Children of Alcoholics Helped by Treating the Alcoholic

Does individual treatment for alcoholic fathers benefit their children? A longitudinal assessment

Psychosocial adjustment in 125 children of alcoholics (COAs) was examined before and at 3 follow-ups in the 15 months after their fathers entered alcoholism treatment.

Before their fathers’ treatment, COAs exhibited greater overall and clinical-level symptomatology than children from the demographically matched comparison sample, but they improved significantly following their fathers’ treatment.

Children of stably remitted fathers were similar to their demographic counterparts from the comparison sample and had fewer adjustment problems than children of relapsed fathers, even after accounting for children’s baseline adjustment.

Thus, COAs’ adjustment improved when their fathers received treatment for alcoholism, and fathers’ recovery from alcoholism was associated with clinically significant reductions in child problems.

Andreas JB, O’Farrell TJ, Fals-Stewart W. Does individual treatment for alcoholic fathers benefit their children? A longitudinal assessment. J Consult Clin Psychol. 2006 Feb;74(1):191-8.

Prescription Drugs Causing More Deaths

Painkillers and Other Prescription Drugs Causing More Deaths and Injuries

A "substantially growing number of patients" are being injured or killed by the prescription drugs they are taking under doctors’ orders, according to a new report from the Institute for Safe Medication Practices.

Reuters reported Sept. 10 that researcher Thomas Moore and colleagues said that reports of such deaths and injuries have more than doubled between 1998 and 2005, largely due to problems with painkillers and immune-system boosters.

Drug-related deaths increased from 5,519 in 1998 to 15,107 in 2005. Overall reports rose from 34,966 to 89,842 during the same period — a rate four times greater than the growth in outpatient prescriptions.

"This growing toll of serious injury shows that the existing system is not adequately protecting patients and underscores the importance of recent reports urging far-reaching legislative, policy and institutional changes," they wrote.

The researchers based their conclusions on data reported by drug makers to the U.S. Food and Drug Administration. Congress is currently considering legislation that would increase such surveillance.

The research findings appear in the Archives of Internal Medicine.

Reference: Moore, TJ, Cohen, MR, Furberg, CD. (2007) Serious Adverse Drug Events Reported to the Food and Drug Administration, 1998-2005. Arch Intern Med., 167(16): 1752-1759.

A dangerous mix

Energy drinks and alcohol: A dangerous mix

Slick marketers appear to have found a lucrative gold mine peddling energy drinks to vulnerable teens and college students who are all too eager to believe their hype. "Tired is in your head. Wake up your brain and your body will follow," they tell the young people and other users who spend billions each year on these highly caffeinated-and potentially dangerous-drinks.

These products are packaged in sleek cans with edgy graphics designed specifically to appeal to young people. Names like "AMP Overdrive," "Burn," "Speed Freak," and "Wired," to name just a few, make no pretense about the intention to market these beverages to consumers looking for a liquid lift.

Some manufacturers are so bold as to lure people further by applying drug-related names to their beverages like "Cocaine." Although the Food and Drug Administration successfully halted the sales of the Cocaine drink in June, another product called "Blow"-a white powder that is mixed into beverages-quickly emerged to take its place.

In addition to high amounts of caffeine, which range from about 80 milligrams (the equivalent of a cup of coffee) to 200 milligrams, the energy drinks usually contain other stimulants such as ephedrine, guarana, and ginseng. Taurine, an amino acid that the body produces naturally, is also added, but according to the Substance Abuse and Mental Health Services Administration (SAMHSA), not much is known about how it works or how much is too much.

The main worry, however, is caffeine, which speeds up the central nervous system-the main processing center that controls the body’s organs and systems. Experts caution that caffeine is a drug-a stimulant upon which people can grow dependent and that can cause withdrawal symptoms like headaches, mood swings, and poor concentration when they attempt to stop using it. High levels of caffeine can dehydrate your body, speed up your heart, and raise your blood pressure, making energy drinks especially unsafe. It is important not to confuse energy drinks with sports drinks that are designed to help athletes rehydrate and replenish electrolytes and carbohydrates.

