The 2002 Official Patient's Sourcebook on Alcoholism

THE 2002 OFFICIAL PATIENT’S SOURCEBOOK

on

LCOHOLISM J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Alcoholism: Revised and Updated for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83134-3 1. Alcoholism-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.

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Dedication To the healthcare professionals dedicating their time and efforts to the study of alcoholism.

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to alcoholism. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

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About ICON Health Publications In addition to alcoholism, Official Patient’s Sourcebooks are available for the following related topics: ·

The Official Patient's Sourcebook on Anabolic Steroid Dependence

·

The Official Patient's Sourcebook on Club Drug Dependence

·

The Official Patient's Sourcebook on Cocaine Dependence

·

The Official Patient's Sourcebook on Dextromethorphan Dependence

·

The Official Patient's Sourcebook on Dissociative Drug Dependence

·

The Official Patient's Sourcebook on Ghb Dependence

·

The Official Patient's Sourcebook on Hepatitis C

·

The Official Patient's Sourcebook on Heroin Dependence

·

The Official Patient's Sourcebook on Inhalants Dependence

·

The Official Patient's Sourcebook on Ketamine Dependence

·

The Official Patient's Sourcebook on Lsd Dependence

·

The Official Patient's Sourcebook on Marijuana Dependence

·

The Official Patient's Sourcebook on Mdma Dependence

·

The Official Patient's Sourcebook on Methamphetamine Dependence

·

The Official Patient's Sourcebook on Nicotine Dependence

·

The Official Patient's Sourcebook on Pcp Dependence

·

The Official Patient's Sourcebook on Prescription Cns Depressants Dependence

·

The Official Patient's Sourcebook on Prescription Drug Dependence

·

The Official Patient's Sourcebook on Prescription Opioids Dendedence

·

The Official Patient's Sourcebook on Prescription Stimulants Dependence

·

The Official Patient's Sourcebook on Rohypnol Dependence

To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

Contents vii

Table of Contents INTRODUCTION...................................................................................... 1

Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4

PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON ALCOHOLISM: GUIDELINES ............ 9

Overview............................................................................................................... 9 What Is Alcoholism?........................................................................................... 11 What Is Alcohol Abuse? ..................................................................................... 12 What Are the Signs of a Problem? ..................................................................... 13 Getting Well ....................................................................................................... 14 Can Alcoholism Be Cured?................................................................................. 15 New Directions................................................................................................... 16 Resources ............................................................................................................ 17 More Guideline Sources ..................................................................................... 18 Vocabulary Builder............................................................................................. 29

CHAPTER 2. SEEKING GUIDANCE ....................................................... 31

Overview............................................................................................................. 31 Associations and Alcoholism .............................................................................. 31 Finding More Associations................................................................................. 76 Finding Drug Treatment and Alcohol Abuse Treatment Programs.................. 77 Selecting Your Doctor ........................................................................................ 79 Working with Your Doctor ................................................................................ 79 Broader Health-Related Resources ..................................................................... 81 Vocabulary Builder............................................................................................. 81

CHAPTER 3. CLINICAL TRIALS AND ALCOHOLISM ............................ 87

Overview............................................................................................................. 87 Recent Trials on Alcoholism............................................................................... 90 Benefits and Risks............................................................................................. 107 Keeping Current on Clinical Trials.................................................................. 110 General References............................................................................................ 111 Vocabulary Builder........................................................................................... 112

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL................................................ 116 CHAPTER 4. STUDIES ON ALCOHOLISM ............................................ 117

Overview........................................................................................................... 117 The Combined Health Information Database ................................................... 117 Federally-Funded Research on Alcoholism....................................................... 119

viii Contents

E-Journals: PubMed Central ............................................................................ 132 The National Library of Medicine: PubMed .................................................... 133 ETOH Database................................................................................................ 136 Vocabulary Builder........................................................................................... 137

CHAPTER 5. PATENTS ON ALCOHOLISM........................................... 141

Overview........................................................................................................... 141 Patents on Alcoholism ...................................................................................... 142 Patent Applications on Alcoholism .................................................................. 156 Keeping Current ............................................................................................... 156

CHAPTER 6. BOOKS ON ALCOHOLISM .............................................. 159

Overview........................................................................................................... 159 Book Summaries: Federal Agencies .................................................................. 159 Book Summaries: Online Booksellers ............................................................... 162 The National Library of Medicine Book Index ................................................. 179 Chapters on Alcoholism.................................................................................... 184 Directories......................................................................................................... 184 General Home References ................................................................................. 185 Vocabulary Builder........................................................................................... 186

CHAPTER 7. MULTIMEDIA ON ALCOHOLISM ................................... 189

Overview........................................................................................................... 189 Video Recordings .............................................................................................. 189 Audio Recordings ............................................................................................. 192 Bibliography: Multimedia on Alcoholism ........................................................ 192 Vocabulary Builder........................................................................................... 194

CHAPTER 8. PERIODICALS AND NEWS ON ALCOHOLISM ................ 197

Overview........................................................................................................... 197 News Services & Press Releases ....................................................................... 197 Newsletter Articles ........................................................................................... 208 Academic Periodicals covering Alcoholism ...................................................... 209 Vocabulary Builder........................................................................................... 210

CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 213

Overview........................................................................................................... 213 NIH Guidelines................................................................................................. 213 NIH Databases.................................................................................................. 214 Other Commercial Databases ........................................................................... 219 The Genome Project and Alcoholism................................................................ 220 Specialized References....................................................................................... 224 Vocabulary Builder........................................................................................... 225

CHAPTER 10. DISSERTATIONS ON ALCOHOLISM .............................. 227

Overview........................................................................................................... 227 Dissertations on Alcoholism............................................................................. 227 Keeping Current ............................................................................................... 228

Contents

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PART III. APPENDICES .................................................. 231 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 233

Overview........................................................................................................... 233 Your Medications: The Basics .......................................................................... 234 Learning More about Your Medications .......................................................... 235 Commercial Databases...................................................................................... 238 Contraindications and Interactions (Hidden Dangers) ................................... 242 A Final Warning .............................................................................................. 243 General References............................................................................................ 243 Vocabulary Builder........................................................................................... 244

APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 247

Overview........................................................................................................... 247 What Is CAM? ................................................................................................. 247 What Are the Domains of Alternative Medicine?............................................ 248 Can Alternatives Affect My Treatment? ......................................................... 251 Finding CAM References on Alcoholism ......................................................... 252 Additional Web Resources................................................................................ 262 General References............................................................................................ 272

APPENDIX C. RESEARCHING NUTRITION ......................................... 275

Overview........................................................................................................... 275 Food and Nutrition: General Principles........................................................... 276 Finding Studies on Alcoholism ........................................................................ 280 Federal Resources on Nutrition........................................................................ 284 Additional Web Resources................................................................................ 285 Vocabulary Builder........................................................................................... 289

APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 291

Overview........................................................................................................... 291 Preparation ....................................................................................................... 291 Finding a Local Medical Library ...................................................................... 292 Medical Libraries Open to the Public............................................................... 292

APPENDIX E. ALCOHOL AND YOUNG TEENAGERS .......................... 299

Overview........................................................................................................... 299 How to Talk to Your Child about Alcohol ........................................................ 300 Young Teens and Alcohol: The Risks ............................................................... 301 Your Young Teen’s World................................................................................ 301 The Bottom Line: A Strong Parent-Child Relationship ................................... 303 Tips for Communicating with Your Teen ........................................................ 304 Talking with Your Teen about Alcohol ............................................................ 304 The “Magic Potion “Myth ............................................................................... 305 Good Reasons Not to Drink.............................................................................. 306 How to Handle Peer Pressure........................................................................... 307 “Mom, Dad, Did You Drink When You Were a Kid?” ................................... 307 How to Host a Teen Party ................................................................................ 307

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Contents

Taking Action: Prevention Strategies for Parents ........................................... 308 Could My Child Develop a Drinking Problem?............................................... 311 Warning Signs of a Drinking Problem ............................................................ 312 Action Checklist................................................................................................ 313 Additional Resources ........................................................................................ 313 Other NIAAA Publications.............................................................................. 314 Additional E-Sources........................................................................................ 315 State Contacts ................................................................................................... 317 Vocabulary Builder........................................................................................... 318

APPENDIX F. ALCOHOL: ADDITIONAL RISKS................................... 321

Overview........................................................................................................... 321 What Is a Drink? .............................................................................................. 322 Drinking and Driving ...................................................................................... 322 Interactions with Medications.......................................................................... 322 Interpersonal Problems..................................................................................... 322 Long-Term Health Problems ............................................................................ 323 Alcohol-Related Liver Disease .......................................................................... 323 Heart Disease.................................................................................................... 323 Cancer ............................................................................................................... 324 Pancreatitis ....................................................................................................... 324 Aging and Alcohol Abuse................................................................................. 324 Physical Effects of Alcohol................................................................................ 324 Who Becomes a Problem Drinker? ................................................................... 325 How to Recognize a Drinking Problem ............................................................ 325 Drinking and Your Pregnancy......................................................................... 326 Research Directions .......................................................................................... 327 Vocabulary Builder........................................................................................... 329

APPENDIX G. REDUCING ALCOHOL CONSUMPTION ....................... 331

Overview........................................................................................................... 331 How to Cut Down on Your Drinking .............................................................. 332 Tips for Reducing Your Alcohol Intake ............................................................ 333

ONLINE GLOSSARIES.................................................... 335 Online Dictionary Directories.......................................................................... 342

ALCOHOLISM GLOSSARY ........................................... 343 General Dictionaries and Glossaries ................................................................ 362

INDEX................................................................................... 364

Introduction

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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don't know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3

Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2

2

Alcoholism

Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor's offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Alcoholism has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to alcoholism, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on alcoholism. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on alcoholism should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate

Introduction

3

options is always up to the patient in consultation with their physician and healthcare providers.

Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching alcoholism (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to alcoholism. It also gives you sources of information that can help you find a doctor in your local area specializing in treating alcoholism. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with alcoholism. Part II moves on to advanced research dedicated to alcoholism. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on alcoholism. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with alcoholism or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with alcoholism. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with alcoholism.

Scope While this sourcebook covers alcoholism, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that alcoholism is often considered a synonym or a condition closely related to the following: ·

Alcohol Abuse

·

Alcohol Addiction

·

Alcohol Dependence

4

Alcoholism

·

Alcohol Dependence Syndrome

In addition to synonyms and related conditions, physicians may refer to alcoholism using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world's illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for alcoholism:4 ·

303 alcohol dependence syndrome

·

303.0 acute alcoholic intoxication

·

303.00 alcohol dependence syndrome unspecified

·

303.01 alcohol dependence syndrome continuous

·

303.02 alcohol dependence syndrome episodic

·

303.03 alcohol dependence syndrome in remission

·

303.9 other and unspecified alcohol dependence

·

305 alcohol abuse

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to alcoholism. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson's approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful.

4 This list is based on the official version of the World Health Organization's 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”

Introduction

5

As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with alcoholism will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with alcoholism is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of alcoholism, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors

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PART I: THE ESSENTIALS

ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on alcoholism. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of alcoholism to you or even given you a pamphlet or brochure describing alcoholism. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.

Guidelines

CHAPTER 1. GUIDELINES

THE

ESSENTIALS

ON

9

ALCOHOLISM:

Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on alcoholism. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on alcoholism can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on alcoholism. Originally founded in 1887, the NIH is one of the world's foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world's most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.

5

Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.

10 Alcoholism

There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with alcoholism and associated conditions: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc. ) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines at http://www.niaaa.nih.gov/publications/publications.htm

Especially noteworthy is the National Institute on Alcohol Abuse and Alcoholism (NIAAA) which is one of the institutes that comprise the National Institutes of Health (NIH).6 The NIAAA supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. NIAAA also provides leadership in the national effort to reduce the severe and often fatal consequences of these problems by: ·

Conducting and supporting research directed at determining the causes of alcoholism, discovering how alcohol damages the organs of the body, and developing prevention and treatment strategies for application in the Nation's health care system;

·

Conducting and supporting research across a wide range of scientific areas including genetics, neuroscience, medical consequences, medication development, prevention, and treatment through the award of grants and within the NIAAA's intramural research program;

·

Conducting policy studies that have broad implications for alcohol problem prevention, treatment and rehabilitation activities;

·

Conducting epidemiological studies such as national and community surveys to assess risks for and magnitude of alcohol-related problems among various population groups;

·

Collaborating with other research institutes and Federal programs relevant to alcohol abuse and alcoholism, and providing coordination for Federal alcohol abuse and alcoholism research activities;

6

Adapted from the NIAAA: http://www.niaaa.nih.gov/about/purpose.htm.

Guidelines 11

·

Maintaining continuing relationships with institutions and professional associations; with international, national, state and local officials; and voluntary agencies and organizations engaged in alcohol-related work; and

·

Disseminating research findings to health care providers, researchers, policymakers, and the public.

The National Institutes of Health has recently published the following guideline for alcoholism:

What Is Alcoholism?7 Alcoholism, also known as alcohol dependence, is a disease that includes four symptoms: ·

Craving: A strong need, or compulsion, to drink.

·

Loss of control: The inability to limit one’s drinking on any given occasion.

·

Physical dependence: Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking.

·

Tolerance: The need to drink greater amounts of alcohol in order to “get high.”

People who are not alcoholic sometimes do not understand why an alcoholic can’t just “use a little willpower” to stop drinking. However, alcoholism has little to do with willpower. Alcoholics are in the grip of a powerful “craving,” or uncontrollable need, for alcohol that overrides their ability to stop drinking. This need can be as strong as the need for food or water. Although some people are able to recover from alcoholism without help, the majority of alcoholics need assistance. With treatment and support, many individuals are able to stop drinking and rebuild their lives. Many people wonder why some individuals can use alcohol without problems but others cannot. One important reason has to do with genetics. Scientists have found that having an alcoholic family member makes it more likely that, if you choose to drink, you too may develop alcoholism. Genes, however, are not the whole story. In fact, scientists now believe that certain factors in a person’s environment influence whether a person with a genetic risk for alcoholism will develop the disease. A person’s risk for developing Adapted from the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/publications/booklet.htm.

7

12 Alcoholism

alcoholism can increase based on the person’s environment, including where and how he or she lives; family, friends, and culture; peer pressure; and even how easy it is to get alcohol. A Widespread Problem For most people who drink, alcohol is a pleasant accompaniment to social activities. Moderate alcohol use—up to two drinks per day for men and one drink per day for women and older people—is not harmful for most adults. (A standard drink is one 12-ounce bottle or can of either beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.) Nonetheless, a large number of people get into serious trouble because of their drinking. Currently, nearly 14 million Americans—1 in every 13 adults—abuse alcohol or are alcoholic. Several million more adults engage in risky drinking that could lead to alcohol problems. These patterns include binge drinking and heavy drinking on a regular basis. In addition, 53 percent of men and women in the United States report that one or more of their close relatives has a drinking problem. The consequences of alcohol misuse are serious and, in many cases, life threatening. Heavy drinking can increase the risk for certain cancers, especially those of the liver, esophagus, throat, and larynx (voice box). Heavy drinking can also cause liver cirrhosis, immune system problems, brain damage, and harm to the fetus during pregnancy. In addition, drinking increases the risk of death from automobile crashes as well as recreational and on-the-job injuries. Furthermore, both homicides and suicides are more likely to be committed by persons who have been drinking. In purely economic terms, alcohol-related problems cost society approximately $185 billion per year. In human terms, the costs cannot be calculated.

What Is Alcohol Abuse? Alcohol abuse differs from alcoholism in that it does not include an extremely strong craving for alcohol, loss of control over drinking, or physical dependence. Alcohol abuse is defined as a pattern of drinking that results in one or more of the following situations within a 12-month period: ·

Failure to fulfill major work, school, or home responsibilities.

·

Drinking in situations that are physically dangerous, such as while driving a car or operating machinery.

Guidelines 13

·

Having recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk.

·

Continued drinking despite having ongoing relationship problems that are caused or worsened by the drinking.

Although alcohol abuse is basically different from alcoholism, many effects of alcohol abuse are also experienced by alcoholics.

What Are the Signs of a Problem? How can you tell whether you may have a drinking problem? Answering the following four questions can help you find out: ·

Have you ever felt you should cut down on your drinking?

·

Have people annoyed you by criticizing your drinking?

·

Have you ever felt bad or guilty about your drinking?

·

Have you ever had a drink first thing in the morning (as an “eye opener”) to steady your nerves or get rid of a hangover?

One “yes” answer suggests a possible alcohol problem. If you answered “yes” to more than one question, it is highly likely that a problem exists. In either case, it is important that you see your doctor or other health care provider right away to discuss your answers to these questions. He or she can help you determine whether you have a drinking problem and, if so, recommend the best course of action. Even if you answered “no” to all of the above questions, if you encounter drinking-related problems with your job, relationships, health, or the law, you should seek professional help. The effects of alcohol abuse can be extremely serious—even fatal—both to you and to others. The Decision to Get Help Accepting the fact that help is needed for an alcohol problem may not be easy. But keep in mind that the sooner you get help, the better are your chances for a successful recovery. Any concerns you may have about discussing drinking-related problems with your healthcare provider may stem from common misconceptions

14 Alcoholism

about alcoholism and alcoholic people. In our society, the myth prevails that an alcohol problem is a sign of moral weakness. As a result, you may feel that to seek help is to admit some type of shameful defect in yourself. In fact, alcoholism is a disease that is no more a sign of weakness than is asthma. Moreover, taking steps to identify a possible drinking problem has an enormous payoff—a chance for a healthier, more rewarding life. When you visit your health care provider, he or she will ask you a number of questions about your alcohol use to determine whether you are having problems related to your drinking. Try to answer these questions as fully and honestly as you can. You also will be given a physical examination. If your health care provider concludes that you may be dependent on alcohol, he or she may recommend that you see a specialist in treating alcoholism. You should be involved in any referral decisions and have all treatment choices explained to you.

Getting Well Alcoholism Treatment The type of treatment you receive depends on the severity of your alcoholism and the resources that are available in your community. Treatment may include detoxification (the process of safely getting alcohol out of your system); taking doctor-prescribed medications, such as disulfiram (Antabuse) or naltrexone (ReVia™), to help prevent a return (or relapse) to drinking once drinking has stopped; and individual and/or group counseling. There are promising types of counseling that teach alcoholics to identify situations and feelings that trigger the urge to drink and to find new ways to cope that do not include alcohol use. These treatments are often provided on an outpatient basis. Because the support of family members is important to the recovery process, many programs also offer brief marital counseling and family therapy as part of the treatment process. Programs may also link individuals with vital community resources, such as legal assistance, job training, childcare, and parenting classes. Alcoholics Anonymous Virtually all alcoholism treatment programs also include Alcoholics Anonymous (AA) meetings. AA describes itself as a “worldwide fellowship of men and women who help each other to stay sober.” Although AA is

Guidelines 15

generally recognized as an effective mutual help program for recovering alcoholics, not everyone responds to AA’s style or message, and other recovery approaches are available. Even people who are helped by AA usually find that AA works best in combination with other forms of treatment, including counseling and medical care.

Can Alcoholism Be Cured? Although alcoholism can be treated, a cure is not yet available. In other words, even if an alcoholic has been sober for a long time and has regained health, he or she remains susceptible to relapse and must continue to avoid all alcoholic beverages. “Cutting down” on drinking doesn’t work; cutting out alcohol is necessary for a successful recovery. However, even individuals who are determined to stay sober may suffer one or several “slips,” or relapses, before achieving long-term sobriety. Relapses are very common and do not mean that a person has failed or cannot recover from alcoholism. Keep in mind, too, that every day that a recovering alcoholic has stayed sober prior to a relapse is extremely valuable time, both to the individual and to his or her family. If a relapse occurs, it is very important to try to stop drinking once again and to get whatever additional support you need to abstain from drinking.

Help for Alcohol Abuse If your health care provider determines that you are not alcohol dependent but are nonetheless involved in a pattern of alcohol abuse, he or she can help you to: ·

Examine the benefits of stopping an unhealthy drinking pattern.

·

Set a drinking goal for yourself. Some people choose to abstain from alcohol. Others prefer to limit the amount they drink.

·

Examine the situations that trigger your unhealthy drinking patterns, and develop new ways of handling those situations so that you can maintain your drinking goal.

Some individuals who have stopped drinking after experiencing alcoholrelated problems choose to attend AA meetings for information and support, even though they have not been diagnosed as alcoholic.

16 Alcoholism

New Directions With NIAAA’s support, scientists at medical centers and universities throughout the country are studying alcoholism. The goal of this research is to develop better ways of treating and preventing alcohol problems. Today, NIAAA funds approximately 90 percent of all alcoholism research in the United States. Some of the more exciting investigations focus on the causes, consequences, treatment, and prevention of alcoholism: ·

Genetics: Alcoholism is a complex disease. Therefore, there are likely to be many genes involved in increasing a person’s risk for alcoholism. Scientists are searching for these genes, and have found areas on chromosomes where they are probably located. Powerful new techniques may permit researchers to identify and measure the specific contribution of each gene to the complex behaviors associated with heavy drinking. This research will provide the basis for new medications to treat alcoholrelated problems.

·

Treatment: NIAAA-supported researchers have made considerable progress in evaluating commonly used therapies and in developing new types of therapies to treat alcohol-related problems. One large-scale study sponsored by NIAAA found that each of three commonly used behavioral treatments for alcohol abuse and alcoholism—motivation enhancement therapy, cognitive-behavioral therapy, and 12-step facilitation therapy—significantly reduced drinking in the year following treatment. This study also found that approximately one-third of the study participants who were followed up either were still abstinent or were drinking without serious problems 3 years after the study ended. Other therapies that have been evaluated and found effective in reducing alcohol problems include brief intervention for alcohol abusers (individuals who are not dependent on alcohol) and behavioral marital therapy for married alcohol-dependent individuals.

·

Medications development: NIAAA has made developing medications to treat alcoholism a high priority. We believe that a range of new medications will be developed based on the results of genetic and neuroscience research. In fact, neuroscience research has already led to studies of one medication—naltrexone (ReVia™)—as an anticraving medication. NIAAA-supported researchers found that this drug, in combination with behavioral therapy, was effective in treating alcoholism. Naltrexone, which targets the brain’s reward circuits, is the first medication approved to help maintain sobriety after detoxification from alcohol since the approval of disulfiram (Antabuse?/sup>) in 1949. The use of acamprosate, an anticraving medication that is widely used in Europe, is based on neuroscience research. Researchers believe that

Guidelines 17

acamprosate works on different brain circuits to ease the physical discomfort that occurs when an alcoholic stops drinking. Acamprosate should be approved for use in the United States in the near future, and other medications are being studied as well. ·

Combined medications/behavioral therapies: NIAAA-supported researchers have found that available medications work best with behavioral therapy. Thus, NIAAA has initiated a large-scale clinical trial to determine which of the currently available medications and which behavioral therapies work best together. Naltrexone and acamprosate will each be tested separately with different behavioral therapies. These medications will also be used together to determine if there is some interaction between the two that makes the combination more effective than the use of either one alone.

In addition to these efforts, NIAAA is sponsoring promising research in other vital areas, such as fetal alcohol syndrome, alcohol’s effects on the brain and other organs, aspects of drinkers’ environments that may contribute to alcohol abuse and alcoholism, strategies to reduce alcoholrelated problems, and new treatment techniques. Together, these investigations will help prevent alcohol problems; identify alcohol abuse and alcoholism at earlier stages; and make available new, more effective treatment approaches for individuals and families.

Resources For more information on alcohol abuse and alcoholism, contact the following organizations: Al-Anon Family Group Headquarters, Inc. 1600 Corporate Landing Parkway Virginia Beach, VA 23454–5617 Phone: (757) 563–1600; Fax: (757) 563–1655 Email: [email protected] Internet address: http://www.al-anon.alateen.org Makes referrals to local Al-Anon groups, which are support groups for spouses and other significant adults in an alcoholic person’s life. Also makes referrals to Alateen groups, which offer support to children of alcoholics. Free informational materials and locations of Al-Anon or Alateen meetings worldwide can be obtained by calling the toll-free number (888) 425–2666 from the United States or Canada, Monday through Friday, 8 a.m.–6 p.m. (e.s.t.).

18 Alcoholism

Alcoholics Anonymous (AA) World Services, Inc. 475 Riverside Drive, 11th Floor New York, NY 10115 Phone: (212) 870–3400; Fax: (212) 870–3003 Email: via AA’s Web site Internet address: http://www.alcoholics-anonymous.org Makes referrals to local AA groups and provides informational materials on the AA program. Many cities and towns also have a local AA office listed in the telephone book. All communication should be directed to AA’s mailing address: AA World Services, Inc., Grand Central Station, P.O. Box 459, New York, NY 10163. National Council on Alcoholism and Drug Dependence, Inc. (NCADD) 20 Exchange Place, Suite 2902 New York, NY 10005 Phone: (212) 269–7797; Fax: (212) 269–7510 Email: [email protected] HOPE LINE: (800) NCA–CALL (24-hour Affiliate referral) Internet address: http://www.ncadd.org Offers educational materials and information on alcoholism. Provides phone numbers of local NCADD Affiliates (who can provide information on local treatment resources) via the above toll-free, 24-hour HOPE LINE. National Institute on Alcohol Abuse and Alcoholism (NIAAA) Scientific Communications Branch 6000 Executive Boulevard,Willco Building, Suite 409 Bethesda, MD 20892–7003 Phone: (301) 443–3860; Fax: (301) 480–1726 Email: [email protected] Internet address: http://www.niaaa.nih.gov Makes available free informational materials on all aspects of alcoholism, including the effects of drinking during pregnancy, alcohol use and the elderly, and help for cutting down on drinking.

More Guideline Sources The guideline above on alcoholism is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to alcoholism. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with

Guidelines 19

alcoholism. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.

Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. ·

Guides On alcoholism Alcoholism http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm Alcoholism http://www.nlm.nih.gov/medlineplus/alcoholism.html

·

Other Guides Alcohol and Youth http://www.nlm.nih.gov/medlineplus/alcoholandyouth.html Pregnancy and Substance Abuse http://www.nlm.nih.gov/medlineplus/pregnancyandsubstanceabus e.html Nausea and vomiting http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Alcohol Consumption http://www.nlm.nih.gov/medlineplus/alcoholconsumption.html Fetal Alcohol Syndrome http://www.nlm.nih.gov/medlineplus/fetalalcoholsyndrome.html Genes and Gene Therapy http://www.nlm.nih.gov/medlineplus/genesandgenetherapy.html

Within the health topic page dedicated to alcoholism, the following was recently recommended to patients:

20 Alcoholism

·

General/Overviews Alcohol: What to Do If It's a Problem for You Source: American Academy of Family Physicians http://familydoctor.org/healthfacts/006/ JAMA Patient Page: Do You Have a Drinking Problem? Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZ ZY4F6B4AC&sub_cat=465

·

Treatment Alcohol Alert: Brief Intervention for Alcohol Problems Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa43-text.htm Naltrexone for Alcoholism Source: American Academy of Family Physicians http://familydoctor.org/handouts/130.html Understanding Alcohol-Related Disorders and their Treatment Source: American Psychological Association http://helping.apa.org/therapy/alcohol.html

·

Specific Conditions/Aspects Alcohol Alert: Alcohol and Sleep Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa41-text.htm Alcohol Alert: Alcohol and the Liver Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa42-text.htm Alcohol Alert: Alcohol and the Workplace Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa44-text.htm Alcohol Alert: Alcohol and Tobacco Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa39-text.htm Alcohol Alert: Cognitive Impairment and Recovery Alcoholism Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa53.htm

From

Guidelines 21

Alcohol Impairment Chart Source: National Clearinghouse for Alcohol and Drug Information http://www.health.org/nongovpubs/bac-chart/index.htm Post-Traumatic Sress Disorder (PTSD) and Problems with Alcohol Use Source: Dept. of Veterans Affairs, National Center for PTSD http://www.ncptsd.org/facts/specific/fs_alcohol.html Smoking Cessation in Recovering Alcoholics Source: American Academy of Family Physicians http://familydoctor.org/handouts/269.html ·

Children Children of Alcoholics: Important Facts Source: National Association for Children of Alcoholics http://www.nacoa.net/impfacts.htm Questions and Answers About Addiction: Alcoholism Source: National Association for Children of Alcoholics http://www.nacoa.net/addictqa.htm

·

From the National Institutes of Health Alcoholism: Getting the Facts Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/booklet.htm FAQ' s on Alcohol Abuse and Alcoholism Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/faq/q-a.htm

·

Latest News Alcohol Researchers Identify Genetic Locus of Human Brain Wave (Beta EEG Frequency) Source: 03/12/2002, National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/press/2002/locus.htm Brain Cells Killed During Binge Drinking Episodes Source: 04/17/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_7174.html Drug May Help Ease Alcohol Withdrawal Symptoms Source: 03/21/2002, Reuters http://www.nlm.nih.gov/medlineplus/news/fullstory_6740.html

22 Alcoholism

Even Short-term Cut in Heavy Drinking Is Good Source: 03/29/2002, Reuters http://www.nlm.nih.gov/medlineplus/news/fullstory_6874.html ·

Organizations AL-ANON/ALATEEN Source: Al-Anon, Alateen http://www.al-anon.alateen.org/ Alcoholics Anonymous http://www.alcoholics-anonymous.org/ American Council for Drug Education http://www.acde.org/ National Association for Children of Alcoholics http://www.nacoa.net/index.htm National Clearinghouse for Alcohol and Drug Information Source: Substance Abuse and Mental Health Services Administration, Dept. of Health and Human Services http://www.health.org/ National Council on Alcoholism and Drug Dependence http://www.ncadd.org National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/

·

Prevention/Screening Alcohol Alert: Screening for Alcohol Problems-An Update Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa56.htm

·

Research Alcohol Alert: Craving Research, Implications for Treatment Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa54.htm Alcohol Alert: Economic Perspectives in Alcoholism Research Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa51.htm

Guidelines 23

Alcohol Alert: From Genes to Geography: the Cutting Edge of Alcohol Research Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa48-text.htm Alcohol Alert: Imaging and Alcoholism: A Window on the Brain Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa47-text.htm Alcohol Researchers Identify Genetic Locus of Human Brain Wave (Beta EEG Frequency) Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/press/2002/locus.htm Alcohol Researchers Localize Brain Region That Anticipates Reward Source: National Institute on Alcohol Abuse and Alcoholism http://www.nih.gov/news/pr/aug2001/niaaa-03.htm Gene Therapy Technique Reduces Alcohol Consumption in Rats Source: National Institute on Alcohol Abuse and Alcoholism http://www.nih.gov/news/pr/sep2001/niaaa-13.htm Neuroimaging Identifies Brain Regions Possibly Involved in Alcohol Craving Source: National Institute on Alcohol Abuse and Alcoholism http://www.nih.gov/news/pr/apr2001/niaaa-12.htm Researchers Identify Potential Medication for Early-Onset Alcoholism Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/press/2000/potential.htm ·

Statistics Alcoholism and Alcohol-Related Problems Source: National Council on Alcoholism and Drug Dependence http://www.ncadd.org/facts/problems.html Economic Costs of Alcohol and Drug Abuse Estimated at $246 Billion in the United States Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/press/1998/economic.htm FASTATS: Alcohol Use Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/alcohol.htm

24 Alcoholism

·

Women Alcohol Alert: Are Women More Vulnerable to Alcohol's Effects? Source: National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/aa46-text.htm

If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on alcoholism and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

The fact is: Alcoholism tends to run in families Source: Rockville, MD: Alcohol, Drug Abuse, and Mental Health Administration, U.S. Department of Health and Human Services. 1992. 2 pp. Contact: Available from National Clearinghouse for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20847-2345. Telephone: (301) 468-2600 or (800) 729-6686 or (800) 487-4889 TDD / fax: (301) 468-6433 / e-mail: [email protected] / Web site: http://www.health.org. Available at no charge. Summary: This brochure provides questions and answers about children of alcoholics (COAs). The common characteristics of COAs, their risks and problems, and how to help COAs are discussed. A list of organizations able to provide information and referrals is included.

Guidelines 25

·

Alcoholism Source: Rochester, NY: Substance and Alcohol Intervention Services for the Deaf (SAISD), Rochester Institute of Technology (RIT). 1996. 2 p. Contact: Available from Substance and Alcohol Intervention Services for the Deaf (SAISD). Rochester Institute of Technology (RIT), Hale-Andrews Student Life Center, 115 Lomb Memorial Drive, Rochester, NY 146235608. Voice/TTY (716) 475-4978; Fax (716) 475-7375; E-mail: [email protected]. PRICE: Single copy free. Summary: This brochure provides basic information for deaf people about alcoholism. The brochure defines alcoholism, lists the symptoms of alcohol abuse, describes the physical damage that can be caused by alcohol, and discusses relapses. The brochure also includes a section listing places and organizations where readers can get help, including interpreted Alcoholics Anonymous meetings, hospitals, employee assistance programs, doctors, alcoholism counselors, the National Council on Alcoholism and Drug Dependency (NCADD), and Substance and Alcohol Intervention Services for the Deaf (SAISD). The front cover of the brochure is illustrated with the sign for alcohol.

·

Treatment options for alcohol abuse: Information for health care purchasers Source: Washington, DC: Washington Business Group on Health. 1991. 24 pp. Contact: Available from Quality Resource Center, Washington Business Group on Health, 777 North Capitol Street, N.E., Suite 800, Washington, DC 20002. Telephone: (202) 408-9320. $30.00. Summary: This booklet is intended to help companies appropriately manage alcohol abusing employees at the worksite and purchase high quality, cost-effective alcoholism treatment for their employees who require such care. The report provides an introduction and overview of alcoholism; discusses appropriate worksite intervention strategies; summarizes the state of the art regarding patient assessment; outcomes measurement and clinical guidelines research; draws implications of the information for purchasers and their employees in terms of benefit design and patient-centered systems of delivery; provides corporate examples of innovative programs addressing alcohol treatment; and gives resources for further information.

26 Alcoholism

The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “alcoholism” or synonyms. Healthfinder™

Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·

Alcoholism: Getting the Facts Summary: This booklet is designed to help individuals and families answer common questions about alcohol problems. Source: National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3207

·

Calendar and Events - National Institute on Alcohol Abuse and Alcoholism Summary: Browse this page for an up-to-date listing of upcoming conferences and national meetings relevant to this Institute's services and programs. Source: National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3802

·

Drink Too Much, Risk Too Much -- Alcohol Abuse, HIV, and Latinos Summary: This article discusses alcohol abuse among Hispanics and the increased risk of contracting HIV for those who drink too much. Source: National Council of La Raza, Institute for Hispanic Health (IHH) http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6067

Guidelines 27

·

FAQ' s on Alcohol Abuse and Alcoholism Summary: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides answers online to some of the most commonly asked questions received at the agency about alcoholism. Source: National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3803

·

How Are Alcohol and Drugs Affecting Your Life? – A Self-Test For Teenagers Summary: This online self-test can help teens decide if they are at risk for developing alcoholism and/or dependence on another drug. Source: National Council on Alcoholism and Drug Dependence, Inc. http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5667

·

Journal of Addictive Diseases Summary: A quarterly journal that focuses on educating physicians and other health care providers involved in the treatment of individuals suffering from alcoholism or other addictions. Source: American Society of Addiction Medicine http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=1950

·

National Institute on Alcohol Abuse and Alcoholism Publications Summary: Resources on alcohol and drug abuse research, practice, and patients. Source: National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=329

28 Alcoholism

·

NIAAA Alcohol and Alcohol Problems Science Database (ETOH) Summary: The Alcohol and Alcohol Problems Science Database, commonly referred to as ETOH, is the most comprehensive online resource covering all aspects of alcohol abuse and alcoholism. Source: National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6298

·

The Fact Is . . .Alcoholism Tends to Run in Families Summary: More than 10 percent of children of alcoholics develop a drinking problem. Source: National Clearinghouse for Alcohol and Drug Information, Center for Substance Abuse Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=931 The NIH Search Utility

After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to alcoholism. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. NORD (The National Organization of Rare Disorders, Inc.) NORD provides an invaluable service to the public by publishing, for a nominal fee, short yet comprehensive guidelines on over 1,000 diseases. NORD primarily focuses on rare diseases that might not be covered by the previously listed sources. NORD’s Web address is www.rarediseases.org. To see if a recent fact sheet has been published on alcoholism, simply go to

Guidelines 29

the following hyperlink: http://www.rarediseases.org/cgibin/nord/alphalist. A complete guide on alcoholism can be purchased from NORD for a nominal fee. Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

·

drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html

·

Family Village: http://www.familyvillage.wisc.edu/specific.htm

·

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

·

Med Help International: http://www.medhelp.org/HealthTopics/A.html

·

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

·

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

·

WebMDÒHealth: http://my.webmd.com/health_topics

Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Craving: A powerful, often uncontrollable desire for drugs. [NIH]

30 Alcoholism

Detoxification: A process of allowing the body to rid itself of a drug while managing the symptoms of withdrawal; often the first step in a drug treatment program. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Homicide: The killing of one person by another. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Suicide: The act of killing oneself. [NIH] Tolerance: A condition in which higher doses of a drug are required to produce the same effect as during initial use; often is associated with physical dependence. [NIH] Withdrawal: A variety of symptoms that occur after chronic use of some drugs is reduced or stopped. [NIH]

Seeking Guidance 31

CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with alcoholism. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with alcoholism. The chapter ends with a discussion on how to find a doctor that is right for you.

Associations and Alcoholism As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8

32 Alcoholism

influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·

Academics Recovering Together Address: Box 1865 Brown University Providence, RI 02912 Telephone: (401) 274-1933; (401) 863-3831 Fax: (401) 863-1961 Web Site: http://www.crml.uab.edu/~jah/art.html Background: Academics Recovering Together (ART) is a support group open to college and university administrators, faculty members and all others in recovery from chemical dependency who define themselves in terms of the academic setting of higher education. Contact the organization for times and dates. Relevant area(s) of interest: Alcoholism; Chemical dependency; Drug recovery

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Addiction Treatment Program Arlington Hospital Address: 1701 North George Mason Drive Arlington, VA 22205 Telephone: (703) 558-6536 Web Site: http://www.arlhosp.org/facilities.htm Background: The Arlington Hospital Addiction Treatment Program (ATP), offers multi-levels of care to adults, including Detoxification, Inpatient treatment, Day treatment, Outpatient treatment, and Aftercare treatment. Patients may enter the ATP through detoxification, day treatment, inpatient treatment, or outpatient treatment, depending upon their medical and intoxication conditions. When a new patient joins the program, a complete intake assessment is made to determine which program, outpatient, inpatient, or day treatment will best suit the patient's needs. Individual counseling is available to help the patient develop the course of treatment that will lead to a stable recovery program.

