol use. They also meet a physician who has struggled with substance abuse addiction, and they hear how it affected careers and personal lives, Dr. Pace said.

All internal medicine residents at Lenox Hill Hospital are required to take the course, said Robin Dibner, MD, director of the hospital’s internal medicine residency program and clinical associate professor at NYU School of Medicine.

“I just felt that there was nowhere in medical school that they were learning about this,” she said. “I think it should be a major part of curriculum for all residencies.”

Nicole Lapinel, MD, chief medical resident at Lenox Hill, said the program was eye-opening. Being able to talk one on one with an AA member and hear stories made a strong impression.

“You got to know this individual — when they first recognized that they had a problem and how they went about seeking treatment,” Dr. Lapinel said. “Sitting there listening to their very personal stories — as a physician you don’t normally get that perspective.”

The American Board of Addiction Medicine also is working to fill gaps in expertise about alcohol and substance abuse addictions. In 2011, the board launched its first residency programs in addiction medicine. There now are 10 programs around the country, Dr. Samet said.

Specialized training will help ensure that more patients who need help can get treatment, Dr. O’Connor said. “There is a huge dearth of specially trained physicians in this area.”

Weblink

National Institute on Alcohol Abuse and Alcoholism (www.niaaa.nih.gov/)
American Board of Addiction Medicine (www.abam.net/)
Alcoholics Anonymous (www.aa.org/)

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“Helping Patients Who Drink Too Much: A Clinician’s Guide,” National Institute on Alcohol Abuse and Alcoholism, Updated 2005 Edition (pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf)

Correction

This article originally incorrectly stated the title of Jeffrey Samet, MD, MPH. He is chief of general internal medicine at Boston Medical Center, professor of medicine at Boston University School of Medicine and professor of community health sciences at Boston University School of Public Health. In addition, the article gave an incorrect percentage of Americans who have an addiction involving alcohol. Seven percent have an addiction involving alcohol. American Medical News regrets the error.

Alcoholism Affects Men’s and Women’s Brains Differently

By Janice WoodAssociate News Editor
Reviewed by John M. Grohol, Psy.D. on August 11, 2012

New research has demonstrated that the effects on white matter brain volume from long-term alcohol abuse are different for men and women.

Researchers from Boston University School of Medicine (BUSM) and Veterans Affairs (VA) Boston Healthcare System also suggest that when they stop drinking, women recover their white matter brain volume more quickly than men.

Previous research has linked alcoholism with white matter reduction, according to the researchers, who explain that white matter forms the connections between neurons, allowing communication between different areas of the brain.

In this latest study, a research team, led by Susan Mosher Ruiz, Ph.D., a postdoctoral research scientist in the Laboratory for Neuropsychology at BUSM and research scientist at the VA Boston Healthcare System, and Marlene Oscar Berman, Ph.D., professor of psychiatry, neurology and anatomy and neurobiology at BUSM and research career scientist at the VA Boston Healthcare System, employed structural magnetic resonance imaging (MRI) to determine the effects of drinking history and gender on white matter volume.

They examined brain images from 42 abstinent alcoholic men and women who drank heavily for more than five years and 42 nonalcoholic men and women. The researchers found that a greater number of years of alcohol abuse was associated with smaller white matter volumes in the alcoholic men and women. In the men, the decrease was observed in the corpus callosum, while in women this effect was observed in cortical white matter regions.

“We believe that many of the cognitive and emotional deficits observed in people with chronic alcoholism, including memory problems and flat affect, are related to disconnections that result from a loss of white matter,” said Mosher Ruiz.

The researchers also found that the number of daily drinks had a strong impact on alcoholic women, with the volume loss 1.5 to 2 percent for each additional drink. Additionally, there was an 8 to 10 percent increase in the size of the brain ventricles, which are areas filled with cerebrospinal fluid (CSF) that play a protective role in the brain. When white matter dies, CSF produced in the ventricles fills the ventricular space.

The researchers also found that in men, white matter brain volume in the corpus callosum recovered at a rate of 1 percent per year for each year of abstinence. For people who abstained less than a year, the researchers found evidence of increased white matter volume and decreased ventricular volume in women, but not in men. However, for people in recovery for more than a year, those signs of recovery disappeared in women and became apparent in men.