Of particular concern is the dangerous popularity of mixing energy drinks with alcohol. "The stimulation from a caffeine-heavy energy drink can make a person feel less intoxicated than he or she really is," warns SAMHSA. "As a result, the person may keep drinking or take a risk such as driving without realizing the danger. In addition, because caffeine dehydrates the body, alcohol becomes harder to absorb, which makes its toxic effects much more damaging to the body."

Fatigue is one way the body signals you’ve had enough to drink, so stimulants can fool you into thinking you aren’t drunk or not as intoxicated as you really are. But no matter how alert you feel, your blood alcohol concentration is the same.

Despite these risks, some beverage manufacturers saw a profitable opportunity in the practice of mixing energy drinks with alcohol and began producing flavored malt beverages that contain 12 percent alcohol by volume in addition to the ingredients of energy drinks. Here again, creative marketers came up with brands designed to entice young people. One called "Spykes" drew the attention and ire of a group of 29 attorneys general.

In a May letter to Spykes’ manufacturer, Anheuser-Busch, the AGs criticized the company for promoting what they termed a "youth-oriented starter drink" on their Web site by offering free ringtones and wallpaper downloads for computers that appeal to adolescents. Spykes attracted underage drinkers because of its fruit and chocolate flavors and its two-ounce cans designed to be mixed with beer and other drinks, or taken as a shot. Although they denied their product was intended for anyone under 21 years, Anheuser-Busch announced that it would discontinue production of Spykes just a week after the AG letter.

A report released in August by the Marin Institute said that the alcohol industry is irresponsibly marketing alcoholic energy drinks to youth. It calls upon the alcohol industry to cease selling these products and recommends that the federal government investigate potentially deceptive marketing aimed at youth.

For more on this topic, visit SAMHSA online at http://family.samhsa.gov/monitor/energydrinks.aspx.

Alive & Free is a health column that offers information to help prevent and address addiction and substance abuse problems. It is provided by Hazelden, a nonprofit agency based in Center City, Minn., that offers a wide range of information and services on addiction and recovery. For more resources check its Web site at www.hazelden.org

‘Binge drinking’ linked to chlamydia

‘Binge drinking’ linked to chlamydia in women

Alcohol has been shown to be a principal risk factor for chlamydia in young women in the UK. A study by Valerie McMunn and Woody Caan of Anglia Ruskin University of over 200 young women aged 16-25 found that three factors were associated with increased risk of chlamydia: alcohol comprised two of them. The two alcohol factors were the age of first drink and binge drinking. The non-alcohol factor was the number of lifetime sexual partners.

Chlamydia has become the most common sexually transmitted infection in UK women aged 16-25. Concerns about the long-term harm to women’s wellbeing, fertility and pregnancy and also about infant health have led the Department of Health to implement a screening programme for chlamydia. At the same time, alcohol consumption in adolescent girls has been rising and there has been, in particular, a growth in episodic heavy consumption – binge drinking – which has led, amongst other things, to a doubling in the number of intoxicated women attending accident and emergency departments.

The study, of women attending a family planning clinic in the East of England was also designed to elucidate the relationship between hazardous drinking and unsafe sex.

The mean age of the women in the sample was 19 years. Two particularly striking findings were the number of sexual partners reported by a high proportion of the women, and the amount of alcohol consumed per night.

The number of sexual partners ranged from 1 to 30, the average being 6.8. 20.2% of the women reported more than one sexual partner at the same time. Women being treated for chlamydia reported more lifetime sexual partners than those who had never been treated.

The number of sexual partners correlated with all the alcohol parameters, in particular the number of drinking days per week and the total amount consumed. Three quarters of the women reported a pattern of binge drinking, consuming 5 or more units on a ‘typical’ night out. However, levels of consumption on ‘heavy’ nights out were far higher, up to 50 units.

Women being treated for Chlamydia reportedly drank a median of 15 units on a ‘heavy’ night, compared to 12 units for those who had not been treated. Women being treated for chlamydia also reported beginning to drink on average 1.2 years earlier than those not being treated.