Seeking Guidance 33

Relevant area(s) of interest: Addiction treatment; Alcoholism; Drug addiction ·

Addictive Behaviors Research Center Department of Psychology University of Washington Address: Box 351525 Guthrie Annex III Seattle, WA 98195-1525 Telephone: (206) 685-1200 Fax: 206-685-1310 Web Site: http://abrc.psych.washington.edu/~abrc4.html Background: Funded by the National Institute on Alcoholism and Alcohol Abuse, ABRC conducts research on the prevention and treatment of alcohol abuse, and uses a simulated cocktail lounge in which drinking behavior can be observed and studied. ABRC's interests are analysis of drinking behavior and the use of alcohol in a naturalistic setting. ABRC answers inquiries, provides advisory services, conducts seminars, evaluates data, and makes referrals to other sources of information. Publication(s): Books; technical reports; journal articles; reviews; reprints. Relevant area(s) of interest: Addictive behaviors; Alcohol addiction; Alcohol education; Alcoholism; Alcoholism prevention; Alcoholism treatment; Drinking behavior

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Akron City Health Department Address: 177 South Broadway Akron, OH 44308-1799 Telephone: (330) 375-2960 Fax: (330) 375-2154 Email: [email protected] Web Site: http://www.ci.akron.oh.us/health.html Background: The Akron City Health Department is concerned with public health and medical and environmental concerns, including alcoholism, child health, prenatal care, infectious disease control, STD treatment, HIV counseling and testing, primary dental care, food and sanitation, air pollution, housing, laboratory services, vital statistics, health education, and other related areas. The Department answers inquiries, provides consulting services, makes referrals, and disseminates health education materials. Publication(s): Educational pamphlets. Relevant area(s) of interest: Air pollution; and publications, education pamphlets, and a computerized; Building codes; database on vital

34 Alcoholism

statistics and abortions.; Educational materials; Food; Food contamination; Health education; Holdings; Library of medical and public health books, public health reports; Meat; Public health; Radiation hazards; Soil pollution; Water pollution ·

Alabama Citizens Action Program Address: (Hoover) 2376 Lakeside Drive Birmingham, AL 35244 Telephone: (205) 985-9062 Background: Interests of the Alabama Citizens Action Program include gambling, drug education, alcohol, and tobacco. The Program answers inquiries, provides consulting services, conducts seminars, makes interlibrary loans of materials, distributes publications, and makes referrals to other sources of information. Services are available to anyone and are free, but contributions to the work are appreciated. Relevant area(s) of interest: Alcoholism; Citizen's groups; Drug education; Drugs; Gambling; Tobacco

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Alabama Department of Mental Health and Mental Retardation Address: 100 Union St. Montgomery, AL 36104 RSA Union Building, Suite 480 Telephone: (334) 242-3112 Web Site: http://www.mh.state.al.us Background: The Alabama Department of Mental Health and Mental Retardation is the state agency responsible for serving Alabama citizens with mental illness, mental retardation and substance abuse problems. The Department's fourteen state-operated facilities have achieved and maintained high standards in health care provision. The four developmental centers for persons with mental retardation are certified by Title XIX, and the ten psychiatric facilities maintain JCAHO accreditation and/or Title XIX certification. The department contracts for services with hundreds of local service providers in all 67 Alabama counties. Relevant area(s) of interest: Alcoholism; Mental hygiene; Psychiatry

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Al-Anon Family Groups World Service Office Address: 1600 Corporate Landing Parkway Virginia Beach, VA 234545617 Telephone: (757) 563-1600; (888) 4AL-ANON (Toll-free)

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Fax: (757) 563-1655 Email: [email protected] Web Site: http://www.al-anon.alateen.org/ Background: Al-Anon Family Groups, which includes Alateen comprise a fellowship of relatives and friends of alcoholics who share their experiences, strengths, and hopes, in order to solve their common problems in anonymous confidential meetings. Al-Anon/Alateen believes that alcoholism is a family illness, and that changed attitudes can aid recovery. There are no dues for membership. Al-Anon/Alateen is self-supporting through its own voluntary contributions. AlAnon/Alateen has but one purpose: to help families of alcoholics by practicing the Twelve Steps; by welcoming and giving comfort to families of alcoholics;and by giving understanding and encouragement to the alcoholic. Today, there are about 30,000 Al-Anon and Alateen groups meeting in 112 countries. Al-Anon/Alateen meetings include: 1. Open meetings that may be attended by anyone interested in learning about the Al-Anon or Alateen program. 2. Closed meetings that are for anyone whose life is or has been affected by a problem drinker. 3. Limited access groups which meet in locations where the general membership may not be able to attend (ie, industrial, military or school settings). Al-Anon is a separate fellowship from Alcoholics Anonymous (AA). Alateen is part of the Al-Anon Fellowship designed for the younger relatives and friends of alcoholics through age nineteen and its members conduct their own meetings with the guidance of an Al-Anon sponsor. Publication(s): Al-Anon Speaks Out. Relevant area(s) of interest: Al-anon; Alateen; Alcoholics Anonymous; Alcoholism; Family services; Self help; Support groups ·

Alaska Department of Health and Social Services Division of Alcoholism and Drug Abuse Address: Box 110607 Juneau, AK 99811-0607 Telephone: (800) 478-2072; (907) 465-2071 Web Site: http://www.hss.state.ak.us/dada/ Background: The Division of Alcoholism and Drug Abuse is partially funded by the ADMS Block Grant. Interests of the Department include all areas of addictive chemical substance usage, prevention, education, treatment, rehabilitation, research, and manpower development and training in service provision. The Department answers inquiries, provides advisory and consulting services, provides information on R&D in progress, provides training services to local program staff

36 Alcoholism

members, and makes referrals to other sources of information. Information services are provided at cost to anyone. Relevant area(s) of interest: Alcohol addiction; Alcoholism; Drug addiction; Drug education; Rehabilitation; Therapy ·

Alcohol and Drug Abuse Administration Maryland Department of Health and Mental Hygiene Address: 201 West Preston Street, 4th Floor Baltimore, MD 21201 O'Conor State Office Building Telephone: (410) 767-6925 Web Site: http://maryland-adaa.org/ Background: Interests of the Alcohol and Drug Abuse Administration include alcoholism and drug abuse (treatment and prevention), alcohol and drug education, and alcoholism programming. The Administration maintains a small collection of books, journals, reprints, reports, and pamphlets; answers inquiries or refers inquirers to other sources of information; provides consultation and technical assistance; provides access to alcoholism education, treatment center referrals, and training; and operates a speaker's bureau. Publication(s): Maryland Alcohol and Drug Programs Directory (199596); Trends and Patterns in Maryland Alcohol and Drug Abuse Treatment Fiscal Year 1995; DWI Annual Report: Fiscal Year 1994. Relevant area(s) of interest: Alcohol addiction; Alcohol education; Alcoholism; Alcoholism treatment; Cocaine; Drug treatment; Drugs; DWI; Heroin; Marijuana; Maryland; Prevention; Substance abuse

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Alcohol and Drug Helpline Highland Ridge Hospital Address: 175 W 7200 S Midvale, UT 84047 Telephone: 800-821-HELP Background: Highland Ridge Hospital (HRH) is a thirty-four (34) bed chemical dependency treatment facility located just outside Salt Lake City, Utah. Situated in the shadows of Mt. Olympus, HRH is the oldest free standing chemical dependency treatment hospital in Utah. HRH expertly evaluates, assesses and treats, numerous clients from across the United States. The Highland Ridge Hospital (HRH), Alcohol and Drug Helpline provides referral services to alcohol and drug dependency units and self-help groups in caller's local area. Relevant area(s) of interest: Alcoholism treatment; Drug addiction treatment

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Alcohol and Drug Services Address: 5209 West Wendover Ave High Point, NC 27265 Telephone: 336-812-8645 Web Site: 1310 Beaman Place,; http://www.adsyes.com/; Other Offices

Greensboro,

NC

27408;

Background: Alcohol and Drug Services (ADS) provides a complete range of substance-abuse treatment for both adolescents and adults including outpatient, detoxification, inpatient, case management, and many other programs for the judicial system. ADS also conducts educational, training, intervention, and prevention programs related to chemical dependency and substance abuse. Chief concerns are chemical dependency prevention and intervention through educational programs, outreach to families and businesses, and the judical system. The staff answers inquiries; provides advisory and consulting services; makes referrals to other sources of information. Publication(s): Pamphlets Relevant area(s) of interest: Chemical dependency; Chemical dependency treatment, education & prevention; Data collected from various assessment, counseling, and; educational programs.; Greensboro, NC 27408; Holdings; LOCATION, IF OTHER THAN MAILING ADDRESS: 1310 Beaman Place,; Other Offices; Substance abuse; Substance abuse prevention; Substance abuse treatment; Substance education ·

Alcohol Epidemiology Program University of Minnesota Address: 1300 South Second Street, Suite 300 Minneapolis, MN 554541015 Telephone: (612) 624-1818 Fax: (612) 624-0315 Email: [email protected] Web Site: http://www.epi.umn.edu/alcohol Background: The Alcohol Epidemiology Program conducts research and teaches community health and epidemiology graduate students in the epidemiology and prevention of alcohol use and problems. Interests of the Program include alcohol research, public policy, prevention, and community intervention programs. The Program has access to a computerized drug information data base and library through the College of Pharmacy. The Program conducts research, designs community interventions, answers inquiries, provides advisory and

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consulting services, evaluates data, and makes referrals to other sources of information. Services are available to anyone via the Internet. Publication(s): Journal articles; book chapters. Relevant area(s) of interest: Adolescents; Alcohol; Alcohol control policy; Community intervention; Content analysis; Curriculum; Epidemiology; Evaluation; Prevention; Public health; Public policy; Research ·

Alcohol Research Group Public Health Institute Address: 2000 Hearst Ave., Suite 300 Berkeley, CA 94709-2176 Telephone: (510) 642-5208 Fax: (510) 642-7175 Email: [email protected] Web Site: http://www.arg.org Background: The Alcohol Research Group (ARG) has been engaged in epidemiological studies of alcohol and health services research since 1959. ARG is the home of one of fifteen National Alcohol Research Centers funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). While the majority of ARG grants are funded by NIAAA, other grants have been awarded from the National Institute on Drug Abuse, the National Institute for Mental Health, the Centers for Disease Control, the Center for Substance Abuse Treatment, and the Robert Wood Johnson Foundation. Current research focuses on alcohol and drug use and related problems, health services research, policy analysis, and the study of community responses and interventions. Groups studied include the general population and specific populations, such as individuals in treatment, welfare recipients, pregnant women, emergency room patients, and homeless persons. Publication(s): The Drinking and Drug Practices Surveyor. Relevant area(s) of interest: Alcohol abuse; ARG maintains a library with a highly specialized collection; Arthritis; Cancer; devoted to alcohol and other drug abuse studies with emphasis on; Emphysema; Heart diseases; Holdings; Immunology; Infectious diseases; Libraries and Information Specialists).; Neurology; Preventive medicine; Rehabilitation engineering; SALIS NEWS (newsletter of the Association of Substance Abuse; sociocultural aspects. It contains 6,000 books, 60,000 other; titles, and recieves approximately 300 periodicals including

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Alcohol Research Information Service Address: 1106 East Oakland Ave. Lansing, MI 48906 Telephone: (517) 485-9900

Seeking Guidance 39

Fax: (517) 485-1928 Email: [email protected] Background: The Alcohol Research Information Service (ARIS), formed in 1931 as the American Businessmen's Research Foundation, is a non-profit group that collects, correlates, and disseminates information about alcohol and alcohol products, their manufacture, sale, and use, and their relationship to the health and well-being of the American public. ARIS's "8:30 Monday Morning" program is an alcohol prevention project for use with junior high and high school students, that emphasizes decisionmaking skills as well as alcohol education. Publication(s): The Bottom Line on Alcohol and Society. Relevant area(s) of interest: Alcohol; Alcohol prevention; Alcoholism; Substance abuse ·

Alcoholics Anonymous General Service Office Address: 475 Riverside Dr. New York, NY 10115 New York, NY 10163 Telephone: (212) 870-3400 Fax: (212) 870-3003 Email: 102367,[email protected] Web Site: http://www.alcoholics-anonymous.org Background: Alcoholics Anonymous (AA), General Service Office, is a fellowship of men and women who share their experiences in order to recover and help others recover from alcoholism. The General Services Office provides information about AA, including central office telephone numbers for each state and province in the US and Canada. Publication(s): About AA, (semi-annually newsletter) General Notes Hours of Operation: Mon.-Fri., 8:30am-4:45pm. Relevant area(s) of interest: Alcoholism recovery; Alcoholism resources

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Alliance for Children and Families Address: 11700 West Lake Park Drive Milwaukee, WI 53224 Telephone: (414) 359-1040; (800) 221-2681 Fax: (414) 359-1074 Web Site: http://www. alliance1.org Background: The Alliance for Children and Families is a nonprofit membership association representing more than 350 child-and familyservicing organizations. Alliance members serve more than 5 million

40 Alcoholism

individuals each year in more than 2,000 communities. The Alliance's mission is to strengthen members' capacity to serve and advocate for children, families, and communities. Alliance members provide a vast array of services covering: marital difficulties; parenting; drug and alcohol abuse; family violence; teenage pregnancy; eldercare; child care and development; HIV/AIDS; school-linked services; residential care; family economics; employment/job training; housing/homelessness; adoption; and family preservation. Relevant area(s) of interest: Child care; Family centered services; Family functioning ·

American Academy of Addiction Psychiatry Address: 7301 Mission Road, Suite 252 Prairie Villiage, KS 66208 Telephone: (913) 262-6161 Fax: (913) 262-4311 Email: [email protected] Web Site: http://www.aaap.org Background: A professional organization, the American Academy of Addiction Psychiatry (AAAP) provides a forum and information exchange center for professionals in this field seeking networking with other professionals. In addition the AAAP promotes high quality treatment for patients, seeks excellence in clinical practice, provides continuing education for its professionals, works to educate the public and influence public policy, disseminates information and encourages research on the etiology, prevention, identification, and treatment of additions. The AAAP tries to assure that new research findings are available to practitioners and are applied in clinical practice. They explore the relationships of addiction psychiatrists to reimbursement systems, to managed care and to third and fourth party payers. Publication(s): AAAP Newsletter (quarterly) Relevant area(s) of interest: Addiction psychiatry; Addition; Alcohol addiction; Drug addiction; Mental health; Psychiatric treatment

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American Council on Alcoholism Address: 3900 North Fairfax Drive, Suite 401 Arlington, VA 22203 Telephone: (703) 248-9005; (800) 527-5344 (Toll-free) Fax: (703) 248-9007 Email: [email protected]

Seeking Guidance 41

Web Site: http://www.aca-usa.org Background: The American Council on Alcoholism (ACA) is a reliable guidance and referral service for persons touched by alcoholism. Via a toll-free helpline, ACA refers its callers to quality facilities in their locale that can provide counselling and/or treatment. ACA's Helpline staff members answer inquiries on various alcohol-based topics including facility services, DWI education/assessment, and self-help groups. ACA's Alliance of Participating Treatment Centers Program (APTC) enables treatment centers nationwide to join its network of facilities that receive referrals based on geographic location of the person needing help. ACA also provides literature and information on alcohol-related issues. Publication(s): Council Connection. Relevant area(s) of interest: Alcohol abuse; Alcoholism; DWI/DUI; Intervention; Teenage drinking ·

American Health Foundation Address: 320 East 43rd St. New York, NY 10017 Telephone: (212) 953-1900 Fax: (212) 687-2339 Web Site: http://www.ahf.org/ Background: The American Health Foundation (AHF), founded in 1969, is a not-for-profit, private research organization devoted primarily to the prevention of chronic diseases, especially cancer, through an interdisciplinary research and intervention approach implemented by investigators in epidemiology and biostatistics; analytical, synthetic, biological and clinical chemistry; molecular biology; cell biology; nutrition; endocrinology; pathology; and behavioral sciences. AHF's mission is based on the following concept: mortality and morbidity from cancer, heart disease, and stroke (which account for more than two-thirds of all premature deaths) can be reduced by a rational program of disease prevention. Many of the current chronic diseases are due to lifestyle choices, which include smoking, nutritional habits, drug and alcohol abuse, sedentary lack of activity, and exposure to occupational and environmental hazards. It is within the power of individuals, and society as a whole, to eliminate, or at least, reduce the risk factors for chronic disease. Health practices and well-being can be improved by implementing research findings through practical health promotion programs. AHF is a National Cancer Institute designated Cancer Center. Publication(s): Preventive Medicine; Prevention Is The Cure; Food And Nutrition Council; The Importance Of Knowing Your Cholesterol:

42 Alcoholism

Cholesterol Check; High Cholesterol; Stopping Smoking: A Nurse's Guide; Live Well: The Low Fat/High-Fiber Way--Food Plan; Health Passport: Guidelines For A Healthy Lifestyle; American Health Foundation Update. Relevant area(s) of interest: Cancer; Chronic diseases; Disease prevention; Health promotion; Heart disease; Preventive medicine; Research; Stroke ·

American Schizophrenia Association Huxley Institute for Biosocial Research Address: 1209 California Rd. Eastchester, NY 10709-1021 Telephone: (914) 337-2252 Web Site: http://www.schizophrenia.org Background: The primary function of the Huxley Institute for Biosocial Research is to promote the acceptance of orthomolecular psychiatry and medicine as a necessary and valid treatment for various types of mental and physical illness, including schizophrenia and manic depression. To this end, they also conduct a referral service to connect patients with orthomolecular physicians. The key concern of the Institute is orthomolecular psychiatric treatment for schizophrenia and related mental disorders, as well as for alcoholism, drug addiction, hyperactivity, learning disabilities, degenerative diseases, allergies, metabolic disorders, and nutrition. The staff answers inquiries; provides reference, currentawareness (SDI), and document reproduction services; provides information on research in progress; sells publications and tapes; conducts seminars; permits onsite use of collections. A training program in orthomolecular practice and theory is conducted for physicians and allied health professionals. Publication(s): The Journal of Orthomolecular Psychiatry (quarterly); The Huxley Institute News (quarterly); reprints, bibliographies, books, films, publications list. Relevant area(s) of interest: Alcoholism; Biochemistry; Books and tapes pertaining to orthomolecular psychiatry and the; Drug addiction; Geriatrics; Holdings; Hypoglycemia; illnesses it is used to treat.; Learning difficulties; Medical services; Mental disorders; Metabolic diseases; Nutrition; Nutritional deficiencies; Orthomolecular psychiatry; Schizophrenia

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American Society of Addiction Medicine Address: American Society of Addiction Medicine 4601 North Park Avenue, Arcade Suite 101, Chevy Chase, MD 20815

Seeking Guidance 43

Telephone: (301) 656-3920 Fax: (301) 656-3815 Email: [email protected] Web Site: http://207.201.185.5/asam50.htm Background: The American Society of Addiction Medicine (ASAM) is a medical specialty society founded in 1954 that is dedicated to educating physicians and improving the treatment of individuals affected by alcoholism or other addictions. The Society is committed to increasing access to and improving the quality of addictions treatment; educating physicians, medical and osteopathic students, and the public; promoting research and prevention; and establishing addiction medicine as a specialty recognized by the American Board of Medical Specialties. The ASAM conducts an annual medical and scientific conference, provides guidelines for addiction treatment, and publishes regular legislative action alerts. The Society also offers a variety of professional publications and materials including the 'Journal of Addictive Disease,' the 'ASAM Principles of Addiction Medicine,' the 'ASAM Newsletter,' and audiotapes of ASAM conferences. The 'ASAM Principles of Addiction Medicine' contains the most current scientific and clinical information for physicians, nurses, counselors, and other health professionals who have a special interest in addiction medicine and all practitioners and administrators who need a comprehensive reference. ·

Andromeda Transcultural, Hispano Mental Health Center Address: 1400 Decatur Street, NW Washington, DC, 20011 Telephone: (202) 291-4707 Voice; (202) 723-4560 FAX Web Site: http://www.adromedatranscultural.org Background: Andromeda, founded in 1970, provides mental health services to the Hispanic community. Bilingual staff members provide services oriented toward integrating clients into American society without the loss of Hispanic cultural values. Services include emergency referrals, a hotline, group and individual counseling, social services, alcoholism and drug abuse treatment programs, and community outreach programs. Fees are on a sliding scale. Relevant area(s) of interest: Transcultural resources

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Association for Addiction Professionals Drug Abuse Counselors, Inc. Address: 901 North Washington St., Suite 600 Alexandria, VA 22314-1535 Telephone: (800) 548-0497 (Toll-free)

44 Alcoholism

Fax: (703) 741-7698 Email: [email protected] Web Site: http://www.naadac.org Background: The core values of NAADAC are leadership, professionalism, openness to change, knowledge-based decision making, empowerment, spirit, diversity, integrity, courage and community. NAADAC's mission is to lead, unify and empower addiction focused professionals to achieve excellence through education, advocacy, knowledge, standards of practice, ethics, professional development and research. NAADAC's efforts are predicated on three basic principles: alcoholism and other drug dependency must be addressed primarily as a public health problem; access to appropriate care, delivered by credentialed/licensed professionals, must be provided to persons dependent on alcohol and other drugs; and a benefit for alcohol and drug abuse treatment must be on parity with other health coverage. Relevant area(s) of interest: Alcohol addiction; Alcoholism prevention; Alcoholism prevention and treatment; Alcoholism treatment; Counseling; Drug abuse; Drug abuse treatment; Drug addiction prevention; Legislative Issues; Professional standards ·

Association for Medical Education and Research in Substance Abuse Address: 125 Whipple Street, Suite 300 Providence, RI 02908 Telephone: (401) 785-8263 Fax: (877) 418-8774 Email: [email protected] Web Site: http://www.amersa.org Background: The Association for Medical Education and Research in Substance Abuse (AMERSA) is an association of multidisciplinary health care professionals working in the field of substance abuse who are dedicated to improving research and education about alcohol, tobacco, and other drugs. AMERSA seeks to expand educational requirements in medical and nursing schools in order to reach all healthcare professionals with training. The organization initiates research programs in substance abuse, emphasizing a multi-disciplinary and multi-cultural approach to intervention and treatment. Relevant area(s) of interest: Alcohol abuse; Drug abuse; Substance abuse; Tobacco

Seeking Guidance 45

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Baltimore City Health Department Address: 210 Guilford Avenue 3rd Floor Baltimore, MD 21202 Telephone: (410) 396-4387 (Commissioner's Office); (410) 396-4398 Email: [email protected] Web Site: http://www.ci.baltimore.md.us/style/health.html Background: The Baltimore City Health Department is interested in public health, including aspects of industrial hygiene, environmental hygiene, food control, cancer control, nutrition, mental health, alcoholism, drug abuse, dental care, preventive medicine, community health nursing, community health planning, health care delivery and coordination, health manpower analysis, health care biostatistical surveys and analysis, emergency and disaster services, and health promotion and education. The Department answers inquiries, makes referrals to other sources of information, provides vital statistics for Baltimore, and disseminates information through the mass media and through radio and television spot announcements and programs. Pamphlets and other publications cannot be provided in large numbers, but reproduction permission can usually be granted. Publication(s): Perspectives (periodical); Vital Statistics, Baltimore, Maryland (annual); medical bulletins to physicians; news releases; pamphlets. Relevant area(s) of interest: Community health services; Department Annual Reports from 1815 to 1974 (annual reports are; Health care delivery systems; Health services; Health statistics; Holdings; Local history; Medicine history; now issued by the Mayor's Office for the entire city government);; other reports; and periodicals.; The Department maintains a complete collection of Health

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Bureau for Public Health West Virginia Department of Health and Human Resources Address: 1800 Washington Street, East Charleston, WV, 25305 State Capitol Complex, Bldg. #3 Telephone: (304) 558-2971 Voice Web Site: http://www.wvdhhr.org/bph/ Background: The West Virginia Department of Health and Human Resources, Bureau for Public Health plans and administers community and environmental health services and hospitals. Health planning activities include plan development and facilities evaluation. Environmental health activities include sanitation inspections and safety evaluation. The Department funds and assists programs in alcoholism

46 Alcoholism

and drug abuse treatment and prevention, community mental health and mental retardation, family planning, perinatal health, nutrition and supplemental food, special children's clinics, health screening, and epidemiology. It also funds and assists programs in immunizations, tuberculosis and venereal disease control, local public health services, training for emergency medical service personnel, public health education, training for Department employees, and assistance for public health nurses. The Department also operates programs to improve hospitals, a foster grandparent program, and developmental disabilities centers. Relevant area(s) of interest: Public health; State health departments ·

Bureau of Alcohol and Drug Abuse Services Tennessee Department of Health Address: 425 5th Avenue North Cordell Hull Building, 3rd Floor Nashville, TN 37247-4401 Telephone: (615) 741-3111 Fax: (615) 741-2491 Email: [email protected] Web Site: http://www.state.tn.us/health/ Background: The Bureau of Alcohol and Drug Abuse Services plans, directs, and coordinates statewide alcohol, tobacco, and drug abuse service activities. Interests include all aspects of alcohol and drug services, including funding of alcohol and drug programs; community needs assessment; development of State Plan for service delivery; thirdparty payments; and minorities, women, HIV/AIDS, IVDU and youth alcohol and drug service coordination. The Bureau Answers inquiries; provides information on treatment, prevention, and training services available within the state; provides consulting and reference services; and makes referrals to other sources of information. Provision of Redline at (800) 889-9789 for information and referrals. Relevant area(s) of interest: Alcohol education; Alcoholism; Drug addiction; Drug education

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Bureau of Alcoholism and Drug Abuse Delaware Health and Social Services Division of Alcoholism, Drug Abuse, and Mental Health Address: 1901 North Du Pont Highway Main Building New Castle, DE 19720 Telephone: (302) 577-4461

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Fax: (302) 577-4484 Email: [email protected] Web Site: http://www.state.de.us/dhss/dadamh/dmhhome.htm Background: The Divisiion of Alcoholism, Drug Abuse, and Mental Health is partially funded by the U.S. Department of Health and Human Services. Interests of the Division include drug and alcohol abuse, drug and alcohol treatment and education, crisis intervention, individual and family counseling, group therapy, residential detoxification, and outpatient clinics. The Division answers inquiries; provides counseling, advisory, reference, and current-awareness services; evaluates data; and makes referrals to other sources of information. Services are free and available to anyone. Relevant area(s) of interest: Alcohol addiction; Alcohol education; Alcoholism treatment; Crisis intervention; Detoxification; Drug addiction; Drug education; Group therapy; Outpatient clinics ·

Bureau of Substance Abuse Services Wisconsin Department of Health and Social Services Address: Madison, WI 53707 PO Box 7851 Telephone: (608) 266-2717 Web Site: http://www.dhfs.state.wi.us/substabuse Background: The Bureau of Substance Abuse Services Has a staff of 22 in two units: Program, Planning, Evaluation, and Monitoring Section; and the Program and Systems Development Section. The Bureau strives to improve coordination among state agencies having responsibilities for substance abuse services, increase the quantity of intervention and treatment programs, improve access to services for high-risk and underserved populations, further strengthen the county and local substance abuse delivery system, and provide staffing to the Governor's appointed 22-member State Council on Alcohol and Other Drug Abuse and its five standing committees. The Bureau also offers Internet access, technical assistance and training; evaluates data; conducts seminars and workshops; distributes publications; and answers inquiries. Relevant area(s) of interest: Alcoholism; Chemical dependency; Drug addiction; Drug education; Mental health; Substance abuse

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Butler Center for Research Hazelden Foundation Address: Center City, MN 55012-0011 PO Box 11, CR9 Telephone: (651) 213-4000; (800) 257-7810

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Fax: (651) 213-4536 Email: [email protected] Web Site: http://www.hazelden.org/research Background: The Butler Center for Research is dedicated to the advancement of knowledge and understanding of addiction recovery through research, collaboration, and communication. Key areas include, research on chemical dependency, alcoholism, and drug dependency (addiction). The staff permits on-site use of collections. Publication(s): Research reports; evaluation studies. A catalog of pamphlets, books, and audiovisual materials is available from the Literature Department. Relevant area(s) of interest: Alcohol addiction; Drug addiction; Holdings; Over 5,000 books and 150 serials. ·

Calix Society Address: 2555 Hazelwood St. Saint Paul, MN 55109-2030 Telephone: (651) 773-3117; (800) 398-0524 Fax: (651) 773-3117 Background: The Calix Society was founded in 1949 as an association of Catholic alcoholics who are maintaining their sobriety through participation in Alcoholics Anonymous (AA). The Society has three objectives: to interest Catholics with an alcohol problem in the virtue of total abstinence; to promote the spiritual development of its membership; and to strive for the sanctification of the whole personality of each member. Members are expected to maintain their sobriety through affiliation with AA while they work at regaining their spiritual lives through Calix. Local Calix units must obtain approval from the bishop of their diocese before forming. Both non-Catholics and non-alcoholics are welcome to join. Publication(s): The Chalice. Relevant area(s) of interest: Catholicism; Mental health

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Abstinence;

Alcohol;

CARF Address: 4891 East Grant Road Tucson, AZ 85712-2704 Telephone: (520) 325-1044 Fax: (520) 318-1129

Alcoholism;

Seeking Guidance 49

Email: [email protected] (Associate Director, Medical Rehabilitation; Division) Web Site: http://www.carf.org Background: CARF is a private, non-profit organization that serves as the standard-setting and accrediting body for the rehabilitation industry. CARF is sponsored by national organizations in the rehabilitation industry and related medical disciplines. CARF is dedicated to identifying competent organizations through accreditation, setting standards by which organizations can measure their performance, and focusing organizations on outcomes through program evaluation. CARF has developed standards in the following areas: comprehensive integrated inpatient rehabilitation programs; spinal cord rehabilitation system; comprehensive pain management programs: acute, chronic, and cancer related; brain injury programs; outpatient medical rehabilitation; home- and community-based programs; health enhancement; pediatric family-centered programs; vocational evaluation; work adjustment; occupational skill training; job placement; work services; supported employment; and industry-based programs. CARF answers inquiries, makes referrals to other sources of information, and distributes publications; grams; early intervention and preschool developmental programs; respite services; alcoholism and other drug dependency rehabilitation programs; mental health programs; and psychosocial rehabilitation programs. Because CARF believes that "outcomes, the results of program services, are the true measure of success for any organization serving people with disabilities," it has developed a number of resource documents to assist organizations with their program evaluations. By holding organizations accountable for the effectiveness and efficiency of their programs, CARF serves its overall purpose of improving the quality of services for people with disabilities. CARF also answers public inquiries and holds seminars for rehabilitation facilities. Relevant area(s) of interest: Outpatient rehabilitation; Pain management; Rehabilitation programs ·

Center for Addiction and Alternative Medicine Research Address: 914 South Eighth Street, Suite D917 Minneapolis, MN 55404 Telephone: (612) 347-7670 Fax: (612) 347-7669 Email: [email protected] Web Site: http://www.mmrfweb.org/research/

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Background: The Center for Addiction and Alternative Medicine Research operates cooperatively with the Office of Alternative Medicine at the National Institutes of Health (OAM, NIH). The CAAMR is one of ten centers for research funded by the OAM to study the field of complementary and alternative medicine and was created to study the prevalence and efficacy of alternative/complementary modalities being used for the treatment of substance abuse; promote technical assistance to those who wish to evaluate the safety and efficacy of promising treatments; provide information to consumers and providers about the potential benefits and/or risks of using a particular CAM modality; facilitate communication with CAM and substance abuse professionals. Relevant area(s) of interest: Alcoholism; Alternative medicine; Complementary medicine; Drug abuse; Research; Substance abuse ·

Center for Alcohol Studies School of Medicine University of North Carolina at Chapel Hill Address: CB #7178 Chapel Hill, NC 27599-7178 Thurston-Bowles Telephone: (919) 966-5678 Web Site: http://www.med.unc.edu/ Background: The primary objective of the Center for Alcohol Studies is to promote and coordinate training and research of the problems associated with alcohol use and abuse. Interests of the Center include etiological research on alcohol abuse and alcoholism and brain, liver, and fetal effects of alcohol. The Center answers inquiries, provides reference services, conducts seminars, co-sponsors an annual symposium, distributes publications, makes referrals to other sources of information, and permits on-site use of collections. Services are available to anyone. Publication(s): Center Line (quarterly); journal articles; bibliographies; reprints. Relevant area(s) of interest: Alcohol abuse; Alcoholism; Books; journals; reprints.; Holdings

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Center for Substance Abuse Prevention Address: 5600 Fishers Lane Ninth Floor Parklawn Building/Rockwall II Rockville, MD 20857 Telephone: (301) 443-0365 Fax: (301) 443-5447 Web Site: http://www.samhsa.gov/csap

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Background: The Center for Substance Abuse Prevention (CSAP) was created by the Anti-Drug Abuse Act of 1986 to lead federal efforts to prevent alcohol and other drug problems and to reduce the demand for illicit drugs. The center is a component of the Substance Abuse and Mental Health Services Administration, Public Health Service. Activities and services include demonstration projects targeting pregnant and postpartum women, their infants, and other high-risk populations; a national clearinghouse of publications and other materials and services; development of media campaigns and other knowledge transfer programs; and technical assistance for communities and organizations that develop and implement prevention and intervention efforts. Relevant area(s) of interest: Alcoholic beverages; Alcoholism; Drugs; High risk adolescents; Prevention; Substance abuse ·

Center of Alcohol Studies Rutgers University Address: 607 Allison Road Piscataway, NJ 08854-8001 Telephone: (732) 445-4442 Fax: (732) 445-5944 Email: [email protected] Web Site: http://www.rci.rutgers.edu/~cas2 Background: The Center of Alcohol Studies (CAS), founded in the early 1940s, is a multidisciplinary institute dedicated to conducting research on alcohol, disseminating information, and engaging in professional and public education. CAS' extensive research library is housed at the Information Services Division Alcohol Studies Library, open to researchers, scholars, and students. The Library acquires, organizes, and disseminates scientific and technical bibliographic and textual information on alcohol; and houses a major collection of books, periodicals, dissertations, and other materials pertaining to alcohol studies. The Library's collection includes the Master Catalog of Alcohol Literature, which lists the world's scholarly literature on alcohol studies since the 15th century; the Classified Abstract Archives of the Alcohol Literature, which covers 1935-1976; the McCarthy Memorial Collection of alcohol research documents; and a collection of questionnaires, interview schedules, and survey forms used in research on drinking and alcoholism. Copies of selected materials and bibliographies may be available through the mail at a cost-recovery fee. CAS publications include technical and nontechnical books, reprints, and pamphlets. Publication(s): Journal of Studies on Alcohol.

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Relevant area(s) of interest: Alcohol abuse; Alcoholism; Psychoactive substance use ·

Centre for Addiction and Mental Health Address: 33 Russell Street, Toronto, ON M5S 2S1 Telephone: (416) 535-8501 Email: [email protected] Web Site: http://www.camh.net Background: The Centre for Addiction and Mental Health (CAMH) is the largest mental health and addictions facility in Canada, only one of four such facilities in that field to receive designation from the World Health Organization as a Centre of Excellence. Underlying all of the Centre's efforts are two principal tasks: advancing our understanding of mental health and addiction, and translating this knowledge into practical resources and tools that can be used in our own programs and in the broader community. This work is key to preventing problems, finding more effective treatments for often debilitating conditions, and improving the quality of life for people who are struggling with mental illness and addictions. The Centre is recognized for its uniqueness and its ability to: integrate biological, social and clinical research; translate research done in a laboratory into practical treatment and tools; provide a complete continuum of care in one setting; integrate the treatment of alcohol, drug and mental disorders; and be at the forefront of leadingedge research, making major advancements in the treatment of a number of diseases including schizophrenia and anorexia. Publication(s): A publications list is available upon request. Relevant area(s) of interest: Aggressive behavior; Alcoholism; Depression; Detoxification; Drug addiction; Dual diagnosis; fields, print, audio-visual and digital collections.; Health promotion; Holdings; Mental disorders; Mental health; Mental illness; Mood disorders; Psychiatric care; Research and collections in the addictions and mental health; Schizophrenia; Sexual dysfunction

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Children of Alcoholics Foundation Address: 164 W. 74th Street New York, NY 10023 Telephone: 212-595-5810, ext. 7760 Web Site: http://www.coaf.org/ Background: Children of Alcoholics Foundation (COAF) is a public nonprofit organization that works to educate young and adult children of

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alcoholics. The Foundation's purposes are to inform the public about children of alcoholics and to stimulate interest in seeking solutions to their problems; to promote research on alcoholism and its effects on children of alcoholics; and to encourage Federal, State, and local agencies to respond to the needs of these children. The Foundation also works to break the intergenerational cycle of alcoholism, focusing on prevention and early intervention. It is supported by contributions. The foundation promotes and disseminates research, provides information and referrals to children of alcoholics, and offers training and materials to professionals who work with children from addicted families. Relevant area(s) of interest: Alcoholism; Substance abuse ·

Children's Aid Society Address: 105 East 22nd Street New York, NY 10010 Telephone: (212) 949-4800 Fax: (212) 460-5941 Web Site: http://www.childrensaidsociety.org Background: The Children's Aid Society, foundedin1853, provides health, social and educational services in community centers, health clinics, homes and the courts in New York City. The society's services include adoption and foster care, arts, camps, community centers and schools, counseling, housing, drug and alcohol abuse prevention, education, special meal programs, school-based clinics, mobile health van, job programs, teen pregnancy prevention, youth mediation and court diversion. Many of these programs are shared nationally as models for meeting the needs of children and families on the community level. Relevant area(s) of interest: Alcohol abuse prevention; Child health; Children; Community programs; Inner city; Job programs; Meals programs; Teenage pregnancy prevention

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Community of Caring Joseph P. Kennedy, Jr. Foundation Address: 1325 G Street NW Suite 500 Washington, DC 20005 Telephone: (202) 393-1250 Fax: (202) 824-0351 Web Site: http://www.communityofcaring.org/ Background: The Community of Caring is a K-12 character education program designed to prevent a wide range of destructive behaviors, including teenage pregnancy, drug and alcohol abuse, juvenile delinquency, and gang involvement. The program is based on five

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universal values - caring, respect, responsibility, trust, and family - which are taught through a combination of student forums, classroom instruction, role modeling, and systemic role change of the school's culture. Publications include a newsletter. Community of Caring sponsors conferences and training seminars and provides materials in Spanish. Relevant area(s) of interest: Adolescent pregnancy; Alcohol abuse; Drug abuse; Gangs; Juvenile delinquency ·

Connecticut Department of Mental Health and Addiction Services Address: 410 Capitol Avenue Hartford, CT 06134 Telephone: (800) 446-7348; (860) 418-6707; (888) 621-3551 (TDD); (860) 418-7000 Email: [email protected] Web Site: http://www.dmhas.state.ct.us Background: The Department of Mental Health and Addiction Services (DMHAS) is the single state agency for providing comprehensive mental health and substance abuse services throughout Connecticut. While the Department's prevention services serve all Connecticut citizens, its primary treatment clients are adults (over 18 years of age) with psychiatric or substance use disorders, or both, who lack the financial means to obtain such services. DMHAS also provides collaborative programs for individuals with special needs, such as persons with HIV/AIDS infection, people in the criminal justice system, those with problem gambling disorders, substance abusing pregnant women, persons with traumatic brain injury or hearing impairment, those with a dual diagnosis of substance abuse and mental illness, and special populations transitioning out of the Department of Children and Families. Relevant area(s) of interest: Alcohol addiction; Alcohol education; Alcoholism; Alcoholism treatment; Drug addiction; Drug addiction prevention; Drug education; Drug therapy; Mental hygiene; Rehabilitation

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Council on Alcoholism and Drug Abuse of Bergen, Inc. Address: Paramus, NJ 07653 PO Box 626 Telephone: (201) 261-2183 Web Site: http://www.bergencouncil.org/

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Background: The Bergen County Council on Alcoholism and Drug Abuse is a nonprofit organization dedicated to the issues of alcoholism and other drug abuse as interrelated public health problems. By providing information and professional referrals to Bergen County residents, the Council addresses substance abuse and addiction as important health conditions which affect the individual, the family, and the community. Relevant area(s) of interest: Alcoholism; Drug abuse; Fetal alcohol syndrome; Parenting ·

Department Library Substance Abuse Services Virginia Department of Mental Health, Mental Retardation and Address: PO Box 1797 Richmond, VA 23218-1797 Telephone: (804) 371-8915 Fax: (804) 786-4146 Email: [email protected] Web Site: http://www.dmhmrsas.state.va.us/; Other Offices; Richmond, VA 23219 Background: Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) provides programs for the needs of mentally ill, mentally retarded, and substance-dependent people; support materials for training activities in these areas. The staff answers inquiries; makes referrals to other sources of information; permits on-site use of collection; makes interlibrary loans. Publication(s): Audiovisual Catalog. Relevant area(s) of interest: Alcohol addiction; Collection of materials on the needs of the mentally ill,; Community service programs; computerized data bases via DIALOG.; Documentation; Drug addiction; Holdings; Information services; Mental deficiency; Mental disorders; Mental health programs; Mental health services; mentally retarded, and substance-dependent people; access to; Other Offices; Public health administration; Richmond, VA 23219; Virginia

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Dependency National Committee for the Prevention of Alcoholism and Drug Address: 12501 Old Columbia Pike Silver Spring, MD 20904-6600 Telephone: (301) 680-6719 Fax: (301) 680-6707 Email: [email protected]

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Web Site: http://www.icpa-dd.org Background: The National Committee for the Prevention of Alcoholism and Drug Dependency (NCPA), founded in 1950, promotes the study of alcohol and drug effects, sponsors research, and conducts an educational program for prevention of alcoholism and drug dependency. Services include publications, films, seminars, and media programs. Seminars address the effective use of educational aids in molding public opinion as well as methods and techniques of rehabilitation. NCPA is an affiliate of the International Commission for the Prevention of Alcoholism (ICPA). Publication(s): ICPA Reporter. Relevant area(s) of interest: Alcoholism; Drugs; Health education; Substance abuse; Substance abuse prevention ·

Division of Alcohol and Substance Abuse Health and Rehabilitation Services Administration Office on Alcoholism Washington State Department of Social and Health Services Address: Olympia, WA 98504-5330 PO Box 45330 Telephone: (360) 438-8200 (reception); (360) 438-8203 (TTY); (800) 6629111 (Help-Line and Clearinghouse); (800) 833-6388 (toll-free, TTY relay operator) Fax: (360) 438-8078 Web Site: http://www.wa.gov/dshs/hrsa/hrsa2hp.html Background: The Division of Alcohol and Substance Abuse (DASA) is the Washington State agency dedicated to helping people avoid and recover from alcoholism and drug addictions. Assistance is provided through a network of prevention, public education, treatment, and support services, through contracts with county governments, tribes, non-profit agencies, and other entities. Areas of interest include chemical dependency; opiates and methadone; alcohol; tobacco; detoxification; transitional housing; vocational services; dependent care; and others. DASA maintains a reporting system for all contracted providers called the Treatment, Assessment and Report Generating Tool (TARGET), which provides demographic, entrance, discharge, modality, substance, funding source, and other information used for research and evaluation. DASA also supports an Alcohol/Drug 24-Hour Help Line and Clearinghouse. Publication(s): Directory of Certified Chemical Dependency Treatment Services; pamphlets; reports; brochures; and others. A publications list is available. Relevant area(s) of interest: Alcoholics; Alcoholism research; Ambulatory medical care; Chemical dependency treatment; Drug courts; Drug free

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workplace; Medical social work; Oxford house; Prevalence research; Program evaluation; Risk/protective factors; Substance abuse prevention ·