“These findings preliminarily suggest that restoration and recovery of the brain’s white matter among alcoholics occurs later in abstinence for men than for women,” said Mosher Ruiz. “We hope that additional research in this area can help lead to improved treatment methods that include educating both alcoholic men and women about the harmful effects of excessive drinking and the potential for recovery with sustained abstinence.”

The research was published online in Alcoholism: Clinical and Experimental Research.
Source: Boston University Medical Center
Brain scan photo by shutterstock.

APA ReferenceWood, J. (2012). Alcoholism Affects Men’s and Women’s Brains Differently. Psych Central. Retrieved on August 22, 2012, from http://psychcentral.com/news/2012/08/11/alcoholism-affects-mens-and-womens-brains-differently/42963.html

 

Consumption of Alcohol/Energy Drinks Linked with Casual Risky Sex

CONSUMPTION OF ALCOHOL/ENERGY DRINKS LINKED WITH CASUAL RISKY SEX

ScienceDaily (July 25, 2012) — A new study from the University at Buffalo's Research Institute on Addictions (RIA) has found a link between the consumption of caffeinated energy drinks mixed with alcohol and casual -- often risky -- sex among college-age adults.

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According to the study's findings, college students who consumed alcohol mixed with energy drinks (AmEDs) were more likely to report having a casual partner and/or being intoxicated during their most recent sexual encounter.

The results seem to indicate that AmEDs may play a role in the "hook-up culture" that exists on many college campuses, says study author Kathleen E. Miller, senior research scientist at UB's RIA.
The problem is that casual or intoxicated sex can increase the risk of unwanted outcomes, like unintended pregnancies, sexually transmitted diseases, sexual assault and depression, says Miller. And previous research has linked energy drink consumption with other dangerous behaviors: drunken driving, binge drinking and fighting, for example.

"Mixing energy drinks with alcohol can lead to unintentional overdrinking, because the caffeine makes it harder to assess your own level of intoxication," says Miller.

"AmEDs have stronger priming effects than alcohol alone," she adds. "In other words, they increase the craving for another drink, so that you end up drinking more overall."

The good news: Miller's study found that consumption of AmEDs was not a significant predictor of unprotected sex. Drinkers were no less likely than nondrinkers to have used a condom during their most recent sexual encounter.

Regardless of their AmED use, participants in the study were more likely to use a condom during sex with a casual partner than during sex with a steady partner, consistent with previous research. A steady or committed partner is a less risky prospect than a casual partner whose sexual history is unknown, Miller notes, so using a condom may not feel as necessary.

To be published in the print edition of Journal of Caffeine Research and available online to subscribers of the journal, the study is part of a larger three-year research project by Miller, funded by the National Institute on Drug Abuse (NIDA).

The research included 648 participants (47.5 percent female) enrolled in introductory-level courses at a large public university. They ranged in age from 18 to 40 but mostly clustered at the lower end of the age spectrum. More than 60 percent were younger than 21.

According to the study's findings, nearly one in three sexually active students (29.3 percent) reported using AmEDs during the month prior to the survey.

At their most recent sexual encounter, 45.1 percent of the participants reported having a casual partner, 24.8 percent reported being intoxicated and 43.6 percent reported that they did not use a condom.

According to Miller, drinking Red Bull/vodkas or Jagerbombs doesn't necessarily lead people to get drunk and become intimate with strangers, but it does increase the odds of doing so. But she points out that these drinks are becoming increasingly popular with college-age adults and should be considered a possible risk factor for potentially health-compromising sexual behaviors.

The findings may provide a basis for educational campaigns or consumer safety legislation, such as warning labels that advise against mixing energy drinks with alcohol, Miller says.

Study: 40 million Americans ages 12 and older have addiction disease

Published on June 26, 2012 at 2:10 AM

Forty million Americans ages 12 and older have addiction involving nicotine, alcohol or other drugs, a disease affecting more Americans than heart conditions, diabetes or cancer according to a five-year national study released today by The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia). Another 80 million people are risky substance users - using tobacco, alcohol and other drugs in ways that threaten health and safety.