The authors suggest that the increased risk of Chlamydia associated with alcohol use may have been mediated by several factors including reduced condom use, sex with strangers and exposure to coercive sex.

The implication of the study for policymakers is that binge drinking is not an isolated phenomenon but occurs in relation to many other behaviours involving both individuals and social networks.

A challenge to the research community is to discover the links in early adolescence (before age 16) between onset of drinking, early sexual behaviour and exposure to sexually transmitted infections.

Alcohol Alert is published by The Institute of Alcohol Studies Issue 2, 2007. www.ias.org.uk

Psychiatrists are the least religious of all physicians

And religious physicians appear to be less willing to refer patients to them

A nationwide survey of the religious beliefs and practices of American physicians has found that the least religious of all medical specialties is psychiatry. Among psychiatrists who have a religion, more than twice as many are Jewish and far fewer are Protestant or Catholic, the two most common religions among physicians overall.

The study, published in the September 2007 issue of Psychiatric Services, also found that religious physicians, especially Protestants, are less likely to refer patients to psychiatrists, and more likely to send them to members of the clergy or to a religious counselor.

"Something about psychiatry, perhaps its historical ties to psychoanalysis and the anti-religious views of the early analysts such as Sigmund Freud, seems to dissuade religious medical students from choosing to specialize in this field," said study author Farr Curlin, MD, assistant professor of medicine at the University of Chicago. "It also seems to discourage religious physicians from referring their patients to psychiatrists."

"Previous surveys have documented the unusual religious profile of psychiatry," he said, "but this is the first study to suggest that that profile leads many physicians to look away from psychiatrists for help in responding to patients’ psychological and spiritual suffering."

"Because psychiatrists take care of patients struggling with emotional, personal and relational problems," Curlin said, "the gap between the religiousness of the average psychiatrist and her average patient may make it difficult for them to connect on a human level."

In 2003, to learn about the contribution of religious factors on physicians’ clinical practices, Curlin and colleagues surveyed 1,820 practicing physicians from all specialties, including an augmented number of psychiatrists; 1,144 (63%) physicians responded, including 100 psychiatrists.

The survey contained questions about medical specialties, religion, and measures of what the researchers called intrinsic religiosity-the extent to which individuals embrace their religion as the "master motive that guides and gives meaning to their life."

Although 61 percent of all American physicians were either Protestant (39%) or Catholic (22%), only 37 percent of psychiatrists were Protestant (27%) or Catholic (10%). Twenty-nine percent were Jewish, compared to 13 percent of all physicians. Seventeen percent of psychiatrists listed their religion as "none," compared to only 10 percent of all doctors.

Curlin’s survey also included this brief vignette, designed to present "ambiguous symptoms of psychological distress" as way measure the willingness of physicians to refer patients to psychiatrists.

"A patient presents to you with continued deep grieving two months after the death of his wife. If you were to refer the patient, to which of the following would you prefer to refer first" (a psychiatrist or psychologist, a clergy member or religious counselor, a health care chaplain, or other)."

Overall, 56 percent of physicians indicated they would refer such a patient to a psychiatrist or psychologist, 25 percent to a clergy member or other religious counselor, 7 percent to a health care chaplain and 12 percent to someone else.

Although Protestant physicians were only half as likely to send the patient to a psychiatrist, Jewish physicians were more likely to do so. Least likely were highly religious Protestants who attended church at least twice a month and looked to God for guidance "a great deal or quite a lot."

"Patients probably seek out, to some extent, physicians who share their views on life’s big questions," Curlin said. That may be especially true in psychiatry, where communication is so essential. The mismatch in religious beliefs between psychiatrists and patients may make it difficult for patients suffering from emotional or personal problems to find physicians who share their fundamental belief systems.

Dark Chocolate OK by Doctors

Surprising health benefits of dark chocolate promoted to healthcare professionals – alternate to antioxidants in alcohol.

Sydney, Australia – 30 August 2007- Doctors, dietitians and nutritionists are being promoted the health benefits of dark chocolate in the new Switch to Dark campaign.

