John A. Ewing

Alcohol Consumption While Viewing Alcoholic Beverage Advertising

Three hypotheses related to viewing alcoholic beverage advertising were examined: (1) alcohol advertising cues drinkings, (2) alcohol advertising prompts faster drinking, and (3) drinkers are more influenced by alcohol advertising when they are drinking. Alcoholic beverage advertisements did not increase either the quantity of liquor poured in mixed drinks or the rate of drinking. However, subjects with an alcoholic predrink who viewed alcohol advertisements second, drank more and reached higher blood alcohol concentrations than alcohol predrinkers who viewed the alcohol advertisements first. In some situations, distilled spirits advertisements may encourage continued drinking.

CAGE questionnaire allows doctors to avoid focusing on specifics of drinking

EDITORőPerhaps I should be flattered that my CAGE questionnaire is so popular that the BMJ printed it twice in 1997 though without proper attribution on both occasions. One of the articles by Ashworth and Gerada in the ABC of Mental Health uses …

ALCOHOL AS A EUPHORIANT DRUG: SEARCHING FOR A NEUROCHEMICAL BASIS*

Although alcohol is almost certainly the drug in longest use and although the ethanol molecule is a relatively simple one, the effects of alcohol upon living organisms are enormously complex. For the most complex organism, man, we know remarkably little about how alcohol produces its effects. Ethanol has long been known to be a general depressant of activity in all living cells.’ However, a naive observer of a cocktail party. as he noticed the increasing euphoria and general uproariousness of the participants, would find it difficult to accept that this is the behavior of depressed people, or at least that of people with depressed central nervous systems (CNS). Thus, it is not surprising that lay people often label alcohol as a “stimulant.” Of course, the standard medical explanation for this phenomenon is disinhibition: alcohol, like other CNS depressants, first affects. the phylogenetically newer parts of the brain. those concerned with self-evaluation and control, particularly in the social setting. By selectively depressing or inhibiting such centers, alcohol appears to promote the release of behavior that otherwise would be suppressed.? However, there is increasing interest in the possibility that alcohol can produce direct stimulation effects, including euphoria in man. A major issue that remains to be elucidated is the relative role of acetaldehyde, the first metabolic breakdown product of alcohol.3 This highly reactive substance appears to be significantly more toxic than alcohol itself.4 Evidence suggests that certain organisms may metabolize acetaldehyde less efficiently than others, thus possibly being subject to more of the effects of acetaldehyde, whatever they may be.s Also, although earlier studies found no difference in blood acetaldehyde levels in alcoholics and n o n a l c o h ~ l i c s , ~ ~ ~ Korsten et al. recently reported data that showed higher levels in alcoholics that did not merely represent more rapid metabolism.” Thus, this subject must be studied in more detail.

Emotional change associated with oral contraceptives in female psychiatric patients

Abstract The occurrence of psychosis in six women associated with their use of combined or sequential hormone oral contraceptive agents, five of whom had a previous psychiatric history, suggested the possibility that there was increased risk in oral contraceptive hormone use in psychiatric patients. This report concerns the data gathered from an interview study on 130 nonpsychiatric patients and 64 women who had undergone psychiatric care. Psychiatric patients more often reported change related to drug use. Depression, irritability, and lethargy occurred most often in both groups, and, while psychiatric patients reported more of these symptoms, the differences did not reach statistical significance. Psychiatric patients were significantly different with regard to feeling increased well-being, increased sexual desire, and capacity for orgasm as well as increased sensitivity to stopping drugs to permit the menses. While these changes would seem to reflect a beneficial effect on psychiatric patients, they seldom occurred without more undersiable symptoms. Psychiatric patients were different from both groups of nonpsychiatric patients with regard to reported irregularity of menses, anxiety during the menses, disability at the menses, and infrequency of sexual intercourse. The nonpsychiatric symptomatic group was significantly different from the asymptomatic control group on ratings of disability at the menses, lessened frequency of sexual intercourse, infrequent orgasm, and menstrual symptoms relieved by drug use. On the latter two factors, the psychiatric patients were also different from the asymptomatic group. The symptomatic nonpsychiatric group, therefore, seemed to fall intermediate in position between the asymptomatic group and the psychiatric group, suggesting the possibility that drug use had enhanced the expression of latent neurotic traits. The interaction of the drug induced pseudopregnant endocrine state with personality factors reported here seems very similar to that associated with pregnancy, where changes in catecholamine metabolism have recently been demonstrated. Similar clinical experiences have been reported with antihypertensive agents where psychologically predisposed individuals have suffered serious depressive illness with drug use. Our data suggest that further investigation of the effect of natural and synthetic hormonal substances on biogenic amine metabolism may be fruitful in assisting the understanding these reactions.

The Effect of Low Dose Intravenous Alcohol on Human Information Processing

A model of multiple-stage information processing predicts alcohol to have a selective effect on mechanisms involving central processing rather than sensory input. However, behavioral effects at low alcohol doses administered orally can be overshadowed by fluctuations in gastrointestinal absorption and metabolism rate. Paid volunteers, who therefore received intravenous doses of alcohol and a barbiturate, were tested on tasks varying in sensory discriminability and in central processing difficulty. The low drug doses did not affect errors of stimulus encoding but increased error rate in memory comparison tasks. These results confirmed the predictions based on the mutiple-stage model.