The report, Addiction Medicine: Closing the Gap between Science and Practice, reveals that while about 7 in 10 people with diseases like hypertension, major depression and diabetes receive treatment, only about 1 in 10 people who need treatment for addiction involving alcohol or other drugs receive it. Of those who do receive treatment, most do not receive anything that approximates evidence-based care.

The CASA Columbia report finds that addiction treatment is largely disconnected from mainstream medical practice. While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they rarely are employed. The report exposes the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of evidence-based services.

"This report shows that misperceptions about the disease of addiction are undermining medical care," said Drew Altman, Ph.D., President, The Henry J. Kaiser Family Foundation who chaired the report's National Advisory Commission. The report finds that while doctors routinely screen for a broad range of health problems like high blood pressure or high cholesterol, they rarely screen for risky substance use or signs of addiction and instead treat a long list of health problems that result, including accidents, unintended pregnancies, heart disease, cancers and many other costly conditions without examining the root cause.

This landmark report examines the science of addiction --a complex disease that involves changes in the structure and function of the brain--and the profound gap between what we know about the disease and how to prevent and treat it versus current health and medical practice.

Few Patients with Addiction Receive Quality Care

The CASA Columbia report found that while almost half of Americans say they would go to their health care providers if someone close needed help for addiction, less than six percent of all referrals to addiction treatment come from health professionals.

The report also found no clearly delineated, consistent and regulated national standards that stipulate who may provide addiction treatment in the U.S.; standards vary by state and by payer. Addiction treatment facilities and programs are not adequately regulated or held accountable for providing treatment consistent with medical standards and proven treatment practices.
Most providers of addiction treatment are addiction counselors who are not required to have any medical training. CASA Columbia's analysis of minimum state requirements found:

• 14 states do not require all addiction counselors to be licensed or certified;
• 6 states do not mandate any educational degree to become credentialed;
• 14 states require only a high school diploma or GED;
• 10 states require an associate's degree;
• 6 states require a bachelor's degree; and
s degree.

Physicians and other medical professionals who make up the smallest share of providers of addiction treatment receive little education in addiction science, prevention and treatment. In fact, CASA Columbia's report cites other research that found that of patients who had visited a general medical provider in the past year only 29 percent were even asked about alcohol or other drug use.
"Right now there are no accepted national standards for providers of addiction treatment," said Susan Foster, CASA Columbia's Vice President and Director of Policy Research and Analysis, who was the principal investigator for the report. "There simply is no other disease where appropriate medical treatment is not provided by the health care system and where patients instead must turn to a broad range of practitioners largely exempt from medical standards. Neglect by the medical profession has resulted in a separate and unrelated system of care that struggles to treat the disease without the resources or knowledge base to keep pace with science and medicine."

A Costly Disease

The CASA Columbia report reveals that addiction and risky use of tobacco, alcohol and other drugs constitute the largest preventable and most costly health problems facing the U.S. today, responsible for more than 20 percent of deaths in the U.S., causing or contributing to more than 70 other conditions requiring medical care and a wide range of costly social consequences and accounting for one-third of all hospital in-patient costs. Research suggests that effective health care interventions to prevent and treat addiction would significantly reduce these costs.
In 2010, only $28 billion was spent to treat the 40 million people with addiction. In comparison, the United States spent:

• $44 billion to treat diabetes which affects 26 million people;
• $87 billion to treat cancer which affects 19 million people;
• $107 billion to treat heart conditions which affect 27 million people.

"As our nation struggles to reduce skyrocketing health care costs, this report makes clear that there are few targets for cost savings that are as straightforward as preventing and treating risky substance use and addiction, " said Commission Chairman Altman.

Other Notable Findings

• Although addiction is often a chronic disease, treatment typically addresses it as an acute condition and does not include the necessary long term disease management.
• Public perceptions do not distinguish between risky substance use and the disease of addiction.
• Costs to federal, state and local governments amount to 11 percent of total spending; 95 cents of every dollar pay for the consequences and only 2 cents go to prevention and treatment.