Division of Mental Health and Substance Abuse Services North Dakota Department of Human Services Address: 600 S. 2nd St., Suite 1E Bismarck, ND 58504-5729 Telephone: (701) 328-8924 Web Site: handSubstanceAbuseServices; http://lnotes.state.nd.us/dhs/dhsweb.nsf/ServicePages/MentalHealt; Internet Address: Background: The Department of Human Services' Mental Health and Substance Abuse Services Division provides leadership for the planning, development, and oversight of a system of care for children, adults, and families with severe emotional disorders, mental illness, and/or substance abuse issues. Mental health and substance abuse services are delivered through eight regional Human Service Centers and the North Dakota State Hospital in Jamestown. Relevant area(s) of interest: Alcoholism; Drug abuse

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Division of Mental Health, Developmental Disabilities, and North Carolina Department of Health and Human Services Substance Abuse Section Substance Abuse Services Address: 325 North Salisbury Street, Suite 1168 Raleigh, NC 27603 Telephone: (919) 733-4670 Fax: (919) 733-9455 Web Site: http://www.dhhs.state.nc.us/mhddsas/ Background: Interests of the Substance Abuse Section encompass alcoholism, including the illness, the family, the employer, treatment resources, medical and psychiatric treatment, prevention, and Alcoholics Anonymous; alcohol in the human body, including metabolism, biochemistry, physiology, etc.; drug abuse and drug addiction, including the illness, the family, the employer, treatment resources, medical and psychiatric treatment, and prevention; and welfare reform. The Section answers inquiries. Publication(s): Indexes; directories; bibliographies;State plan; pamphlets; brochures. Relevant area(s) of interest: Alcohol addiction; Alcoholics; Alcoholism; Alcohols; Drug addiction; Drugs; Managed care; Metabolism; Physiology; Psychotherapy

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Division of Substance Abuse Utah Department of Human Services Address: 120 North 200 West, Room 201 Salt Lake City, UT 84103 Telephone: (801) 538-3939 Fax: (801)-538-4696 Web Site: 120 West 200 North, Room 201; http://www.hsdsa.state.ut.us/; Other Offices Background: The Division of Substance Abuse is the state agency responsible for the funding of prevention and educational programs and establishment of treatment and rehabilitaton centers dealing with problems of alcoholism and drug abuse in cooperation with local alcohol and drug authorities. The Division is also responsible for assessment of the extent of alcohol and drug use and abuse. The Division makes referrals to local programs, lends materials, and provides education prevention and treatment information, monitors local programs, conducts conferences, certifies instructors for driving under the influence (DUI) educational seminars, and certifies servers of alcoholic beverages. Publication(s): Annual consolidated social services plan; federal reports; and annual summary data on clients served. Relevant area(s) of interest: 120 West 200 North, Room 201; Alcohol addiction; Alcohol education; Alcoholism treatment; Drug addiction; Drug education; Drug therapy; Educational programs; Holdings; Lecturers; Management information systems; Other Offices; pamphlets, and films and alcohol and drug use surveys.; Rehabilitation centers; Research; The Division's holdings include collections of videotapes,

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Division on Alcoholism and Drug Abuse Office of Behavioral Health Services West Virginia Department of Health and Human Resources Address: Building 6, Room 717 Charleston, WV 25305 State Capitol Telephone: (304) 348-2276 Web Site: http://www.wvdhhr.org/obhs/Dad.htm Background: The Division on Alcoholism and Drug Abuse of the Office of Behavioral Health Services oversees the statewide provision of substance abuse treatment and prevention services for adults and adolescents. The Division fulfills this function primarily through contractual arrangements with the state's fourteen community behavioral health centers and other agencies. The Division's other primary responsibilities as the federal government's identified single state agency for substance abuse funds are: to manage the block grant funding,

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identify service needs, facilitate training, and provide leadership for collaborative community efforts in the areas of both prevention and treatment. Relevant area(s) of interest: Alcohol education; Alcoholics; Alcoholism; Drug addiction; Drug education; Narcotic addicts; West Virginia ·

Drug Dependency International Commission for the Prevention of Alcoholism and Address: 12501 Old Columbia Pike Silver Spring, MD, 20904 Telephone: (301) 680-6719 Web Site: http://www.health2020.org/icpa.htm Background: The International Commission for the Prevention of Alcoholism and Drug Dependency (ICPA) was established in 1950 as a nongovernmental organization of the United Nations and the World Health Organization, dedicated to the prevention of alcoholism and drug dependencies. The ICPA encourages research, study, and application of prevention ideas and techniques. It also seeks to provide information on the impact of alcohol and drug dependency on the economic, political, social, and religious life of nations. ICPA encourages the use of education and communication media, personal decisionmaking, democratic legislative action, and moral values to stimulate motivation for the avoidance of alcohol and drug dependencies. World Congresses are held to provide an international forum for discussion of ways to prevent dependencies and create drug-free societies. 56 National committees provide practical information programs and educational materials for community leaders and serve as national educational organizations. Relevant area(s) of interest: Alcoholism; Consumer resources; Drug abuse; Professional resources

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Endeavor House Address: 6 Broadway Keyport, NJ 07735 Telephone: (732) 264-3824 Fax: (732) 264-6497 Web Site: http://www.endeavorhouse.baweb.com Background: Endeavor House is a small private treatment center for people who are recovering from drug and alcohol addiction. Endeavor House strives to help overcome the harmful consequences of chemical dependency by providing a way to learn more adaptative ways to deal with problems. Believing that chemical dependency is a progressive yet

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treatable disease, the Twelve Step Program serves as a foundation for the recovery process. Residential, halfway, and outpatient care services; and crisis intervention counseling, and other mental health services are also available. The admission process begins with a telephone interview assessment and proceeds with a complete personal profile, and medical and relapse history. Treatment is provided by the multidisciplinary treatment team, consisting of a psychiatrist; social workers; physicians; and certified alcoholism and drug counselors. Endeavor House accepts most insurance policies. Financial consultation is available to determine eligibility for sliding scale if insurance is not available. Relevant area(s) of interest: Addiction; Alcohol; Chemical dependency treatment; Detox centers; Drugs; Mental health ·

Hazelden Foundation Address: Center City, MN 55012-0011 PO Box 11 Telephone: (800) 257-7810 Web Site: http://www.hazelden.org/ Background: The Hazelden Foundation (HF) provides rehabilitation, education, and professional services for chemical dependency. The Foundation also produces and distributes audiovisual and printed materials that provide information on areas involving addictive behaviors. Support groups and individual counseling are also available. HF operates a treatment center; fellowship club in New York, St. Paul and West Palm Beach, Florida, and intermediate care facility; Hazelden Center for Youth and Families for adolescents and young adults; a renewal center for individuals recovering from addictive behaviors and their families. Hanley-Hazelden Center at St. Mary's in West Palm Beach offers inpatient and outpatient treatment; aftercare therapy; counselor training; a live-in family program that acquaints relatives and other associates of chemically-dependent individuals with problems of chemical dependency; and continuing-education programs for professionals and communities. Relevant area(s) Substance abuse

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of

interest:

Alcoholism;

Chemical

Health Connection Address: 55 West Oak Ridge Drive Hagerstown, MD 21740 Telephone: (301) 790-9735; (800) 548-8700 (Toll-free) Web Site: http://www.healthconnection.org

dependency;

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Background: The Health Connection is a nonprofit organization providing a wide variety of drug- and violence-prevention teaching materials including curriculum, pamphlets, posters, videos, software, puppets, and books. Target audiences range from pre-kindergarten to adult. Topics addressed in the information include AIDS, alcohol and drug abuse, careers, characters, drugs, health and nutrition, tobacco use, and violence prevention. Relevant area(s) of interest: Alcohol; Alcoholism; Audiovisual materials; Smoking; Substance abuse; Violence prevention ·

Health Education Foundation Address: 2600 Virginia Ave. NW, Suite 502 Washington, DC 20037 Telephone: (202) 338-3501 Email: [email protected] Background: The Health Education Foundation (HEF), founded in 1976, is a nonprofit corporation whose main role is maintaining and promoting the quality of health. This goal is achieved by developing a greater awareness of the public's role in achieving and maintaining mental and physical well-being, to make information enabling people to make decisions about their physical and mental health easily accessible, to change people's behavior in making decisions about their habits and health, and to promote an atmosphere in which the potential of health education can be released. Because of the background and experience of its directors, activities are focused around alcohol and the responsible use of alcohol. In 1979, the Foundation developed the TIPS (Training for Intervention Procedures by Servers of Alcohol) program, designed to train servers and sellers of alcohol techniques to prevent drunkenness. HEF is also working on new educational programs to promote the responsible use of alcohol, and it undertakes research and analysis regarding the issues of the responsible use of alcohol. Relevant area(s) of interest: Alcohol abuse; Health education; Health promotion; Mental health

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Institute of American Indian Studies Address: 414 East Clark Vermillion, SD 57069 Telephone: (605) 677-5011 Web Site: http://www.usd.edu/iais Background: The Institute of American Indian Studies is a nonacademic department of the University which serves as the focal point for the

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planning, advice, and coordination of University resources within the University, tribal groups, community colleges, federal and state agencies, and those concerned with the welfare and education of the Native American people. The University has the capacity and the commitment to maintain comprehensive, academic, research, and service programs to the Indian people on a permanent basis. Interests of the Institute include contemporary affairs and history of Northern Plains Indians, including the Chippewa, Dakota, Lakota, Nakota, Cree, Salish, Crow, and other tribes; Indian languages, religion, and music; and alcoholism among Indians. The Institute has a library of over 4,000 volumes, news article clippings, tribal constitutions, conference reports, photographs, music recordings, and 5,000 oral history tapes and transcripts; answers inquiries; provides advisory, reference, and reproduction services; makes referrals to other sources of information; and permits onsite use of collections. Services are free. Relevant area(s) of interest: American Indian languages; Native American studies; Plains Indians ·

Legal Action Center Address: 236 Massachusetts Avenue NE Suite 505 Washington, DC 20002 Telephone: (202) 544-5478 Email: [email protected] Web Site: (212) 243-1313; 153 Waverly Place; http://www.lac.org/; lacinfo.org; New York, NY 10014; Other Offices; Paul Samuels (Executive Director) Background: Legal Action Center is a non-profit, law, and policy office that specializes in alcohol, drug and AIDS issues. The Center conducts policy work and advocacy on a state and federal basis on issues such as: funding for alcohol and drug treatment, prevention and research; welfare reform; confidentiality of treatment records; disability discrimination; child welfare; health care; HIV services for drug dependent individuals; and women's treatment. The Center also provides legal assistance to individuals who face discrimination on the basis of alcoholism, drug dependence or AIDS and to the programs that serve them , as well as extensive legal advice to individuals in New York City who have HIV disease. The Center conducts training on confidentiality and other issues in its area of expertise. Publication(s): Of Substance: A Newsletter for the substance Abuse Treatment Community; Making Welfare Reform Work: Tools for Confronting Alcohol and Drug Problems Among Welfare Recipients; Welfare As We Know It Now: What New Yorker's New Welfare Laws

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Mean for People With Criminal Records, Substance Abuse Histories and HIV/AIDS; A Legal, Policy, and Practical Guide for Human Service Providers in New York; Confidentiality: A Guide to the Federal Laws and Regulations; A Legal Issues Handbook for School-Based Programs. Relevant area(s) of interest: (212) 243-1313; 153 Waverly Place; AIDS/HIV; Alcohol; Contact: Paul Samuels (Executive Director); Discrimination; Drugs; lacinfo.org; Law; New York, NY 10014; Other Offices; Welfare reform ·

Maine Department of Mental Health, Mental Retardation, and Office of Substance Abuse Substance Abuse Services Address: Augusta, ME 04333-0159 State House Station 159 Telephone: (207) 287-2595 Web Site: http://www.state.me.us/dmhmrsa/osa/ Background: The Office of Substance Abuse (OSA) establishes the overall planning, policy directives, and priorities for all drug and alcohol abuse prevention, education, and treatment functions, except the prevention of drug traffic, that are conducted or supported in Maine. Interests of OSA include drug and alcohol programs and statistics and prevention and treatment of drug and alcohol abuse problems. The Information and Resource Center answers inquiries, provides advisory services, conducts seminars and workshops, evaluates data, provides information on research in progress, and makes referrals to other sources of information. Publication(s): Standards; directories; data compilations. Relevant area(s) of interest: Drug addiction; Drug addiction prevention; Rehabilitation

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Missouri Institute of Mental Health Library Address: 5400 Arsenal Street St. Louis, MO 63139-1494 Telephone: (314) 644-8838 Fax: (314) 644-8839 Email: [email protected] Web Site: http://mimh.library.net Background: The Missouri Institute of Mental Health (MIMH) is affiliated with the University of Missouri-Columbia School of Medicine. Interests of the Institute include psychiatry; psychology; outcome evaluation; biomedical aspects of mental disease; computer applications in psychiatry, mental health policy and ethics; alcoholism; and drug abuse. The Library has 27,000 volumes; 400 periodical subscriptions; access to

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the OCLC, PHILSOM, OVID, DIALOG computerized data bases, and inhouse CD-ROM Psyc LIT, MEDLINE, ECER, CINAHL, HealthSTAR. The Library answers inquiries, provides computerized literature-searching services, makes interlibrary loans, and permits on-site use of collection. A catalogue is available on the Internet. Publication(s): Missouri Institute of Mental Health Staff Publications (annual). Relevant area(s) of interest: Alcoholism; Computer applications; Drug abuse; Mental disorders; Mental health; Neurology; Outcomes evaluation; Psychiatry; Psychology ·

Moderation Management Network, Inc. Address: PO Box 3055 Point Pleasant, NJ 08742 Telephone: (732) 295-0949 Email: [email protected] Web Site: http://www.moderation.org Background: Moderation Management (MM) is a behavioral change program and national support group network for people who wish to change their drinking habits. It is designed for those without heavy substance abuse problems, who are able to control drinking behavior without complete abstinence. MM promotes early self-recognition of drinking problems and designs an evaluation program to ascertain the most appropriate course of action. The organization relies on a mutual self-help environment that encourages people who are concerned about their drinking to take action to cut back or quit before their problems become severe. A nine step, professionally reviewed program is used to determine the degree of help needed. However, MM does not provide professional treatment. Relevant area(s) of interest: Abstinence; Alcohol; Drinking programs; Drug abuse; Self-help programs; Substance abuse

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Nassau County Department of Drug and Alcohol Addiction Address: 175 Fulton Ave. Hempstead, NY 11550 Telephone: (516) 572-1900 Web Site: http://www.co.nassau.ny.us Background: The Nassau County Department of Drug and Alcohol Addiction coordinates and implements plans for computerizing data, designs and monitors record keeping, data collection systems, issues required special research studies, and maintains the Department Library.

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The Department is funded primarily through the New York State Office of Alcoholism and Substance Abuse (OASAS) and the County of Nassau. Interests of the Department include alcoholism and drug abuse in Nassau County. The Department has a collection of books, journals, reports, and computerized client census reports; answers inquiries; provides advisory services; evaluates data; distributes publications; makes referrals to other sources of information; and permits onsite use of collection. Services are free and available to anyone. Relevant area(s) of interest: Alcoholism; Drug addiction ·

National Asian Pacific American Families Against Substance Abuse Address: 340 E. Second Street, Suite 409 Los Angeles, CA 90012 Telephone: (213) 625-5795 Fax: (213) 625-5796 Email: [email protected] Web Site: http://www.napafasa.org/ Background: National Asian Pacific American Families Against Substance Abuse (NAPAFASA) is committed to eliminating alcohol and drug abuse among Asian and Pacific Islander families through public and private cooperation in support of the family's capacity to prevent the use of all forms of harmful drugs. The goals of NAPAFASA are to collect and disseminate information on the nature and extent of the problem of substance abuse among Asian and Pacific Islander communities in the US; promote public education and national awareness among the Asian and Pacific Islander groups in their own language regarding substance abuse prevention; establish an Asian and Pacific Islander curricula and related materials; establish a bilingual alcohol and drug abuse staff to translate publications; sponsor regional workshops; collaborate with government agencies to establish peer review groups to approve grants and contracts; develop alcohol and drug abuse literature; conduct training and technical assistance; support the development of model community programs; help develop educational materials on HIV/AIDS; and assist in the preparation of documentary films and public service announcements (PSAs) in various Asian and Pacific Islander languages. Publication(s): Newsletter: FYI, (semi-annually). General Notes Hours of Operation: Mon.-Fri., 9am-5:30pm. Relevant area(s) of interest: Alcohol abuse; Asians; Pacific Islanders; Substance abuse

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National Association for Children of Alcoholics Address: 11426 Rockville Pike Rockville, MD 20852 Suite 100 Telephone: (301) 468-0985, (888) 554-COAS (tollfree) Fax: (301) 468-0987 Email: [email protected] Web Site: http://www.health.org/nacoa Background: The National Association for Children of Alcoholics (NACoA) serves as an advocate for children and families affected by alcoholism and other drug dependencies. The association provides educational materials, information, and referral to other resources. Publication(s): Newsletter. Relevant area(s) of interest: Alcoholism; Substance abuse

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National Association for Native American Children of Alcoholics Address: 1402 Third Avenue Seattle, WA 98101 Suite 1110 Telephone: 206-903-6574 Email: [email protected] Background: Founded in 1988, the National Association for Native American Children of Alcoholics (NANACOA) is a non-profit organization that believes in the spirit of healing and recovery for Native people. The association maintains a national network for Native American children of alcoholics, provides educational and supportive information for Native American communities, holds a national conference for Native American children of alcoholics and people working in Native communities to come together to heal and recharge energies, and informs local and national policymakers about the needs of these children. NANACOA receives support from members, private corporations and foundations, and government sources. Relevant area(s) of interest: Alcoholism; Minority health; Native Americans; Substance abuse

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National Association of State Mental Health Program Directors Address: 66 Canal Center Plaza, Suite 302 Alexandria, VA 22314 Telephone: (703) 739-9333 Fax: (703) 548-9517 Web Site: http://www.nasmhpd.org

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Background: The National Association of State Mental Health Program Directors (NASMHPD) coordinates the actions of the 55 state and territorial mental health agencies with other state agencies, national citizen voluntary associations and their state affiliates, national professional associations, national associations of other state agencies, city and county government associations, national mental health and mental health provider groups, and consumer and patient advocacy groups and labor unions. It provides a vehicle for the exchange of information between state agencies for the mentally disabled on state programs, laws, plans, needs, and practices and a means for communicating the objectives and needs of the state mental health agencies to the federal government. Particular areas of interest are mental health, mental retardation, and state mental health programs dealing with drug addiction and alcoholism. Publication(s): Connections (newsletter); Networks (newsletter); NASMHPD U.S. Congress; NASMHPD Info; and NASMHPD Federal Agencies. Relevant area(s) of interest: Mental deficiency; Mental health planning; Mental health programs; Mental health services; Mental hygiene; Professional associations ·

National Black Alcoholism/Addictions Council Address: 1101 14TH St. NW Washington, DC 20005 Telephone: 202-296-2696 Email: [email protected] Web Site: http://www.borg.com/~nbac Background: The National Black Alcoholism and Addictions Council Inc. (NBAC) is a non-profit, tax exempt organization of Black persons concerned about alcoholism and over drugs of abuse. In 1978, a number of individuals and organizations concerned about the devastating effects that alcoholism has on millions of Blacks, came together to form NBAC. The organization is a nationwide voluntary organization which addresses the problems and concerns related to alcoholism and other drugs of abuse among Black people. Alcoholism is viewed as the number one health and social problem in the Black community. NBAC is committed to educating the public about the prevention of alcohol abuse, alcoholism, and other drugs of abuse, increasing services for alcoholics and their families, providing quality care and treatment, and developing research models specifically designed for Blacks. Relevant area(s) of interest: Alcoholism; Blacks; Drug addiction

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·

National Clearinghouse for Alcohol and Drug Information Address: PO Box 2345 Rockville, MD 20847-2345 Telephone: (301) 468-2600; (800) 487-4889 (TDD); (800) 729-6686 Fax: (301) 468-6433 Email: [email protected] Web Site: http://www.health.org Background: The National Clearinghouse for Alcohol and Drug Information (NCADI) is sponsored by the Center for Substance Abuse Prevention (CSAP), as the central point within the federal government for current print and audiovisual materials about alcohol and other drugs. NCADI's resources include databases on scientific findings; prevention programs and materials; field experts; federal grants; market research; tailored materials for parents, teachers, and youth; and information about organizations and groups concerned about alcohol and other drug problems. NCADI shares this information with the nation through 24hour telephone service for information requests and referral, distribution of federally developed materials, and exhibits at national conferences. Publication(s): The Challenge, (quarterly newsletter); Prevention Pipeline (bi-monthly) General Notes Hours of Operation: Mon.-Fri., 8am-6:30pm. Relevant area(s) of interest: Alcohol addiction; Drug addiction

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National Commission Against Drunk Driving Address: 1900 L St. NW Suite 705 Washington, DC 20036 Telephone: (202) 452-6004 Fax: (202) 223-7012 Web Site: http://www.ncadd.com Background: The National Commission Against Drunk Driving (NCADD) is a non-profit organization of public and private sector leaders who are dedicated to minimizing the human and economic losses resulting from motor vehicle crashes by working to make driving impaired a socially unacceptable act. The Commission works closely with all related federal, state, local officials, and with interested private sector groups to identify developing strategies and programs that show promise in reducing the incidences of driving impaired. NCADD believes that national awareness must be combined with targeted efforts to reach the three most intractable groups of drunk drivers: 21-34 year old young adults, chronic drunk drivers, and underage drinkers.

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Publication(s): NCADD Newsletter Relevant area(s) of interest: Alcoholism; Driving under the influence; Drunk driving ·

National Council on Alcoholism and Drug Dependence, Inc. Address: 12 West 21st Street New York, NY 10010 Telephone: (212) 206-6770; (800) NCA-CALL Fax: (212) 645-1690 Email: [email protected] Web Site: http://www.ncadd.org/ Background: Key interest of the Council include, alcohol and alcoholism (psychological, medical, and sociological aspects), especially the prevention of alcoholism through education, community services, and research; alcoholism as a public health problem; impact of alcoholism on the individual and society; history of alcoholism. The staff answers inquiries; provides consulting and reference services; makes referrals. Publication(s): Newsletter; annual report; popular pamphlets; leaflets; videos. A publications list is available on request. Relevant area(s) of interest: Alcoholics; Alcoholism

·

National Families in Action (NFIA) Address: 2957 Clairmont Road, Suite 150 Atlanta, GA 30329 Telephone: (404) 248-9676 Fax: (404) 248-1312 Web Site: http://www.emory.edu/NFIA/ Background: National Families in Action (NFIA) is sponsored by public grants, private contributions, and revenues from publication sales. National Families in Action educates parents and community leaders on the health consequences of drug abuse among children and adolescents. They are committed to all aspects of drug and alcohol abuse; parent/child relationships; parent drug prevention groups; adolescent mental health; illicit drugs; drug education; drug smuggling; drug lobbies; drug paraphernalia. NFIA answers inquiries; provides advisory, reference, abstracting, indexing, and copying services; conducts workshops; distributes publications and data compilations; makes referrals to other sources of information; permits on-site use of collections.

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Publication(s): Drug Abuse Update (quarterly 20-page journal that abstracts current documents in collection; with annual index); Drug Abuse Update for Kids (for middle school students), and other brochures and fact cards. Relevant area(s) of interest: Adolescent psychology; bases at Emory University Library.; Drug addiction; Drug education; Drug effects; Drugs and youth; Holdings; Lobbying; Narcotic traffic; Over 500,000 documents on the areas above; access to the data; Parent child relations; Parent education; Parent participation ·

National Institute on Alcohol Abuse and Alcoholism Address: 6000 Executive Boulevard - Willco Building Bethesda, MD, 20892-7003 Telephone: (301) 443-3885 Web Site: http://www.niaaa.nih.gov/ Background: The National Institute on Alcohol Abuse And Alcoholism (NIAAA) supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. NIAAA also provides leadership in the national effort to reduce the severe and often fatal consequences of these problems by: conducting and supporting research directed at determining the causes of alcoholism, discovering how alcohol damages the organs of the body, and developing prevention and treatment strategies for application in the Nation's health care system; supporting and conducting research across a wide range of scientific areas including genetics, neuroscience, medical consequences, medication development, prevention, and treatment through the award of grants and within the NIAAA's intramural research program; conducting policy studies that have broad implications for alcohol problem prevention, treatment and rehabilitation activities; conducting epidemiological studies such as national and community surveys to assess risks for and magnitude of alcohol-related problems among various population groups; collaborating with other research institutes and Federal programs relevant to alcohol abuse and alcoholism, and providing coordination for Federal alcohol abuse and alcoholism research activities; maintaining continuing relationships with institutions and professional associations; with international, national, state and local officials; and voluntary agencies and organizations engaged in alcohol-related work; and disseminating research findings to health care providers, researchers, policymakers, and the public. Publication(s): Alcohol Alert; pamphlets; brochures.

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Relevant area(s) of interest: Alcohol abuse; Alcoholism; Preventive medicine; Public health ·

NY State Office of Alcoholism and Substance Abuse Services Address: 1021 Main St. Buffalo, NY 14203 Telephone: (518) 473-3460 Web Site: http://www.oasas.state.ny.us/ Background: The New York State Office of Alcoholism and Substance Abuse Services (OASAS) administers the nation's most comprehensive system of services for substance abusing populations. Each day, about 120,000 New Yorkers receive treatment for alcohol and/or drug addiction from OASAS-licensed programs. Services are delivered through a network of over 1,200 community-based providers. OASAS also directly operates 13 Addiction Treatment Centers around the state. In addition to treatment services, thousands of people benefit daily from prevention initiatives carried out by OASAS-sponsored or licensed prevention programs. Relevant area(s) of interest: Alcohol abuse; Alcoholism; Drug abuse

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Ohio Department of Alcohol and Drug Addiction Services Address: 280 North High Street, 12th Floor Columbus, OH 43215-2537 Telephone: (614) 466-3445 Fax: (614) 752-8645 Web Site: http://www.state.oh.us/ada/odada.htm Background: The Ohio Department of Alcohol and Drug Addiction Services coordinates, certifies, funds, monitors, and evaluates alcohol and other drug prevention for education, treatment, research, and counseling services under public auspices and provides technical assistance in developing alcohol and other drug addiction programming. It also coordinates programming among state departments. Interests of the Department include comprehensive alcoholism and other drug addiction programming, including education, prevention, and programs for treatment, rehabilitation, and program evaluation, particularly focused on the needs of the indigent, minorities, women, youth, the elderly, and the handicapped. The Department has a database on Driver Intervention Program, a database on alcoholism and other drug addiction treatment programs, and names and addresses for 5,000 professionals in Ohio directly or indirectly connected with recovery efforts; answers inquiries; and provides consulting and reference services.

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Publication(s): pamphlets.

Reports;

bibliographies;

specifications;directories;

Relevant area(s) of interest: Alcohol addiction; Alcohol education; Alcoholism; Counseling; Drug addiction; Program evaluation; Public health; Rehabilitation; Research grants; Substance abuse ·

Parents Association to Neutralize Drug and Alcohol Abuse Address: 4111 Watkins Trail Annandale, VA 22003 Telephone: (703) 750-9285 Background: The Parents Association to Neutralize Drug and Alcohol Abuse (PANDAA) was founded in Fairfax County, Virginia, in 1980 by parents concerned about adolescent alcohol and drug abuse. The association works to combat substance abuse in the home, school, and community and to educate the public about all aspects of substance abuse. Referrals, publications, and reference information are available to consumers. Publications include a newsletter. Relevant area(s) of interest: Adolescent health; Substance abuse

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Partners Association Office Partners, Inc. Address: 735 South Ave Grand Junction, CO 81501 Telephone: (970) 351-0700 Background: Partners, Inc., is a private, nonprofit association of mentorship programs for at-risk youth. The eleven Partners affiliate programs recruit, screen, train, and supervise adult volunteers who act as friends, role models, and advocates to youth and offer life skills training, recreational activities, alcohol and drug abuse prevention projects, and other community-specific programs. Partners, Inc., supports its affiliates with joint purchasing, technical assistance, development and management assistance, and monitoring for compliance with Partners Accreditation Standards. Partners, Inc., will also offer these services to communities wishing to organize a mentorship program. General publications include policy, training, and resource manuals and an annual report. Relevant area(s) of interest: Alcoholism prevention; Community development; Community involvement; Compensatory education; Delinquent rehabilitation; Drug addiction prevention; Health; Juvenile court diversion; Juvenile delinquents; Program evaluation; Project management; Volunteer workers

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·

Prevention First Address: 2800 Montvale Drive Springfield, IL 62704 Telephone: (217) 793-7353; (217) 793-7355 (TDD) Web Site: http://www.prevention.org Background: Prevention First, Inc. (PFI) provides current, comprehensive information and training on alcohol and other drug abuse prevention for Illinois residents. PFI believes that health and well-being are basic human rights. Through training, consultation, information services, and advocacy, it tries to promote health and wellness among individuals, organizations, and communities. Services to consumers include reference information and publications. Some materials are available in Spanish. PFI publishes a catalog and newsletter. Relevant area(s) of interest: Alcohol abuse prevention; Drug abuse prevention; Fetal alcohol syndrome; Substance abuse

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Project Return Foundation, Inc. Women in Crisis, Inc. Address: 360 West 125th Street, Suite 11 New York, NY 10027 Telephone: (212) 665-2018 Fax: (212) 665-2022 Web Site: http://www.projectreturn.org/index.html Background: Women in Crisis (WIC), Inc., is a program of Project Return Foundation, Inc. WIC provides HIV/AIDS prevention programming, education, training, and resource materials and primarily targets its services to Black and Latina women and their families. WIC places particular emphasis on the relationships between alcohol and drug use and the risk of HIV infection. WIC is committed to empowering women to implement risk-reducing behaviors and to understand the full range of their options and choices in daily living. WIC provides women with support and information on how to access a broad range of health and human services and plays a strong advocacy role for women afflicted by alcohol, drug, and AIDS-related problems. Relevant area(s) of interest: Alcoholism; Drug abuse; Female offenders; HIV/AIDS education and prevention; Mental health; Women; Women alcoholics; Women's health services

·

Services South Carolina Department of Alcohol and other Drug Abuse The Drugstore Information Clearinghouse Address: 3700 Forest Drive Columbia, SC 29204 Suite 204

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Telephone: (800) 942-DIAL; (803) 734-9559 Web Site: http://www.daodas.state.sc.us/services/drugstore.html Background: The Drugstore Information Clearinghouse deals with alcoholism and alcohol-related problems and drug abuse. The Clearinghouse answers inquiries, provides technical assistance and reference services, makes referrals to other sources of information, lends audiovisuals to anyone in South Carolina free, lends other materials to State Commission and County Commission personnel only, and is a State Radar site. Publication(s): The Big Issue (bimonthly). General Notes A toll-free information line on alcohol and other drugs is available at (800) 942DIAL. Relevant area(s) of interest: Alcoholism; Drug abuse; Drug addiction; Holdings; materials.; Small collection of books, periodicals, reports, and audiovisual ·

Substance Abuse Librarians and Information Specialists Address: Berkeley, CA 94709 PO Box 9513 Telephone: (510) 642-5208 Fax: (510) 642-7175 Email: [email protected] Web Site: http://salis.org/ Background: Substance Abuse Librarians and Information Specialists (SALIS) is an international association of individuals and organizations working or having an interest in the retrieval and dissemination of knowledge and information concerning alcohol/drug abuse. It serves as a network of communication, provides a forum for advancement of the field, and acts to promote the common interests and professional development of its members. Interests of SALIS include alcohol,drug, and substance abuse. Collections and automation vary with the member organizations. SALIS answers inquiries; provides consulting, reference, literature-searching, current-awareness, and copying services; conducts seminars; lends materials; distributes publications and data compilations; makes referrals to other sources of information; and permits onsite use of collections. Fees vary according to each member organization. Publication(s): SALIS News (newsletter); bibliographies. Relevant area(s) of interest: Alcohol education; Alcohol use/abuse; Drug use/abuse; Tobacco use

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·

Women for Sobriety Address: PO Box 618 Quakertown, PA 18951-0618 Telephone: (215) 536-8026 Fax: (215) 538-9026 Email: [email protected] Web Site: http://www.womenforsobriety.org/ Background: Women For Sobriety (WFS) is a non-profit organization of women dedicated to helping women overcome alcoholism and other addictions. Its "New Life" program is a national self-help program for women alcoholics. Based upon a Thirteen Statement Program of positivity that encourages emotional and spiritual growth, the "New Life" Program has been extremely effective in helping women to overcome their alcoholism and learn a wholly new lifestyle. As a program, it can stand alone or be used along with other programs. It is being used not only by women alcoholics in small self-help groups but also in hospitals, clinics, treatment facilities, women's centers, and wherever alcoholics are being treated. WFS is dedicated to the establishing of self-help groups, and distributing literature to women who ask for its help. WFS is not affiliated with Alcoholics Anonymous. Publication(s): Sobering Thoughts. Relevant area(s) of interest: Alcoholism; Patient education; Self help; Substance abuse; Women's health

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Zeta Phi Beta Sorority, Inc. Address: 1734 New Hampshire Avenue NW Washington, DC 20009 Telephone: (202) 387-3103 Fax: (202) 232-4593 Email: [email protected] Web Site: http://www.zpb1920.org Background: Zeta Phi Beta Sorority, a predominantly African American organization founded in 1920, is committed to improving the health and welfare of youth and their parents, and has conducted local and national programs to improve conditions for them. The Stork's Nest program provides information on safer sex, AIDS, and drug and alcohol abuse education and prevention. It also provides education, counseling, and recreational programs for older Americans. Publication(s): ARCHON (semi-annually) Magazine.

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Relevant area(s) of interest: African american; AIDS; Counseling; Drug and alcohol abuse; Drug and alcohol education; Drug and alcohol prevention; Health and welfare; Older americans; Parents; Recreational programs; Safer sex; Youth

Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.

The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about alcoholism. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “alcoholism” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “alcoholism”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search

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by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “alcoholism” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with alcoholism. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “alcoholism” (or a synonym) in the search box. Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.

Finding Drug Treatment and Alcohol Abuse Treatment Programs To find the right drug abuse treatment program or alcohol abuse treatment program for you, two useful resources are available.

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National Drug and Treatment Referral Routing Service10 The U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration's (SAMHSA) National Drug and Treatment Referral Routing Service provides a toll-free telephone number for alcohol and drug information/treatment referral assistance. The number is 1-800-662-HELP. When you call the toll-free number, a recorded message gives you the following options: 1 - Printed materials on alcohol and drug information or 24-hour substance abuse treatment referral information in your area (additional options guide you through information and referral choices, including a Spanish language message). 2 - Location of a substance abuse treatment office in your state.

Substance Abuse Treatment Facility Locator11 Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), this searchable directory of drug and alcohol treatment programs shows the location of facilities around the country that treat alcoholism, alcohol abuse and drug abuse problems (http://findtreatment.samhsa.gov/). The Locator includes more than 11,000 addiction treatment programs, including residential treatment centers, outpatient treatment programs, and hospital inpatient programs for drug addiction and alcoholism. Listings include treatment programs for marijuana, cocaine, and heroin addiction, as well as drug and alcohol treatment programs for adolescents, and adults. SAMHSA endeavors to keep the Locator current. All information in the Locator is completely updated each year, based on facility responses to SAMHSA's National Survey of Substance Abuse Treatment Services. New facilities are added monthly. Updates to facility names, addresses, and telephone numbers are made monthly, if facilities inform SAMHSA of changes. The site is http://findtreatment.samhsa.gov/facilitylocatordoc.htm.

10 11

Adapted from NIAAA: http://www.niaaa.nih.gov/other/referral.htm. Adapted from SAMHSA: http://findtreatment.samhsa.gov/.

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Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·

Give me a chance to ask questions about alcoholism?

·

Really listen to my questions?

·

Answer in terms I understood?

·

Show respect for me?

·

Ask me questions?

·

Make me feel comfortable?

·

Address the health problem(s) I came with?

·

Ask me my preferences about different kinds of treatments for alcoholism?

·

Spend enough time with me?

Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.

Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·

You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.

·

It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.

12 This

section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 13 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.

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·

Bring a “health history” list with you (and keep it up to date).

·

Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.

·

Tell your doctor about any natural or alternative medicines you are taking.

·

Bring other medical information, such as x-ray films, test results, and medical records.

·

Ask questions. If you don't, your doctor will assume that you understood everything that was said.

·

Write down your questions before your visit. List the most important ones first to make sure that they are addressed.

·

Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.

·

Ask your doctor to draw pictures if you think that this would help you understand.

·

Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.

·

Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.

·

Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.

·

After leaving the doctor's office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.

By following these steps, you will enhance the relationship you will have with your physician.

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Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·

Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html

·

Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html

·

Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html

Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Anorexia: Lack or loss of the appetite for food. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibiotics: Substances produced by microorganisms that can inhibit or suppress the growth of other microorganisms. [NIH] Antidote: A remedy for counteracting a poison. [EU] Autonomic: Self-controlling; functionally independent. [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

14

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specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dioxins: Chlorinated hydrocarbons containing heteroatoms that are present as contaminants of herbicides. Dioxins are carcinogenic, teratogenic, and mutagenic. They have been banned from use by the FDA. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Emphysema: A lung disease in which tissue deterioration results in increased air retention and reduced exchange of gases. The result is difficult breathing and shortness of breath. It is often caused by smoking. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Geriatric: Pertaining to the treatment of the aged. [EU] Geriatrics: The branch of medicine concerned with the physiological and pathological aspects of the aged, including the clinical problems of senescence and senility. [NIH]

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Hormone: A chemical substance formed in glands in the body and carried in the blood to organs and tissues, where it influences function, structure, and behavior. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Immunization: The induction of immunity. [EU] Intoxication: Poisoning, the state of being poisoned. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Methadone: A long-acting synthetic medication shown to be effective in treating heroin addiction. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to

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twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prisons: Penal institutions, or places of confinement for war prisoners. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]

Radar: A system using beamed and reflected radio signals to and from an object in such a way that range, bearing, and other characteristics of the object may be determined. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Schizophrenia:

A severe emotional disorder of psychotic depth

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characteristically marked by a retreat from reality with delusion formation, hallucinations, emotional disharmony, and regressive behavior. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Telemedicine: Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU]

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CHAPTER 3. CLINICAL TRIALS AND ALCOHOLISM Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning alcoholism.

What Is a Clinical Trial?15 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for alcoholism is to try it on patients in a clinical trial.

The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.

15

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What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·

Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.

·

Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on alcoholism.

·

Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for alcoholism compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?

Various organizations support clinical trials at medical centers, hospitals, universities, and doctors' offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on alcoholism carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on alcoholism. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This

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treatment, like a placebo, has no effect on alcoholism and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how alcoholism develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for alcoholism. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial's investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo

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surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.

Recent Trials on Alcoholism The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to alcoholism.16 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·

Acamprosate Treatment: Mechanisms of Action Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will examine whether pretreatment with two doses of acamprosate for seven days prior to abstinence lessens the intensity of acute withdrawal from alcohol compared with a placebo. Subjects will be randomly assigned to receive either one of two doses of acramprosate or placebo for seven days. This will be followed by a fourday inpatient period when withdrawal will be monitored. Additional drinking information will be obtained at a three month followup interview. Phase(s): Phase II Study Type: Interventional

16

These are listed at www.ClinicalTrials.gov.