SOME RECENT ATTEMPTS TO INCULCATE CONTROLLED DRINKING IN PATIENTS RESISTANT TO ALCOHOLICS ANONYMOUS

In spite of the enormous success of the Alcoholics Anonymous movement, which has now extended over several decades, no one would claim that A.A. has all the answers to the problems of alcoholism. Initial resistance to joining A.A. is fairly commonly encountered by the professional when he explores with the patient his needs for a treatment program. Even if a patient attends a few meetings, this by no means insures his continued participation, and it would seem to be common knowledge that only continued devoted identification with the organization and its tenets offers real hope. Undoubtedly the prospect of a future of total absintence is frightening for some people and may lead to defection. In addition to those who only flirt with A.A. without ever seeking a permanent alliance, there are others who stick with the organization for some time but then drift away, often to reenter the drinking phase of their alcoholism. Before going further let me state unequivocally that I regard solid participation in A.A., along with a firm resolve of total abstinence, as the best and simplest solution for the average sufferer from alcoholism. However, it clearly is not a panacea for all and it behooves us to search for realistic alternatives. One such is commitment to total abstinence with the help of disulfirani (Antabusem) and other sources of support.’ However, professionals in the field have long known that an absolute demand of total abstinence can lead to loss of contact with the alcoholic, at least for the time being. Therefore, let us consider if a real alternative to total abstinence does exist and, if so, may be pursued. Jellinek2 applied his “disease concept” solely to those alcoholics who showed loss of control after many years of excessive drinking. H e and many others have contributed to the large body of professional opinion that says in effect that there is little or no hope of returning to controlled drinking once alcoholism has occurred. Fox? has stated that none of her 3.000 patients returned to moderate social drinking, since exposure to alcohol seemingly triggers the craving. Many previous authorities have similarly stated the need to accept a completely nonalcoholic future,‘ the impossibility of reverting to controlled drinking,5 the incapacity ever to handle alcohol as d o others,” and the fact has been cited that even a successful psychoanalysis did not permit the individual to become a moderate social drinker.’ However, in 1962 Davies” reported a few examples of apparently normal drinking in recovered alcohol addicts. The controversy that has raged ever since has a t least had the virtue of forcing some professionals to reexamine their established prejudices. Giving alcohol to alcoholics and even suggesting that alcoholics might be taught social drinking have been the inevitable consequences of such reevalua-

Norepinephrine, Alcohol, and Alcoholism

Publisher Summary This chapter discusses several effects of long-term alcohol use on noradrenergic systems in the brain. In the studies in which alcohol is given by intragastric intubation or in the drinking water or liquid diet in the home cage, little if any change in the endogenous level of norepinephrine (NE) is generally found. Inconsistent results are reported with respect to the synthesis of NE from tyrosine, its use as measured by its disappearance, or its so-called release as reflected by the accumulation of the metabolite vanillyl-mandelic acid. Complicating factors in the interpretation of these data involve—(1) technique of administering alcohol, that is, vapor inhalation versus drinking, (2) the consequent blood alcohol levels, (3) duration of exposure to alcohol from less than 3 weeks to up to 12 months, and (4) analytic procedures for amine determination in tissue. The majority of human studies on the relationship of NE and ethanol are performed with patient populations, but occasionally healthy subjects are used. The clinical picture of alcohol withdrawal in humans suggests a hyperadrenergic state.

The Role of Psychiatry in Medical Education

library budget was about

The Temporal and Volumetric Components of Stress Induced Drinking in Rats

25.000-say £10,000. The average number of librarians in attendance was three. Subscriptions to current periodicals varied from 140 to 456. No medical school would dare to fall below these medium figures in any respect. I think I could do no better here than quote the summary of the paper presented by Frank B. Rogers, the Director of the Armed Forces Medical Library in Washington, at the First World Conference on Medical Education:

Therapeutic Abortion—Quo Vadimus

Two experiments are presented which describe the temporal and volumetric changes in ethanol consumption with rats exposed to recurring schedules of inescapable random shock stress. The animals in Experiment I had an ethanol and water choice and the data demonstrated cumulative increases in voluntary ethanol consumption which occurred immediately after the shock schedule. The post shock changes occurred with both 5% and 10% V/V ethanol, were specific to the appearance of shock and were not reflected by measures of total daily ethanol intake. Experiment II exposed rats to extended 22 hr. stress sessions and each animal had four simultaneous fluid choices available: water, saccharin. 1% W/V, ethanol 5% V/V, and ethanol 10% V/V. Temporal intake patterns for both 5% and 10% ethanol showed pronounced peaks for the interval immediately following the shock schedule. A progressive shift of intake from 5% to 10% ethanol was also evidenced with increasing time under shock, while saccharin and water intake decreased. Blood ethanol levels during shock increased significantly from baseline for all animals and ranged from 30 to 162 mg/100 ml. The results are interpreted as a relationship between voluntary ethanol intake and escape from the consequences of stress.