Recommendations
The report offers a comprehensive set of recommendations to overhaul current intervention and treatment approaches and to bring practice in line with the scientific evidence and with the standard of care for other public health and medical conditions.
"It is time for health care practice to catch up with the science. Failure to do so causes untold human suffering and is a wasteful misuse of taxpayer dollars," noted Director Foster.
SOURCE The National Center on Addiction and Substance Abuse (CASA) at Columbia University

How Alcohol Can Damage Your Liver

How Alcohol Can Damage Your Liver


Drinking too much alcohol can have serious consequences for your health, especially your liver, which is involved with detoxification of the body after excessive alcohol intake.The controversy linked to alcohol intake has been raging for many years: on the one hand, alcohol when used in moderation, can help people to relax and has recently been found to lower the risk of mortality; on the other hand soaring statistics of alcoholism and all its attendant ills, particularly in a country such as South Africa, paint a scary picture of "demon drink".



Positive findings

A report published in the American Journal of Clinical Nutrition in 2011 by Akbaraly and his coworkers at the University College, and the Imperial College in London, as well as the University of Montpellier and other research organisations in France, showed that “Consumption of nuts and soy and moderate alcohol intake appeared to be the most important independent contributors to decreased mortality [death] risks”. The authors pointed out that moderate alcohol consumption is also part of the Mediterranean Diet, which is becoming increasingly popular worldwide to combat most diseases that plague populations with a Western dietary intake.

The most important factor that we need to keep in mind is the word "moderate" which was linked to alcohol intake in this study. A "moderate" alcohol intake is presently regarded as 1-2 drinks per day for men and 1 drink per day for women, and Not Every Day.

The dire consequences of excessive alcohol intake as practised by so many people throughout the world and also in South Africa, are listed below.

Dire consequences

Excessive alcohol intake has many dire social and medical consequences, including trauma, abuse, loss of income and a wide spectrum of disease conditions. For today, we will concentrate on those conditions which affect the liver. The liver is the one organ in the body that is most intimately involved with the detoxification of the body after excessive alcohol intake, and it is, therefore, the organ that often suffers the most damage.

Alcoholic liver disease

This is probably the most common manifestation of liver disease in many countries where alcohol is consumed in excessive quantities. A toxic byproduct of excessive alcohol intake, is acetaldehyde which causes damage to the structure and function of the mitochondria in human body cells, particularly in the liver ( Mahan et al, 2011).

Susceptibility

Some individuals and populations are more susceptible to alcoholic liver disease than others. The following factors have been identified as potential markers of susceptibility to alcoholic liver disease:

• Genetic variations or polymorphisms of the enzymes that metabolise alcohol in the body
• Gender - women are more vulnerable to alcoholic liver disease than men
• Simultaneous exposure to drugs that can harm the liver
• Infections with viruses that attack the liver
• Poor dietary status, which is often associated with high alcohol intakes (see below).

(Mahan et al, 2011)

Three stages

According to Mahan and her coauthors (2011), alcoholic liver disease progresses in three stages, namely hepatic steatosis or fatty liver, alcoholic hepatitis and alcoholic cirrhosis.

Each one of these stages is characterised by many and varied metabolic disturbances, such as:

Fat deposition in the cells of the liver in Stage 1 - this dire consequence of excess alcohol intake can be reversed provided the patient stops drinking.

The following symptoms characterised Alcoholic Hepatitis:

• Enlargement of the liver
• Increased liver enzyme levels
• Increase in a compound called bilirubin in the blood
• Anaemia
• Abdominal pain, loss of appetite, vomiting, weakness, diarrhoea, weight loss and/or fever

(Mahan et al, 2011)

Despite the severity of these symptoms, total abstinence and nutritional support can resolve Stage 2 symptoms and permit the patient to lead a normal life again, but without ever drinking alcohol again.

Once Stage 3 of alcoholic liver disease is reached, the prognosis becomes serious. Additional symptoms to those of Stage 2, such as bleeding from the digestive tract, encephalopathy (a reversible change in mental status when toxins are not filtered and removed properly by the liver), portal hypertension (increased blood pressure in veins that drain blood from the liver, because the blood flow through the liver is blocked), and ascites (accumulation of fluid, proteins and electrolytes such as sodium and potassium in the peritoneal cavity), are often present.