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Contact(s): Connecticut; Substance Abuse Treatment Unit, University of Connecticut, New Haven, Connecticut, 06511, United States; Recruiting; Dr. Stephanie O'Malley 203-789-6988 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00004552 ·

Behavioral Counseling for Alcohol Dependent Smokers Condition(s): Alcoholism; Smoking Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study is to evaluate the effectiveness of a mood management intervention on abstinent alcoholic smokers with a history of major depression. The second aim is to determine the effect of smoking treatments on alcohol abstinence and to identify factors associated with smoking and alcohol outcomes (e.g., more days of abstinence). A randomized, two-group design will be used to evaluate the added benefit of mood management compared to a state-of-the-art smoking cessation treatment. Treatment will consist of 8 weekly group sessions and 1, 3, 6, and 12-month follow-up. Phase(s): Phase IV Study Type: Interventional Contact(s): Minnesota; Department of Internal Medicine, Mayo Foundation, Rochester, Minnesota, 55905, United States; Recruiting; Dr. Christi Patten 507-266-1644 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00004551

·

Behavioral Therapy Plus Naltrexone for Alcoholism Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will compare cognitive behavioral therapy with a time-limited motivational enhancement therapy to which naltrexone (Revia) or placebo medication is added. In this randomized clinical trial, 160 alcohol-dependent outpatients, after 5 days of abstinence, will receive one of the two psychosocial therapies and either naltrexone (Revia) or placebo for a 12-week treatment period. Abstinence rates, alcohol use, and time to alcohol relapse will be evaluated in all four

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groups along with measures of alcohol craving, biological measures of alcohol consumption, drinking consequences, changes in self-confidence for avoiding alcohol, and medication compliance. All study participants will be assessed for measures of outcome variables at 3 and 6 months after completing the treatment protocol. Phase(s): Phase IV Study Type: Interventional Contact(s): South Carolina; Medical Univ. of South Carolina, Charleston, South Carolina, 29425, United States; Recruiting; Dr. Raymond Anton 843-792-1226 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000456 ·

Behavioral/Drug Therapy for Alcohol-Nicotine Dependence Condition(s): Alcoholism; Smoking Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will develop a behavioral and drug relapse prevention program for individuals who are dependent on both alcohol and tobacco. The study's goal is to show that individuals receiving nicotine replacement therapy and naltrexone (Revia) with behavior therapy will have higher rates of abstinence from both smoking and drinking than individuals who do not receive the drug therapies. Individuals will be placed in a 12-week outpatient treatment program with followup assessments 1, 3, and 6 months after treatment. Phase(s): Phase IV Study Type: Interventional Contact(s): Texas; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, 77030, United States; Recruiting; Dr. Joy Schmitz 713-500-2874 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000447

·

COMBINE Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA)

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Purpose - Excerpt: Combine is a multicenter, randomized clinical trial that will evaluate combinations of three interventions for treating alcohol dependence. The goal is to determine whether improvement in treatment outcomes can be achieved by various combinations of drug and behavioral interventions. Two of the interventions will consist of pharmacological treatment with naltrexone (Revia) or acamprosate (Campral). The third intervention is a multicomponent behavioral therapy including such components as motivational enhancement therapy, cognitive behavioral therapy, and referral to self-help groups, including AA. All three interventions will include a component supporting compliance to medications and reduction in drinking. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00006206 ·

Combined Pharmacotherapies for Alcoholism Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will compare the effectiveness of ondansetron (Zofran) and naltrexone (ReVia) both alone and in combination in treating Early Onset Alcoholics versus Late Onset Alcoholics. All subjects will received standardized Cognitive Behavioral Therapy. Followup assessments will be completed at 1, 3, 6, and 9 months after treatment. Phase(s): Phase II Study Type: Interventional Contact(s): Texas; University of Texas Health Science Center, San Antonio, Texas, 78229, United States; Recruiting; Dr. Bankole Johnson 210-567-2544 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00027079

·

Comparing Gabapentin Withdrawal

and

Lorazepam

for

Treating

Condition(s): Alcoholism Study Status: This study is currently recruiting patients.

Alcohol

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Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will evaluate a safe and useful medication for outpatient detoxification that is as effective as benzodiazepines in the short-term, and more effective in the protracted withdrawal period. Gabapentin (Neurontin) will be compared to a standard benzodiazepine, lorazepam (Ativan), for its effectiveness in treating alcohol withdrawal. Phase(s): Phase II Study Type: Interventional Contact(s): South Carolina; Medical University of South Carolina, Charleston, South Carolina, 29425, United States; Recruiting; Dr. Robert Malcolm 843-792-5214 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00011297 ·

Drug Therapy for Alcohol Dependence in Alaska Natives Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will assess the ability of naltrexone (Revia) to reduce the risk of relapse in Alaska natives with alcohol dependence. The study will also examine whether a combination of naltrexone and sertraline (Zoloft) yields better abstinence rates than naltrexone used alone. Alaska Native individuals will be recruited into a 16 week outpatient study. Phase(s): Phase II Study Type: Interventional Contact(s): Alaska; South East Alaska Regional Health Consortium, Sitka, Alaska, 99835, United States; Recruiting; Dr. Robert Robin 907-966-2411. Study chairs or principal investigators: Dr. Stephanie O'Malley, Principal Investigator; Yale University, New Haven, CT Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000451

·

Drug Treatment for Alcoholism Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA)

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Purpose - Excerpt: This study is to determine if alcoholics who differ on genetic variations of serotonin activity respond differently to ondansetron (Zofran) treatment. Subjects will receive one week of singleblind placebo lead-in followed by randomization to 11 weeks of doubleblind treatment with ondansetron or placebo. All subjects will receive weekly cognitive behavioral therapy and have brain imaging and genetic testing. Participants will be scheduled for followup assessments at 1, 2, 3, 6, and 9 months after treatment. Phase(s): Phase II Study Type: Interventional Contact(s): Texas; University of Texas Health Science Center, San Antonio, Texas, 78229, United States; Recruiting; Dr. Bankole Johnson 210-567-5480 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00006205 ·

Drug Treatment for Depressed Alcoholics Condition(s): Alcoholism; Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will examine the effects of combing naltrexone and fluoxetine (Prozac) versus fluoxetine and placebo in alcoholics with co-occurring major depression. Both groups will actively participate in the 6-month study, which includes weekly individual Dual Disorders Recovery Counseling during the first month and every two weeks during the second through sixth months, plus the naltrexone and fluoxetine or fluoxetine and placebo. Subjects will complete follow-up assessments at 9 and 12 months. Phase(s): Phase IV Study Type: Interventional Contact(s): Pennsylvania; Department of Psychiatry, Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, Philadelphia, Pennsylvania, 15213, United States; Recruiting; Dr. Ihsan Salloum 412-383-2710 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00006204

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·

Effects of Acute Plasma Tryptophan Depletion on Serotonin Receptor occupancy and Binding Affinity using PET in Healthy and Alcoholic Human Subjects Condition(s): Alcoholism; Healthy Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This research concerns the study of serotonin (5-HT) synthesis, metabolism (turnover), and release. We hypothesize that neuronal 5-HT turnover and release is altered in alcoholic individuals, and that this plays a role in alcohol seeking behavior. We wish to determine the following: a) Whether there are differences in 5-HT turnover and release in alcoholics compared to healthy controls, before and after Acute Tryptophan Depletion (ATD); b) Whether putative differences in 5-HT turnover are governed primarily by genetic variation in the 5-HT transporter (5-HTT) in alcoholics; c) Whether 5-HTT genetic variation correlates with [(18) F]-FCWAY/5HT(1A), binding, and cerebrospinal fluid (CSF) 5-Hydroxyindoleacetic acid (5-HIAA) concentration, before and after ATD; and d) If regional cerebral blood flow (rCBF) differs at baseline and after ATD in alcoholics and healthy controls. To investigate the underlying biochemistry of 5-HT neurometabolism, we will use two experimental strategies, Acute Tryptophan (TRP) Depletion (ATD) and positron emission tomography (PET) imaging, to investigate 5-HT neurochemistry. We will deplete plasma TRP, using ATD, while simultaneously collecting CSF 5-HIAA and performing intermittent plasma sampling via indwelling catheters. TRP is the amino acid (AA) precursor needed for 5-HT synthesis. 5-HIAA is the principal metabolite of 5-HT. It is a neurochemical marker of neuronal 5-HT metabolism. PET will allow indirect measurements of synaptic 5-HT concentration by measuring binding of [(18)F]-FCWAY, a 5-HT (1A)-receptor antagonist. rCBF will be measured with [(15)O]-water imaging. Studies will be performed before and after ATD. Individuals will be genotyped for the 5-HT transporter (5-HTT). Plasma TRP and Large Neutral Amino Acids (LNAAs), and CSF TRP and 5-HIAA concentrations will be measured using High Performance Liquid Chromatography (HPLC). Study Type: Observational Contact(s): Maryland; National Institute on Alcohol Abuse and Alcoholism (NIAAA), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222 [email protected]; TTY 1-866-411-1010

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Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00011752 ·

Naltrexone for Early Problem Drinkers Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: Early problem drinkers are prevalent in the United States. Recent controlled trials have shown that brief interventions in the primary care setting can reduce drinking and alcohol-related problems in patients who lack evidence of alcohol dependence. Although naltrexone (Revia) has been approved for the treatment of alcohol dependence, few pharmacotherapy studies have been undertaken with early problem drinkers. This study is an 8-week trial of naltrexone versus placebo, combined with coping skills treatment that either focuses on targeted use of medication or serves as background to daily use of the medication. A total of 160 early problem drinkers recruited through screening in primary care medical settings will be randomly assigned to one of four treatment groups. Followup evaluations will be conducted at the end of treatment and again 3, 6, and 12 months. Phase(s): Phase IV Study Type: Interventional Contact(s): Connecticut; Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, 06030, United States; Recruiting; Dr. Henry Kranzler 860-679-4151 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000455

·

Naltrexone for Relapse Prevention Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study is to evaluate the safety and effectiveness of an injectable slow releasing preparation of naltrexone to reduce alcohol consumption and risk of relapse in alcohol-dependent subjects. Individuals will receive either naltrexone or a placebo injection for a total of three months, with two subsequent followup visits spanning a 6month period.

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Phase(s): Phase IV Study Type: Interventional Contact(s): Connecticut; Department of Psychiatry, University of Connecticut, Farmington, Connecticut, 06030, United States; Recruiting; Dr. Henry Kranzler 860-679-4151 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000442 ·

Naltrexone Maintenance Treatment of Alcoholism Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: The purpose of this study is to determine the longterm effectiveness of naltrexone treatment in alcohol-dependent patients who respond to short-term treatment. Those who respond to short-term treatment will be randomized to a 1-year, double-blind, placebocontrolled maintenance phase with a 6-month posttreatment followup. Phase(s): Phase IV Study Type: Interventional Contact(s): Florida; Department of Psychiatry, University of Miami School of Medicine, Miami, Florida, 33136, United States; Recruiting; Dr. Barbara Mason 305-243-4644 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000450

·

Naltrexone Treatment for Alcoholism Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will evaluate the effectiveness of the medication naltrexone (Revia) for treating alcoholism. Individuals will be inpatients for a 2 week period and provide assessments of their alcohol withdrawal symptoms, craving, and mood. Following hospital discharge, individuals will be assigned randomly to receive naltrexone daily, naltrexone twice a day or a placebo. This part of the study will last 12 weeks, with regular measurements of drinking level, craving and mood. Assessments will be conducted 6 and 12 months after the beginning of the study.

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Phase(s): Phase IV Study Type: Interventional Contact(s): Maryland; John Hopkins Hopsital, Baltimore, Maryland, 21205, United States; Recruiting; Dr. Mary McCaul 410-955-5439 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000438 ·

Naltrexone Treatment of Alcohol Dependence Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: The long-range goal of this ongoing research program is to find more effective treatments for alcohol dependence by combining medication with the appropriate psychosocial support. This proposal has three specific aims: (1) to compare the effectiveness of naltrexone (Revia) in three types of treatment settings; (2) to assess the effects of psychosocial support on medication compliance and treatment retention; and (3) to investigate the individual characteristics that may predict who is likely to benefit from additional psychosocial support versus simple medication management. Phase(s): Phase IV Study Type: Interventional Contact(s): Pennsylvania; Treatment Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, United States; Recruiting; Dr. Joseph Volpicelli 215-898-4746 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000452

·

Naltrexone, Craving, and Drinking Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This 5-week study will examine the effects of naltrexone on alcohol craving, drinking rates, and reaction to drinkingrelated triggers, or cues, in participants' everyday environment and in laboratory sessions. Participants will monitor and record their daily desires to drink, environmental circumstances in which urges occur, and drinking behavior using a palm top computer. Participants will receive

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naltrexone or a placebo. One week after receiving medication, all participants will be asked to respond to alcohol-related cues that may or may not arouse the desire to drink. Phase(s): Phase IV Study Type: Interventional Contact(s): Rhode Island; Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, 02919, United States; Recruiting; Dr. Peter Monti 401-444-1849 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00006203 ·

Pharmacological Intervention Project Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This is a large scale study involving fluoxetine (Prozac) versus a placebo in the treatment of adolescents with alcohol use disorder and major depression. All individuals will receive treatment for 12 weeks with a followup phase lasting 9 months. Phase(s): Phase II Study Type: Interventional Contact(s): Pennsylvania; Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania, 15213, United States; Recruiting; Dr. Jack Cornelius 412-578-3424 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00027378

·

Post-Treatment Effects of Naltrexone Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: The aims of this protocol are to compare 3 and 6 months of naltrexone treatment coupled with two psychotherapies that differ in scope and intensity. The effect of these treatments will be assessed with patients who differ in their psychosocial need and resources at their disposal, and in their level of cravings for alcohol. Phase(s): Phase IV

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Study Type: Interventional Contact(s): Indiana; Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, Indiana, 46202, United States; Recruiting; Dr. Dena Davidson 317-278-3867 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00006449 ·

Sertraline and Naltrexone for Alcohol Dependence Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study is a double-blind, placebo-controlled outpatient trial to improve, through the addition of sertraline (Zoloft), the abstinence and relapse rates in alcohol- dependent individuals currently taking naltrexone (Revia). Phase(s): Phase II Study Type: Interventional Contact(s): New York; Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, 10029, United States; Recruiting; Dr. Conor Farren 718-584-9000 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000440

·

Sertraline for Alcohol Dependence and Depression Condition(s): Alcoholism; Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will examine depressed alcoholic outpatients to assess whether combining naltrexone (Revia) and sertraline (Zoloft) will result in greater reductions in both drinking and depression over either medication alone or placebo. A secondary aim is to determine whether certain patient features will predict response to sertraline, naltrexone or the combination of the two drugs. Subjects will be randomized into treatment groups for 16 weeks. The followup phase includes two visits at 6 and 9 months after treatment. Phase(s): Phase IV Study Type: Interventional

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Contact(s): Pennsylvania; Treatment Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, United States; Recruiting; Dr. Helen Pettinati 215-222-3200 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00004554 ·

Smoking Cessation in Alcoholism Treatment Condition(s): Alcoholism; Smoking Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study is designed to increase understanding of the processes that affect the treatment outcome of individuals with both alcohol and nicotine dependence. Treatment outcome methodology will be combined with a computerized self-monitoring methodology to examine the extent to which smoking serves as a cue for alcohol craving and/or as a response to alcohol craving in treated alcoholics. Subjects will be veterans participating in the Substance Abuse Day Programs at the Newington and West Haven campuses of the VA Connecticut Healthcare System. Nonveteran women will be recruited from the community and enrolled in the day program. Subjects will be randomly assigned to one of the following two conditions: (1) intensive smoking cessation therapy (counseling plus nicotine replacement using nicotine patches) concurrent with alcohol treatment, or (2) brief smoking cessation advice concurrent with alcohol treatment. Phase(s): Phase IV Study Type: Interventional Contact(s): Connecticut; Substance Abuse Treatment Center, VA Medical Center, West Haven, Connecticut, 06516, United States; Recruiting; Dr. Ned Cooney 203-937-4806 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000454

·

Timing of Smoking Intervention in Alcohol Treatment Condition(s): Alcoholism; Smoking Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will attempt to determine the best time to begin a smoking cessation program in individuals who undergo intensive

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treatment for alcohol dependence. The goal of this trial is to determine whether a smoking cessation program is more effective if it occurs at the same time as or after treatment for alcohol dependence. The study also will attempt to determine the effect of smoking cessation programs on the outcome of treatment for alcohol dependence. Phase(s): Phase IV Study Type: Interventional Contact(s): Minnesota; General Internal Medicine, VA Medical Center, Minneapolis, Minnesota, 55417, United States; Recruiting; Dr. Anne Joseph 612-725-2000 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000444 ·

Trazodone for Sleep Disturbance in Early Alcohol Recovery Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study is a randomized, double-blind clinical trial comparing trazodone (Desyrel) and placebo among sleep-disturbed, alcohol-dependent individuals shortly after discharge from an inpatient detoxification program. Subjects will undergo a baseline assessment and random assignment to trazodone or identical placebo for 12 weeks. All persons completing the alcohol detoxification at Stanley Street Treatment and Resources (SSTAR) will be screened. (SSTAR of Rhode Island provides detoxification services to non/underinsured persons of Rhode Island.) Phase(s): Phase II Study Type: Interventional Contact(s): Rhode Island; Rhode Island Hospital, Providence, Rhode Island, 02903, United States; Recruiting; Dr. Peter Friedman 410-444-3347 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00027053

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Treating Alcohol Use In Older Adults With Depression Condition(s): Alcoholism; Depression Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Medical Research Service

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Purpose - Excerpt: The purpose of this study is to test the efficacy combining a treatment for depression with a treatment for alcohol dependence. Phase(s): Phase IV Study Type: Interventional Contact(s): Pennsylvania; Philadelphia VAMC, Philadelphia, Pennsylvania, 19104, United States; Recruiting; David Oslin, MD 215-6153083 [email protected]; David W. Oslin, Principal Investigator Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00018824 ·

Treatment for Alcoholism and Post-Traumatic Stress Disorder Condition(s): Alcoholism; Post-Traumatic Stress Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will evaluate naltrexone and cognitivebehavioral therapy treatments for alcohol dependence and post-traumatic stress disorder (PTSD). Subjects will be randomly assigned a 6-month treatment of either: 1) naltrexone alone, 2) naltrexone with PTSD psychosocial therapy, 3) a placebo with PTSD psychosocial therapy, or 4) placebo alone. An enhanced medication management intervention will accompany all treatment conditions. Followup assessments will be completed at 9 and 12 months after treatment. Phase(s): Phase IV Study Type: Interventional Contact(s): Pennsylvania; Center for Anxiety, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, United States; Recruiting; Dr. Edna Foa 215-746-3327 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00006489

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Use of Naltrexone in a Clinical Setting Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This 12-week trial will compare individuals receiving naltrexone or placebo plus substance abuse counseling therapy versus those receiving only substance abuse counseling therapy in a rural,

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nonacademic setting. A followup period of 12 months is included. The effect on service utilization and the cost of the addition of naltrexone to treatment services for alcohol dependence also will be assessed. The study will expand existing research concerning the effectiveness of naltrexone in clinical trials versus a clinical setting. Phase(s): Phase IV Study Type: Interventional Contact(s): South Carolina; Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, South Carolina, 29425, United States; Recruiting; Dr. Kathleen Brady 843-792-5215 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000445 ·

Behavior and Naltrexone Treatment for Alcoholics Condition(s): Alcoholism Study Status: This study is completed. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: The study's purpose is to improve alcoholism treatment by investigating the combined effectiveness of a psychotherapy (Coping Skills Training and Cue Exposure Treatment - CSTCET) with naltrexone in a randomized clinical trial. Individuals will receive 2 weeks of CSTCET or a control treatment as inpatients followed by 12 consecutive weeks of receiving either naltrexone or placebo as outpatients. Followups at 24, 48, and 72 weeks after treatment is completed. Phase(s): Phase IV Study Type: Interventional Contact(s): Rhode Island; Brown University, Center for Alcohol and Addiction Studies, Providence, Rhode Island, 02912, United States; Dr. Peter Monti 401-273-7100 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000449

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Naltrexone Treatment for Alcoholic Women Condition(s): Alcoholism; Eating Disorder Study Status: This study is completed. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA)

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Purpose - Excerpt: This study will assess naltrexone's effectiveness in treating alcoholism in women and provide information on its potential value in treating eating disorders common among alcoholic women. Alcoholic women with and without both eating disorders and depression will be randomly assigned to placebo or naltrexone treatment. Each group will receive behavioral therapy for 12 weeks, with followup 6 months after treatment. Phase(s): Phase IV Study Type: Interventional Contact(s): Connecticut; Substance Abuse Treatment Unit, Yale University, New Haven, Connecticut, 06511, United States; Dr. Stephanie O'Malley 203-789-6988 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000448 ·

Ondansetron Treatment for Alcoholism Condition(s): Alcoholism Study Status: This study is completed. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: The purpose of this study is to: a) evaluate the effectiveness of ondansetron (Zofran) in the treatment of alcohol dependent patients; b) investigate whether early versus late onset alcoholism predicts treatment outcome; and c) determine whether the early and late onset groups respond differently to treatment. Individuals will be "typed" into early onset and late onset alcoholism groups. Individuals will be randomly assigned to a 12-week outpatient treatment program. Phase(s): Phase II Study Type: Interventional Contact(s): Texas; Substance Abuse Research Center, University of Texas Health Science Center, Houston, Texas, 77030, United States; Dr. Bankole Johnson 210-567-5480 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000443

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Sertraline and Cognitive Therapy in Depressed Alcoholics Condition(s): Alcoholism; Depression Study Status: This study is completed.

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Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will assess whether individuals treated with sertraline (Zoloft) and cognitive behavior therapy will experience improvement with their depression and consume less alcohol than individuals treated with a placebo and cognitive behavior therapy. This is a 12-week, random assignment, placebo-controlled, double-blind study with followup assessments 1 and 3 months after treatment. Phase(s): Phase II Study Type: Interventional Contact(s): South Carolina; Medical University of South Carolina, Charleston, South Carolina, 29425, United States; Dr. Darlene Moak 843792-1226 Web Site: http://clinicaltrials.gov/ct/gui/c/a1b/show/NCT00000458

Benefits and Risks17 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·

A new treatment could be more effective than the current treatment for alcoholism. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.

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If the treatment is effective, then it may improve health or prevent diseases or disorders.

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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.

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People who take part in trials contribute to scientific discoveries that may help other people with alcoholism. In cases where certain diseases or

This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 17

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disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial's risks and benefits, the researcher’s expectations of you, and your rights as a patient.

What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention.

How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital's Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent. What Are a Patient's Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·

Information on all known risks and benefits of the treatments in the study.

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Know how the researchers plan to carry out the study, for how long, and where.

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Know what is expected of you.

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Know any costs involved for you or your insurance provider.

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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.

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Talk openly with doctors and ask any questions.

After you join a clinical trial, you have the right to: ·

Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.

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Receive any new information about the new treatment.

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Continue to ask questions and get answers.

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Maintain your privacy. Your name will not appear in any reports based on the study.

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Know whether you participated in the treatment group or the control group (once the study has been completed).

What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don't have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Questions Should You Ask before Deciding to Join a Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·

What is the purpose of the clinical trial?

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What are the standard treatments for alcoholism? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?

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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?

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How long will the treatment last? How often will I have to come back for follow-up exams?

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What are the treatment's possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?

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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?

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How will my health be monitored?

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Where will I need to go for the clinical trial? How will I get there?

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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?

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Will I be able to see my own doctor? Who will be in charge of my care?

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Will taking part in the study affect my daily life? Do I have time to participate?

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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?

Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “alcoholism” (or synonyms).

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While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

A Guide to Patient Recruitment : Today's Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna

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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna

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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna

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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information

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Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna ·

Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna

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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna

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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Acid: Common street name for LSD. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigens: Substances that are recognized by the immune system and induce an immune reaction. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Benzodiazepine: A type of CNS depressant prescribed to relieve anxiety; among the most widely prescribed medications, including Valium and Librium. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any H-isomer. [NIH] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking

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cessation treatment. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]

Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Dopamine: A neurotransmitter present in regions of the brain that regulate movement, emotion, motivation, and feeling of pleasure. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Lorazepam: An anti-anxiety agent with few side effects. It also has hypnotic, anticonvulsant, and considerable sedative properties and has been proposed as a preanesthetic agent. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Metabolite: process. [EU]

Any substance produced by metabolism or by a metabolic

Neurotransmitter: Chemical compound that acts as a messenger to carry signals or stimuli from one nerve cell to another. [NIH] Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are

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neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Nicotine: An alkaloid derived from the tobacco plant that is responsible for smoking's psychoactive and addictive effects; is toxic at high doses but can be safe and effective as medicine at lower doses. [NIH] Ondansetron: A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and it has reported anxiolytic and neuroleptic properties. [NIH] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Placebos: Any dummy medication or treatment. Although placebos originally were medicinal preparations having no specific pharmacological activity against a targeted condition, the concept has been extended to include treatments or procedures, especially those administered to control groups in clinical trials in order to provide baseline measurements for the experimental protocol. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Pulmonary: Pertaining to the lungs. [EU] Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Serotonin: A neurotransmitter that causes a very broad range of effects on perception, movement, and the emotions by modulating the actions of other neurotransmitters in most parts of the brain. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH]

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Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]

Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]

Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. it is a precursor serotonin and niacin. [NIH]

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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

ABOUT PART II In Part II, we introduce you to additional resources and advanced research on alcoholism. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on alcoholism. In Part II, as in Part I, our objective is not to interpret the latest advances on alcoholism or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with alcoholism is suggested.

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CHAPTER 4. STUDIES ON ALCOHOLISM Overview Every year, academic studies are published on alcoholism or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on alcoholism. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on alcoholism and teach you how to keep current on new studies as they are published or undertaken by the scientific community.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and alcoholism, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the

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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “alcoholism” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·

Hepatitis C and Alcohol Source: Hepatology. 26(3, Supplement 1): 39S-42S. September 1997. Summary: This article reviews the interplay between hepatitis C and alcohol consumption. The author notes that chronic alcoholism in patients with chronic hepatitis C appears to cause more severe and rapidly progressive liver disease leading more frequently to cirrhosis of the liver and hepatocellular carcinoma. Alcoholics' primary risk factor for acquiring hepatitis C is injection drug use. However, the epidemiology is not well defined, and other sources of spread must be important. Alcohol intake in excess of 10 g per day has been associated with increased serum hepatitis C viral RNA and aminotransferase levels, the mechanism of which is poorly understood. The histological picture of hepatitis C in patients with chronic alcoholism is typically indistinguishable from chronic hepatitis C in nonalcoholic patients. Interferon therapy is less effective among alcoholic than non-alcoholic patients, even after a period of abstinence. The author emphasizes that patients with chronic hepatitis C should restrict their alcohol intake to less than 10 g per day, and if cirrhosis is present or interferon therapy is planned, abstinence from alcohol should be encouraged. Future research efforts should focus on the epidemiology and pathogenesis of combined chronic hepatitis C and alcoholism. 3 figures. 24 references. (AA-M).

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Intercessory Prayer in the Treatment of Alcohol Abuse and Dependence: A Pilot Investigation Source: Alternative Therapies in Health and Medicine. 3(6): 79-86. November 1997. Summary: This journal article describes a study funded by the Office of Alternative Medicine to examine the effect of intercessory prayer on patients entering treatment for alcohol abuse or dependence. Forty patients entering a public substance abuse treatment center were randomly assigned to receive or not receive intercessory prayer by outside volunteers (in addition to usual care). Assessments of alcohol and illicit drug use, including interviews, alcohol breath tests, and urine drug

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screens, were completed at baseline, 3 months, and 6 months. No differences were found between the prayer intervention and nonintervention groups on alcohol consumption. Compared with a normative sample of patients (n=123) treated at the same facility, participants in the prayer study experienced a 3-month delay in the reduction of their alcohol consumption. Those who reported at baseline that a family member or friend was already praying for them were found to be drinking significantly more at 6 month than were those who reported being unaware of anyone praying for them. Greater frequency of prayer by the participants themselves was associated with less drinking at months 2 and 3 only. The authors conclude that intercessory prayer had no benefit in the treatment of alcohol abuse and dependence under these study conditions. The article has 1 figure, 4 tables, and 50 references. (AA-M).

Federally-Funded Research on Alcoholism The U.S. Government supports a variety of research studies relating to alcoholism and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.18 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to alcoholism and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore alcoholism and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for alcoholism:

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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·

Project Title: Adult Offspring of Alcoholism Discordant Twins Principal Investigator & Institution: Jacob, Theodore; Chairman; Palo Alto Institute for Res & Edu and Information, Inc. Palo Alto, Ca 94304 Timing: Fiscal Year 2000; Project Start 1-MAR-1998; Project End 8-FEB2002 Summary: The purpose of this study is to clarify the role of family genetic and family environmental influences in the development of alcoholism. In pursuing this objective, we will implement a twin-family design whereby data are obtained from MZ and DZ co-twins who are concordant and discordant for alcoholism and from their spouses and adult offspring. The opportunity to obtain such data is made available by our access to the Vietnam Era Twin (VET) Registry, a nationally distributed panel of over thirty-two hundred twin pairs recently assessed using structured psychiatric interviews. Given these data, we will be able to address four specific aims: (1) To determine the extent to which offspring of alcoholic versus nonalcoholic co-twins differ in regards to alcohol abuse, other psychopathology, and socio-educationaloccupational- interpersonal achievements; (2) To determine how genetic and environmental influences vary in relation to different types of paternal alcoholism; (3) To determine the genetic and nongenetic contributions that spouse influences make in accounting for offspring outcomes; and (4) To determine what moderators and mediators associated with childhood (in particular, behavioral undercontrol and affect regulation) and young adulthood (in particular, young adult transition events, social networks, and young adult-parent relationships) serve to qualify and/or account for risk-outcome relationships and what kinds of influences best explain these associations. In this effort, we are particularly interested in understanding gene-environment correlations and gene- environment interactions that characterize the development and expression of alcoholism, drawing on the powerful yet infrequently used twin family design. Beyond simply estimating the strength of genetic/environmental influences, we hope to identify and clarify genetically-based and environmentally-based influences that help explain how family history of alcoholism predisposes individuals to alcoholism outcomes, and that increase or decrease the likelihood of adverse outcomes among high risk individuals. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Behavioral Genetic Study of Religiosity and Alcoholism Principal Investigator & Institution: Haber, Jon R.; ; Palo Alto Institute for Res & Edu and Information, Inc. Palo Alto, Ca 94304

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Timing: Fiscal Year 2001; Project Start 1-JUL-2001; Project End 0-JUN2003 Summary: (provided by applicant): Although religion and spirituality have always been thought to influence a wide range of human experience, the scientific study of this phenomenon has not kept pace with the growing evidence of its relevance to health, medical, and alcoholism concerns. This application seeks small grant support (R03) for secondary analyses involving data from three large-scale NIAAAsupported twin projects involving adolescent twins and adult twins. Given these data, we can elaborate on recent behavioral- genetic findings that have bearing on the relationship between religion and alcoholism; in particular how religion can impact the transmission and development of alcoholism across generations. The specific aims are: (1) to examine interaction of effects between religion and those variables thought to be genetic precursors to alcoholism and between religion and alcoholism variables per se; (2) to examine the moderating role that religion can play in qualifying the impact of family history of alcoholism on offspring alcoholism and other negative outcomes, and (3) to conduct preliminary examinations relevant to future research directions including (a) the multidimensional nature of religiosity; (b) the relationship between religiosity and other individual difference variables;(c) how religiosity is related to other models of alcoholism etiology; and (d) consideration of developmental issues (each data set utilizes a cohort sequential design) regarding the moderating role of religiosity on development and course of alcoholism and other disorders. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Brain Dysfunction and Alcoholism Principal Investigator & Institution: Begleiter, Henri; Professor; Psychiatry; Suny Downstate Medical Center 450 Clarkson Ave New York, Ny 11203 Timing: Fiscal Year 2000; Project Start 1-AUG-1979; Project End 8-FEB2003 Summary: For the past twenty years our laboratory as well as several others have repeatedly observed a significantly lower amplitude of the P3 component of the Event-related brain potentials (ERP) in both abstinent alcoholics and offspring of alcoholics. It has been demonstrated that this important finding is not the result of excessive alcohol abuse but is highly related to family density of alcoholism. We have recently postulated that this significantly reduced P3 component of the ERP may be indicative of increased central nervous system disinhibition (CNSD). In this grant proposal we hypothesize that beyond the

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phenomenological/symptomatic level in which presentation may be exceptionally heterogeneous, alcoholic patients may well display unexpected homogeneity along a continuum of Central Nervous System Disinhibition. It is well established that the male offspring of alcoholics are more likely to display undercontrolled behavior, and children with conduct disorders are more likely to have a positive family history of alcoholism. There is no doubt that loss in inhibitory control is an important component of the frontal-lobe. These characteristics are not only prevalent in abstinent alcoholics, but are also present in children of alcoholics. We propose that disinhibitory processes may identify abnormalities in the function of the prefrontal cortex in alcoholic patients. In this application, we propose to assess neurophysiological correlates of inhibition by implementing novel neurophysiologic paradigms in conjunction with the well-known reduced P3 amplitude of the ERP typically observed in abstinent alcoholics. We postulate that CNS disinihibition will be prevalent in individuals with a positive family history of alcoholism, and to a lesser degree in individuals without an obvious family history of alcoholism. We have invariably assumed that the great variability of symptoms in alcohol dependent individuals is strongly indicative of different pathogenesis, without considering a single underlying mechanism. This seemingly overwhelming evidence has compelled us to consider alcoholism as a heterogeneous disorder. However it is conceivable that the result of the proposed studies could alter our current approaches concerning heterogeneity . The electrophysiological results obtained from this application may find that aspects of brain dysfunction (i.e. lack of differential inhibition) may be involved in a predisposition for alcoholism. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Center for the Translational Neuroscience of Alcoholism Principal Investigator & Institution: Krystal, John H.; Kent Professor and Deputy Chairman for r; Psychiatry; Yale University New Haven, Ct 06520 Timing: Fiscal Year 2001; Project Start 4-JUN-2001; Project End 1-MAY2006 Summary: A gap remains in the translation of basic research advances into clinical neuroscience insights related to alcoholism.. This gap persists despite a growing array of outstanding basic and clinical studies in the field of alcoholism research. A new generation of psychopharmacology, neuroimaging, and molecular genetic studies rooted in molecular neuroscience with broad clinical implications may contribute to bridging the gap between basic and clinical research. The CTNA is designed to

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bridge the gap between the basic and clinical neuroscience of alcoholism. It will attempt to: 1. Conduct programmatic research that will identify factors modulating glutamatergic circuitry that contribute to ethanol reward, vulnerability to self-administration, and dependence; 2. Build from basic neuroscience insights to hypotheses regarding the etiology, pathophysiology, and treatment of alcoholism; 3. Facilitate transdisciplinary research within projects and between projects; 4. Establish a mechanism to review and fund pilot promising pilot projects; 5. Provide career development activities for graduate and medical students, postdoctoral trainees, and junior faculty that will promote their development and retention within the field of alcoholism research; 6. Promote ethnical and humane clinical neuroscience studies of alcoholism. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Combined Pharmacotherapies for Alcoholism Principal Investigator & Institution: Johnson, Bankole A.; Deputy Chairman for Research; Psychiatry; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78224 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 1-JUL-2005 Summary: Recent scientific and clinical interest in combining therapeutic agents for the treatment of alcoholism are based on the fact that derangement of multiple-neurotransmitter systems are likely to underlie biological predisposition to the disease. Thus, combining effective medications working at different neurotransmitters should produce a synergistic or at least an added clinical response. In animals, the combination of the 5-HT3 antagonist, ondansetron, and the mu receptor antagonist, naltrexone show synergism of action at reducing ethanol consumption. Alcoholics with an early onset of disease are effectively treated by ondansetron, and those with a family history of alcoholism in first degree relatives may have the best clinical outcome to treatment with naltrexone. Given that family history of alcoholism is associated with an early onset of disease, it reasonable for us to predict that the combination of ondansetron and naltrexone should be more optimal than either alone for the treatment of Early Onset Alcoholics (EOA). Indeed, preliminary clinical data from our group provide strong support that the medication combination is an effective treatment for EOA. We will test this hypothesis by comparing the effectiveness of ondansetron (4 mg/kg) and naltrexone(50 mg/day), both alone and in combination, in treating EOA vs. Late Onset Alcoholics (LOA) (total N of 45 subjects/cell x 8 cells = 360) in a randomized, double-blind, placebo-controlled, 12-week (1 week of single-blind placebo followed by 11 weeks of the double-blind condition) outpatient clinical trial. All subjects will receive standardized

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Cognitive Behavioral Therapy, and follow-up at 1, 3, 6, and 9 months post-treatment. Specifically, we predict that: 1) EOA, compared with LOA, will be more responsive to treatment with either ondansetron or naltrexone alone, and 2) that the combination of ondansetron and naltrexone will be superior to either medication alone in the treatment of EOA. We will have the unique opportunity to test with adequate power the secondary hypothesis that the combination of ondansetron and naltrexone will be better tolerated than naltrexone alone, thereby improving compliance. This is because nausea is an important side-effect of naltrexone which can limit compliance, and as shown in our preliminary study, ondansetron by having anti-nausea and anti-emetic properties counteracts this naltrexone side-effect. We support NIAAA's mission to develop effective pharmacotherapies as adjuncts to psychotherapy for the treatment of alcoholism. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Dopamine Transmission in Alcoholism Principal Investigator & Institution: Abi-Dargham, Anissa; Irving Associate Professor; New York State Psychiatric Institute 1051 Riverside Dr New York, Ny 10032 Timing: Fiscal Year 2000; Project Start 6-SEP-2000; Project End 1-AUG2003 Summary: (Adapted from applicant's abstract) The neurobiology of alcoholism in humans is still poorly understood. Experiments in rodents have suggested that the mesolimbic dopaminergic system is critically involved in the rewarding properties of alcohol, and that a deficit of mesolimbic dopamine (DA) transmission might constitute a risk factor for developing alcoholism. Furthermore, it has been suggested that low mesolimbic D2 receptor transmission might be implicated in alcohol craving and vulnerability to relapse. However, relatively little data is available to support the relevance of these preclinical studies to alcoholism in humans. Recent developments in brain imaging technology make it possible to test these hypotheses in alcoholic subjects. The general aim of this proposal is to test the hypothesis that alcoholism is associated with a deficit in mesolimbic DA function. Using neuroreceptor imaging and a state of the art positron emission tomography (PET) scanner, the investigators propose to evaluate the association between alcoholism and alteration in pre- and post synaptic parameters of dopamine transmission in the ventral striatum: 1) D2 receptor availability; 2) amphetamineinduced intrasynaptic dopamine release. D2 receptors's availability will be measured as the binding potential of the radiotracer [~ ~C]raclopride. The amphetamine-induced intrasynaptic DA release will be evaluated by

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the displacement of [~C]raclopride from D2 receptors following the amphetamine challenge. D2 receptor availability (specific aim #1) and amphetamine-induced intrasynaptic DA release (specific aim #2) will be measured in 24 recently abstinent alcoholics (within 3 to 4 weeks of abstinence) and 24 healthy controls matched for age, gender, ethnicity, parental socioeconomic status and nicotine dependence. The hypotheses are that, compared to matched control subjects, alcoholics will display lower D2 receptors availability and blunted amphetamine-induced DA release in the ventral striatum, and that these abnormalities will correlate with severity of alcoholism and intensity of alcohol craving. This study will provide a comprehensive description of synaptic dopaminergic parameters in alcoholism. If indeed deficits in DA function are found in chronic alcoholics, the investigators can examine as a second step, possibly in the renewal of this application, whether these deficits represent a toxic effect of alcohol or a vulnerability factor. Understanding the neurochemical abnormalities underlying vulnerability to alcoholism would guide future treatment interventions and risk prevention strategies. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Genetic and Epidemiological Models of Alcohol Abuse Principal Investigator & Institution: Heath, Andrew C.; Spencer T. Olin Professor of Psychiatry; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2000; Project Start 1-JUL-1989; Project End 0-JUN2003 Summary: The goal of this project, for which we now request funding for grant years 11-15, is to support continuing methodologic research and secondary data-analysis in order to (i) better understand the joint and interactive effects of genes and environment in determining differences in alcoholism risk, the course of drinking patterns and alcohol problems through time, and the sequelae of alcohol problems, and (ii) stimulate and refine the implementation of new research approaches to address these questions. Major areas of focus will include (a) the attempted identification of alcoholism subtypes, or stages in the progression of alcoholic symptoms, (b) the extension of this work within an event history framework, to examine genetic and environmental influences on probability of transition from social problem drinking, or from mild to severe dependence, (c) the testing of potential mediators of genetic influences on alcoholism risk, including GE correlation effects, (d) the testing of risk-modifiers (e.g. genotype x environment interaction effects), (e) the use of genetically informative high-risk sampling designs to

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investigate more efficiently the ways in which genetic differences lead to differences in alcoholism risk (e.g. challenge studies of alcohol sensitivity; e.g. QTL-mapping studies), (f) the use of genetically informative designs to investigate the sequelae of alcoholism. Secondary data-analyses will be used for 'reality-testing' of methodologic research, principally utilizing data-bases from alcohol- related studies of the Australian twin panel, maintained via subcontract to QIMR. These studies have generated diagnostic interview data on some 9000 twins and 3500 spouses of twins, as well as questionnaire measures (N is greater than 20,000) on twins and a subsample of their relatives (siblings, spouses, parents and adult children) and, for a subsample of twins, alcohol challenge measures (obtained in 1979-81), genotype data (ADH2, ADH3) and biochemical markers of drinking. The data thus permit analyses of the multiple pathways by which genetic differences between individuals, and differences in environmental exposure, lead to differences in alcoholism risk, leading to predictions that can be tested in future and ongoing studies. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Genetic Models for Susceptibility to Alcoholism Principal Investigator & Institution: Neuman, Rosalind J.; Research Assistant Professor; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2000; Project Start 1-MAY-1996; Project End 0-APR2002 Summary: This is a 5-year proposal to extend current methodologies and develop optimal strategies for investigating the genetics of susceptibility to alcoholism. Long term objectives are to develop realistic genetic and nongenetic transmission models which accurately represent the complexities of the familial distribution patterns of alcoholism, to identify optimal techniques to detect genetic effects in the etiology of alcoholism, and ultimately, to find the chromosomal location of those genes, both of small and large effect, responsible for the disease. The collaboration with others in the genetic study of alcoholism and its complications will result in a better understanding of the pathogenesis of alcoholism and will lead to a significant improvement in the treatment accorded to those affected with this illness and its medical consequences. The specific goals are to: (1) investigate the properties of oligogenic models of disease by, among other things, deriving analytically the recurrence risk to various classes of relatives of an affected individual and determining sample size needed to do effectively linkage analysis under such models; (2) determine sampling strategies for pedigrees in which alcoholism is segregating in

