Advances in alcohol & substance abuse最新文献

Children from alcoholic homes frequently develop defenses similar to those found in children who have been physically abused. During adulthood these defenses lead to over-control of one's emotions and interpersonal interactions. Therapeutic implications involve management of grief reactions as illusions of the "good" parent are relinquished.

Minorities and women who are engaging in activities which place them at high risk for infection with HTLV-III are developing HTLV-III related illnesses including AIDS. In Northeastern urban areas the relatively large number of minorities who use intravenous drugs are responsible for producing large numbers of patients with AIDS (PWAs). Eighty percent of heterosexual male and female PWAs are Black or Hispanic. The development and implementation of effective prevention and education programs for these individuals rests upon an understanding of the less traditional approaches which may be necessary to reach these groups. The general public must be made aware of the hazards of HTLV-III related diseases and that the risk of infection is restricted to very well defined high risk groups. Minorities must be made to understand that they are at increased risk for HTLV-III related diseases only because of the high incidence of drug abuse in their community.

A brief overview of current interest in public policy related to alcohol problems is presented. Issues having special relevance to children of alcoholics are discussed, including: prevention (identification of subjects at risk, public recommendations about drinking and pregnancy, child abuse and neglect); treatment (reaching treatment professionals, parental consent, confidentiality, third-party coverage, early intervention), and research.

The weight of the evidence suggests a positive relationship between alcohol consumption and HDLc. The relationship showed a linear dose response relationship with HDLc over the range of alcohol consumption from non-drinkers to alcoholics. The effect appears to be reversible since changes in alcohol intake result in changes in HDLc. Preliminary evidence has suggested that in alcoholics, the effect may primarily be on the HDL-2 subfraction, while in the general population, it may primarily raise the HDL-3 subfraction. Limited research has shown a positive relationship between alcohol consumption and apo A-I levels. The exact underlying mechanisms for this relationship is not known. It remains to be determined if alcohol also exerts an effect on Coronary Heart Disease that is independent of its effect on HDLc. It is important to further evaluate these important leads both because it may provide a better understanding of the relationship between HDL, lipoprotein metabolism and coronary artery disease and the role of alcohol in the genesis of heart disease. A public health recommendation to increase alcohol consumption to reduce risk of heart attack is not indicated. Cessation of moderate alcohol consumption, however, should also not be part of the current recommendation to improve lipoprotein profiles.

Opiate use in humans is associated with a reduction in the number of circulating T-lymphocytes and in their ability to undergo transformation, probably resulting from opiate binding to T-cell antigens. (See Table 4). Patients also manifest a diffuse hyperglobulinemia, without change in circulating B-cell numbers. In vitro exposure of rodent and human lymphocytes to cannabinoids depresses their transformation, natural killer activity, and interferon production. Similar results occur with in vivo exposure of rodents, but data in man are mixed. Cannabinoids also inhibit primary and secondary antibody responses in rodents. Data regarding the effects of CNS stimulants are too scanty to allow comment. Barbiturate anesthesia in man and animals produces a short-lived depression of lymphocyte transformation, NK activity, and ADCC; no studies of the effects of chronic exposure have been performed. Amyl nitrite has not been proven to possess any immunosuppressive activity.

One-hundred and fifty eight cases of overdose were studied for alcohol use following their admission to an Accident and Emergency Department. Forty one percent of these patients had consumed alcohol and 29% had blood alcohol levels exceeding 17.4 mmol/l (80 mgm/100 ml). Higher blood-alcohol levels were associated with increasing age (40+). There was a tendency for higher blood-alcohol levels to be more associated with weekends, than weekdays, this association being stronger for males. More female overdoses were impaired on weekdays. Blood-alcohol levels of women arriving during "risk" time (2200-0659 hours) were significantly higher than those of women arriving at other times. These findings suggest that alcoholism assessment and treatment services need to be integrated with Accident and Emergency Services.