A Switch To Dark campaign highlighting the health benefits of consuming small portions of dark chocolate has been launched in leading healthcare publications, which include the Australian Doctor and Medical Observer; the Dietitians Association of Australia as well as the "prescriber’s bible", MIMS.

Chocolate Couple

Emerging evidence suggests that dark chocolate is a surprisingly rich source of antioxidants which may contribute to some health benefits.

"The evidence is there, that dark chocolate is a good alternative to milk chocolate and is a source of some key antioxidants." said Professor Sandra Capra from the University of Newcastle "Anyone already on a healthy and balanced diet, should be able to indulge occasionally in one or two squares of dark chocolate and benefit from a few health benefits as well."

Reputable journals such as JAMA, BMJ and The Lancet have all published studies on the health benefits of dark chocolate. Cocoa is a rich source of antioxidant flavonoids, and studies have shown that dark chocolate contains a higher level of antioxidants than common foods such as red wine and tea (Ding et al., 2006).

"The Switch to Dark campaign is a breath of fresh air, showing us that we can all indulge a little in a food we love and still lead a healthy lifestyle," commented dietitian, Dr Joanna McMillan Price. "Chocolate should always be eaten in moderation but when the urge to indulge hits, dark chocolate is an excellent alternative to eating milk chocolate."

"At the heart of the Switch to Dark campaign, the message is that if we choose to indulge occasionally in chocolate, a small amount of dark chocolate is by far the wiser choice." says Penny Small, Nestle’s Corporate Nutritionist.

Nestle is a proud supporter of the Switch To Dark campaign. More information is available under the Switch to Dark website at www.switchtodark.com.au

Risky Partners and Domestic Violence

Risk indicators to identify intimate partner violence

Intimate partner violence against women is prevalent and is associated with poor health outcomes.

Understanding indicators of exposure to intimate partner violence can assist health care professionals to identify and respond to abused women. This study was undertaken to determine the strength of association between selected evidence-based risk indicators and exposure to intimate partner violence.

In this cross-sectional study of 768 women aged 18-64 years who presented to 2 emergency departments in Ontario, Canada, participants answered questions about risk indicators and completed the Composite Abuse Scale to determine their exposure to intimate partner violence in the past year.

Results: Intimate partner violence was significantly associated with

  • being separated,
  • in a common-law relationship or
  • single
  • depression
  • somatic symptoms (pain, nausea, depression, dizziness or concerns for which no adequate medical explanation can be found. Somatic symptoms imply that psychological factors are a large contributor to the symptoms’ onset, severity and duration. The symptoms are serious enough to cause significant emotional distress and impairment of social and/or occupational functioning)
  • having a male partner who was employed less than part time, or
  • having a partner with an alcohol or
  • drug problem

Each unit increase in the number of indicators corresponded to a four-fold increase in the risk of intimate partner violence; women with 3 or more indicators had a greater than 50% probability of a positive score on the Composite Abuse Scale.

Intimate partner violence was not associated with pregnancy status.

Specific characteristics of male partners, relationships and women’s mental health are significantly related to exposure to intimate partner violence in the past year. Identification of these indicators has implications for the clinical care of women who present to health care settings. (Source: Open Medicine

Heavy Alcohol Drinking Shortens Life

Heavy Alcohol Use Hastens Death by Up to 25 Years

Neuropsychiatric patients at great risk.

A history of heavy drinking cuts the life span by up to 25 years across all major chronic diseases, Hsiao-ye Yi, Ph.D., reported at the annual meeting of the Research Society on Alcoholism.

The effect seems particularly pronounced in women drinkers, who lose their survival advantage over men at an early age, wrote Dr. Yi, an epidemiologist with the National Institute on Alcohol Abuse and Alcoholism.

The average years of life lost due to heavy drinking varied by disease, ranging from 25 years for neuropsychiatric conditions to 7 years for malignant neoplasms, and was generally much greater in women than in men.