The prognosis of alcoholic liver disease after a patient has reached Stage 3 is to a great degree dependent on how much damage the liver has suffered, the type of nutritional and medical support the patient receives and total abstinence from all alcohol (Mahan et al, 2011).

Excessive alcohol Intake and malnutrition

In the above discussion, it was repeatedly mentioned that patients with alcoholic liver disease need nutritional support, which when coupled to total abstinence from alcohol may return even very sick patients to good health. The reason why nutritional support makes such a difference, is that most alcoholic suffer from extensive malnutrition. In most cases they are totally unaware of their malnourished state. According to Mahan and her coauthors (2011), the following nutritional deficiencies are associated with excessive alcohol intake:

• Too little or too much energy - alcohol often replaces food in the diets of even moderate drinkers which can either lead to weight loss or weight gain. In heavy drinker who are addicted to alcohol, alcohol replaces nutrient-rich food which leads to deficiencies.
• Poor protein absorption - because alcohol interferes with normal digestion and absorption, the liver is unable to absorb amino acids properly and can thus not produce all the proteins it, and the body require.
• Fat metabolism is impaired and patients tend to deposit triglycerides in liver cells thus exacerbating the fatty liver condition.
• Most alcoholic also develop insulin resistance and do not metabolise carbohydrates efficiently.
• Probably the most serious and dramatic nutritional insults suffered by alcoholics, are vitamin and mineral deficiencies. Thiamine or vitamin B1 deficiency is the most common vitamin deficiency in alcoholics and can cause so-called Wernicke encephalopathy. Severe vitamin A deficiency can also occur leading to night blindness. In addition, deficiencies of folic acid, vitamins B6, C, D, E and K are common. In regard to minerals, alcoholics may suffer from low calcium, magnesium, phosphate and zinc intakes.

(Mahan et al, 2011)

It is evident from the above that moderate intake of alcohol can probably lower the risk of mortality, but that the moment this moderate intake increases to excessive levels, alcohol literally becomes "poisonous" and can do our bodies, especially the liver, great harm.

If you have been diagnosed with any symptoms related to alcoholic liver disease, stop drinking alcohol immediately, follow the instructions of your physician and consult a registered dietician urgently. The dietician will help you redress your nutritional deficiencies and provide you with an individual diet prescription that is tailored to your specific condition, the severity of your symptoms and the amount of damage your liver has suffered.

Alcoholic liver disease is one of the many negative consequences of excessive alcohol intake, so if you suspect that your moderate drinking is getting out of control, get help fast before you do irreparable damage to your liver.

- (Dr IV van Heerden, DietDoc, June 2012)

(Photo of woman drinking too much alcohol from Shutterstock)

References:

(Akbaraly et al, 2011. Alternative Healthy Eating Index and mortality over 18 y follow-up: results from the Whitehall II cohort. American Journal of Clinical Nutrition, Vol 94(1):247-53; Mahan LK et al (2011). Krause’s Food & the Nutrition Care Process. Ed. 13. Elsevier, USA; Unilever.)

Any questions? Ask DietDoc

Read more:

Do you have a problem with alcohol or drugs?
Alcoholism
When is it too much?

Heroin and Other Opiates Use Rising in Colorado, Figures Show

HEROIN AND OTHER OPIATES USE RISING IN COLORADO, FIGURES SHOW

Federal and local data suggest an uptick in heroin use in Colorado, a troubling development for local drug enforcement agencies and treatment programs.

One new federal drug use survey, the Arrestee Drug Abuse Monitoring Annual Report, shows that street use of opiate drugs, including heroin and opiate-based prescription medicines such as oxycodone, has doubled between 2000 and 2011.

The report, released May 17 by the National Office of Drug Control Policy, tracks the blood test results of adult male arrestees in Denver and nine other U.S. cities. In Denver; Indianapolis; Sacramento, Calif.; and Minneapolis, the number of adult male arrestees testing positive for opiates, including heroin and prescription painkillers, rose from 3 percent to 4 percent in 2000 to 8 percent to 10 percent in 2011.