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order to optimize opportunities to identify linkage between genetic markers and trait genes; (3) determine the most effective linkage methods for detecting genes involved in the etiology of traits determined by a variety of oligogenic models; (4) determine the extent to which maximization of lod scores over genetic parameters predict the underlying mode of inheritance; (5) assess the techniques developed on existing sets of data for compatibility with the theoretical results obtained on various genetic models. This proposal consists of theoretical exploration, computer simulation, and data analysis. First, solutions of theoretical questions relating to models of inheritance, sampling strategies, and linkage analysis, will be pursued; second, adaptation of computer programs to implement simulation of data, evaluation of existing linkage analytic methods, and investigations into alternative research strategies will be accomplished. After these goals are met, the new strategies will be applied to simulated data, and finally, to existing data sets of pedigrees in which alcoholism has been diagnosed. This research will significantly contribute to the ability to locate susceptibility loci in complex traits and to the clarification of those etiological mechanisms responsible for susceptibility to alcoholism. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Impulsivity and Serotonin at Risk for Type II Alcoholism Principal Investigator & Institution: Crean, John; None; Illinois Institute of Technology 3300 S Federal St Chicago, Il 60616 Timing: Fiscal Year 2000; Project Start 1-MAR-2000 Summary: Type II alcoholism is characterized by early onset heavy drinking, risk taking, and violence which are commonly described as impulsive behaviors. This subtype of alcoholism has been demonstrated to be highly heritable, transmittable primarily from father to son. There is also considerable evidence suggesting that neurochemical substrates may underlie this condition. In particular, numerous studies have demonstrated that impaired serotonergic functioning correlates with the described impulsive behaviors associated with Type II alcoholism. The overall aim of this project is to examine the link between impulsivity and serotonergic dysfunction in young men at high risk for Type II alcoholism. In a controlled laboratory environment, using double blind, placebo controlled conditions, central nervous system serotonin levels will be manipulated by depleting plasma tryptophan stores. The effects of these manipulations on behavior will be examined using several standardized, performance based measures of impulsivity. It is predicted that individuals at high risk for Type II alcoholism will be more sensitive to the effects of serotonin depletion than low risk individuals as indicated

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by their performance on the impulsivity measures. Using laboratory procedures to examine the relationship between serotonin deficiency and impulsivity in high risk subjects will add validity to the serotonergic theory of Type II alcoholism. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Naltrexone Treatment for Alcoholism Principal Investigator & Institution: Krishnan-Sarin, Suchitra; ; Yale University New Haven, Ct 06520 Timing: Fiscal Year 2001; Project Start 4-JUN-2001; Project End 1-MAY2006 Summary: Evidence from both preclinical studies and retrospective data from clinical trials indicate that opioid antagonists reduce alcohol drinking, especially continued alcohol drinking following lapse in drinking, as well as reduce craving for alcohol. However, the cascade of events that mediates this efficacy of opioid antagonists is still unknown. Increased knowledge of this mechanism may help to further understanding of the processes mediating continued alcohol drinking and result in the development of more effective treatments of alcohol dependence. Family history of alcoholism is known to be a significant risk factor for development of heavy alcohol drinking and understanding the biological basis of developing this genetic risk would also advance our ability to develop better treatments for this disorder. Our group has prospectively demonstrated using a laboratory paradigm of alcohol selfadministration that naltrexone does indeed reducer alcohol consumption during an ad-libitum alcohol self-administration period following exposure to a priming drink of alcohol. We would now like to extend these findings to a laboratory model of relapse to alcohol that includes an alcohol deprivation period prior to the self-administration session. The results from this laboratory paradigm would more closely model evidence from clinical trials of naltrexone for alcohol dependence which indicate that one of the most important effects of naltrexone is to prevent relapse following a lapse of abstinence. The results of our selfadministration paradigm also indicate that naltrexone induces HPA activation as evidenced by increased cortisol levels, that could either mediate naltrexone's effects or be a marker of naltrexone's efficacy. Recent evidence indicates that a genetic risk of alcoholism results in an attenuated release of cortisol in response to the opioid antagonist naloxone suggesting that the sensitivity of the endogenous opioid system to alcohol is altered by increased genetic risk. Therefore, we will conduct this study in heavy drinkers with or without a family history of alcoholism and address the following specific aims: 1) To evaluate the

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efficacy of six days of pretreatment with one of three doses of naltrexone (o,50 and 100 mg/day) using a laboratory model consisting of four days of alcohol deprivation following by exposure to a priming drink of alcohol and subsequent ad-libitum drinking and 2) To evaluate the influence of family history of alcoholism on the efficacy of naltrexone using a laboratory model consisting of four days of alcohol deprivation followed by exposure to a drinking drink of alcohol and subsequent adlibitum alcohol drinking. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Pathways to Alcoholism Through Psychopathology Principal Investigator & Institution: Zhang, Heping; Associate Professor of Biostatistics; Epidemiology and Public Health; Yale University New Haven, Ct 06520 Timing: Fiscal Year 2000; Project Start 1-MAY-2000; Project End 0-APR2002 Summary: (Adapted from Investigator's Abstract) The purpose of this project is to examine the major psychopathologic pathways to alcoholism. To achieve this goal, the following questions will be addressed. (1) What is the relationship between alcoholism and psychiatric disorders (namely, anxiety disorders, affective disorders and behavior disorders)? (2) How do psychiatric disorders influence the transitions between different stages of alcoholism? (3) Does the comorbidity between psychiatric disorders and alcoholism differ for females and males at different developmental stages? Several existing data sets using diverse study designs and samples will be used to identify the magnitude of comorbidity between specific disorders and each of the stages of alcoholism ranging from exposure to use to problematic use to dependence. Retrospective and prospective data will be used simultaneously to examine the links between psychopathology and each of the stages of the development of alcohol disorders, as well as the rate of transition between stages. Multiple statistical approaches for studying associations, transitions and subtypes including Cox models, tree-based methods and latent class approaches will be employed. Results from different studies will be synthesized to either replicate patterns of comorbidity or to generate hypotheses regarding inconsistencies across studies, using techniques of metaanalysis such as combining likelihoods from different studies. The investigators state that the aggregation of data from studies using multiple designs, samples and methods will provide stronger evidence of the consistency and stability of the link between psychiatric disorders and the stages of development of alcoholism than could be derived from a single study. They further state that identifying these pathways will

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ultimately assist in the development of an empirical basis for the primary prevention of secondary alcoholism. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Patient Education Videos: Neurobiology of Alcohol Principal Investigator & Institution: George, Frank R.; President and Executive Producer; Amethyst Technologies, Inc. 1435 N Hayden Rd Scottsdale, Az 85257 Timing: Fiscal Year 2000; Project Start 8-SEP-2000; Project End 0-JUN2001 Summary: The long term goal of this project is information transfer and science education concerning the neurobiology of alcohol for patients receiving alcoholism treatment though the development of video tapes. The last two decades have seen significant advances in our understanding of the neurobiological and genetic factors influencing the development of alcoholism, but little of this information has been effectively transferred to alcoholism treatment programs. In particular, alcoholism practitioners report a critical lack of neuroscience information presented at an appropriate level for patient education. This shortage of accessible science education materials has led to misunderstanding and mistrust of new treatment approaches, especially biomedical research based approaches directed by advances in neuroscience, within both the treatment community and many twelve-step support groups. Our experience in science education related to the neurobiology of alcoholism has led to an understanding of the nature of this communication gap and the education needs of alcoholism treatment patients. It is clear that l) it is critical for patients to have a better understanding of the neurobiology of alcoholism; 2) patients are interested in this information; 3) this information is not readily available in appropriate forms. We propose to use the advantages of video technology for developing science education materials related to the neurobiology of alcohol. Providing current scientific knowledge to alcoholism treatment patients will result in a better understanding of alcohol as a drug and its effects on the brain. Improving information transfer will increase the "grass roots" level understanding and acceptance of new treatment approaches based upon recent advances in neuroscience within the treatment community. PROPOSED COMMERCIAL APPLICATIONS: Video tapes will provide science education related to alcohol and the brain. The target audience is patients receiving treatment for alcoholism. The target market for the videos will be alcoholism treatment professionals who will purchase them for patient education purposes. The potential exists for broader

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educational distribution of these materials for use with the family members and concerned others of alcoholics. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Risk Factors for Alcoholism in Native Americans Principal Investigator & Institution: Ehlers, Cindy L.; Associate Member; Scripps Research Institute 10550 N Torrey Pines Rd San Diego, Ca 92037 Timing: Fiscal Year 2000; Project Start 6-SEP-1994; Project End 1-MAY2005 Summary: Certain tribes of Native Americans have very high rates of alcoholism and other alcohol related disease when compared to Euroamericans, African Americans, and Asian American samples. These ethnic differences in rates of alcoholism are thought to reflect a combination of sociocultural and biological factors. Within the biological realm few studies have evaluated whether ethnic and/or racial diversities exist in physiological markers of alcoholism risk. Recent data do suggest that there is genetic diversity in biologic sensitivity to alcohol among ethnic groups. The source of the differences in alcohol sensitivity results, in part, from genetic differences in metabolic factors, i.e., polymorphisms of the genes that regulate alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), as well as inborn differences in brain cellular responses to alcohol. The overall objective of the proposed studies is to extend our previous investigations, which evaluated risk factors for the development of alcoholism as well as biological responses to alcohol and placebo challenge. Our studies suggest that Native American men have a quantitatively different response to alcohol than Euro- American and Asian American men using subjective (feelings of intoxication) as well as objective (EEGs, ERPs, cardiovascular responsivity, hormone levels) measures of intoxication. We believe that this diversity in level of response to alcohol may, in part, account for their increased risk for the development of alcoholism. In order to explore this further, these studies will be extended to Native American women age 18-25 years who will be tested for biologic response to alcohol and placebo using a modification of the same alcohol challenge protocol from our previous studies. Our preliminary studies in Native Americans ages 8-11 years will also be extended in order to determine whether specific risk factors might be present in young boys and girls prior to any alcohol exposure. A follow-up study of both the children and young adults will be carried out to deter-mine if factors identified at the initial interview are predictive of the development of alcohol- related life problems. Additionally, 18-50 year old Native American adult sibling-pairs and family members with and without alcohol dependence will be assessed

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using a structured diagnostic interview (SSAGA). These assessments will serve as the basis for future genetic analyses. These studies have the potential to verify whether Native Americans have any specific biological or behavioral factors that may help to explain the high risk for alcoholism within the tribes evaluated. The identification of such variables may potentially be useful in the development of specific prevention and treatment programs for this population as well as other Native American tribes. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

E-Journals: PubMed Central19 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access to this growing archive of e-journals is free and unrestricted.21 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “alcoholism” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for alcoholism in the PubMed Central database: ·

Cladistic association analysis of Y chromosome effects on alcohol dependence and related personality traits by Rick A. Kittles, Jeffrey C. Long, Andrew W. Bergen, Monica Eggert, Matti Virkkunen, Markku Linnoila, and David Goldman; 1999 March 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22445

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Nonhuman Primate Model of Alcohol Abuse: Effects of Early Experience, Personality, and Stress on Alcohol Consumption by JD Higley, MF Hasert, SJ Suomi, and M Linnoila; 1991 August 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52274

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 20 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 21 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 19

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.22 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with alcoholism, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “alcoholism” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “alcoholism” (hyperlinks lead to article summaries): ·

A controlled trial of cue exposure treatment in alcohol dependence. Author(s): Drummond DC, Glautier S. Source: J Consult Clin Psychol. 1994 August; 62(4): 809-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7962885&dopt=Abstract

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Alcohol abuse and HIV infection have additive effects on frontal cortex function as measured by auditory evoked potential P3A latency. Author(s): Fein G, Biggins CA, MacKay S. Source: Biological Psychiatry. 1995 February 1; 37(3): 183-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7727627&dopt=Abstract

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Alcohol dependence and hospitalization in schizophrenia. Author(s): Gerding LB, Labbate LA, Measom MO, Santos AB, Arana GW. Source: Schizophrenia Research. 1999 July 27; 38(1): 71-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10427612&dopt=Abstract

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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Alternative religion and outcome of alcohol dependence in Brazil. Author(s): Miranda CT, Labigalini E Jr, Tacla C. Source: Addiction (Abingdon, England). 1995 June; 90(6): 847. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7633304&dopt=Abstract

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An exploration of women's perceptions of the major factors that contributed to their alcohol abuse. Author(s): Long A, Mullen B. Source: Journal of Advanced Nursing. 1994 April; 19(4): 623-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8021382&dopt=Abstract

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Cognitive and behavioural factors as predictors of abstinence following treatment for alcohol dependence. Author(s): Vielva I, Iraurgi I. Source: Addiction (Abingdon, England). 2001 February; 96(2): 297-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11182875&dopt=Abstract

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Cue exposure with coping skills training and communication skills training for alcohol dependence: 6- and 12-month outcomes. Author(s): Rohsenow DJ, Monti PM, Rubonis AV, Gulliver SB, Colby SM, Binkoff JA, Abrams DB. Source: Addiction (Abingdon, England). 2001 August; 96(8): 1161-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11487422&dopt=Abstract

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Current strategies for the treatment of alcohol dependence in the United States. Author(s): O'Malley SS. Source: Drug and Alcohol Dependence. 1995 September; 39 Suppl 1: S3-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8565795&dopt=Abstract

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Maintenance factors of recovery from alcohol dependence in treated and untreated individuals. Author(s): Bischof G, Rumpf HJ, Hapke U, Meyer C, John U.

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Source: Alcoholism, Clinical and Experimental Research. 2000 December; 24(12): 1773-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11141035&dopt=Abstract ·

Naltrexone in alcohol dependence. Author(s): Hartmann PM. Source: American Family Physician. 1997 April; 55(5): 1877-9, 1883-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9105212&dopt=Abstract

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Naltrexone in the treatment of alcohol dependence. Author(s): Krystal JH, Cramer JA, Krol WF, Kirk GF, Rosenheck RA. Source: The New England Journal of Medicine. 2001 December 13; 345(24): 1734-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11742047&dopt=Abstract

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Naltrexone: a controversial therapy for alcohol dependence. Author(s): Freed PE, York LN. Source: J Psychosoc Nurs Ment Health Serv. 1997 July; 35(7): 24-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9243420&dopt=Abstract

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Periods of abstinence following the onset of alcohol dependence in 1,853 men and women. Author(s): Schuckit MA, Tipp JE, Smith TL, Bucholz KK. Source: J Stud Alcohol. 1997 November; 58(6): 581-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9391917&dopt=Abstract

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Prevention of relapse in alcohol dependence. Author(s): Malerich JA Jr. Source: American Family Physician. 1999 April 1; 59(7): 1753-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10208698&dopt=Abstract

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Project 5: triggering and maintenance factors of remitting from alcohol dependence without formal help. Author(s): Rumpf HJ, Hapke U, Dawedeit A, Meyer C, John U.

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Source: European Addiction Research. 1998 December; 4(4): 209-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10094601&dopt=Abstract ·

Purpose in life and outcome of treatment for alcohol dependence. Author(s): Waisberg JL, Porter JE. Source: The British Journal of Clinical Psychology / the British Psychological Society. 1994 February; 33 ( Pt 1): 49-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8173543&dopt=Abstract

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Treating alcohol dependence. Supplementation with parenteral B vitamins should be routinely considered. Author(s): Cook CC, Thomson AD. Source: Bmj (Clinical Research Ed.). 1997 November 29; 315(7120): 1465; Discussion 1466. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9418114&dopt=Abstract

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Treatment of alcohol dependence. Author(s): Kranzler HR. Source: Liver Transpl Surg. 1997 May; 3(3): 311-21. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9346757&dopt=Abstract

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Treatment/self-help for alcohol-related problems: relationship to social pressure and alcohol dependence. Author(s): Hasin DS. Source: J Stud Alcohol. 1994 November; 55(6): 660-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7861793&dopt=Abstract

ETOH Database In addition to PubMed, ETOH is a comprehensive online bibliographic database containing over 100,000 records on alcohol abuse and alcoholism (http://etoh.niaaa.nih.gov/). ETOH is updated monthly and contains research findings from the late 1960s to the present, as well as historical

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research literature. A thesaurus is available for searching alcohol and other drug terms including a subset index of language used in the ETOH database.

Vocabulary Builder Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Autopsy: Postmortem examination of the body. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Chromosomal: Pertaining to chromosomes. [EU] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Deprivation: Loss or absence of parts, organs, powers, or things that are

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needed. [EU] Emetic: An agent that causes vomiting. [EU] Encephalopathy: Any degenerative disease of the brain. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Intramuscular: Within the substance of a muscle. [EU] Intravenous: Within a vein or veins. [EU] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients;

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those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous sytem. [NIH] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Sarin: An organophosphorous ester compound that produces potent and irreversible inhibition of cholinesterase. It is toxic to the nervous system and

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is a chemical warfare agent. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Soporific: 1. causing or inducing profound sleep. 2. a drug or other agent which induces sleep. [EU] Steatosis: Fatty degeneration. [EU] Substrate: A substance upon which an enzyme acts. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]

Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Ventral: 1. pertaining to the belly or to any venter. 2. denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viremia: The presence of viruses in the blood. [NIH]

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CHAPTER 5. PATENTS ON ALCOHOLISM Overview You can learn about innovations relating to alcoholism by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with alcoholism within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with alcoholism. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.

23Adapted

from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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Patents on Alcoholism By performing a patent search focusing on alcoholism, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. ·

Method of treating alcoholism and complications resulting therefrom Inventor(s): Peddaiahgari; Seetharamulu (San Antonio, TX) Assignee(s): BioNumerik Pharmaceuticals, Inc. (San Antonio, TX) Patent Number: 6,245,815 Date filed: April 15, 2000 Abstract: This invention relates to a method of treating patients afflicted with alcoholism. The method includes administering to a patient in need of treatment an effective amount of a thiol or reducible disulfide compound according to the formula set forth in the specification. Excerpt(s): This invention relates to a method for treating a patient suffering from alcoholism, or from complications caused thereby. The method involves administering an effective amount of a disulfide or thiol-containing compound to a patient suffering from alcoholism or from complications of alcoholism. ... Alcoholism has been and continues to be the foremost social problem of our era. Each year, alcohol is blamed for thousands of highways deaths and injuries, thousands of lost work hours, hospital costs due to related complications, and many other societal problems. ... Effective treatments for alcoholism include psychological support and reinforcement through support groups. Like other substance abuse treatment programs, alcohol support groups are heavily dependent on the desire of the individual to treat his/her dependence. Web site: http://www.delphion.com/details?pn=US06245815__

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Combination of an opioid antagonist and a selective serotonin reuptake inhibitor for treatment of alcoholism and alcohol dependence Inventor(s): Cook; Leonard (Newark, DE) Assignee(s): Dupont Pharmaceuticals Company (Wilmington, DE) Patent Number: 6,071,918 Date filed: July 21, 1999 Abstract: The invention relates to a method of treating alcoholism and alcohol dependence in a mammal comprising administering to the mammal a therapeutically effective amount of a synergistic combination of: (i) at least one opioid antagonist, and (ii) at least one selective serotonin reuptake inhibitor. The invention also relates to compositions and kits containing the same. Excerpt(s): This invention relates to a method of treating alcoholism and alcohol dependence in a mammal comprising administering to the mammal a therapeutically effective amount of a synergistic combination of: (i) at least one opioid antagonist, and (ii) at least one selective serotonin reuptake inhibitor. This invention also relates to compositions and kits containing the same. ... Medications that enhance brain serotonergic activity have also shown effectiveness in reducing alcohol consumption and are currently under evaluation for long-term treatment of alcoholism. For example, C. A. Naranjo et al., Clin. Pharm. Ther., 35, 374, 1984, and Clin. Pharm. Ther., 41, 266, 1987, have shown that the serotonin uptake inhibitors citalopram and zimeldine attenuate ethanol intake in nondepressed alcohol abusers. C. L. Hubbell et al., Alcohol, 8, 355, 1991, demonstrated that fluoxetine, another serotonin uptake inhibitor, attenuates alcohol intake in rats. In a review article, C. A. Naranjo et al., J. Clin. Psychiatry, 47, 16, 1986, indicate that several serotonin uptake inhibitors including zimelidine, citalopram, fluoxetine, and fluvoxamine decrease ethanol drinking in rats. ... In the present invention, we claim an unexpected synergistic interaction between naltrexone, an opioid antagonist, and paroxetine, a serotonin uptake inhibitor, on alcohol fluid consumption in rats. The synergism may be demonstrated where small combined doses of naltrexone and paroxetine which are minimally active by themselves are more effective than maximally effective doses of either drug alone. Alternatively, the data may show that the observed median effective doses (ED50 responses) for various fixed dose combinations of naltrexone and paroxetine are significantly lower than can be accounted for by a simple additivity hypothesis. The data may show that the combination of a long-lasting opioid antagonist with a serotonin uptake inhibitor may provide a novel adjunctive treatment for alcohol abuse and alcoholism in man.

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Web site: http://www.delphion.com/details?pn=US06071918__ ·

Detection of a carbohydrate biomarker directly associated with chronic alcoholism Inventor(s): Pullarkat; Raju K. (Staten Island, NY), Pullarkat; Premilia S. (Staten Island, NY), Raguthu; Simhachalam (Staten Island, NY) Assignee(s): Research Foundation for Mental Hygiene (Albany, NY) Patent Number: 5,958,785 Date filed: August 22, 1997 Abstract: Chronic or long-term alcohol consumption is detected and diagnosed by determining the levels of an alcohol-specific ethanol glycoconjugate biomarker, identified as ethyl .beta.-glucuronide, in body fluids (e.g. urine) of subjects by calorimetric reaction using qualitative and quantitative assay methods. Ethyl glucuronide has been newly observed and detected as a direct indicator of chronic alcohol consumption, and can be isolated and purified. Economical and reproducible assay methods, such as a chromatographic spot assay, ascending or thin layer chromatography assay, and high pressure liquid chromatography assay provide reliable, objective, and sensitive methods for detecting and monitoring a chronic alcoholic condition. Both the presence of the alcohol-specific ethyl glucuronide and a substantial increase in its levels are diagnostic of chronic alcoholism. Since ethyl glucuronide is produced and appears as a direct response to chronic alcohol intake as determined by the present methods, this carbohydrate is considered to be a unique biomarker for the detection of alcoholism, with virtually no possibility of false positive results. Excerpt(s): The present invention relates to detectable carbohydrate biomarkers of alcohol consumption and to novel and improved methods for the detection and monitoring of chronic alcoholism. ... Alcoholism is a major health and economic problem which imposes broad reaching concerns not only to the afflicted individuals, but to society at large. In the United States alone, at least ten to twenty million people are classified as chronic alcoholics and long-term alcohol abusers. In addition, other countries have serious problems with chronic alcohol consumption as well as with the objective diagnosis and detection of long-term alcohol use. ... It is known that chronic (i.e. over a period of weeks, months, or longer) alcoholic and long-term alcohol users rarely admit their excessive consumption of alcohol. In spite of attempts to standardize the diagnosis of alcohol abuse and chronic alcoholism based on operational and functional criteria, many problems exist in the detection and diagnosis of

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alcohol-related disorders. One major problem is that patient cooperation is required, and often, alcoholics do not approach their physicians to ask for help specifically to stop their excessive or pathological drinking. Unfortunately, even when questioned directly by their physicians, alcoholics rarely disclose the true extent of their alcohol consumption, and often deny and minimize any association between their use of alcohol and their other symptoms or problems. Because it is difficult to detect and diagnose alcoholism and alcohol abuse in patients, physicians frequently misdiagnose or under-diagnose alcohol-related disorders. Web site: http://www.delphion.com/details?pn=US05958785__ ·

Galanthamine containing transdermal applicator for the treatment of alcoholism Inventor(s): Opitz; K. (Munster, DE) Assignee(s): LTS Lohmann Therapie-Systeme GmbH & Co. (Neuwied, DE), KG and Hefa-Frenon Arzneimittel GmbH & Co. KG. (Werne, DE) Patent Number: 5,932,238 Date filed: September 29, 1992 Abstract: Galanthamine and the pharmaceutically suitable acid addition salts thereof can be used for the treatment of alcoholism; these compounds are released from adequate pharmaceutic formulations which are administered, e.g., orally, transdermally, or otherwise parenterally, in a continuous and controlled manner. Excerpt(s): The present invention relates to the use of galanthamine as well as the pharmaceutically suitable acid addition salts thereof for the treatment of alcoholism. These compounds are released in a continuous and controlled manner from adequate pharmaceutical formulations which are administered, e.g., orally, transdermally or otherwise parenterally. ... The present invention in particular provides pharmaceutical formulations which release suitable compounds in a controlled manner to treat alcoholism. ... Whereas today the acute withdrawal and the treatment of the perilous alcoholic delirium in special wards do not constitute medical problems, there is still no satisfying treatment of chronic alcoholism. About 80% of the treated alcoholics get a relapse within the term of one year. They are in need of a remedy against the alcohol desire resulting in the relapse, which remedy is reliably effective and well tolerated. Web site: http://www.delphion.com/details?pn=US05932238__

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Detection of novel carbohydrates directly associated with chronic alcoholism Inventor(s): Pullarkat; Raju K. (Staten Island, NY), Pullarkat; Premila S. (Staten Island, NY), Raguthu; Simhachalam (Staten Island, NY) Assignee(s): Research Foundation for Mental Hygiene, Inc. (Albany, NY) Patent Number: 5,747,346 Date filed: May 27, 1994 Abstract: Chronic or long-term alcohol consumption is detected and monitored by determining the level of a newly-observed, alcohol-specific carbohydrate in body fluids (e.g. urine) of subjects by calorimetric reaction using qualitative and quantitative assay methods. The alcoholspecific carbohydrate have been identified as a novel ethyl glucuronide. Ethyl glucuronide is observed and detected in direct response to alcohol consumption in body fluids, and can be isolated and purified. Simple, economical, and reproducible assay methods, such as a spot assay and an ascending or thin layer chromatography assay, provide reliable, objective, and sensitive methods for detecting and monitoring a chronic alcoholic condition. Both the presence of the alcohol-specific ethyl glucuronide and a substantial increase in its levels are indicative of chronic alcoholism. Since the novel ethyl glucuronide is produced and appears as a direct response to chronic alcohol intake, the novel carbohydrate is considered to be a unique biomarker for the detection of alcoholism, with virtually no possibility of false positive results. Excerpt(s): The present invention describes the isolation and characterization of a novel carbohydrate biomarker of alcohol consumption and relates generally to improvements in detecting and monitoring chronic alcoholism. ... Alcoholism is a major health and economic problem which imposes broad reaching concerns not only to the afflicted individuals, but to society at large. In the United States alone, at least ten to twenty million people are classified as chronic alcoholics and long-term alcohol abusers. In addition, other countries have serious problems with chronic alcohol consumption as well as with the objective diagnosis and detection of long-term alcohol use. ... It is known that chronic (i.e. over a period of weeks, months, or longer) alcoholic and long-term alcohol users rarely admit their excessive consumption of alcohol. In spite of attempts to standardize the diagnosis of alcohol abuse and chronic alcoholism based on operational and functional criteria, many problems exist in the detection and diagnosis of alcohol-related disorders. One major problem is that patient cooperation is required, and often, alcoholics do not approach their physicians to ask for help specifically to stop their excessive or pathological drinking.

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Unfortunately, even when questioned directly by their physicians, alcoholics rarely disclose the true extent of their alcohol consumption, and often deny and minimize any association between their use of alcohol and their other symptoms or problems. Because it is difficult to detect and diagnose alcoholism and alcohol abuse in patients, physicians frequently misdiagnose or underdiagnose alcohol-related disorders. Web site: http://www.delphion.com/details?pn=US05747346__ ·

Marker for individuals susceptible to alcoholism Inventor(s): Manowitz; Paul (East Brunswick, NJ), Poretz; Ronald D. (Marlboro, NJ), Park; David (New York, NY), Ricketts; Michael (Somerset, NJ) Assignee(s): Algene LLC (East Brunswick, NJ) Patent Number: 5,736,325 Date filed: August 31, 1994 Abstract: The present invention relates to methods for diagnosis of susceptibility to alcoholism or the pathological effects of alcoholism based on detection of a genetic marker in an individual. The present invention is directed generally to methods and associated compositions and kits for detecting the presence of arylsulfatase A (ASA) pseudodeficiency (PD) mutations in humans. Detection of these mutations has been surprisingly found to be a strong indicator for susceptibility to alcoholism and/or susceptibility to alcohol's pathological effects, as well as an important marker in evaluating the likelihood of metachromatic leukodystrophy (MLD). Excerpt(s): The present invention relates to methods for diagnosis of susceptibility to alcoholism or the pathological effects of alcoholism based on detection of a genetic marker in an individual. ... A large number of adoption and twin studies indicate that there is a genetic factor or factors to at least some forms of alcoholism (Goodwin, 1979, Arch. Gen. Psychiatry 36:57-61). However, to date, the only genetic factor that has been clearly identified in alcoholism is a deficiency in aldehyde dehydrogenase activity. This deficiency leads to a reduction, not an increase, in the rate of alcoholism. ... Earlier studies showed that arylsulfatase A (ASA) electrophoresed in native polyacrylamide gels and stained for enzymatic activity exhibited a variety of electrophoretic patterns, some of which were more likely to be found in alcoholic patients than in non-alcoholic psychiatric and normal control subjects (Hulyalkar et al., 1984, Alcoh.: Clin. Exp. Res. 8:337-341). However,

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lacking any biochemical explanation for these observations, no correlation with a genetic basis or marker for alcoholism was possible. Web site: http://www.delphion.com/details?pn=US05736325__ ·

Pharmaceutic formulation for the treatment of alcoholism Inventor(s): Opitz; Klaus (Munster, DE) Assignee(s): LTS Lohmann Therapie-Systeme GmbH + Co. KG (Neuwied, DE), Hefa-Frenon Arzneimittel GmbH & Co. KG (Werne, DE) Patent Number: 5,519,017 Date filed: May 5, 1994 Abstract: Galanthamine and the pharmaceutically suitable acid addition salts thereof can be used for the treatment of alcoholism; these compounds are released from adequate pharmaceutic formulations which are administered, e.g., orally, transdermally, or otherwise parenterally, in a continuous and controlled manner. Excerpt(s): The present invention relates to the use of galanthamine as well as the pharmaceutically suitable acid addition salts thereof for the treatment of alcoholism. These compounds are released in a continuous and controlled manner from adequate pharmaceutical formulations which are administered, e.g., orally, transdermally or otherwise parenterally. ... The present invention in particular provides pharmaceutical formulations which release suitable compounds in a controlled manner to treat alcoholism. ... Whereas today the acute withdrawal and the treatment of the perilous alcoholic delirium in special wards do not constitute medical problems, there is still no satisfying treatment of chronic alcoholism. About 80% of the treated alcoholics get a relapse within the term of one year. They are in need of a remedy against the alcohol desire resulting in the relapse, which remedy is reliably effective and well tolerated. Web site: http://www.delphion.com/details?pn=US05519017__

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Allelic association of the human dopamine (D.sub.2) receptor gene in compulsive disorders such as alcoholism Inventor(s): Blum; Kenneth (San Antonio, TX), Noble; E. P. (Los Angeles, CA), Sheridan; P. J. (San Antonio, TX) Assignee(s): Board of Regents, The University of Texas System (Austin, TX), Regents of the University of California (Berkeley, CA) Patent Number: 5,210,016 Date filed: January 23, 1992 Abstract: In an important embodiment, the present invention concerns a method for diagnosing compulsive disease predisposition of an individual. The method comprises initially obtaining a DNA sample of said individual and then determining the presence or absence of a particular human D.sub.2 receptor gene allele in said sample. Detection of said allele in the sample is indicative of predilection to compulsive disease. A most preferred embodiment is to detect predisposition to alcoholism, particularly because said allele has been found to be present in a majority of clinically diagnosed alcoholics. The human D.sub.2 receptor gene A1 allele is most preferably detected in said sample. Excerpt(s): The identification of a genetic marker that is closely linked to alcoholism means that the gene's inheritance can be followed, leading to simple tests for diagnosing carriers and future disease victims, and potential gene therapy. ... Some authors believe that dopaminergic cells are implicated in the rewarding action of alcohol (23) and of opiates (2). In contrast, others (3) argue that at least alcohols/opiates and alcohol reinforcing effects are mediated primarily by nonadrenergic and not dopaminergic systems in the brain. Whether or not multiple systems exist, the question of several parallel reward mechanisms, or a very few, even one, is yet to be fully resolved. The cause and effect of compulsive behavior diseases, including alcoholism, appears to be biogenic. Regardless of the number of systems involved, the ability to identify an allelic gene segment associated with specific compulsive behavior is a significant step forward in developing predictive tests for compulsive behavior patterns. ... Alcoholism is a major and devastating health problem with an unknown etiological basis. The question of whether environment or heredity is the prime determinant for the development of alcoholism continues to receive extensive attention throughout the world, and has recently involved the Supreme Court of the United States (4). However, family, twin, and adoption studies (5) are pointing to genetic factors as significant contributors to alcoholism. These studies also demonstrate that other forms of mental illness such as schizophrenia and other major psychoses are not found at higher frequencies in families of

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alcoholics compared with the general population. This would suggest that alcoholism is a primary disease. Web site: http://www.delphion.com/details?pn=US05210016__ ·

Method and means for treating alcoholism by extinguishing the alcohol-drinking response using a transdermally administered opiate antagonist Inventor(s): Sinclair; John D. (Espoo, FI) Assignee(s): Alko Ltd. (Helsinki, FI) Patent Number: 5,096,715 Date filed: November 20, 1989 Abstract: A method for treating alcoholism by extinguishing the alcoholdrinking response in which an opiate antagonist is transdermally administered to a subject and a device for transdermally administering the antagonist. The device is a package containing a fixed dose of opiate antagonist, a vehicle and a permeation enhancer. Excerpt(s): This invention relates to the treatment of alcoholism and particularly to an extinction method of treating alcoholism using a transdermally administered opiate antagonist. The invention also relates to a device for the rapid, transdermal administration or delivery of a fixed dose of the opiate antagonist. ... A method for treating alcoholism by extinguishing the alcohol-drinking response is described in copending United States patent application Ser. No. 205,758, the disclosure of which is incorporated herein in its entirety by reference. In this extinction method, an opiate antagonist is administered to a subject suffering from alcoholism in a daily dosage sufficient to block the stimulatory effect of alcohol and, while the amount of antagonist in the subject's body is sufficient to block the stimulatory effect of alcohol, the subject is made to drink an alcoholic beverage. The steps of administration of the opiate antagonist and drinking of an alcoholic beverage are continued until the alcohol-drinking response is extinguished. ... Injection produces a strong stimulus which, together with any lingering irritation, would clearly distinguish the extinction sessions from normal alcohol drinking. The presence of such stimuli are known to interfere with the process of extinction (David W.M. and Smith, S.G. Biological Psychiatry 9: 181-189, 1974). Injection also reduces motivation and the willingness of the patient to remain in the treatment, which is an important consideration in alcoholism treatment. Web site: http://www.delphion.com/details?pn=US05096715__

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Method for treating alcoholism with nalmefene Inventor(s): Sinclair; John D. (Espoo, FI), Scheinin; Harry (Piispanristi, FI), Lammintausta; Risto (Turku, FI) Assignee(s): Alko Ltd. (Helsinki, FI), Orion-Yhtyma Oy (Espoo, FI) Patent Number: 5,086,058 Date filed: June 4, 1990 Abstract: A method for treating alcoholism. The alcohol-drinking response of alcoholics is extinguished by having them drink alcoholic beverages while nalmefene, an opiate antagonist, blocks the positive reinforcement effect of ethanol in the brain. Excerpt(s): U.S. Pat. No. 4,882,335 discloses a method for treating alcoholism in which the learned response of alcohol drinking is extinguished by being emitted while the reinforcement from alcohol in the brain is blocked with an opiate antagonist. ... It is an object of the present invention, therefore, to provide a method for treating alcoholism in which the learned response of alcohol drinking is extinguished while the reinforcement from alcohol in the brain is blocked with an opiate antagonist which avoids the disadvantages of the antagonists previously disclosed for such use. ... Extinction of the alcohol drinking response, either selectively or non-selectively, should not be expected to be successful alone in the treatment of alcoholism because the patient can readily relearn the response if drinking is attempted after the termination of nalmefene administration. However, once the extinction has been completed, the accompanying craving for alcohol should also be greatly reduced. Consequently, conventional methods for increasing the motivation and incentive for remaining abstinent should be sufficient to prevent relapse. Web site: http://www.delphion.com/details?pn=US05086058__

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Injectable fomulations of disulfiram for the treatment of alcoholism Inventor(s): Phillips; Michael (1740 Hinman Ave., Apt. 3B, Evanston, IL 60201) Assignee(s): none reported Patent Number: 4,678,809 Date filed: February 1, 1985

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Abstract: The disclosure is of the use of an injectable formulation of disulfiram for the treatment of alcoholism. One formulation comprises disulfiram and a biodegradable polymer. Another formulation comprises a slurry of disulfiram in normal saline. After injection, disulfiram is released from the injection site in a sustained-release manner. Excerpt(s): The present invention concerns an improved injectable formulation of the drug disulfiram, for use in the treatment of alcoholism. ... Disulfiram (DSF) is a drug widely used in the treatment of alcoholism. Anyone who consumes ethyl alcohol after pretreatment with DSF (taken orally) will experience the subjectively unpleasant Disulfiram-Ethanol Reaction (DER) characterized by nausea, palpitations, flushing, hyperventilation and hypotension. In theory, treatment of an alcoholic patient with DSF should discourage a relapse into impulsive drinking. In practice, DSF therapy often ends in failure when the patient stops taking the drug and resumes drinking after the effects have worn off. An alternative approach, parenteral therapy with subcutaneous implants of sterile DSF tablets has been widely practiced for many years but it is now clear that these implants are inactive placebos which can not elicit a true DER in alcoholic humans. Alcoholics implanted with DSF tablets do not experience a DER after drinking alcohol, nor do they drink significantly less alcohol than those implanted with an inactive placebo. These failures of therapy are probably due to subtherapeutic dosage as well as the poor bioavailability of DSF tablets in the subcutaneous milieu where they often become encapsulated by fibrotic tissue. The following references describe relevant prior art methods: Bergstrom et al., Lancet 1:49-50, 1982; Kline and Kingstone, Can Med Assoc. J. 116:1382-1383, 1977; Lewis et al., Can Psychiatr. Assoc J. 20:283-286, 1975. ... The present invention comprises a method of treating alcoholic subjects with injectable formulations of disulfiram (DSF). Oral DSF has been widely used for the treatment of alcoholism. It is now possible for the first time to treat alcoholics successfully with injected DSF, without requiring the subject to take a tablet every day, because the iniected DSF is released into the circulation in a steady fashion over a long period of time. An alcoholic thus treated would then respond to consumption of alcohol with a variety of unpleasant reactions, including flushing of the face, shortness of breath, dizziness, headaches and blurred vision, and would therefore be motivated to abstain from drinking. Web site: http://www.delphion.com/details?pn=US04678809__

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Hemoglobin marker of alcoholism Inventor(s): Hoberman; Henry D. (New Rochelle, NY) Assignee(s): Albert Einstein College of Medicine of Yeshiva University a Division of (Bronx, NY) Patent Number: 4,463,098 Date filed: October 3, 1983 Abstract: An in vitro method for identifying alcoholism and alcohol abuse in humans is disclosed which comprises the isolation and measurement of a unique and stable form of glycosylated hemoglobin. Excerpt(s): To the present time, efforts to identify markers of alcoholism have relied chiefly on evaluating changes in liver biochemistry reflected in the blood by changes in the concentrations of certain amino acids. See Shaw, et al, 1976, Plasma a-amino-n-butyric acid to leucine ratio: An empirical biochemical marker of alcoholism, Science, 194: 1057. ... Accumulating evidence indicates, however, that probes that depend on the development of abnormalities of liver function lack the specificity required of a test that, in principle, should do no more than reflect a dosetime record of alcohol consumption. See Morgan, M. Y., et al, 1977, Ratio of plasma a-amino-n-butyric acid to leucine as an empirical marker of alcoholism: Diagnostic value, Science, 197: 1183; Eriksson, S., et al, 1979, Plasma a-amino-n-butyric acid/leucine ratio in alcoholism, N. Eng. J. Med. 300L 93; Kristensson, H., et al, 1977, Serum glutamyl-transferase in alcoholism, Lancet, 1: 609; and Whitehead, T. P., et al, 1978, Biochemical and hematological markers of alcohol intake, Lancet, 1: 978. ... Now, there is provided by the present invention a method for providing an accurate in vitro test which will identify alcoholism in humans. Web site: http://www.delphion.com/details?pn=US04463098__

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Method for treating alcoholism and eliminating and preventing alcohol intoxication Inventor(s): Revici; Emanuel (1111 Park Ave., New York, NY 10028) Assignee(s): none reported Patent Number: 4,368,206 Date filed: December 21, 1979 Abstract: The invention relates to a method of treating alcoholism and for aiding in controlling alcohol intoxication in humans by the internal administration of a composition produced by heating certain allylically unsaturated compounds sufficient to substantially increase the peroxide

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titer. The incorporation of sulfur in the composition during the heating has been found to be particularly advantageous. Excerpt(s): There has been much recent interest in the study of alcoholism involving biological, psychological, and sociological investigations. Publications such as the various "Proceedings of the . . . Annual Alcoholism Conference" and "Recent Advances in Studies of Alcoholism", obtainable from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, indicate the rather intensive scientific investigations in this area. Some of these studies are concerned with the effect on a host produced by certain chemicals in combination with alcohol. ... An article by E. B. Truitt and M. J. Walsh appearing at p. 100 et sequa of "Proceedings of the First Annual Alcoholism Conference of the National Institute on Alcohol Abuse and Alcoholism", DHEW Publication No. (NIH) 74-675 (1973) discloses a number of chemicals and drugs which have been reported to have anti-alcohol effects. Included in this list are disulfiram (tetraethylthiuram disulfide--see also U.S. Pat. No. 2,567,814 Jacobsen et al), calcium carbimide (see also U.S. Pat. No. 2,998,350 de Grunigen et al), and thiocyanates which are used specifically for their anti-alcohol properties. ... Russian Inventor's Certificate 187250 discloses the use of the "thiolic" preparations--"unitol" and "dicaptol"--for use in treating alcoholism. The Merck Index (Eighth Edition) discloses that Dicaptol (BAL or British Anti-Lewisite) is 2,3-dimercaptopropanol and is marketed as a 10% solution in peanut oil with 20% benzyl benzoate. It is further asserted that in the U.S.S.R. a water soluble form is available under the name Unithiol or Unitiol and is 2,3-dimercapto-1propanol sodium sulfonate. Web site: http://www.delphion.com/details?pn=US04368206__ ·

Method of employing therapeutic composition comprising ammonium or substituted ammonium compounds for treatment of alcoholism Inventor(s): Revici; Emanuel (New York, NY) Assignee(s): The Vinoxen Company (New York, NY) Patent Number: 4,346,082 Date filed: February 27, 1981 Abstract: This invention relates to a method of treating alcoholism and for eliminating, reducing or preventing alcohol intoxication or the manifestations of alcohol intoxication in humans by administering thereto a therapeutic composition comprising an ammonium compound or compounds, said compounds and each of said compounds having a pH greater than 5.0 when in aqueous solution at a concentration of 5

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grams per 100 grams of solution (5 weight percent), and particularly ammonium salt compounds containing ammonium cations and sulfur anions. Excerpt(s): None of the reference teaches the use of the compositions of the present invention as a treatment for alcoholism or eliminating and preventing alcohol intoxication or the manifestations of alcohol intoxication. ... The invention relates to a method of treating alcoholism and for eliminating, reducing or preventing alcohol intoxication or the manifestations of alcohol intoxication in humans by administering thereto an ammonium compound or compounds, said compounds and each of said compounds having a pH greater than 5.0 moles when in aqueous solution at a concentration of 5 weight percent. Especially preferred embodiments are the salt compounds containing ammonium cations and sulfur anions. The ammonium compound can be administered to the patient by various known methods of injection or orally as by capsule form. ... It is to be especially noted that applicant is not claiming a cure for alcoholism; rather, this invention encompasses a method to treat acute and chronic effects of alcoholism or its manifestations or to prevent or reduce alcohol intoxication in which are used therapeutic compositions comprising any non-toxic compound having ammonium cations or substituted ammonium in its molecule, or mixtures or more than one such compound wherein said compound and each of said compounds have a pH greater than 5.0 when in aqueous solution at a concentration of 5 weight percent. Such preparations administered to humans may also help in detoxification of patients addicted to alcohol. Web site: http://www.delphion.com/details?pn=US04346082__ ·

Method of treating nutritional deficiency during cardiac cachexia, diabetes, hypoglycemia, gastroenterology, lipid, cell glycogen and keratin-related skin conditions and alcoholism Inventor(s): Gans; Arnold M. (Closter, NJ), Goren; Alvin J. (North Bergen, NJ), Gorenberg; Eli M. (Fair Lawn, NJ) Assignee(s): Control Drug Inc. (Port Redding, NJ) Patent Number: 4,053,589 Date filed: June 22, 1976 Abstract: A method of treating nutritional deficiency during cardiac cachexia, diabetes, hypoglycemia, gastroenterology, skin conditions related to lipid, cell glycogen and keratin deficiencies and alcoholism which comprises ingestion of a pre-digested protein composition

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containing all of the essential amino acids and having a palatable taste and odor. Excerpt(s): The present invention is not only clearly valuable in the treatment of patients undergoing surgery or cancer therapy but in many other instances where nutritional deficiency is a serious obstacle to treatment or recovery such as cardiac cachexia, diabetes, hypoglycemia, gastroenterology, alcoholism, and the like. Furthermore, the invention is valuable not only in disease-related conditions but in many other situations where body build-up in a relatively rapid and efficient manner is desired. In this respect, it may be used to provide weight-gain for ingerently thin or run-down persons, without the addition of excess fats. It may also be used by athletes to build up their lean body mass and by persons under stress who cannot tolerate large amounts of bulk food. It is also useful in skin disorders related to lipid, cell glycogen or keratin deficiencies since it provides a nutritionally satisfactory diet without fats and oils and improves the formation of keratin by amino acid supplementation. Web site: http://www.delphion.com/details?pn=US04053589__

Patent Applications on Alcoholism As of December 2000, U.S. patent applications are open to public viewing.24 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years).

