Prevention and Treatment of Alcohol Problems Research Opportunities (1990) / Chapter Skim
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13 The Health Consequences of Alcohol Abuse: Opportunities for Trearment Research
13 The Health Consequences of Alcohol Abuse: Opportunities for Trearment Research
Pages 267-288
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From page 267... ...
Because alcohol intoxication is associated with a wide variety of central nervous system effects including anxiolysis, psychomotor depression, problems of coordination and gait, cognitive impairment, and changes in mood and behavior related to environmental contexts, studies of amethystic agents will have to specify the particular effects of alcohol that are reversed or blocked by the drug. At the present time, certain calcium channel blockers and drugs that serve as partial inverse agonists at the benzodiazepine/GABA chloride channel complex offer promising opportunities for future research on amethystic agents.
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From page 268... ...
However, as with the beta blockers, neither anticonvulsant effects nor the ability to suppress other severe alcohol withdrawal symptoms has been demonstrated with alpha-2 agonists (Schuckit, 1987~. Calcium channel blockers have also been tried.
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From page 269... ...
Trainees had a probationary period of one month during which they worked with an experienced person. Special attention was given to alerting the therapists to clinical signs of severe alcohol withdrawal requiring evaluation by a physician and pharmacotherapy.
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From page 270... ...
The severity of the alcohol withdrawal syndrome may be accentuated in patients with dual diagnoses if they are not given ancillary psychotropic medication. Many homeless alcoholics suffer from schizophrenia or other major mental disorders (Koegel and Burnam, 1988)
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From page 271... ...
There may be optimum benzodiazepine blood levels that are associated with the marked suppression of withdrawal symptoms, but little information is currently available in this area. A recent report describes two representative cases from a total of ten who developed benzodiazepine-resistant delirium tremens and who responded to 4 to 6 mg of dexamethasone per day, given parenterally (Fischer et al., 1988~.
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From page 272... ...
Because haloperidol lowers the seizure threshold, it should be used in combination with a benzodiazepine, an anticonvulsant, or both. The following are opportunities for research on the treatment of alcohol withdrawal: · Research is needed to determine whether there are advantages to combining other drugs (e.g., anticonvulsants, beta blockers, calcium channel blockers, alpha-2 adrenergic agonists)
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From page 273... ...
They are noted on the electroencephalogram by decreased slow-wave sleep, frequent arousals, more rapid shifts of sleep stage, and increased frequency of REM sleep and REM disruptions. With continued heavy drinking, such as occurs in alcoholics, the sedative effects diminish, and increased amounts of alcohol are required to attain the original levels of sedation.
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From page 274... ...
Moreover, although the kinds of sleep problems that generally occur are highly suggestive of toxic effects secondary to excessive and prolonged alcohol consumption, the studies do not exclude the possibility that some of the observed sleep problems predate the alcoholism and are contributors to its onset and maintenance. Influence of Detoxification Procedures on Sleep Disorders There is little information available about the influence of detoxification procedures on sleep disturbances.
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From page 275... ...
· Studies could be performed using pharmacotherapies and behavior therapies for postdetoxification insomnia. Types of Impairments NERVOUS SYSTEM EPPE;CrS Cognitive Impairment in Alcoholism Lee two most prominent cognitive impairments in alcoholism are alcoholic amnestic disorder (Wernicke-Korsakoff syndrome)
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From page 276... ...
Treatment Programs and Cognitively Impaired Patients The overall structure of the treatment program may have an important interaction with cognitive function. Some work indicates that cognitively impaired alcoholics do best in a highly structured program, whereas nonimpaired patients do better in a less structured -276
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From page 277... ...
Very little information is available about how programs manage cognitively impaired alcoholics. For example, it is not known whether there are systematic differences between the ways cognitively impaired patients are managed in medically/psychiatrically oriented programs as opposed to freestanding programs.
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From page 278... ...
The following questions represent opportunities for research on cognitive retraining: · How effective are cognitive retraining techniques for cognitively impaired alcoholics? If these techniques are effective, how do they influence outcome?
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From page 279... ...
The ingestion of only 3 ounces of 80-proof whiskey caused atrial and ventricular tachyarrhythmias in 14 patients with a history of chronic alcohol consumption and palpitations or lightheadedness (Greenspon and Schaal, 1983~. It is likely that alcohol-induced arrhythmias are due to the direct toxic effects of alcohol on the myocardium and on the conduction system (Van Thiel and Gavaler, 1985~.
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From page 280... ...
, alcoholic liver disease is the most common cause of chronic illness and death from alcoholism. Approximately 8 to 15 percent of chronic abusers of alcohol develop liver cirrhosis, and most people who die from alcoholic liver disease have cirrhosis.
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From page 281... ...
Liver Transplantation Liver transplantation has become an accepted treatment for end-stage liver disease, and the number of centers that perform hepatic transplantation is increasing. The timing of surgery is critical because transplantation should be reserved for those who are otherwise likely to live less than a year.
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From page 282... ...
Persistence of a Subacute withdrawal syndromes following chronic ethanol intake. Drug Alcohol Depend.
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From page 283... ...
Psychological recoverability following chronic alcohol abuse.
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From page 284... ...
Ohshima et al. Circadian rhythm of REM sleep of chronic alcoholics during alcohol withdrawal.
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From page 285... ...
Calcium channel antagonists decrease the ethanol withdrawal syndrome.
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From page 286... ...
Israel et al. Effect of short-term therapy with propylthiouracil in patients with alcoholic liver disease.
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From page 287... ...
Altered sleep physiology in chronic alcoholics: Reversalw~th abstinence. Alcoholism Clin.
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