Most of the heroin in Denver comes from Mexican drug cartels selling black and brown heroin, said Tom Gorman, director of the Rocky Mountain High Intensity Drug Trafficking Area program.
Heroin use still lags behind methamphetamine, cocaine and marijuana, accounting for 3 percent of drug arrests in Colorado.

"It's out there," Gorman said. "It is increasing in our area. Heroin hasn't reached the level of other drugs yet, but pharmaceutical opiate abuse is skyrocketing. Those drugs are more expensive than heroin, and that moves people to go from opiates to heroin. It's the same kind of high, but cheaper."
New heroin users increasingly are under age 35, white non-Hispanics, and more likely to smoke heroin than inject it, said Bruce Mendelson, senior data consultant at the Denver Office of Drug Strategy.

Alcohol and marijuana still lead the list of the most-abused drugs in Denver, Mendelson said, followed by heroin. In 2010, heroin overdoses ranked third (behind marijuana and cocaine) in Denver metro emergency department visits related to illicit drug abuse.

During the first half of 2011, of Denver residents admitted for addiction treatment, nearly 18 percent were admitted for heroin and prescription opiate addiction treatment, surpassing methamphetamines, according to statistics from the Colorado Health Foundation and Denver Office of Drug Strategy. Heroin and opiate drugs have become the third-leading cause of deaths that are alcohol- or drug-related.

Data from drug-abuse-treatment programs also show an uptick in heroin use and a sharp rise in opiate pharmaceuticals, said Marc Condojani, associate director of community intervention programs at the state division of behavioral health.

"We had 1,676 heroin admissions in 2003, and then the numbers dipped for a few years, but then they went up again," Condojani said.

"In 2010, we had 1,755 treatment admissions for heroin. In the other-opiates category, we had 541 people admitted for treatment in 2003, and in 2010, there were 1,715. That's over a threefold increase. The alarming part, to me, is that people who are dependent on those prescription medications eventually look for alternatives. And that's usually heroin."
Claire Martin: 303-954-1477 or cmartin@denverpost.com


Read more: Heroin and other opiate use rising in Colorado, figures show - The Denver Post http://www.denverpost.com/news/ci_20823072/heroin-and-other-opiate-use-rising-colorado-figures#ixzz1xPQlY2b9
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Baby Boomers Getting into Sex, Drugs, and Alcohol

Baby Boomers Getting into Sex, Drugs, and Alcohol

Submitted by My Addiction on Jun 1, 2012

Perhaps it is the influence of coming of age in the 1960’s but according to the Senior Housing Newsa great deal of older adults are partaking in sex and are using drugs and alcohol as they coast into a new phase of life. A recent survey found the number of people 50 and older seeking treatment for addiction is rising drastically.

When it comes to sex, previous research has indicated that 80% of adults between the ages of 50-90 are sexually active. Between 2000 and 2009 the number of sexually transmitted infections in this age group has doubled.

Sex, drugs and rocking chairs
Aside from engaging sex, seniors are also consuming alcohol and using drugs. The Hanley Center, a drug and alcohol treatment center, predicts that without early intervention and treatment addiction levels will continue to increase which will lead to an addiction epidemic among older Americans.
For example, according to the Substance Abuse and Mental Health Services Administration, the number of older adults who reported illegal drug use within a year almost doubled between 2002 and 2007. In this study, 40% stated they didn’t begin to use drugs or alcohol until after age 48. Substances of choice included alcohol with (90%) and prescription drugs (49.5%). The survey also found the reasons this population used drugs or alcohol were depression, anxiety, financial stress and retirement concerns.

While this may be distressing news to some, the cannabis activist group Silver Tour is taking an active role is advocating the legalization of marijuana. Their rationale is that marijuana can help treat chronic pain and insomnia, both of which are common among older adults. While a 2009 report by the Substance Abuse and Mental Health Services Administration showed that in the 50-54 age range the number of people who use marijuana either recreationally or medicinally is 6.1% and less for people 65 and older one theory is that as the baby boomers age that statistic will increase significantly as the baby boomer generation is more tolerant of marijuana use.