Keeping Current In order to stay informed about patents and patent applications dealing with alcoholism, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “alcoholism” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on alcoholism. You can also use this procedure to view pending patent applications concerning alcoholism. Simply go back to the following Web 24

This has been a common practice outside the United States prior to December 2000.

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address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON ALCOHOLISM Overview This chapter provides bibliographic book references relating to alcoholism. You have many options to locate books on alcoholism. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on alcoholism include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “alcoholism” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on alcoholism:

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·

Circle of Hope: Our Stories of AIDS, Addiction and Recovery Source: 1990. Contact: Hazelden Foundation Educational Materials, P.O. Box 176, Center City, MN 55012-0176. (612) 257-4010. ISBN: 0-89486-610-9; Order no. 5055. Summary: This monograph examines the interrelationship between Acquired immunodeficiency syndrome (AIDS) and addiction. It discusses drug addiction, alcoholism, sexually compulsive behavior and childhood abuse, living with Human immunodeficiency virus (HIV) infection, recovery, and healing. It describes implementation of the Twelve-Step Program of Alcoholics Anonymous as a holistic alternative to decreasing susceptibility to disease and increasing recovery from addiction. This monograph recounts personal experiences of persons in correctional facilities, Vietnam veterans, drug users, homosexuals, alcoholics, and persons with sexually compulsive behavior. Stories of native and new age spirituality, treatment, abusive childhoods, lost childhoods, and parents with AIDS are also included.

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AIDS, Alcoholism and Drug Abuse: Dilemmas in the Workplace; Employers' Rights and Responsibilities, Volume II Source: 1989. Contact: National Legal Center for the Public Interest, 1000 16th St., NW, Ste. 301, Washington, DC 20036. (202) 296-1683. ISBN: 0-937299-10-3; ISBN: 0-937299-12-X. Summary: This monograph looks at the problems that Acquired immunodeficiency syndrome (AIDS), alcoholism, and drug abuse can cause in the workplace. This, the second volume, examines employers' rights and responsibilities. The first chapter presents a general background on Human immunodeficiency virus (HIV). It explains the widespread problem of AIDS, how a virus infects the body, how HIV causes disease, the clinical picture of HIV infection, routes of HIV transmission, and the treatment of viral infections. The second chapter looks at employers' rights and responsibilities with regard to AIDS. It examines legal principles concerning AIDS in the workplace, and business interests and AIDS. The third chapter studies the treatment of HIV infection as a handicap, including making accommodations and the legislative response to AIDS as a handicap. The next chapter is drawn from a speech made by Surgeon General C. Everett Koop before the AIDS Interfaith Council meeting in Houston, TX, on May 27, 1988. The final chapter looks at the need for achieving a drug-free workplace.

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Encyclopedia of Alcoholism. 2nd ed Source: New York, NY: Facts on File, Inc. 1991. 346 p. Contact: Available from Facts on File, Inc. 460 Park Avenue South, New York, NY 10016. (212) 683-2244. PRICE: $45. Shipping and handling free if prepaid. ISBN: 081601955X. Summary: This volume presents a dictionary approach to information about alcoholism. With more than 600 entries, the encyclopedia defines and explains all facets of alcoholism: biological, medical and psychological areas, its social and economic impact, legal implications, terminology used in the treatment of the disease, slang, organizations that deal with alcoholism, various theories on the causes of the disease, and the prevalence of alcohol abuse around the world and what different countries have tried to do about controlling it. Entries of interest to those in the field of digestive diseases include those about alcoholic hepatitis, alcoholic liver disease, alcoholic myopathy, black Americans, blood sugar, cirrhosis, diabetes, diseases, gastrointestinal tract, hemochromatosis, hypoglycemia, intestine, liver, Mallory-Weiss syndrome, nutrition, pancreas, post-necrotic cirrhosis, stomach, and Switzerland. Appendices include tables and figures and sources of information. A subject index is included. 620 references.

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Ounce of Prevention: Strategies for Solving Tobacco, Alcohol, and Drug Problems Source: San Francisco, CA, Jossey-Bass, Inc., Publishers, 290 p., 1991. Contact: Jossey-Bass, Inc., Publishers, 350 Sansome Street, San Francisco, CA 94104. Summary: Ounce of Prevention: Strategies for Solving Tobacco, Alcohol, and Drug Problems, based on the premise that only a realistic public health approach (as opposed to a moralistic or punitive policy) can make real progress in reducing addictive substances' heavy toll, provides information on recent national developments in the prevention of harm from addictive substances. The monograph describes recently developed coordinated strategies and programs on which the Federal government and prevention-oriented nonprofit organizations are cooperating to reduce the level of health and economic problems caused by alcohol, illicit drugs, and tobacco. The monograph summarizes the growth of American markets for alcohol and other addictive drugs and the impact these substances have had on American well-being. Topics discussed include (1) Putting Prevention on the National Agenda, (2) What Makes and Breaks Prevention Programs, (3) Reducing Tobacco-caused Deaths, (4) Treating Addiction to Tobacco, (5) Preventing Alcohol Problems, (6)

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Improving the Treatment of Alcoholism, (7) Coping With Illicit Drugs (Have We Lost This War on Drugs?), (8) Key Problems in Treating Drug Addiction, (9) Organizing Effective Prevention Programs, and (10) Rebuilding a Prevention-oriented Society. A resource list provides selected sources of information on the use of alcohol, tobacco, and illicit drugs and on preventive and treatment programs.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to alcoholism (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·

12 Steps and 12 Traditions (1988); ISBN: 0916856291; http://www.amazon.com/exec/obidos/ASIN/0916856291/icongroupin terna

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12 Steps for Adult Children by Friends in Recovery (1996); ISBN: 0941405125; http://www.amazon.com/exec/obidos/ASIN/0941405125/icongroupin terna

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7 Weeks to Safe Social Drinking : How to Effectively Moderate Your Alcohol Intake by Donna J. Cornett (2001); ISBN: 0595174965; http://www.amazon.com/exec/obidos/ASIN/0595174965/icongroupin terna

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A Bar on Every Corner : Sobering Up in a Tempting World by Jack Erdmann, et al (2001); ISBN: 1568387377; http://www.amazon.com/exec/obidos/ASIN/1568387377/icongroupin terna

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A Clinician's Guide to the Personality Profiles of Alcohol and Drug Abusers : Typological Descriptions Using the MMPI by Donald J., Ph.D. Tosi, Dennis M., Ph.D. Eshbaugh (1993); ISBN: 0398058857; http://www.amazon.com/exec/obidos/ASIN/0398058857/icongroupin terna

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A Nation Under the Influence: America's Addiction to Alcohol by J. Vincent Peterson, et al (2002); ISBN: 0205327141; http://www.amazon.com/exec/obidos/ASIN/0205327141/icongroupin terna

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A Woman Like You : Life Stories of Women Reovering from Alcoholism and Addiction by Rachel V (1985); ISBN: 006250701X; http://www.amazon.com/exec/obidos/ASIN/006250701X/icongroupi nterna

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Adult Children of Alcoholics by Janet Geringer Woititz (1990); ISBN: 1558741127; http://www.amazon.com/exec/obidos/ASIN/1558741127/icongroupin terna

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Advertising, Alcohol Consumption, and Abuse: A Worldwide Survey (Contributions to the Study of Mass Media and Communications) by Joseph C. Fisher (1993); ISBN: 031328959X; http://www.amazon.com/exec/obidos/ASIN/031328959X/icongroupi nterna

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Alcohol (1987); ISBN: 0422611204; http://www.amazon.com/exec/obidos/ASIN/0422611204/icongroupin terna

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Alcohol (1998); ISBN: 1902690001; http://www.amazon.com/exec/obidos/ASIN/1902690001/icongroupin terna

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Alcohol (Drugs of Abuse : A Comprehensive Series for Clinicians, Vol 2) by Norman S. Miller, Mark S. Gold (1991); ISBN: 0306436418; http://www.amazon.com/exec/obidos/ASIN/0306436418/icongroupin terna

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Alcohol : Cradle to Grave by Eric Newhouse (2001); ISBN: 1568387342; http://www.amazon.com/exec/obidos/ASIN/1568387342/icongroupin terna

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Alcohol : Drug Dangers (Drug Dangers) by Lawrence, Ph.D. Clayton (2001); ISBN: 0766017354; http://www.amazon.com/exec/obidos/ASIN/0766017354/icongroupin terna

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Alcohol : How to Give It Up and Be Glad You Did by Philip Tate Ph.D., Philip Tate (1996); ISBN: 1884365108; http://www.amazon.com/exec/obidos/ASIN/1884365108/icongroupin terna

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Alcohol : The World's Favorite Drug by Griffith Edwards (2002); ISBN: 0312283873; http://www.amazon.com/exec/obidos/ASIN/0312283873/icongroupin terna

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Alcohol Abuse (At Issue (San Diego, Calif.).) by Haisong Harvey (Editor) (2003); ISBN: 0737711604; http://www.amazon.com/exec/obidos/ASIN/0737711604/icongroupin terna

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Alcohol Abuse : Straight Talk Straight Answers by Pippa Sales (1999); ISBN: 1884633048; http://www.amazon.com/exec/obidos/ASIN/1884633048/icongroupin terna

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Alcohol Addiction and Chronic Alcoholism by Research Council on Problems of Alcohol. Scientific Committee. (1981); ISBN: 0405135939; http://www.amazon.com/exec/obidos/ASIN/0405135939/icongroupin terna

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Alcohol and Drugs : Research and Policy by Martin Plant (Editor) (1991); ISBN: 0748601139; http://www.amazon.com/exec/obidos/ASIN/0748601139/icongroupin terna

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Alcohol and Drugs : The Scottish Experience by Martin Plant, et al (1992); ISBN: 0748603778; http://www.amazon.com/exec/obidos/ASIN/0748603778/icongroupin terna

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Alcohol and Drugs in the Workplace Attitudes, Policies, and Programmes in Denmark : Attitudes, Policies and Programmes in Denmark (Skrifter Fra center by Knud-Erik Sabroe (1995); ISBN: 8789029143; http://www.amazon.com/exec/obidos/ASIN/8789029143/icongroupin terna

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Alcohol and the Addictive Brain : New Hope for Alcoholics from Biogenetic Research by Kenneth Blum, James E. Payne (1991); ISBN: 0029037018; http://www.amazon.com/exec/obidos/ASIN/0029037018/icongroupin terna

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Alcohol and the Family: A Comprehensive Bibliography (Bibliographies and Indexes in Sociology) by Grace M. Barnes, Diana K. Augustino (1987); ISBN: 031324782X; http://www.amazon.com/exec/obidos/ASIN/031324782X/icongroupi nterna

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Alcohol Problems in the Community by Larry Harrison (Editor) (1996); ISBN: 0415110424; http://www.amazon.com/exec/obidos/ASIN/0415110424/icongroupin terna

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Alcohol Use Among Adolescents (Developmental Clinical Psychology and Psychiatry (Cloth), Vol 42) by Michael Windle (1999); ISBN: 0761909192; http://www.amazon.com/exec/obidos/ASIN/0761909192/icongroupin terna

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Alcohol, Youth and the State : Drinking Practices, Controls and Health Education by Nicholas Dorn (1983); ISBN: 0709908415; http://www.amazon.com/exec/obidos/ASIN/0709908415/icongroupin terna

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Alcoholic Family by Peter Steinglass, et al (1993); ISBN: 0465001122; http://www.amazon.com/exec/obidos/ASIN/0465001122/icongroupin terna

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Alcoholic Thinking by Danny M. Wilcox (1998); ISBN: 0275960498; http://www.amazon.com/exec/obidos/ASIN/0275960498/icongroupin terna

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Alcoholics Alive by Neal J., Neal J (2000); ISBN: 0595140483; http://www.amazon.com/exec/obidos/ASIN/0595140483/icongroupin terna

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Alcoholics Anonymous (2000); ISBN: 1893007170; http://www.amazon.com/exec/obidos/ASIN/1893007170/icongroupin terna

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Alcoholics Anonymous (English Edition) (1976); ISBN: 0916856593; http://www.amazon.com/exec/obidos/ASIN/0916856593/icongroupin terna

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Alcoholics Anonymous : Cult or Cure? by Charles Bufe, Stanton Peele (Introduction) (1998); ISBN: 1884365124; http://www.amazon.com/exec/obidos/ASIN/1884365124/icongroupin terna

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Alcoholics Anonymous : The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism (2002); ISBN: 1893007162; http://www.amazon.com/exec/obidos/ASIN/1893007162/icongroupin terna

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Alcoholics Anonymous : The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism (1986); ISBN: 091585600X; http://www.amazon.com/exec/obidos/ASIN/091585600X/icongroupi nterna

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Alcoholics Anonymous : The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism by Alcoholics Anonymous (1986); ISBN: 0916856186; http://www.amazon.com/exec/obidos/ASIN/0916856186/icongroupin terna

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Alcoholism (1987); ISBN: 3540965459; http://www.amazon.com/exec/obidos/ASIN/3540965459/icongroupin terna

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Alcoholism : A Molecular Perspective (NATO Asi Series. Series A, Life Sciences, Vol 206) by T. Palmer (Editor) (1991); ISBN: 0306439263; http://www.amazon.com/exec/obidos/ASIN/0306439263/icongroupin terna

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Alcoholism and Human Sexuality by Gary G. Forrest (1983); ISBN: 0398046913; http://www.amazon.com/exec/obidos/ASIN/0398046913/icongroupin terna

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Alcoholism and Sexual Dysfunction by David J. Powell (1984); ISBN: 0866563652; http://www.amazon.com/exec/obidos/ASIN/0866563652/icongroupin terna

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Alcoholism and Substance Abuse : Strategies for Clinical Intervention by Gary Forrest (Editor), Thomas E. Bratter (Editor) (1985); ISBN: 0029042607; http://www.amazon.com/exec/obidos/ASIN/0029042607/icongroupin terna

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Alcoholism and the Family : A Guide to Treatment and Prevention by Gary Lawson (1983); ISBN: 0894436740; http://www.amazon.com/exec/obidos/ASIN/0894436740/icongroupin terna

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Alcoholism in the Elderly : Social and Biomedical Issues by James T. Hartford, T. Samorajski (Editor) (1983); ISBN: 0890049246; http://www.amazon.com/exec/obidos/ASIN/0890049246/icongroupin terna

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Alcoholism, Narcissism and Psychopathology (Master Work Series) by Gary G. Forrest (1995); ISBN: 1568213778; http://www.amazon.com/exec/obidos/ASIN/1568213778/icongroupin terna

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Alcoholism: Its Cause and Cure from the View-Point of Science of Mind by Ernest Holmes (2000); ISBN: 0917849299;

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http://www.amazon.com/exec/obidos/ASIN/0917849299/icongroupin terna ·

Alcoholism's Children : Acoas in Priesthood and Religious Life by Sean D. Sammon (1989); ISBN: 081890545X; http://www.amazon.com/exec/obidos/ASIN/081890545X/icongroupi nterna

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Alcoholism-The Disease and the Benefits : The Highly Effective Recovering Adult-Child by Linda Parks Tague (2001); ISBN: 059519902X; http://www.amazon.com/exec/obidos/ASIN/059519902X/icongroupi nterna

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Alternatives to Abstinence: A New Look at Alcoholism and the Choices in Treatment by Heather Ogilvie, et al (2001); ISBN: 1578260817; http://www.amazon.com/exec/obidos/ASIN/1578260817/icongroupin terna

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Anger, Alcoholism, and Addiction : Treating Individuals, Couples, and Families by Ronald T. Potter-Efron, Patricia S. Potter-Efron (Contributor) (1992); ISBN: 0393701263; http://www.amazon.com/exec/obidos/ASIN/0393701263/icongroupin terna

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Another Chance : Hope and Health for the Alcoholic Family by Sharon Wegscheider-Cruse (1989); ISBN: 0831400722; http://www.amazon.com/exec/obidos/ASIN/0831400722/icongroupin terna

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Becoming Alcoholic : Alcoholics Anonymous and the Reality of Alcoholism by David R. Rudy (1986); ISBN: 080931245X; http://www.amazon.com/exec/obidos/ASIN/080931245X/icongroupi nterna

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Behavioral Approaches to Alcoholism by G. A. Marlatt, P. E. Nathan (Editor) (1978); ISBN: 0911290486; http://www.amazon.com/exec/obidos/ASIN/0911290486/icongroupin terna

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Behavioral Therapy for Rural Substance Abusers : A Treatment Intervention for Substance Abusers by Carl G. Leukefeld (Editor), et al (2000); ISBN: 0813109841; http://www.amazon.com/exec/obidos/ASIN/0813109841/icongroupin terna

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Beyond AA : Dealing Responsibly With Alcohol by Clarence Barrett (1991); ISBN: 0963029266; http://www.amazon.com/exec/obidos/ASIN/0963029266/icongroupin terna

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Binge by Charles Ferry (1992); ISBN: 0963279904; http://www.amazon.com/exec/obidos/ASIN/0963279904/icongroupin terna

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Broadening the Base of Treatment for Alcohol Problems (Photocopy Only) by Institute of Medicine (1990); ISBN: 0309040388; http://www.amazon.com/exec/obidos/ASIN/0309040388/icongroupin terna

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Canadian Profile : Alcohol, Tobacco and Other Drugs, 1997 by Eric Single (Compiler), et al (1997); ISBN: 1896323200; http://www.amazon.com/exec/obidos/ASIN/1896323200/icongroupin terna

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Children of Alcoholism : The Struggle for Self and Intimacy in Adult Life by Barbara L. Wood (1989); ISBN: 0814792227; http://www.amazon.com/exec/obidos/ASIN/0814792227/icongroupin terna

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Choices and Consequences : What to Do When a Teenager Uses Alcohol/Drugs by Dick Schaefer, Dick Schaefer (1996); ISBN: 0935908420; http://www.amazon.com/exec/obidos/ASIN/0935908420/icongroupin terna

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Clinical Supervision in Alcohol and Drug Abuse Counseling : Principles, Models, Methods by David J. Powell, et al (1998); ISBN: 0787940747; http://www.amazon.com/exec/obidos/ASIN/0787940747/icongroupin terna

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Communities That Care : Action for Drug Abuse Prevention (JosseyBass Social and Behavioral Science Series.) by J. David Hawkins, Richard F. Catalano (1992); ISBN: 1555424716; http://www.amazon.com/exec/obidos/ASIN/1555424716/icongroupin terna

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Comparative Treatments of Substance Abuse (Comparative Treatments for Psychological Disorders Series) by E. Thomas Dowd (Editor), Loreen Rugle (Editor) (1999); ISBN: 0826112765; http://www.amazon.com/exec/obidos/ASIN/0826112765/icongroupin terna

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Cool Water : Alcoholism, Mindfulness, and Ordinary Recovery by Bill Alexander, William Alexander (1997); ISBN: 157062254X; http://www.amazon.com/exec/obidos/ASIN/157062254X/icongroupi nterna

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Cost-Effective Alternatives in Alcoholism Treatment by Richard L. Greenstreet (1988); ISBN: 0398054681;

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Currents in Alcohol Research and the Prevention of Alcohol Problems by Jean-Pierre Von Wartburg (1985); ISBN: 345681397X; http://www.amazon.com/exec/obidos/ASIN/345681397X/icongroupi nterna

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Dear John: Lover Letters and Lessons Learned from the Wife of an Alcoholic by Mary Gjetson Levin, et al (1999); ISBN: 0828113491; http://www.amazon.com/exec/obidos/ASIN/0828113491/icongroupin terna

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Dear Kids of Alcoholics ... by Lindsey Hall, et al (1988); ISBN: 0936077182; http://www.amazon.com/exec/obidos/ASIN/0936077182/icongroupin terna

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Diseases of the Will : Alcohol and the Dilemmas of Freedom (Cambridge Studies in Law and Society) by Mariana Valverde (1998); ISBN: 0521644690; http://www.amazon.com/exec/obidos/ASIN/0521644690/icongroupin terna

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Diseasing of America : Addiction Treatment Out of Control by Stanton Peele (1989); ISBN: 0669200158; http://www.amazon.com/exec/obidos/ASIN/0669200158/icongroupin terna

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Diseasing of America : How We Allowed Recovery Zealots and the Treatment Industry to Convince Us We Are Out of Control by Stanton Peele (1999); ISBN: 0787946435; http://www.amazon.com/exec/obidos/ASIN/0787946435/icongroupin terna

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Drink As Much As You Want and Live Longer : The Intelligent Person's Guide to Healthy Drinking by Frederick M. Beyerlein, Fred M. Beyerlein (1999); ISBN: 155950188X; http://www.amazon.com/exec/obidos/ASIN/155950188X/icongroupi nterna

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Drinking : A Love Story by Caroline Knapp (1997); ISBN: 0385315546; http://www.amazon.com/exec/obidos/ASIN/0385315546/icongroupin terna

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Drug and Alcohol Abuse (1995); ISBN: 030643041X; http://www.amazon.com/exec/obidos/ASIN/030643041X/icongroupi nterna

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Drunkard's Progress : Narratives of Addiction, Despair, and Recovery by John William Crowley (Editor) (1999); ISBN: 0801860075; http://www.amazon.com/exec/obidos/ASIN/0801860075/icongroupin terna

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Dying for a Drink: A Pastor and a Physician Talk About Alcoholism by Alexander Dejong, Martin Doot (1999); ISBN: 080284622X; http://www.amazon.com/exec/obidos/ASIN/080284622X/icongroupi nterna

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Eating Right to Live Sober by Katherine Ketcham, Ann Mueller (1985); ISBN: 0880890061; http://www.amazon.com/exec/obidos/ASIN/0880890061/icongroupin terna

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Educating Young Drinkers by Gellisse Bagnall (1991); ISBN: 0415017181; http://www.amazon.com/exec/obidos/ASIN/0415017181/icongroupin terna

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Educating Yourself About Alcohol and Drugs : A People's Primer by Marc Alan Schuckit (1998); ISBN: 0306457830; http://www.amazon.com/exec/obidos/ASIN/0306457830/icongroupin terna

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Families Alcoholism and Therapy by Juliette. Karow (1981); ISBN: 0398041571; http://www.amazon.com/exec/obidos/ASIN/0398041571/icongroupin terna

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First-Year Sobriety : When All That Changes Is Everything by Guy Kettelhack (1998); ISBN: 1568382308; http://www.amazon.com/exec/obidos/ASIN/1568382308/icongroupin terna

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Freeing Someone You Love from Alcohol and Other Drugs (1992); ISBN: 0399517200; http://www.amazon.com/exec/obidos/ASIN/0399517200/icongroupin terna

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From Survival to Recovery : Growing Up in an Alcoholic Home by Inc Al-Anon Family Group Head (1994); ISBN: 0910034974; http://www.amazon.com/exec/obidos/ASIN/0910034974/icongroupin terna

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Getting Started in AA by Hamilton B., et al (1995); ISBN: 1568380917; http://www.amazon.com/exec/obidos/ASIN/1568380917/icongroupin terna

Books 171

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Getting Them Sober : Vol 4 : Separations and Healings by Toby Rice Drews (1992); ISBN: 0961599510; http://www.amazon.com/exec/obidos/ASIN/0961599510/icongroupin terna

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Getting Them Sober : You Can Help! by Toby Rice Drews (1998); ISBN: 0961599596; http://www.amazon.com/exec/obidos/ASIN/0961599596/icongroupin terna

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God Is for the Alcoholic by Bernard Alvin Palmer (Photographer), Jerry G. Dunn (1986); ISBN: 0802432840; http://www.amazon.com/exec/obidos/ASIN/0802432840/icongroupin terna

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Happy Hours: Alcohol in a Woman's Life by Devon Jersild (2002); ISBN: 0060929901; http://www.amazon.com/exec/obidos/ASIN/0060929901/icongroupin terna

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Heavy Drinking : The Myth of Alcoholism As a Disease by Herbert Fingarette (1989); ISBN: 0520067541; http://www.amazon.com/exec/obidos/ASIN/0520067541/icongroupin terna

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Hour to Hour : The First Thirty Days by Shelly Marshall (2001); ISBN: 0743428439; http://www.amazon.com/exec/obidos/ASIN/0743428439/icongroupin terna

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How Al-Anon Works for Families & Friends of Alcoholics by Inc AlAnon Family Group Head (1995); ISBN: 0910034265; http://www.amazon.com/exec/obidos/ASIN/0910034265/icongroupin terna

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How Alcoholics Anonymous Failed Me : My Personal Journey to Sobriety Through Self-Empowerment by Marianne Gilliam (1999); ISBN: 0688170137; http://www.amazon.com/exec/obidos/ASIN/0688170137/icongroupin terna

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How to Quit Drinking Without AA : A Complete Self-Help Guide by Jerry Dorsman (1998); ISBN: 076151290X; http://www.amazon.com/exec/obidos/ASIN/076151290X/icongroupi nterna

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I'll Quit Tomorrow : A Practical Guide to Alcoholism Treatment by Vernon E. Johnson (1990); ISBN: 0062504339;

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In the Open : Diary of a Homeless Alcoholic by Timothy E. Donohue (1997); ISBN: 0226157687; http://www.amazon.com/exec/obidos/ASIN/0226157687/icongroupin terna

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In-Patient Treatment for Alcoholism (1989); ISBN: 3540506985; http://www.amazon.com/exec/obidos/ASIN/3540506985/icongroupin terna

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Living With Drink : Women Who Live With Problem Drinkers by Richard Velleman (Editor), et al (1998); ISBN: 0582298873; http://www.amazon.com/exec/obidos/ASIN/0582298873/icongroupin terna

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Moderate Drinking: The Moderation Management Guide for People Who Want to Reduce Their Drinking by Audrey Kishline, Audrey Kischline (1996); ISBN: 0517886561; http://www.amazon.com/exec/obidos/ASIN/0517886561/icongroupin terna

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My Mama's Waltz : A Book for Daughters of Alcoholic Mothers by Eleanor Agnew, Sharon Robideaux (1999); ISBN: 0671013866; http://www.amazon.com/exec/obidos/ASIN/0671013866/icongroupin terna

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Nature's Road to Recovery : Nutritional Supplements for the Recovering Alcoholic, Chemical-Dependent and the Social Drinker: A Health Learning handboo by Beth M. Ley-Jacobs, et al (1999); ISBN: 1890766038; http://www.amazon.com/exec/obidos/ASIN/1890766038/icongroupin terna

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New Light on Alcoholism : God, Sam Shoemaker, and A. A. by Dick B., et al (1999); ISBN: 1885803273; http://www.amazon.com/exec/obidos/ASIN/1885803273/icongroupin terna

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Nineteenth Century Medical Attitudes Toward Alcoholic Addiction : Six Studies, 1814 to 1867, an Original Anthology (Addiction in America Series) by Gerald, N. Grob (Editor) (1981); ISBN: 0405135629; http://www.amazon.com/exec/obidos/ASIN/0405135629/icongroupin terna

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Note Found in a Bottle : My Life As a Drinker (Wsp Readers Club) by Susan Cheever (2000); ISBN: 0671040731;

Books 173

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Not-God: A History of Alcoholics Anonymous by Ernest Kurtz (1998); ISBN: 0894860658; http://www.amazon.com/exec/obidos/ASIN/0894860658/icongroupin terna

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One Day at a Time in Al-Anon by Al-Anon, Inc Al-Anon Family Group Head (1988); ISBN: 0910034214; http://www.amazon.com/exec/obidos/ASIN/0910034214/icongroupin terna

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Out of the Rough : An Intimate Portrait of Laura Baugh and Her Sobering Journey by Laura Baugh, et al (1999); ISBN: 1558537554; http://www.amazon.com/exec/obidos/ASIN/1558537554/icongroupin terna

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Outwitting Your Alcoholic : Exploring and Escaping from the Strange World of Alcoholism by Kenneth Lucas (1998); ISBN: 1882883381; http://www.amazon.com/exec/obidos/ASIN/1882883381/icongroupin terna

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Perfect Daughters : Adult Daughters of Alcoholics by Robert J. Ackerman (1989); ISBN: 1558740406; http://www.amazon.com/exec/obidos/ASIN/1558740406/icongroupin terna

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Powerfully Recovered! A Confirmed 12 Stepper Challenges the Movement by Anne Wayman (2001); ISBN: 1581128762; http://www.amazon.com/exec/obidos/ASIN/1581128762/icongroupin terna

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Practical Approaches to Alcoholism Psychotherapy (1985); ISBN: 0306400863; http://www.amazon.com/exec/obidos/ASIN/0306400863/icongroupin terna

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Preventing Alcohol and Tobacco Problems : Manipulating Consumption : Information, Law and Voluntary Controls by Christine Godfrey, David Robinson (Editor) (1990); ISBN: 0566057026; http://www.amazon.com/exec/obidos/ASIN/0566057026/icongroupin terna

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Rational Recovery : The New Cure for Substance Addiction by Jack Trimpey (1996); ISBN: 0671528580; http://www.amazon.com/exec/obidos/ASIN/0671528580/icongroupin terna

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Recent Developments in Alcoholism : Alcoholism and Women by Marc Galanter (Editor) (1995); ISBN: 0306449218; http://www.amazon.com/exec/obidos/ASIN/0306449218/icongroupin terna

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Recent Developments in Alcoholism : Children of Alcoholics : Genetic Predisposition, Fetal Alcohol Syndrome, Vulnerability to Disease, Social and Env by Marc Galanter (Editor) (1991); ISBN: 0306438402; http://www.amazon.com/exec/obidos/ASIN/0306438402/icongroupin terna

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Recent Developments in Alcoholism : Combined Alcohol and Other Drug Dependence : The Syndrome, Social Deviancy, Biological Issues, Clinical Issues by Marc Galanter (Editor) (1990); ISBN: 0306433494; http://www.amazon.com/exec/obidos/ASIN/0306433494/icongroupin terna

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Recent Developments in Alcoholism : Posttraumatic Stress Disorder, the Workplace, Consequences in Women, Markers for Risk by Marc Galanter (1988); ISBN: 0306427214; http://www.amazon.com/exec/obidos/ASIN/0306427214/icongroupin terna

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Recent Developments in Alcoholism : Ten Years of Progress : Social and Cultural Perspectives : Physiology and Biochemistry : Clinical Pathology : Tre by Marc Galanter, Helen Edwards (Editor) (1993); ISBN: 0306444429; http://www.amazon.com/exec/obidos/ASIN/0306444429/icongroupin terna

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Recovery : A Guide for Adult Children of Alcoholics by Julie D. Bowden, et al (1987); ISBN: 0671645285; http://www.amazon.com/exec/obidos/ASIN/0671645285/icongroupin terna

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Reducing the Risks for Substance Abuse : A Lifespan Approach (Prevention in Practice Library) by Raymond P. Daugherty, et al (1998); ISBN: 0306458993; http://www.amazon.com/exec/obidos/ASIN/0306458993/icongroupin terna

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Research Advances in Alcohol and Drug Problems by Lynn T. Kozlowski, et al (1990); ISBN: 0306432951; http://www.amazon.com/exec/obidos/ASIN/0306432951/icongroupin terna

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Second-Year Sobriety : Getting Comfortable Now That Everything Has Changed by Guy Kettelhack (1998); ISBN: 1568382316;

Books 175

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Seeds of Grace : Reflections on the Spirituality of Alcoholics Anonymous by Molly Monahan (2002); ISBN: 1573229121; http://www.amazon.com/exec/obidos/ASIN/1573229121/icongroupin terna

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Self-Sabotage Syndrome : Adult Children in the Workplace by Janet Geringer Woititz (1989); ISBN: 1558740503; http://www.amazon.com/exec/obidos/ASIN/1558740503/icongroupin terna

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Seven Weeks to Sobriety by Joan Mathews Larson, Joan MathewsLarson (1997); ISBN: 0449002594; http://www.amazon.com/exec/obidos/ASIN/0449002594/icongroupin terna

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Seven Weeks to Sobriety : The Proven Program to Fight Alcoholism Through Nutrition by Joan Mathews-Larson (1994); ISBN: 0449908968; http://www.amazon.com/exec/obidos/ASIN/0449908968/icongroupin terna

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Sober...and Staying That Way : The Missing Link in the Cure for Alcoholism by Susan Powter (1999); ISBN: 0684847973; http://www.amazon.com/exec/obidos/ASIN/0684847973/icongroupin terna

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Solutions Step by Step : A Substance Abuse Treatment Manual by Insoo Kim Berg, Norman H. Reuss (1997); ISBN: 0393702510; http://www.amazon.com/exec/obidos/ASIN/0393702510/icongroupin terna

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SOS Sobriety : The Proven Alternative to 12-Step Programs by James Christopher (1992); ISBN: 0879757264; http://www.amazon.com/exec/obidos/ASIN/0879757264/icongroupin terna

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Staying Sober by T. Richard Adair (2001); ISBN: 1931391513; http://www.amazon.com/exec/obidos/ASIN/1931391513/icongroupin terna

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Staying Sober : A Guide for Relapse Prevention by Terence T. Gorski, Merlene Miller (1986); ISBN: 083090459X; http://www.amazon.com/exec/obidos/ASIN/083090459X/icongroupi nterna

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Step-By-Step : Daily Meditations for Living the Twelve Steps by Muriel Zink (1991); ISBN: 0345367596;

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Stop the Chaos : How to Get Control of Your Life by Beating Booze & Drugs by Allen A. Tighe (1998); ISBN: 1568382820; http://www.amazon.com/exec/obidos/ASIN/1568382820/icongroupin terna

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Struggles in an Alcoholic Family, by Edward M. Scott (1970); ISBN: 0398017026; http://www.amazon.com/exec/obidos/ASIN/0398017026/icongroupin terna

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Substance Abuse in the Workplace by Reginald L. Campbell, R. Everett Langford (Contributor) (1995); ISBN: 0873711319; http://www.amazon.com/exec/obidos/ASIN/0873711319/icongroupin terna

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Teens and Alcohol (Current Controversies (Cloth)) by James D. Torr (Editor) (2001); ISBN: 073770859X; http://www.amazon.com/exec/obidos/ASIN/073770859X/icongroupi nterna

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Terry : My Daughter's Life-And-Death Struggle With Alcoholism by George S. McGovern (1997); ISBN: 0452278236; http://www.amazon.com/exec/obidos/ASIN/0452278236/icongroupin terna

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That Amazing Grace: The Role of Clarence and Grace S. in Alcoholics Anonymous by Dick B., Harold Hughes (1996); ISBN: 1885803060; http://www.amazon.com/exec/obidos/ASIN/1885803060/icongroupin terna

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The 12 Steps : A Way Out : A Spiritual Process for Healing (1995); ISBN: 0941405117; http://www.amazon.com/exec/obidos/ASIN/0941405117/icongroupin terna

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The 12 Steps to Self-Parenting for Adult Children by Patricia O'Gorman, et al (1988); ISBN: 0932194680; http://www.amazon.com/exec/obidos/ASIN/0932194680/icongroupin terna

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The Addiction Workbook : A Step-By-Step Guide to Quitting Alcohol and Drugs by Patrick Fanning, John O'Neill (Contributor) (1996); ISBN: 1572240431; http://www.amazon.com/exec/obidos/ASIN/1572240431/icongroupin terna

Books 177

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The Adult Children of Alcoholics Syndrome : From Discovery to Recovery by Wayne Kritsberg (1988); ISBN: 0553272799; http://www.amazon.com/exec/obidos/ASIN/0553272799/icongroupin terna

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The Alcoholic Empire : Vodka & Politics in Late Imperial Russia by Patricia Herlihy (2002); ISBN: 0195134311; http://www.amazon.com/exec/obidos/ASIN/0195134311/icongroupin terna

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The Alternative 12 Steps; A Secular Guide to Recovery by Martha Cleveland, Arlys G. Cleveland (1992); ISBN: 1558741674; http://www.amazon.com/exec/obidos/ASIN/1558741674/icongroupin terna

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The Betty Ford Center Book of Answers : Help for Those Struggling With Substance Abuse and for the People Who Love Them by James W. West, et al (1997); ISBN: 0671001825; http://www.amazon.com/exec/obidos/ASIN/0671001825/icongroupin terna

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The Gifts of Sobriety : When the Promises of Recovery Come True by Barbara S. Cole (2000); ISBN: 1568383541; http://www.amazon.com/exec/obidos/ASIN/1568383541/icongroupin terna