More research at Clinical Psychiatry News

Most people never get help

Alcohol use disorders abound – yet most people never get help

Nearly one in three people experience alcohol use disorders at some point in their lives, but most of these people do not get any form of treatment, and those who actually seek help wait up to a decade to do so.

These are results from a new analysis of the 2001-2002 US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The findings are published in the July 2007 issue of the Archives of General Psychiatry.

Alcohol use disorders are defined as alcohol abuse and alcohol dependence. Alcohol abuse refers to continued drinking even when it leads to social, legal, or health problems. Alcohol dependence-also called alcohol addiction or alcoholism-refers to the total inability to limit drinking.

More specifically, researchers found that:

  • Nearly 30 percent of survey respondents had met the criteria for an alcohol use disorder at some point in their lives.
  • Of those with alcohol abuse, only 7 percent had received treatment.
  • Of those with alcohol dependence, only 24.1 percent had received any type of treatment. Treatment was defined broadly-anything from Twelve Step programs to services from a medical professional, crisis center, or employee assistance program.
  • On average, alcohol dependence began at about age 22. However, the average age of first treatment was nearly 30-a delay of 8 years.
  • The average age when alcohol abuse began was also 22. Yet the average age of first treatment was 32-a gap of 10 years.

"A lost decade between AUD [alcohol use disorders] onset and treatment leads to personal disability and societal damage," says Dr. Ting-Kai Li, director of the National Institute on Alcohol Abuse and Alcoholism. Li adds that the report "signals the need for intensive efforts to educate professionals and the public to identify and address AUDs early in their course."

Results from NESARC did not come as a total surprise. Other studies yield similar findings. For example, the 2005 National Survey on Drug Use and Health revealed that 23.5 million Americans needed treatment for an alcohol or illicit drug use problem. Of these, only 2.3 million-10 percent-received treatment at a specialty facility.

What the studies do not explain is why people wait so long to get help.

William Cope Moyers, vice president of External Affairs for Hazelden, says that many factors are at work. He describes them as a "perfect storm of uncertainties" that make treatment the exception rather than the rule.

"This is a notable moment in our country’s history around alcohol and drug problems," says Moyers. "On the one hand, there seems to be a lot of awareness about the pervasiveness of these issues. But on the other hand, denial, shame, public policy, and economics are all coming together in a way that makes it difficult to bridge the gap between need and help."

Moyers calls for a three-part solution:

First is a "public dialogue around the reality that addiction doesn’t discriminate-and neither should recovery." This conversation needs to begin in schools, workplaces, and other community settings. From there it can move to the halls of Congress, which sets the national agenda for addiction treatment.

Second, says Moyers, is public policy based on the latest research: "Science is telling us a lot more about addiction than we’ve ever known-that addiction does have its origins in the brain, and that there are pharmacological tools that can help treat addiction and sustain recovery."

Finally, we need to remember that the brain-based disease of addiction is "an illness of the body and the soul." Recovery depends on factors that transcend science-courage to tell the truth, willingness to receive help, and sustained practice of new beliefs and new behaviors. In summary, says Moyers, "we must continue to treat the whole person."

Alive & Free is a health column that offers information to help prevent and address addiction and substance abuse problems. It is provided by Hazelden, a nonprofit agency based in Center City, Minn., that offers a wide range of information and services on addiction and recovery. For more resources check its Web site at www.hazelden.org.

Love First: A New Approach to Intervention for Alcoholism and Drug Addiction (A Hazelden Guidebook) (Hezelden Guidebook)

Drink driving by women on rise

In Britain the number of women caught drink driving has risen sharply in recent years, Liberal Democrat research has found. The research shows:

  • A 58% increase in women of all ages found guilty of drink driving since 1995,
  • compared with a slight fall amongst men;
  • There has been an increase of nearly 50% in women younger than 30 found guilty of drink or drug driving since 1995,
  • compared with just 4% for men in the same age group.

Commenting, Liberal Democrat Shadow Transport Secretary, Alistair Carmichael MP said:

"We warmly welcome moves to put Britain’s drink driving laws in line with other European countries. Instead of focusing drink driving campaigns only on men, these figures show women also need to be targeted."