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The Miracle Method : A Radically New Approach to Problem Drinking by Scott D. Miller, Insoo Kim Berg (Contributor) (1996); ISBN: 0393315339; http://www.amazon.com/exec/obidos/ASIN/0393315339/icongroupin terna

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The Natural History of Alcoholism Revisited by George E. Vaillant (1995); ISBN: 0674603788; http://www.amazon.com/exec/obidos/ASIN/0674603788/icongroupin terna

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The Pharmacology of Alcohol Abuse (Handbook of Experimental Pharmacology, Vol 114) by Henry R. Kranzler (Editor) (1995); ISBN: 0387571256; http://www.amazon.com/exec/obidos/ASIN/0387571256/icongroupin terna

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The Pharmacology of Alcohol and Drugs of Abuse and Addiction by Norman S. Miller (1991); ISBN: 0387973834; http://www.amazon.com/exec/obidos/ASIN/0387973834/icongroupin terna

178 Alcoholism

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The Pharmacology of Alcohol and Drugs of Abuse and Addiction (1991); ISBN: 3540973834; http://www.amazon.com/exec/obidos/ASIN/3540973834/icongroupin terna

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The Real AA: Behind the Myth of 12-Step Recovery by Ken Ragge (1998); ISBN: 1884365140; http://www.amazon.com/exec/obidos/ASIN/1884365140/icongroupin terna

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The Responsibility Trap : A Blueprint for Treating the Alcoholic Family by Claudia Bepko, Jo-Ann Krestan (1985); ISBN: 0029028809; http://www.amazon.com/exec/obidos/ASIN/0029028809/icongroupin terna

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The Roots of Alcoholics Anonymous by Bill Pittman, Daniel J. Anderson (1999); ISBN: 1568385056; http://www.amazon.com/exec/obidos/ASIN/1568385056/icongroupin terna

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The Secret History of Alcoholism : The Story of Famous Alcoholics and Their Destructive Behavior by James Graham (1996); ISBN: 1852308915; http://www.amazon.com/exec/obidos/ASIN/1852308915/icongroupin terna

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The Tao of Sobriety : Helping You to Recover from Alcohol and Drug Addiction by David Gregson, et al (2002); ISBN: 0312242506; http://www.amazon.com/exec/obidos/ASIN/0312242506/icongroupin terna

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The Thinking Person's Guide to Sobriety by Bert Pluymen (2000); ISBN: 0312254288; http://www.amazon.com/exec/obidos/ASIN/0312254288/icongroupin terna

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The Twelve Steps of Alcoholics Anonymous (1987); ISBN: 0317566792; http://www.amazon.com/exec/obidos/ASIN/0317566792/icongroupin terna

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Time to Heal; The Road to Recovery for Adult Children of Alcoholics by Timmen L. Cermak (1989); ISBN: 0380707225; http://www.amazon.com/exec/obidos/ASIN/0380707225/icongroupin terna

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To Slake a Thirst : The Matt Talbot Way to Sobriety by Philip Maynard (2000); ISBN: 0818908432; http://www.amazon.com/exec/obidos/ASIN/0818908432/icongroupin terna

Books 179

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Twelve Jewish Steps to Recovery : A Personal Guide to Turning from Alcoholism and Other Addictions by Kerry M. Olitzky, et al (1992); ISBN: 1879045095; http://www.amazon.com/exec/obidos/ASIN/1879045095/icongroupin terna

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Twelve Steps and Twelve Traditions by Alcoholics Anonymous (1996); ISBN: 0916856011; http://www.amazon.com/exec/obidos/ASIN/0916856011/icongroupin terna

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Understanding the Alcoholic's Mind : The Nature of Craving and How to Control It by Arnold M., MD Ludwig (1989); ISBN: 0195059182; http://www.amazon.com/exec/obidos/ASIN/0195059182/icongroupin terna

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When AA Doesn't Work for You : Rational Steps to Quitting Alcohol by Albert Ellis, Emmett Velten (1992); ISBN: 0942637534; http://www.amazon.com/exec/obidos/ASIN/0942637534/icongroupin terna

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Women Celebrate Long-Term Sobriety : Sober Women Share About Life, Love, Family, Work, and Money by Sylvia Cary (1999); ISBN: 0737302631; http://www.amazon.com/exec/obidos/ASIN/0737302631/icongroupin terna

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Work and Alcohol Abuse by John J. Miletich (Compiler) (1987); ISBN: 0313256896; http://www.amazon.com/exec/obidos/ASIN/0313256896/icongroupin terna

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Working With the Problem Drinker : A Solution-Focused Approach by Insoo Kim Berg, Scott D. Miller (Contributor) (1992); ISBN: 0393701344; http://www.amazon.com/exec/obidos/ASIN/0393701344/icongroupin terna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “alcoholism” (or synonyms) into the search box, and select “books only.” From there,

180 Alcoholism

results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:25 ·

Alcohol and other drug treatment: predictors of outcome and routine monitoring systems. Author: Jan Copeland ... [et al.]; Year: 2000; [S.l.]: National Drug and Alcohol Research Centre, University of New South Wales, [2000]

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Alcohol in health and disease. Author: edited by Dharam P. Agarwal, Helmut K. Seitz; Year: 2001; New York: Marcel Dekker, c2001; ISBN: 0824705335 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824705335/icongroupin terna

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Alcohol problems in older adults: prevention and management. Author: Kristen Lawton Barry, David W. Oslin, Frederic C. Blow; Year: 2001; New York: Springer Pub. Co., c2001; ISBN: 0826114032 http://www.amazon.com/exec/obidos/ASIN/0826114032/icongroupin terna

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Alcohol, tobacco, and other drugs: challenging myths, assessing theories, individualizing interventions. Author: Ann A. Abbott, editor; Year: 2000; Washington, DC: NASW Press/National Association of Social Workers, 2000; ISBN: 0871013169 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0871013169/icongroupin terna

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Alcoholic family in recovery: a developmental model. Author: Stephanie Brown, Virginia Lewis; Year: 1999; New York: Guilford Press, c1999; ISBN: 1572304022 (hc.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1572304022/icongroupin terna

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Alcoholics Anonymous comes of age: a brief history of A. A. Author: Symposium on Alcohol Education (1948); Year: 1957; New York: Alcoholics Anonymous Pub., 1957

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

25

Books 181

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Alcoholism: genetic culpability or social irresponsibility?: the challenge of innovative methods to determine final outcomes. Author: Ronald Marshall; Year: 2001; Lanham, Md.: University Press of America, c2001; ISBN: 0761818464 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0761818464/icongroupin terna

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Alcoholism and pathological gambling: similarities and differences. Author: Arthur G. Herscovitch; Year: 1999; Holmes Beach, Fla.: Learning Publications, c1999; ISBN: 1556911467 http://www.amazon.com/exec/obidos/ASIN/1556911467/icongroupin terna

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Alcoholism sourcebook: basic consumer health information about the physical and mental consequences of alcohol abuse, including liver disease, pancreatitis, Wernicke-Korsakoff syndrome (alcoholic dementia), fetal alcohol syndrome, heart disease, kidney d. Author: Hartigan, Francis; Year: 2000; Detroit: Omnigraphics, c2000; ISBN: 0780803256 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0780803256/icongroupin terna

·

Bill W.: a biography of Alcoholics Anonymous cofounder Bill Wilson. Author: Francis Hartigan; Year: 2000; New York: Thomas Dunne Books, St. Martin's Press, 2000; ISBN: 0312200560 http://www.amazon.com/exec/obidos/ASIN/0312200560/icongroupin terna

·

Children of addiction: research, health, and public policy issues. Author: edited by Hiram E. Fitzgerald, Barry M. Lester, Barry S. Zuckerman; Year: 2000; New York: Routledge/Falmer, 2000; ISBN: 0815338996 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0815338996/icongroupin terna

·

Classification of drinking habits and alcohol related problems: report from a prospective longitudinal study. Author: Michael Bohman, Peter Wennberg and Tommy Andersson; Year: 1999; Stockholm: Dept. of Psychology, Stockholm University, 1999

·

Confidentiality of patient records for alcohol and other drug treatment [microform]. Author: Felix Lopez; Year: 1994; Rockville, MD (Rockwall II, 5600 Fishers Lane, Rockville 20857): U.S. Dept. of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, [1994]

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·

Confrontation in psychotherapy with the alcoholic. Author: Gary G. Forrest; with foreword by Arthur P. Knauert; Year: 1992; Holmes Beach, Fla.: Learning Publications, c1992; ISBN: 1556910851 http://www.amazon.com/exec/obidos/ASIN/1556910851/icongroupin terna

·

Coordination of alcohol, drug abuse, and mental health services [microform]. Author: Frank Baker; Year: 1991; Rockville, MD (Rockwall II, 5600 Fishers Lane, Rockville 20857): U.S. Dept. of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, [1991

·

Drinking and what to do about it. Author: by William A. DeWitt; Year: 1952; New York: Grosset & Dunlap, c1952

·

Encyclopedia of drugs, alcohol, & addictive behavior. Author: Rosalyn Carson-DeWitt, editor in chief; Year: 2001; New York: Macmillan Reference USA, c2001; ISBN: 0028655419 (set) http://www.amazon.com/exec/obidos/ASIN/0028655419/icongroupin terna

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Epidemiology of alcohol problems in small geographic areas. Author: edited by Robert A. Wilson, Mary C. Dufour; Year: 2000; Bethesda, MD: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, [2000]

·

Ethanol and intracellular signaling: from molecules to behavior. Author: edited by Jan B. Hoek ... [et al.]; Year: 2000; Bethesda, MD: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, [2000]

·

Hospital admissions in Western Australia wholly attributable to alcohol use, 1981-1990. Author: Margherita Veroni, Greg Swensen, Neil Thomson; Year: 1993; [East Perth, W.A.]: WA Drug Data Collection Unit, Health Services Statistics and Epidemiology Branch, Health Dept. of Western Australia, [1993]

·

International handbook of alcohol dependence and problems. Author: edited by Nick Heather, Timothy J. Peters, Tim Stockwell; Year: 2001; Chichester; New York: Wiley, c2001; ISBN: 0471983756 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0471983756/icongroupin terna

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Man takes a drink: facts and principles about alcohol. Author: by John C. Ford; Year: 1955; New York: P.J. Kenedy, c1955

·

Naltrexone and alcoholism treatment. Year: 1998; Rockville: SAMHSA, 1998

Author: Stephanie O'Malley;

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·

Need, demand, and problem assessment for substance abuse services [microform]. Author: Wayne A. Kimmel; Year: 1992; Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, Office for Treatment Improvement, 1992

·

Resisting 12-step coercion: how to fight forced participation in AA, NA, or 12-step treatment. Author: by Stanton Peele and Charles Bufe with Archie Brodsky; Year: 2000; Tucson, AZ: See Sharp Press, c2000; ISBN: 1884365175 http://www.amazon.com/exec/obidos/ASIN/1884365175/icongroupin terna

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Review of NIAAA's neuroscience and behavioral research portfolio. Author: edited by Antonio Noronha, Michael Eckardt, Kenneth Warren; Year: 2000; Bethesda, MD: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, [2000]

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Siting drug and alcohol treatment programs [microform]: legal challenges to the NIMBY syndrome. Author: Ellen M. Weber, Robb Cowie; Year: 1995; Rockville, MD (Rockwall II, 5600 Fishers Lane, Rockville 20857): U.S. Dept. of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, [1995]

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Symposium on Alcohol Education: health education institute, school and community problems in alcohol education. Author: compiled and edited by Morey R. Fields; Year: 1948; [New York]: New York University, School of Education, [1948]

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Treating adult children of alcoholics: a behavioral approach. Author: Douglas H. Ruben; Year: 2001; San Diego, Calif.: Academic, 2001; ISBN: 0126011303 http://www.amazon.com/exec/obidos/ASIN/0126011303/icongroupin terna

·

Treating alcohol and other drug abusers in rural and frontier areas [microform]: 1994 Award for Excellence papers. ; Year: 1995; Rockville, MD (Rockwall II, 5600 Fishers Lane, Rockville 20857): U.S. Dept. of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, [1995]

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Chapters on Alcoholism Frequently, alcoholism will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with alcoholism, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and alcoholism using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “alcoholism” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on alcoholism: ·

Debilitating Diseases: Osteoporosis, Alcoholism, Arthritis, and Renal Disease Source: in Frank-Spohrer, G.C. Community Nutrition: Applying Epidemiology to Contemporary Practice. Gaithersburg, MD: Aspen Publishers, Inc. 1996. p. 535-557. Contact: Available from Aspen Publishers, Inc. 7201 McKinney Circle, Frederick, MD 21701. (800) 638-8437. PRICE: $48.00. ISBN: 0834207842. Summary: This chapter on debilitating diseases, including osteoporosis, alcoholism, arthritis, and renal disease, is from a nursing text on community nutrition. The author describes the occurrence and etiology of these four diseases, identifies secondary and tertiary prevention approaches for each one, and lists and enumerates the role of dietary components in the secondary prevention of these diseases. One chart summarizes the general dietary recommendations for renal patients. The author also relates suggestions to the Healthy People 2000 objectives. 4 figures. 7 tables. 59 references.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to alcoholism have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on alcoholism. The Combined Health

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Information Database lists the following, which you may wish to consult in your local medical library:26 ·

Directory of drug and alcohol abuse treatment services for pregnant women in Rhode Island Source: Providence, RI: Rhode Island Department of Health. 1990. 10 pp. Contact: Available from Tricia Leddy, Program Director, Rhode Island Department of Health, RIte Start, Cannon Building, Room 302, 75 Davis Street, Providence, RI 02908. Telephone: (800) 346-1004. Available at no charge. Request publication by mail only. Summary: The purpose of this directory is to assist maternity care providers in referring pregnant women to the appropriate drug and/or alcohol treatment program in Rhode Island. This directory was developed by the RIte Start Program, Rhode Island Department of Health, with information from the Division of Substance Abuse in the Rhode Island Department of Mental Health, Retardation and Hospitals, and the Rhode Island Council on Alcoholism. The RIte Start Program provides comprehensive maternity care for uninsured women, living in Rhode Island, who are not eligible for medical assistance and who meet income guidelines.

General Home References In addition to references for alcoholism, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): ·

Alcohol (Health Issues) by Kirsten Lamb; Library Binding - 64 pages (January 2002), Raintree/Steck Vaughn; ISBN: 0739847724; http://www.amazon.com/exec/obidos/ASIN/0739847724/icongroupinter na

·

The Encyclopedia of Drugs and Alcohol (Reference) by Greg Roza; School & Library Binding - 199 pages (September 2001); Franklin Watts,

You will need to limit your search to “Directories” and alcoholism using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “alcoholism” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with alcoholism. You should check back periodically with this database as it is updated every three months.

26

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Incorporated; ISBN: 0531118991; http://www.amazon.com/exec/obidos/ASIN/0531118991/icongroupinter na

Vocabulary Builder Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Cachexia: A profound and marked state of constitutional disorder; general ill health and malnutrition. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Fluvoxamine: A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders. [NIH] Galanthamine: A cholinesterase inhibitor. It has been used to reverse the muscular effects of gallamine and tubocurarine and has been studied as a treatment for Alzheimer's disease and other central nervous system disorders. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Hyperventilation: A state in which there is an increased amount of air entering the pulmonary alveoli (increased alveolar ventilation), resulting in reduction of carbon dioxide tension and eventually leading to alkalosis. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU]

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Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]

Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Palpitation: A subjective sensation of an unduly rapid or irregular heart beat. [EU] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Thiocyanates: Organic derivatives of thiocyanic acid which contain the general formula R-SCN. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Unithiol: A chelating agent used as an antidote to heavy metal poisoning. [NIH]

Multimedia 189

CHAPTER 7. MULTIMEDIA ON ALCOHOLISM Overview Information on alcoholism can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on alcoholism. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.

Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on alcoholism is the Combined Health Information Database. You will need to limit your search to “video recording” and “alcoholism” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “alcoholism” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on alcoholism:

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·

Aging Brain Source: Sacramento, CA: Department of Aging. 1987. (videocassette, 6 handouts and 6 page training manual.). Contact: California Department of Aging, Training and Education Section. 1600 K Street, Sacramento, CA 95814. (916) 322-3110. PRICE: $10.00. Summary: This tape contains seven training segments designed for administrators and staff working in residential facilities for the aged. It reviews commonly held beliefs about aging that may negatively influence the care given to aging residents and how these myths developed. According to the tape, many believe that aged people are naturally "senile". Aged people can either accept this belief and act accordingly, creating a self-fulfilling prophecy in which they relinquish their independence to those caring for them, or they can rebel against their caregivers. Several studies related to aging are reviewed that suggest that there are only minor differences between the mental capacities of the young and aged. Treatable diseases that can affect the aged person's mental abilities are described including drug overdoses, malnutrition, dehydration, blood clots, brain tumors, depression, alcoholism, liver failure, kidney failure, drastic environmental changes, thyroid problems, heart failure, infections, diabetes, constipation, and emphysema. Organic brain syndromes, incurable diseases that affect mental capability, also are reviewed, including multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Korsakoff's syndrome, Parkinson's disease, and Alzheimer's disease. Specific attention is given to changes in the brain that occur as the disease progresses, the symptoms, and possible risk factors and causes of the disease. Contact points for the Alzheimer's Association are provided for further information.

·

Disease of Alcoholism Source: Cahokia, IL: Gary Whiteaker Corporation. 1991. (videocassette). Contact: Available from Gary Whiteaker Corporation, Inc. P.O. Box 5023, Cahokia, IL 62206. (800) 851-5406 or (618) 337-9300. PRICE: $500.00. Summary: This videotape presents the latest information on the disease of alcoholism. Topics covered include the neurochemical and genetic aspects of the disease, the signs and symptoms, and diagnostic techniques used to confirm the disease. The videotape is designed to be used as a training tool in chemical dependency treatment programs. The video aims to remove the stigma from alcoholism and help people with

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alcoholism overcome denial about the disease. The videotape is opencaptioned. (AA-M). ·

Another chance to change: A teenager's struggle with relapse and recovery Source: Minneapolis, MN: Johnson Institute. 1991. 1 videotape (30 minutes, VHS), 1 facilitator's guide (12 pp.). Contact: Available from Johnson Institute, 7151 Metro Boulevard, Minneapolis, MN 55439-2122. Telephone: (800) 231-5165 or (612) 9440511. $495 plus $4.25 for the shipping and handling. Preview is $35.00. Summary: This videotape is a dramatization of an adolescent's struggle with relapse and recovery from alcoholism and drug use. It is a sequel to the Johnson Institute videotape, 'Choices and Consequences.' Designed for junior and senior high students, parents, teachers, counselors, and other professionals working with youth, the film highlights relapse risk factors and warning signs, help that can be offered to recovering adolescents, and how peers, parents, mentors, school professionals and employers can work together to provide a support system to prevent relapse in a recovering adolescent alcoholic. A facilitator's guide includes an overview of relapse risk factors, a synopsis of the video, suggestions for using the videotape, discussion questions, and participant's information sheets.

·

Different like me Source: Minneapolis, MN: Johnson Institute. 1990. 1 videotape (30 minutes, VHS) or 16 mm film, 1 facilitator's guide (9 pp.). Contact: Available from Johnson Institute, 7151 Metro Boulevard, Minneapolis, MN 55439-2122. Telephone: (800) 231-5165 or (612) 9440511. Videocassette $495.00, 16 mm film $545.00 plus $4.25 for shipping and handling. Summary: This video recording focuses on the home life and school life of an adolescent with an alcoholic parent. Eventually the protagonist joins a Children of Alcoholics support group. The target audience is adolescents, parents, teachers, counselors and other professionals working with high-risk youths. Objectives of the videotape include assisting adolescents in accepting and understanding their reactions and the impact of alcohol and other drug use by family members, recognizing that many other students are in painful family situations, and seeking support through school and community programs. A nine-page facilitator's guide accompanies the videotape that includes an overview of the videotape and alcoholism, information on Children of Alcoholics, a

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role identification chart for teachers, discussion questions, and recommended readings. ·

Families in trouble: Learning to cope Source: Pleasantville, NY: Sunburst Communications. 1990. 1 videotape (35 minutes, VHS 1/2 inch). Contact: Available from Sunburst Communications, 101 Castleton Street, P.O. Box 40, Pleasantville, NY 10570-9971. Telephone: (800) 431-1934 / fax: (914) 747-4109. $199.00 plus 6 percent shipping and handling. Summary: This videotape helps adolescents struggling with family trouble understand that they are not at fault for someone else's problems. It tells the stories of three adolescents who experience the coping process by dealing with the crises they face at home: divorce, sibling alcoholism, and child abuse. It also helps adolescents understand family dynamics and the important of family roles. The learning objectives include: illustrate a step-by-step process for use in a crisis situation; demonstrate the importance of identifying and acknowledging one's feelings; encourage adolescents to talk about their problems; explain the importance of family roles; and identify possible community resources.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “alcoholism” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many).

Bibliography: Multimedia on Alcoholism The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in alcoholism (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication

Multimedia 193

date, author, or relevance. The following multimedia has been indexed on alcoholism. For more information, follow the hyperlink indicated: ·

Alcohol & women. Source: NHV, National Health Video Inc; Year: 1998; Format: Videorecording; Los Angeles, CA: NHV, c1998

·

Alcohol & women. Source: NHV, National Health Video Inc; Year: 1998; Format: Videorecording; Los Angeles, CA: National Health Video, c1998

·

Alcohol and substance abuse in the elderly and smoking cessation. Source: presented by Center for the Study of Aging in cooperation with the Health Communications Network and the Geriatric Education Center, University of Alabama at Birmingham;; Year: 1992; Format: Videorecording; Charleston, S.C.: Medical University of South Carolina, c1992

·

Alcohol and you. Source: an Avanti Films, Inc. production; Year: 1969; Format: Motion picture; United States: Distributed by Bailey-Film Associates, c1969

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Alcohol treatment research : new prospects, new methods. Source: Roger E. Meyer; Year: 1995; Format: Sound recording; [Bethesda, Md.: National Institutes of Health, 1995]

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Alcohol, pills & recovery. Source: an FMS production; Year: 1978; Format: Motion picture; [Los Angeles, Calif.: FMS], c1978

·

Alcoholism ; Drug abuse. Source: Marc Schuckit; Year: 1998; Format: Videorecording; [Irvine, Calif.]: CME, c1998

·

Alcoholism. Source: Time Life Medical; produced in association with Sonalysts Studios; Year: 1996; Format: Videorecording; New York, NY: Patient Education Media, c1996

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Boozers and users. Source: [presented by] Motivational Media; an Avanti Films production; Year: 1974; Format: Motion picture; Los Angeles, Calif.: Avanti Films, c1974

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CAGE test. Source: produced by MPS, Media Production Services, UTMB Biocommunications Services; Year: 1993; Format: Videorecording; Boynton Beach, FL: Universal Health Communications, c1993

·

Chalk talk on alcoholism. Source: by Joseph C. Martin; produced by Department of Navy Human Resources Project; Year: 1973; Format: Videorecording; [Washington, D.C.?]: Dept. of Defense, [1978]

·

Drinking, are you in control? Source: ABC News; producer[s], Carol Berczuk, Resa Matthews; Year: 2000; Format: Videorecording; New York, NY: ABC News Home Video, c2000

·

History and addiction : a look at addiction and treatment throughout the ages. Source: [presented by] Claudja inc; Year: 1999; Format: Videorecording; Bainbridge Island, WA: MAC Pub., c1999

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·

Homeopathic treatment of alcoholism. Source: Nat'l Center for Homeopathy, Los Angeles 1990; Year: 1990; Format: Sound recording; [United States: The Center?, 1990?]

·

Intervention. Source: produced by the Filmakers, Inc. for Johnson Institute; Year: 1978; Format: Videorecording; Minneapolis: The Institute, c1978

·

Management of alcohol dependency in the medical patient. Source: Ayerst Medical Information Service; produced by Intermedica Communications Inc. for Ayerst; Year: 1975; Format: Motion picture; New York: Ayerst, [1975]

·

Managing addiction withdrawal syndromes. Source: Williams & Wilkins, a Waverly company; produced by the Production Company; Year: 1994; Format: Videorecording; Baltimore, Md.: Williams & Wilkins, c1994

·

Mental disorders & alcoholism : October 25-28, 1990. Source: André Saine; Year: 1990; Format: Videorecording; [United States]: Interdimensional Arts, [1990]

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Road to recovery : women and alcohol. Source: Nimco; a production of KPBS-TV San Diego; Year: 1988; Format: Videorecording; San Diego: KPBS-TV, c1988

·

Sex & alcohol. Source: NHV, National Health Video Inc; Year: 1999; Format: Videorecording; Los Angeles, CA: NHV, c1999

·

Treatment of alcohol dependence. Source: [presented by] Medical Video Library; co-produced by IMS, Faculty of Medicine, University of Toronto and Medical Productions and Associates; Year: 1989; Format: Videorecording; [Toronto, Ont.]: Burn-Shield, [1989]

·

We never talked about my drinking. Source: a co-production of Connecticut Public Television & the Stepping Stones Foundation; Year: 1990; Format: Videorecording; [Hartford, Conn.]: Connecticut Public Television/Stepping Stones Foundation, c1990

Vocabulary Builder Accommodation: distances. [EU]

Adjustment, especially that of the eye for various

Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode

Multimedia 195

of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Membranes: Thin layers of tissue which cover parts of the body, separate adjacent cavities, or connect adjacent structures. [NIH] Motility: The ability to move spontaneously. [EU] Myopathy: Any disease of a muscle. [EU] Narcissism: A psychoanalytic term meaning self-love. [NIH] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Prejudice: A preconceived judgment made without adequate evidence and not easily alterable by presentation of contrary evidence. [NIH] Sociology: A social science dealing with group relationships, patterns of collective behavior, and social organization. [NIH]

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Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Temperance: Abstinence from alcohol. [NIH]

Periodicals and News 197

CHAPTER 8. PERIODICALS AND NEWS ON ALCOHOLISM Overview Keeping up on the news relating to alcoholism can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on alcoholism. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover alcoholism beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.

News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on alcoholism is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.

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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “alcoholism” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·

Early Success Cited by National Effort to Reduce High-Risk Drinking Among College Students Summary: ROCKVILLE, Md., April 9 /PRNewswire/ -- The consequences of college drinking are larger and more destructive than commonly realized, according to a new study supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Commissioned by the NIAAA Task Force on College Drinking, the study reveals that drinking by college students age 18-24 contributes to an estimated 1,400 student deaths, 500,000 injuries, and 70,000 cases of sexual assault or date rape each year. It also estimates that more than one- fourth of college students that age have driven in the past year while under the influence of alcohol. "The harm that college students do to themselves and others as a result of excessive drinking exceeds what many would have expected," says lead author Ralph W. Hingson, Sc.D., Professor of Social Behavioral Sciences and Associate Dean for Research at Boston University School of Public Health. "Our data clearly point to the need for better interventions against high-risk drinking in this population." Dr. Hingson and colleagues from Boston University, the Harvard University School of Public Health, and the U.S. Substance Abuse and Mental Health Services Administration, derived their data by integrating a number of national databases containing information about drinking and its consequences. Their study appears in the March 2002 issue of the Journal of Studies on Alcohol. "These numbers paint a picture of a deeply entrenched threat to the health and well-being of our young people," adds Raynard S. Kington, M.D., Ph.D., Acting Director of NIAAA. "This study, and the NIH report released today by the Task Force on College Drinking, are an urgent callto-action for educators, researchers, students and society in general. Today, NIAAA is sending the Task Force report to every college in the

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U.S. The findings of the Task Force also serve as a timely reminder for students and others to assess their personal drinking habits on National Alcohol Screening Day, which takes place this week on April 11. The 2,500 screening locations across the country include sites at more than 550 colleges and universities." A blue-ribbon panel of more than three dozen college presidents, scientists, and students, the Task Force was convened by NIAAA's National Advisory Council to conduct a comprehensive review of research on college drinking and the effectiveness of methods to prevent it. The Hingson study is one of two dozen studies commissioned by the Task Force as part of this review. Most of the commissioned papers have been published in a special supplement to the March 2002 issue of the Journal of Studies on Alcohol. The Task Force's report, titled "A Call to Action: Changing the Culture of Drinking at U.S. Colleges," outlines recommendations for college administrators and researchers to address high-risk college drinking. "The consequences of excessive drinking are far too common on many college campuses nationwide, and efforts to reduce high-risk drinking and its related problems have largely failed," says Task Force co-chair Mark Goldman, Ph.D., Distinguished Research Professor of Psychology at the University of South Florida. "But we need not accept high-risk drinking on our campuses as inevitable. If colleges and communities work together, they can change these harmful drinking patterns. We hope this report will help them do that, by providing tools to help them make more informed decisions." A Minority of Heavy Drinkers Though common on many campuses, alcohol abuse does not run rampant among all college and university students. Previous studies have shown that most students drink moderately or abstain, with the proportion of nondrinkers increasing from 15 to 19 percent between 1993 and 1999. Other evidence, however, points to an increase in more extreme forms of college drinking. About 40 percent of students binge drink, defined as five or more drinks in a row for men and four or more drinks for women. In a recent survey, about 20 percent of students reported bingeing more than three times in the last two weeks. This group of frequent binge drinkers accounts for nearly 70 percent of all the alcohol consumed by college students. "Although a minority of college students engage in high-risk drinking, all students, and their parents, faculty, and members of the surrounding

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community suffer the negative consequences of alcohol abuse, such as assault, vandalism, and traffic accidents," says Reverend Edward Malloy, President of the University of Notre Dame, and co-chair of the Task Force. "And I've lived in college dormitories for much of my adult life, so I know firsthand the impact irresponsible drinking has on the quality of residential life." According to the Task Force research, drinking rates are highest among incoming freshmen, males, members of fraternities or sororities, and athletes. Students who attend two-year institutions, religious schools, commuter schools, or predominantly or historically black colleges and universities drink the least.

Recommended Strategies and Future Research The Task Force studied research on alcohol prevention among college students to find out what works, what doesn't, and what research is needed to develop better prevention programs. They noted that research on prevention of college drinking is relatively new and the data are incomplete. "The evidence supporting the alcohol abuse prevention strategies in the literature varies widely," explains Dr. Goldman, "often reflecting the fact that some strategies have not been as thoroughly studied as others or have not been evaluated in college settings." However, the Task Force noted that alcohol research clearly indicates that multiple factors, from genetic and biological characteristics, to family and cultural backgrounds, to particular college environments interact to produce various drinking patterns. They called for the use of comprehensive, integrated programs with multiple complementary components to address the problem. "Prevention strategies must simultaneously target three constituencies: the student population as a whole; the college and its surrounding environment; and the individual at-risk or alcohol-dependent drinker," says Dr. Goldman. "Research strongly supports strategies that target each of these factors." The Task Force developed a 3-in-1 Framework to help colleges and universities design prevention programs that target each of these constituencies. The framework identifies the target area(s) that each strategy addresses and uses the following four-tier system to rank the

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strength of the scientific evidence available to support or refute each strategy: * Effective and Targeted at College Students - (examples: combining cognitive-behavioral skills with norms clarification; brief motivational interventions; altering students' expectations about the effects of alcohol) * Effective With General Populations and Could Be Applied to College Environments - (examples: enforcement of minimum drinking age laws; restrictions on alcohol retail outlet density, responsible beverage service policies; formation of campus and community coalitions) * Promising - (examples: reinstate Friday classes and exams and Saturday morning classes; expand alcohol-free dormitories; consistently enforced discipline for alcohol policy violations; awareness of personal liability issues; "Safe-Ride" programs; regulation of happy hours and sales) * Ineffective - (examples: interventions that rely entirely on providing information about problems related to risks from drinking) "Another dominant theme that emerged from our work," says Reverend Malloy, "is the importance of science-based research in establishing alcohol policies and prevention programs. Although research alone will not solve the problem, it will point the way to solutions." The Task Force's Report urges expanded funding for studies of underage and excessive college drinking and calls on NIAAA to assume primary responsibility for: * Supporting the research community's efforts to address existing knowledge gaps and alter the culture of drinking on campus; * Facilitating long-term, campus-community research aimed at preventing hazardous student drinking; and * Imparting what is known about the patterns of college drinking and the quality of current interventions to encourage college presidents, administrators, and other campus and community leaders to adopt policies and implement strategies based on research.

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In addition to its main report, the Task Force's findings and recommendations are available in the following formats: * Two Task Force panel reports - High-Risk Drinking in College: What We Know and What We Need to Learn and How to Reduce High-Risk College Drinking: Use Proven Strategies, Fill Research Gaps; * A handbook for college planners on implementing and evaluating alcohol prevention programs; and * Brochures for college and university presidents, student peer educators, and parents.

These materials are available on the Web at: http://www.collegedrinkingprevention.gov . They also may be ordered by calling NIAAA at 301-443-3860.

NIAAA is a component of the National Institutes of Health (NIH). NIAAA conducts and supports a broad program of biomedical and behavioral research on the causes, treatment, and prevention of alcohol abuse and alcoholism and its medical consequences.

Reuters The Reuters' Medical News database can be very useful in exploring news archives relating to alcoholism. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “alcoholism” (or synonyms). The following was recently listed in this archive for alcoholism: ·

Alcoholism increases risk of high-risk adenomas and colon cancer Source: Reuters Medical News Date: January 07, 2002 http://www.reuters.gov/archive/2002/01/07/professional/links/20020 107epid005.html

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Anti-alcohol dependence drug doesn't work: study Source: Reuters Health eLine Date: December 12, 2001 http://www.reuters.gov/archive/2001/12/12/eline/links/20011212elin 001.html

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Naltrexone found not useful for treatment of severe alcohol dependence Source: Reuters Industry Breifing Date: December 11, 2001 http://www.reuters.gov/archive/2001/12/11/business/links/20011211 clin001.html

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Drug, alcohol abuse on rise in US after Sept. 11 Source: Reuters Health eLine Date: December 05, 2001 http://www.reuters.gov/archive/2001/12/05/eline/links/20011205elin 033.html

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Forest licenses US rights to Merck KgaA alcoholism drug Source: Reuters Industry Breifing Date: October 23, 2001 http://www.reuters.gov/archive/2001/10/23/business/links/20011023 inds003.html

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Alkermes' once-monthly alcohol addiction drug enters phase III Source: Reuters Industry Breifing Date: April 01, 2002 http://www.reuters.gov/archive/2002/04/01/business/links/20020401 drgd002.html

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Forest files NDA for drug to treat alcoholism Source: Reuters Industry Breifing Date: February 27, 2002 http://www.reuters.gov/archive/2002/02/27/business/links/20020227 rglt003.html

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Brief physician intervention reduces alcohol abuse over long term Source: Reuters Medical News Date: January 28, 2002 http://www.reuters.gov/archive/2002/01/28/professional/links/20020 128prof001.html

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Brain receptors linked to alcoholism in rat study Source: Reuters Health eLine Date: September 18, 2001 http://www.reuters.gov/archive/2001/09/18/eline/links/20010918elin 009.html

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Alcoholism associated with a decreased risk of endometrial cancer Source: Reuters Medical News Date: August 02, 2001 http://www.reuters.gov/archive/2001/08/02/professional/links/20010 802epid003.html

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Cholecystokinin peptide fragment treats alcoholism in rats Source: Reuters Medical News Date: May 25, 2001 http://www.reuters.gov/archive/2001/05/25/professional/links/20010 525scie005.html

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Brain imbalance linked to alcoholism Source: Reuters Medical News Date: March 22, 2001 http://www.reuters.gov/archive/2001/03/22/professional/links/20010 322scie004.html

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Women report more disability from alcoholism than men Source: Reuters Medical News Date: March 15, 2001 http://www.reuters.gov/archive/2001/03/15/professional/links/20010 315epid002.html

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Women report being more disabled by alcoholism Source: Reuters Health eLine Date: March 15, 2001 http://www.reuters.gov/archive/2001/03/15/eline/links/20010315elin 039.html

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Women's brains are more vulnerable to alcoholism Source: Reuters Health eLine Date: February 08, 2001 http://www.reuters.gov/archive/2001/02/08/eline/links/20010208elin 014.html

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Mexico sees alcoholism rising, esp. among urban men Source: Reuters Health eLine Date: January 25, 2001 http://www.reuters.gov/archive/2001/01/25/eline/links/20010125elin 027.html

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Adolescent alcohol abuse linked to increased psychopathology in adulthood Source: Reuters Medical News Date: January 15, 2001 http://www.reuters.gov/archive/2001/01/15/professional/links/20010 115clin004.html

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Gene mutation could increase alcoholism risk Source: Reuters Health eLine Date: December 26, 2000 http://www.reuters.gov/archive/2000/12/26/eline/links/20001226elin 002.html

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Alcoholism changes brain's genetic wiring Source: Reuters Health eLine Date: December 14, 2000 http://www.reuters.gov/archive/2000/12/14/eline/links/20001214elin 009.html

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Alcohol abuse undermines ability to focus Source: Reuters Health eLine Date: December 14, 2000 http://www.reuters.gov/archive/2000/12/14/eline/links/20001214elin 010.html

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Anxiety-linked drinking ups alcoholism risk Source: Reuters Health eLine Date: November 20, 2000 http://www.reuters.gov/archive/2000/11/20/eline/links/20001120elin 014.html

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Many believe alcoholism a genetic disorder Source: Reuters Health eLine Date: October 05, 2000 http://www.reuters.gov/archive/2000/10/05/eline/links/20001005elin 018.html

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Ondansetron effective for treatment of early-onset, but not late-onset, alcoholism Source: Reuters Industry Breifing Date: August 23, 2000 http://www.reuters.gov/archive/2000/08/23/business/links/20000823 clin001.html

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Nicotine dependence linked to risk for alcohol dependence Source: Reuters Medical News Date: August 09, 2000 http://www.reuters.gov/archive/2000/08/09/professional/links/20000 809epid002.html

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Genetic link suggested between nicotine and alcohol dependence Source: Reuters Health eLine Date: August 08, 2000 http://www.reuters.gov/archive/2000/08/08/eline/links/20000808elin 041.html

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Alcoholism, problem gambling may share roots Source: Reuters Health eLine Date: July 17, 2000 http://www.reuters.gov/archive/2000/07/17/eline/links/20000717elin 016.html

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Nociceptin effects may surpass naltrexone in treating alcohol dependence Source: Reuters Medical News Date: July 14, 2000 http://www.reuters.gov/archive/2000/07/14/professional/links/20000 714scie008.html

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"Date rape" drug used in treatment of alcoholism Source: Reuters Health eLine Date: June 28, 2000 http://www.reuters.gov/archive/2000/06/28/eline/links/20000628elin 025.html

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Alcoholism drug found effective against cocaine habit Source: Reuters Health eLine Date: June 15, 2000 http://www.reuters.gov/archive/2000/06/15/eline/links/20000615elin 025.html

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Sex differences observed in response to citalopram for alcohol dependence Source: Reuters Industry Breifing Date: June 12, 2000 http://www.reuters.gov/archive/2000/06/12/business/links/20000612 clin006.html

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Family doctor may miss signs of alcoholism in patients Source: Reuters Health eLine Date: May 11, 2000 http://www.reuters.gov/archive/2000/05/11/eline/links/20000511elin 042.html

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Alcoholism put blacks at greater risk of infection Source: Reuters Health eLine Date: April 28, 2000 http://www.reuters.gov/archive/2000/04/28/eline/links/20000428elin 002.html

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Beta-endorphin may signal alcoholism risk Source: Reuters Health eLine Date: March 20, 2000 http://www.reuters.gov/archive/2000/03/20/eline/links/20000320elin 023.html

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Beta-endorphin may be biomarker for risk of alcoholism Source: Reuters Medical News Date: March 17, 2000 http://www.reuters.gov/archive/2000/03/17/professional/links/20000 317epid002.html

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Role of NMDA receptors in alcohol addiction confirmed in mice Source: Reuters Medical News Date: March 16, 2000 http://www.reuters.gov/archive/2000/03/16/professional/links/20000 316clin011.html

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.

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Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.

Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “alcoholism” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.

Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “alcoholism” (or synonyms). If you know the name of a company that is relevant to alcoholism, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “alcoholism” (or synonyms).

Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.”

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Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “alcoholism” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on alcoholism: ·

Experiments in Good Taste Source: Food Insight. p. 1, 4-5. March/April 1995. Contact: International Food Information Council (IFIC), Foundation. 1100 Connecticut Avenue, N.W., Suite 430, Washington, D.C. 20036. (202) 2966540; E-mail: [email protected]. Summary: This article brings readers up-to-date on research in the area of the physiology of taste. Topics covered include how the taste buds taste food; the biochemistry of taste; genetic differences in taste sensitivity; the so-called 'supertasters' who are highly sensitive to taste; differences in the fungiform papillae of the tongues of supertasters; non-genetic factors that may heighten or diminish the sense of taste, including nutritional factors, the sense of smell, and drug effects; the relationship between taste sensitivity and food preferences; taster status and alcoholism; and if and how taster status affects overall eating patterns. The author concludes with a brief mention of future research in the area of taste and the ability to follow a restricted diet.

Academic Periodicals covering Alcoholism Academic periodicals can be a highly technical yet valuable source of information on alcoholism. We have compiled the following list of periodicals known to publish articles relating to alcoholism and which are currently indexed within the National Library of Medicine's PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on alcoholism published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical's name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index

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of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on alcoholism: ·

American Family Physician. (Am Fam Physician) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Family+Physician&dispmax=20&dispstart=0

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Biological Psychiatry. (Biol Psychiatry) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi ological+Psychiatry&dispmax=20&dispstart=0

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BMJ (Clinical Research Ed. . (BMJ) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=B mj+(Clinical+Research+Ed.+&dispmax=20&dispstart=0

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Health & Social Work. (Health Soc Work) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=He alth+&+Social+Work&dispmax=20&dispstart=0

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Journal of Advanced Nursing. (J Adv Nurs) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Advanced+Nursing&dispmax=20&dispstart=0

Vocabulary Builder Crack: Short term for a smokable form of cocaine. [NIH] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Jejunostomy: Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells.

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Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [nih]

Physician Guidelines and Databases 213

CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.

NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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·

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.27 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:28 ·

Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 28 See http://www.nlm.nih.gov/databases/databases.html. 27

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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

While all of the above references may be of interest to physicians who study and treat alcoholism, the following are particularly noteworthy.

The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and alcoholism using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “alcoholism” (or synonyms) into the

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“For these words:” box above, you will only receive results on fact sheets dealing with alcoholism. The following is a sample result: ·

New York Division of Alcoholism and Alcohol Abuse Administrative Bulletin Source: May 1988. Contact: New York Division of Alcoholism and Alcohol Abuse, 1450 Western Ave., Albany, NY 12203. (518) 473-3460. Summary: This report examines the relationship between Acquired immunodeficiency syndrome (AIDS) and alcohol use and the impact of AIDS on recovering alcoholics and alcoholics in-and not-in-treatment. The AIDS-related policies and procedures for the alcoholism treatment system are provided. They cover diagnosis and testing; treatment of seropositive individuals; special treatment populations; legal issues; discharge planning; staff education and training; and employee policies. Appendixes list New York State antibody counseling and testing sites, information resources, and hotlines.

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Women and alcohol: Issues for prevention research Source: Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services; for sale by the U.S. Government Printing Office. 1996. 361 pp. Contact: Available from National Institute on Alcohol Abuse and Alcoholism, Willco Building, Suite 409, 6000 Executive Boulevard, Bethesda, MD 20892-7003. Telephone: (301) 443-3860 / fax: (301) 443-6077 / Web site: http://www.niaaa.nih.gov. Available at no charge. Summary: This book addresses alcohol use and abuse among women. The chapters discuss patterns and trends in women's drinking, the inheritance of alcoholism, research issues in the prevention of fetal alcohol syndrome and alcohol-related birth defects, gender differences in alcohol involvement in children and adolescents, parenting interventions to prevent alcohol and other drug use among children, women's drinking practices and problems from a life span perspective, drinking and driving among women, women's alcohol use and their violent victimization, occupational culture and drinking in women, the effects of alcoholism on the labor market, alcohol consumption and female sexuality, and future directions for psychosocial and prevention research on women and alcohol.

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Alcohol and minorities Source: Alcohol alert. 23: 1-4. January 1994. 1994. 4 pp.

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Contact: Available from National Clearinghouse for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20847-2345. Telephone: (301) 468-2600 or (800) 729-6686 or (800) 487-4889 TDD / fax: (301) 468-6433 / e-mail: [email protected] / Web site: http://www.health.org. Available at no charge. Summary: This issue of 'Alcohol Alert' discusses why some minorities have more medical problems related to alcohol use than others and whether minorities receive adequate treatment and prevention services. It examines genetic and environmental factors that may pub minorities at risk for or protect them from alcohol problems. It also reviews research on screening to identify those at risk for alcoholism or alcohol abuse. ·

Alcohol research: Promise for the decade Source: Rockville, MD: National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services. 1991. 72 pp. Contact: Available from National Clearinghouse for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20847-2345. Telephone: (301) 468-2600 or (800) 729-6686 or (800) 487-4889 TDD / fax: (301) 468-6433 / e-mail: [email protected] / Web site: http://www.health.org. Summary: This report provides an overview of current research in alcohol dependence syndrome. Chapters focus on the neurochemistry of alcohol use, genetic and environmental factors in the development of alcohol abuse, the clinical effects of alcoholism, fetal alcohol syndrome, prevention and treatment, and the development of new drugs from treating alcoholism.

The NLM Gateway29 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM's information resources or databases.30 One target audience for the Gateway is the Internet user who is new to NLM's online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).

29 30

218 Alcoholism

researchers, librarians, students, and, increasingly, patients, their families, and the public.31 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “alcoholism” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 50915 Books / Periodicals / Audio Visual 3943 Consumer Health 135 Meeting Abstracts 164 Other Collections 200 Total 55357

HSTAT32 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.33 HSTAT's audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ's Put Prevention Into Practice.34 Simply search by “alcoholism” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Other users may find the Gateway useful for an overall search of NLM's information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 32 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 33 The HSTAT URL is http://hstat.nlm.nih.gov/. 34 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) 31

Physician Guidelines and Databases 219

Coffee Break: Tutorials for Biologists35 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.36 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.37 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

·

Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center's MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.

Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 35 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 36 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 37 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

220 Alcoholism

·

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

·

MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.

·

Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; go to http://www.lexical.com/Metaphrase.html.

The Genome Project and Alcoholism With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to alcoholism. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.

Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).38 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI's Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “alcoholism” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

38

Physician Guidelines and Databases 221

“Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for alcoholism: ·

Alcoholism Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?103780 Genes and Disease (NCBI - Map)

The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·

Cancer: Uncontrolled cell division. Examples: Breast And Ovarian Cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

·

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn's disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

·

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

·

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome,

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Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html ·

Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich's ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html

·

Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

·

Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson's disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html

Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

·

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

·

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

·

Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

·

Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

Physician Guidelines and Databases 223

·

PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

·

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

·

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

·

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

·

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

NCBI's Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genom e, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “alcoholism” (or synonyms) and click “Go.”

Jablonski's Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database39 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index:. You can search at: http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html.

Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.

39

224 Alcoholism

The Genome Database40 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB's mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “alcoholism” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.

Specialized References The following books are specialized references written for professionals interested in alcoholism (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · International Handbook of Alcohol Dependence and Problems by Nick Heather (Editor), et al; Hardcover - 910 pages, 1st edition (May 11, 2001), John Wiley & Sons; ISBN: 0471983756; http://www.amazon.com/exec/obidos/ASIN/0471983756/icongroupinterna

Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.

40

Physician Guidelines and Databases 225

· Understand and Treat Alcoholism by Paul Berenson; Hardcover (May 2002), Basic Books; ISBN: 0465088759; http://www.amazon.com/exec/obidos/ASIN/0465088759/icongroupinterna

Vocabulary Builder Adenoma: A benign epithelial tumour in which the cells form recognizable glandular structures or in which the cells are clearly derived from glandular epithelium. [EU]

Dissertations 227

CHAPTER 10. DISSERTATIONS ON ALCOHOLISM Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master's dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to alcoholism. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.

Dissertations on Alcoholism ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to alcoholism. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with alcoholism: ·

Alcoholism and Self-esteem among Women with a Female Sex Object Preference by Haven, Martha Jane, Phd from California School of Professional Psychology - Los Angeles, 1981, 146 pages http://wwwlib.umi.com/dissertations/fullcit/8124399

228 Alcoholism

·

Alcoholism and Social Structure: a Sociological Study of Illness, Deviance and Social Response. by Dean, Alfred, Phd from The University of North Carolina at Chapel Hill, 1965, 589 pages http://wwwlib.umi.com/dissertations/fullcit/6604701

·

Alcoholism and Substance Abuse Related Problems among Children and Adolescents by Balakrishnan, Nagesh, Mph from New York Medical College, 1988, 76 pages http://wwwlib.umi.com/dissertations/fullcit/1338861

·

Alcoholism and Suicide among Females by Maxson, Charles Elvin, Phd from University of California, Los Angeles, 1981, 339 pages http://wwwlib.umi.com/dissertations/fullcit/8122822

·

Alcoholism and the Aged. by Lanz Morales, Delia Isabel, Ma from California State University, Long Beach, 1979, 134 pages http://wwwlib.umi.com/dissertations/fullcit/1313774

·

Alcoholism and the Black Female by Tooley, Joan Ethel, Phd from United States International University, 1990, 120 pages http://wwwlib.umi.com/dissertations/fullcit/9026915

·

Alcoholism and the Elderly: a Comparative Study of Coping Strategies Utilized by Alcoholics and Non-alcoholics. by Downing, Rita Ann Mcloughlin, Ma from California State University, Dominguez Hills, 1979, 141 pages http://wwwlib.umi.com/dissertations/fullcit/1314164

·

Alcoholism and the Family: the Destructive Forces in Hardy's 'tess of the D'urbervilles' (thomas Hardy) by Alexander, Elizabeth Chenoweth, Ma from University of North Texas, 1992, 64 pages http://wwwlib.umi.com/dissertations/fullcit/1350973

·

Alcoholism and the Menstrual Cycle by Charette, Lina, Phd from University of Ottawa (canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/f3525700

·

Alcoholism and Visuospatial Skills: a Test of the Right Hemisphere Vulnerability Hypothesis by Kiefner, Mark Gregory, Phd from University of Wyoming, 1988, 150 pages http://wwwlib.umi.com/dissertations/fullcit/8827920

Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to alcoholism is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address:

Dissertations 229

http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.

231

PART III. APPENDICES

ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with alcoholism and related conditions.

Researching Your Medications 233

APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with alcoholism. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for alcoholism. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of alcoholism. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

234 Alcoholism

Your Medications: The Basics41 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of alcoholism. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with alcoholism take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·

Ask about all parts of your treatment, including diet changes, exercise, and medicines.

·

Ask about the risks and benefits of each medicine or other treatment you might receive.

·

Ask how often you or your doctor will check for side effects from a given medication.

Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for alcoholism. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·

The name of the medicine and what it is supposed to do.

·

How and when to take the medicine, how much to take, and for how long.

·

What food, drinks, other medicines, or activities you should avoid while taking the medicine.

·

What side effects the medicine may have, and what to do if they occur.

·

If you can get a refill, and how often.

41

This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.

Researching Your Medications 235

·

About any terms or directions you do not understand.

·

What to do if you miss a dose.

·

If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).

Do not forget to tell your doctor about all the medicines you are currently taking (not just those for alcoholism). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·

Name of medicine

·

Reason taken

·

Dosage

·

Time(s) of day

Also include any over-the-counter medicines, such as: ·

Laxatives

·

Diet pills

·

Vitamins

·

Cold medicine

·

Aspirin or other pain, headache, or fever medicine

·

Cough medicine

·

Allergy relief medicine

·

Antacids

·

Sleeping pills

·

Others (include names)

Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for alcoholism. One such source

236 Alcoholism

is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration's (FDA) Drug Approvals database.42 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of alcoholism. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to alcoholism: Ascorbic Acid (Vitamin C) ·

Systemic - U.S. Brands: Ascorbicap; Cecon; Cee-500; Cemill; Cenolate; Cetane; Cevi-Bid; Flavorcee; Ortho/CS; Sunkist http://www.nlm.nih.gov/medlineplus/druginfo/ascorbicacidvita mincsystemic202071.html

Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.

42

Researching Your Medications 237

Benzodiazepines ·

Systemic - U.S. Brands: Alprazolam Intensol; Ativan; Dalmane; Diastat; Diazepam Intensol; Dizac; Doral; Halcion; Klonopin; Librium; Lorazepam Intensol; Paxipam; ProSom; Restoril; Serax; Tranxene T-Tab; Tranxene-SD; Tranxene-SD Half Strength; Valium; Xanax http://www.nlm.nih.gov/medlineplus/druginfo/benzodiazepine ssystemic202084.html

Disulfiram ·

Systemic - U.S. Brands: Antabuse http://www.nlm.nih.gov/medlineplus/druginfo/disulfiramsyste mic202603.html

Folic Acid (Vitamin B 9 ) ·

Systemic - U.S. Brands: Folvite http://www.nlm.nih.gov/medlineplus/druginfo/folicacidvitamin b9systemic202250.html

Lithium ·

Systemic - U.S. Brands: Cibalith-S; Eskalith; Lithane; Lithobid; Lithonate; Lithotabs http://www.nlm.nih.gov/medlineplus/druginfo/lithiumsystemic 202330.html

Naltrexone ·

Systemic - U.S. Brands: ReVia http://www.nlm.nih.gov/medlineplus/druginfo/naltrexonesyste mic202388.html

Niacin (Vitamin B 3 ) ·

Systemic - U.S. Brands: Endur-Acin; Nia-Bid; Niac; Niacels; Niacor; Nico-400; Nicobid Tempules; Nicolar; Nicotinex Elixir; SloNiacin http://www.nlm.nih.gov/medlineplus/druginfo/niacinvitaminb3 systemic202405.html

Paraldehyde ·

Systemic - U.S. Brands: Paral http://www.nlm.nih.gov/medlineplus/druginfo/paraldehydesys temic202440.html

238 Alcoholism

Pyridoxine (Vitamin B 6 ) ·

Systemic - U.S. Brands: Beesix; Doxine; Nestrex; Pyri; Rodex http://www.nlm.nih.gov/medlineplus/druginfo/pyridoxinevita minb6systemic202493.html

Thiamine (Vitamin B 1 ) ·

Systemic - U.S. Brands: Biamine http://www.nlm.nih.gov/medlineplus/druginfo/thiaminevitami nb1systemic202560.html

Urea ·

Intra-Amniotic - U.S. Brands: Ureaphil http://www.nlm.nih.gov/medlineplus/druginfo/ureaintraamniot ic202584.html

Vitamin B 12 ·

Systemic - U.S. Brands: Alphamin; Cobex; Cobolin-M; Crystamine; Crysti-12; Cyanoject; Cyomin; Hydrobexan; HydroCobex; Hydro-Crysti-12; Hydroxy-Cobal; LA-12; Nascobal; Neuroforte-R; Primabalt; Rubramin PC; Shovite; Vibal; Vibal LA; Vitabee 12 http://www.nlm.nih.gov/medlineplus/druginfo/vitaminb12syste mic202596.html

Vitamin D and Related Compounds ·

Systemic - U.S. Brands: Calciferol; Calciferol Drops; Calcijex; Calderol; DHT; DHT Intensol; Drisdol; Drisdol Drops; Hectorol; Hytakerol; Rocaltrol; Zemplar http://www.nlm.nih.gov/medlineplus/druginfo/vitamindandrel atedcompoundssys202597.html

Zinc Supplements ·

Systemic - U.S. Brands: Orazinc; Verazinc; Zinc 15; Zinc-220; Zinca-Pak; Zincate http://www.nlm.nih.gov/medlineplus/druginfo/zincsupplement ssystemic202622.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their

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institutions. You may be able to access these sources from your local medical library or your doctor's office.

Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters' database as associated with alcoholism (including those with contraindications):43 ·

Acetaminophen with Codeine Phosphate http://www.reutershealth.com/atoz/html/Acetaminophen_with_Codei ne_Phosphate.htm

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Benzphetamine HCL http://www.reutershealth.com/atoz/html/Benzphetamine_HCL.htm

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Bupropion HCl http://www.reutershealth.com/atoz/html/Bupropion_HCl.htm

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Chloral Hydrate http://www.reutershealth.com/atoz/html/Chloral_Hydrate.htm

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Chlordiazepoxide Amitriptyline http://www.reutershealth.com/atoz/html/Chlordiazepoxide_Amitript yline.htm

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Chloroquine http://www.reutershealth.com/atoz/html/Chloroquine.htm

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Codeine http://www.reutershealth.com/atoz/html/Codeine.htm

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Disulfiram http://www.reutershealth.com/atoz/html/Disulfiram.htm

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Doxepin HCl http://www.reutershealth.com/atoz/html/Doxepin_HCl.htm

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Dronabinol http://www.reutershealth.com/atoz/html/Dronabinol.htm

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Ethchlorvynol http://www.reutershealth.com/atoz/html/Ethchlorvynol.htm

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Fentanyl http://www.reutershealth.com/atoz/html/Fentanyl.htm

43

Adapted from A to Z Drug Facts by Facts and Comparisons.

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·

Fentanyl Transdermal System http://www.reutershealth.com/atoz/html/Fentanyl_Transdermal_Syst em.htm

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Flumazenil http://www.reutershealth.com/atoz/html/Flumazenil.htm

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Fluoxetine HCl http://www.reutershealth.com/atoz/html/Fluoxetine_HCl.htm

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Fosphenytoin http://www.reutershealth.com/atoz/html/Fosphenytoin.htm

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Hydromorphone HCl http://www.reutershealth.com/atoz/html/Hydromorphone_HCl.htm

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Hydroxychloroquine Sulfate http://www.reutershealth.com/atoz/html/Hydroxychloroquine_Sulfat e.htm

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Hydroxyzine HCl http://www.reutershealth.com/atoz/html/Hydroxyzine_HCl.htm

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Levomethadyl Acetate HCl http://www.reutershealth.com/atoz/html/Levomethadyl_Acetate_HCl .htm

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Magnesium Oxide http://www.reutershealth.com/atoz/html/Magnesium_Oxide.htm

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Meperidine HCl http://www.reutershealth.com/atoz/html/Meperidine_HCl.htm

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Methadone HCl http://www.reutershealth.com/atoz/html/Methadone_HCl.htm

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Methotrexate http://www.reutershealth.com/atoz/html/Methotrexate.htm

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Methylphenidate HCl http://www.reutershealth.com/atoz/html/Methylphenidate_HCl.htm

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Morphine Sulfate http://www.reutershealth.com/atoz/html/Morphine_Sulfate.htm

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Oxaprozin http://www.reutershealth.com/atoz/html/Oxaprozin.htm

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Oxycodone HCl http://www.reutershealth.com/atoz/html/Oxycodone_HCl.htm

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·

Phenelzine Sulfate http://www.reutershealth.com/atoz/html/Phenelzine_Sulfate.htm

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Phenytoin http://www.reutershealth.com/atoz/html/Phenytoin.htm

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Propoxyphene http://www.reutershealth.com/atoz/html/Propoxyphene.htm

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Propoxyphene Acetaminophen http://www.reutershealth.com/atoz/html/Propoxyphene_Acetaminop hen.htm

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Propoxyphene HCl Acetaminophen http://www.reutershealth.com/atoz/html/Propoxyphene_HCl_Acetam inophen.htm

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Thiamine HCl http://www.reutershealth.com/atoz/html/Thiamine_HCl.htm

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Topiramate http://www.reutershealth.com/atoz/html/Topiramate.htm

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Zalcitabine http://www.reutershealth.com/atoz/html/Zalcitabine.htm

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Zolpidem Tartrate http://www.reutershealth.com/atoz/html/Zolpidem_Tartrate.htm

Mosby's GenRx Mosby's GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.

Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.

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Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.

Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with alcoholism--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat alcoholism or potentially create deleterious side effects in patients with alcoholism. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it's especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take.

Researching Your Medications 243

The package insert provides more information about potential drug interactions.

A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with alcoholism. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with alcoholism. The FDA warns patients to watch out for44: ·

Secret formulas (real scientists share what they know)

·

Amazing breakthroughs or miracle cures (real breakthroughs don't happen very often; when they do, real scientists do not call them amazing or miracles)

·

Quick, painless, or guaranteed cures

·

If it sounds too good to be true, it probably isn't true.

If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H. Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupinterna

44

This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.

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·

The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna

·

Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna

·

Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000), Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna

·

Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna

·

PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna

·

Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna

·

Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna

·

Physician's Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Chloral Hydrate: A hypnotic and sedative used in the treatment of insomnia. The safety margin is too narrow for chloral hydrate to be used as a general anesthetic in humans, but it is commonly used for that purpose in animal experiments. It is no longer considered useful as an anti-anxiety

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medication. [NIH] Chloroquine: The prototypical antimalarial agent with a mechanism that is not well understood. It has also been used to treat rheumatoid arthritis, systemic lupus erythematosus, and in the systemic therapy of amebic liver abscesses. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Ethchlorvynol: A sedative and hypnotic that has been used in the shortterm management of insomnia. Its use has been superseded by other drugs. [NIH]

Fentanyl: A medically useful opioid analog that is 50 times more potent than heroin. [NIH] Flumazenil: A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as an antidote to benzodiazepine overdoses. [NIH] Lithium: Lithium. An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Vitamin B12: A cobalt-containing coordination compound produced by intestinal micro-organisms and found also in soil and water. Higher plants do not concentrate vitamin B12 from the soil and so are a poor source of the substance as compared with animal tissues. [NIH] Zalcitabine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is a potent inhibitor of HIV replication at low concentrations, acting as a chain-terminator of viral DNA by binding to reverse transcriptase. Its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy. [NIH]

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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to alcoholism. Finally, at the conclusion of this chapter, we will provide a list of readings on alcoholism from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine's (NCCAM) overview of complementary and alternative medicine.

What Is CAM?45 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 45

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.

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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.

What Are the Domains of Alternative Medicine?46 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are

46

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.

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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India's traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body's defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.

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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.

Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine's use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.

Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body's systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.

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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient's recovery and that healing is promoted when the body's energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.

Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.47

47

Adapted from http://www.4woman.gov/faq/alternative.htm.

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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.

Finding CAM References on Alcoholism Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for alcoholism. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “alcoholism” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique:

Researching Alternative Medicine 253

·

Pilot Study Exploring the Effect of Kudzu Root on the Drinking Habits of Patients With Chronic Alcoholism Source: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice and Policy. 6(1): 45-48. 2000. Summary: This journal article describes the effects of kudzu extract on the drinking habits of veterans with chronic alcoholism. Although no controlled human trials have documented the efficacy of kudzu root in alcoholism, recent studies using hamsters have demonstrated that alcohol consumption is reduced after injection of kudzu root extract. Forty-nine patients admitted to the substance abuse treatment program at the Prescott, Arizona, Veterans Affairs Medical Center were enrolled in a randomized, double-blind, controlled clinical trial. Participants were assigned to receive either kudzu root extract 1.2 g twice daily or placebo for 4 months. The patients were assessed monthly on sobriety status and craving for alcohol. Of 38 patients who completed the first month, 21 received kudzu and 17 placebo. No significant differences in sobriety and craving scores were observed at any time between the kudzu and placebo groups. One patient in the kudzu group reported headache, dry mouth, and anxiety; no side effects were noted in the placebo group. In this pilot study, kudzu root appeared to be no better than placebo in reducing the craving for alcohol or promoting sobriety. The article has 2 tables and 6 references.

·

Potential Use of Medicinal Plants in the Treatment of Alcoholism Source: Fitoterapia. 71(Supplement I): S38-S42. August 2000. Summary: This journal article discusses the potential of selected medicinal herbs to reduce voluntary alcohol intake in animal models of alcoholism. 'Pueraria lobata,' Tabermanthe iboga,' 'Panax ginseng,' 'Salvia miltiorrhiza,' and 'Hypericum perforatum' have all been shown to reduce voluntary alcohol intake in alcohol-preferring rats. Reduction of alcohol absorption from the gastrointestinal system seems to be a common feature among most of these plants. Hypericum has an antidepressantlike effect that may substitute for that of alcohol in rats. The available data suggest that medicinal plants may constitute novel and effective pharmacotherapies for alcoholism. The article has 1 figure and 12 references. (AA-M).

·

Use of Body Acupuncture for Treatment of Alcohol Dependence and Withdrawal Syndrome: A Controlled Study Source: American Journal of Acupuncture. 24(1): 19-25. 1996.

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Summary: This journal article describes a study comparing body acupuncture with conventional medical detoxification as a treatment for alcohol dependence and withdrawal syndrome. The participants were 118 patients from the Outpatient Detoxification Unit of the University Hospital in Sofia, Bulgaria. They were randomly assigned to acupuncture (n=50) or control treatment (n=68); the two groups were similar in terms of age, duration of alcohol dependence, and educational level. Patients in the acupuncture group received daily treatments, using different combinations of five or six bilateral acupuncture sites, in sessions lasting 20-30 minutes. The number of treatments ranged from 12 to 15. Those in the medical detoxification program received parenteral application of serum glucose and vitamin C; intramuscular injection of B-complex vitamins; and oral administration of benzodiazepines, soporifics, and propranolol. Patients were assessed by various criteria before, during, and 6 months after treatment. The acupuncture group had significantly better outcomes than the control group on the following measures: desire for alcohol use, depressive symptoms, participation in psychotherapeutic programs, dropout rate, and remission rate at 6 months posttreatment. The authors conclude that acupuncture may be useful for the treatment of alcohol dependence and withdrawal symptoms, without the side effects often associated with medical detoxification. The article has 5 figures and 16 references. National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine's databases to allow patients to search for articles that specifically relate to alcoholism and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “alcoholism” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to alcoholism: ·

A case-specific approach to the treatment of alcoholism: the application of control mastery theory to alcoholics anonymous and professional practice. Author(s): Lieb RJ, Young NP.

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Source: Journal of Substance Abuse Treatment. 1994 January-February; 11(1): 35-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8201632&dopt=Abstract ·

A pilot study exploring the effect of kudzu root on the drinking habits of patients with chronic alcoholism. Author(s): Shebek J, Rindone JP. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 2000 February; 6(1): 45-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10706235&dopt=Abstract

·

A review of the treatment of alcoholism. Author(s): McLellan AS. Source: N J Med. 1996 August; 93(8): 39-42. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8797340&dopt=Abstract

·

A Russian-American approach to the treatment of alcoholism in Russia: preliminary results. Author(s): Levine BG, Nebelkopf E. Source: J Psychoactive Drugs. 1998 January-February; 30(1): 25-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9565206&dopt=Abstract

·

Acupuncture in alcoholism treatment: a randomized out-patient study. Author(s): Sapir-Weise R, Berglund M, Frank A, Kristenson H. Source: Alcohol and Alcoholism (Oxford, Oxfordshire). 1999 July-August; 34(4): 629-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10456592&dopt=Abstract

·

Adverse effects of paclitaxel in patients with alcohol abuse histories. Author(s): Henderson-Martin B. Source: Clin J Oncol Nurs. 2000 January-February; 4(1): 11-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10865578&dopt=Abstract

·

Alcoholism among indigent inpatients: identification and intervention by internal medicine residents.

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Author(s): Cerise FP, Scarinci IC, Thibodaux R, Cannatella M, Stark S, Brantley PJ. Source: Southern Medical Journal. 1998 January; 91(1): 27-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9438398&dopt=Abstract ·

Alcoholism and trauma: a theoretical overview and comparison. Author(s): Brown S. Source: J Psychoactive Drugs. 1994 October-December; 26(4): 345-55. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7884596&dopt=Abstract

·

Alcoholism in Ghana--a socio-cultural exploration. Author(s): Akyeampong E. Source: Culture, Medicine and Psychiatry. 1995 June; 19(2): 261-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7497735&dopt=Abstract

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Alcoholism in the family. A multicultural exploration. Author(s): Barthwell AG. Source: Recent Dev Alcohol. 1995; 12: 387-407. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7624554&dopt=Abstract

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Alcoholism treatment in the United States. An overview. Author(s): Fuller RK, Hiller-Sturmhofel S. Source: Alcohol Research & Health : the Journal of the National Institute on Alcohol Abuse and Alcoholism. 1999; 23(2): 69-77. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10890799&dopt=Abstract

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Clinical characteristics of alcoholism in alcohol-dependent subjects with and without a history of alcohol treatment. Author(s): Raimo EB, Daeppen JB, Smith TL, Danko GP, Schuckit MA. Source: Alcoholism, Clinical and Experimental Research. 1999 October; 23(10): 1605-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10549991&dopt=Abstract

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Cognitive-behavioral treatment for depression in alcoholism. Author(s): Brown RA, Evans DM, Miller IW, Burgess ES, Mueller TI.

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Source: J Consult Clin Psychol. 1997 October; 65(5): 715-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9337490&dopt=Abstract ·

Comorbid alcoholism and depression: treatment issues. Author(s): Thase ME, Salloum IM, Cornelius JD. Source: J Clin Psychiatry. 2001; 62 Suppl 20: 32-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11584873&dopt=Abstract

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Comparison of hypericum extracts with imipramine and fluoxetine in animal models of depression and alcoholism. Author(s): De Vry J, Maurel S, Schreiber R, de Beun R, Jentzsch KR. Source: European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology. 1999 December; 9(6): 461-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10625112&dopt=Abstract

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Concurrent alcoholism and social anxiety disorder: a first step toward developing effective treatments. Author(s): Randall CL, Thomas S, Thevos AK. Source: Alcoholism, Clinical and Experimental Research. 2001 February; 25(2): 210-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11236835&dopt=Abstract

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Constraint, alcoholism, and electrodermal response in aversive classical conditioning and mismatch novelty paradigms. Author(s): Finn PR, Justus AN, Mazas C, Rorick L, Steinmetz JE. Source: Integrative Physiological and Behavioral Science : the Official Journal of the Pavlovian Society. 2001 April-June; 36(2): 154-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11666043&dopt=Abstract

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Emergency physicians' ratings of alcoholism treaters. Author(s): Chang G, Astrachan BM, Bryant KJ. Source: Journal of Substance Abuse Treatment. 1994 March-April; 11(2): 131-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8040916&dopt=Abstract

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Employee alcoholism in the healthcare setting. Author(s): Syre TR. Source: Hospital Topics. 1994 Winter; 72(1): 9-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10136315&dopt=Abstract

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Entering treatment for alcohol abuse: a stress and coping model. Author(s): Finney JW, Moos RH. Source: Addiction (Abingdon, England). 1995 September; 90(9): 1223-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7580820&dopt=Abstract

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Genetic basis of event-related potentials and their relationship to alcoholism and alcohol use. Author(s): Porjesz B, Begleiter H. Source: Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society. 1998 January; 15(1): 44-57. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9502512&dopt=Abstract

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Genetics and alcoholism: implications for advanced practice psychiatric/mental health nursing. Author(s): Kutlenios RM. Source: Arch Psychiatr Nurs. 1998 June; 12(3): 154-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9628046&dopt=Abstract

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Help-seeking for alcohol-related problems: social contexts surrounding entry into alcoholism treatment or Alcoholics Anonymous. Author(s): George AA, Tucker JA. Source: J Stud Alcohol. 1996 July; 57(4): 449-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8776687&dopt=Abstract

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Human GABAA receptor alpha 1 and alpha 3 subunits genes and alcoholism. Author(s): Parsian A, Cloninger CR.

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Source: Alcoholism, Clinical and Experimental Research. 1997 May; 21(3): 430-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9161602&dopt=Abstract ·

Influence of acupuncture and pharmacotherapy on sensitivity of sensory systems to alcohol irritants in patients with alcoholism. Author(s): Timofeev MF. Source: Am J Chin Med. 1996; 24(2): 177-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8874675&dopt=Abstract

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Intercessory prayer in the treatment of alcohol abuse and dependence: a pilot investigation. Author(s): Walker SR, Tonigan JS, Miller WR, Corner S, Kahlich L. Source: Alternative Therapies in Health and Medicine. 1997 November; 3(6): 79-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9375433&dopt=Abstract

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Jesus, peyote, and the holy people: alcohol abuse and the ethos of power in Navajo healing. Author(s): Garrity JF. Source: Med Anthropol Q. 2000 December; 14(4): 521-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11224979&dopt=Abstract

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Long-term outcome in 306 males with alcoholism. Author(s): Noda T, Imamichi H, Kawata A, Hirano K, Ando T, Iwata Y, Yoneda H. Source: Psychiatry and Clinical Neurosciences. 2001 December; 55(6): 579-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11737790&dopt=Abstract

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Models of alcoholism used in treatment: contrasting AA and other perspectives with which it is often confused. Author(s): Miller WR, Kurtz E. Source: J Stud Alcohol. 1994 March; 55(2): 159-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8189736&dopt=Abstract

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One hundred years of alcoholism: the Twentieth Century. Author(s): Mann K, Hermann D, Heinz A. Source: Alcohol and Alcoholism (Oxford, Oxfordshire). 2000 January; 35(1): 10-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10684770&dopt=Abstract

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Osteoreflectory treatment of alcohol abstinence syndrome and craving for alcohol in patients with alcoholism. Author(s): Yankovskis G, Beldava I, Livina B. Source: Acupunct Electrother Res. 2000; 25(1): 9-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10830971&dopt=Abstract

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Outcome of treatment for alcohol abuse and involvement in Alcoholics Anonymous among previously untreated problem drinkers. Author(s): Timko C, Moos RH, Finney JW, Moos BS. Source: Journal of Mental Health Administration. 1994 Spring; 21(2): 14560. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10133776&dopt=Abstract

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Potential use of medicinal plants in the treatment of alcoholism. Author(s): Carai MA, Agabio R, Bombardelli E, Bourov I I, Luigi Gessa G, Lobina C, Morazzoni P, Pani M, Reali R, Vacca G, Colombo G. Source: Fitoterapia. 2000 August; 71 Suppl 1: S38-S42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10930711&dopt=Abstract

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Recovery from alcoholism: a spiritual journey. Author(s): Bowden JW. Source: Issues in Mental Health Nursing. 1998 July-August; 19(4): 337-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9782855&dopt=Abstract

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Religious practices and alcoholism in a southern adult population. Author(s): Koenig HG, George LK, Meador KG, Blazer DG, Ford SM. Source: Hosp Community Psychiatry. 1994 March; 45(3): 225-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8188192&dopt=Abstract

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Skin-conductance orienting deficits and increased alcoholism in schizotypal criminals. Author(s): Raine A, Bihrle S, Venables PH, Mednick SA, Pollock V. Source: Journal of Abnormal Psychology. 1999 May; 108(2): 299-306. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10369040&dopt=Abstract

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Social and community resources and long-term recovery from treated and untreated alcoholism. Author(s): Humphreys K, Moos RH, Cohen C. Source: J Stud Alcohol. 1997 May; 58(3): 231-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9130214&dopt=Abstract

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The disease concept of alcoholism: its impact on women's treatment. Author(s): Burman S. Source: Journal of Substance Abuse Treatment. 1994 March-April; 11(2): 121-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8040914&dopt=Abstract

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Traditional and western healing practices for alcoholism in American Indians and Alaska Natives. Author(s): Abbott PJ. Source: Substance Use & Misuse. 1998 November; 33(13): 2605-46. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9818991&dopt=Abstract

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Treating alcoholism: an age-specific intervention that works for older patients. Author(s): Peterson M, Zimberg S. Source: Geriatrics. 1996 October; 51(10): 45-9; Quiz 50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8863757&dopt=Abstract

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Visuospatial perception, construction and memory in alcoholism. Author(s): Beatty WW, Hames KA, Blanco CR, Nixon SJ, Tivis LJ. Source: J Stud Alcohol. 1996 March; 57(2): 136-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8683962&dopt=Abstract

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Women and alcoholism: how a male-as-norm bias affects research, assessment, and treatment. Author(s): Wilke D. Source: Health & Social Work. 1994 February; 19(1): 29-35. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8168775&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Open Directory Project: http://dmoz.org/Health/Alternative/

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TPN.com: http://www.tnp.com/

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs

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WellNet: http://www.wellnet.ca/herbsa-c.htm

The following is a specific Web list relating to alcoholism; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation:

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·

General Overview Alcoholism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/alc oholism.html Alcoholism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html

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Alternative Therapy Art therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,671, 00.html Biofeedback Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,675, 00.html Native American medicine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,721, 00.html Relaxation Techniques Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Relaxat ionTechniquescm.html Urine therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,744, 00.html ·

Herbs and Supplements Benzodiazepines Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Beta-Carotene Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000104.html Caffeine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Dandelion Alternative names: Taraxacum officinale Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Dandelion.htm Gamma-Linolenic Acid (GLA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Gam maLinolenicAcidGLAcs.html GLA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Gam maLinolenicAcidGLAcs.html

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Glutamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Gluta minecs.html Glutamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Glutamine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 30,00.html Glutathione Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Guaran Alternative names: Paullinia cupana Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Guarana.htm Herbal Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Kava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,798, 00.html Kudzu Alternative names: Pueraria lobata

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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Kudzu.htm Kudzu Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000193.html Kudzu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,858, 00.html Lipotropic combination Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,861, 00.html Milk Thistle Alternative names: Silybum marianum, Carduus marianus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Milk_Thistle.htm Milk Thistle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Milk Thistle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 44,00.html NAC (N-acetylcysteine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,809, 00.html

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Pueraria Alternative names: Kudzu; Pueraria lobata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ SAMe Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/SAMe.htm Soy isoflavones Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 57,00.html St. John's wort Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,824, 00.html Taurine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000196.html Valerian Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 64,00.html ·

Related Conditions Alcohol Withdrawal Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Alcohol.htm Alzheimer's Disease, Non-Alzheimer's Dementia, and Normal AgeRelated Memory Loss Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000259.html

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Amenorrhea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ameno rrheacc.html Blood Pressure, High Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Bone Loss Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Osteop orosiscc.html Brain Inflammation, Meningitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Menin gitiscc.html Cancer Prevention and Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Diet.htm Cardiomyopathy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cardiomyopathy.htm Cirrhosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cirrhos isoftheLivercc.html Congestive Heart Failure Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Conges tiveHeartFailurecc.html Dementia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Demen tiacc.html Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diabetes.htm Erectile Dysfunction Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Erectile_Dysfunction. htm Gastritis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gastritis.htm Heart Attack Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Heart_Attack.htm Heart Failure, Congestive Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Conges tiveHeartFailurecc.html Hepatitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm

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High Blood Pressure Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/High_Cholesterol.htm High Triglycerides Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/High_Triglycerides.htm Hypertension Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Hypothyroidism Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypothyroidism.htm Liver Cirrhosis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Liver_Cirrhosis.htm Liver Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cirrhos isoftheLivercc.html Meningitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Menin gitiscc.html

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Menstruation, Absence of Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ameno rrheacc.html Osteoporosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Osteop orosiscc.html Pancreas, Inflammation of Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Pancreatic Insufficiency Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Pancreatic_Insufficie ncy.htm Pancreatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Peptic Ulcer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Peptic Ulcercc.html Premenstrual Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/PMS.htm

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Senile Dementia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Demen tiacc.html Ulcer, Peptic Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Peptic Ulcercc.html Vitamin B12 Deficiency Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Vitamin_B12_Deficie ncy.htm

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternatives to Abstinence : A New Look at Alcoholism and the Choices in Treatment by Heather Ogilvie; Paperback - 224 pages (April 2002), Hatherleigh Press; ISBN: 1578261139; http://www.amazon.com/exec/obidos/ASIN/1578261139/icongroupinterna · End Your Addiction Now: The Proven Nutritional Supplement Program That Can Set You Free by Charles Gant, Greg Lewis; Hardcover - 320 pages (January 2002), Warner Books; ISBN: 0446527238; http://www.amazon.com/exec/obidos/ASIN/0446527238/icongroupinterna · The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors by Lance M. Dodes; Hardcover - 257 pages, 1st edition (February 2002), HarperCollins;

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ISBN: 0060198117; http://www.amazon.com/exec/obidos/ASIN/0060198117/icongroupinterna · The Tao of Sobriety : Helping You to Recover from Alcohol and Drug Addiction by David Gregson, et al; Paperback - 176 pages, 1st edition (January 2002), St. Martin's Press; ISBN: 0312242506; http://www.amazon.com/exec/obidos/ASIN/0312242506/icongroupinterna · Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218

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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with alcoholism. Any dietary recommendation is based on a patient's age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with alcoholism may be given different recommendations. Some recommendations may be directly related to alcoholism, while others may be more related to the patient's general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of alcoholism. We will then show you how to find studies dedicated specifically to nutrition and alcoholism.

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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·

Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.

·

Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.

·

Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.

·

Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.

Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·

Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.

·

Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.

·

Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from

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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·

Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains

·

Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.

·

Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.

·

Vitamin C allows the body's immune system to fight various diseases, strengthens body tissue, and improves the body's use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.

·

Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.

·

Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.

·

Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.

·

Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.

It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·

Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.

·

Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.

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·

Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.

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Iodine helps regulate the body's use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.

·

Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.

·

Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.

·

Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.

·

Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.

·

Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.

The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:48 ·

DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.

·

DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.

48

Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.

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·

RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”

·

RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?49

Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”50 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.51 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 50 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail: [email protected]. 51 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 49

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To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail: [email protected]

Finding Studies on Alcoholism The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.52 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture. 52

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researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “alcoholism” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on alcoholism: ·

Alcohol abuse and fatty acid ethyl esters. Source: Nutrition-reviews (USA). (October 1986). volume 44(10) page 343-344. fatty acids lipid metabolism 0029-6643

·

Leaky gut of alcoholism. Source: Nutr-Rev. Washington, D.C. : Nutrition Foundation. March 1985. volume 43 (3) page 72-74. 0029-6643

·

Nutrition and alcoholism in rats. Source: Anonymous Nutr-Revolume 1988 January; 46(1): 28-30 0029-6643

The following information is typical of that found when using the “Full IBIDS Database” when searching using “alcoholism” (or a synonym): ·

ICLAS proceedings: Laboratory animal research in the discovery and development of the new alcoholism treatment using opioid antagonists. Source: Sinclair, J.D. Scandinavian-Journal-of-Laboratory-AnimalScience.-Supplement (Denmark). (1996). volume 23(suppl.1) page 379390. laboratory animals animal models alcoholism drugs abnormal behaviour ethanol brain therapy 0901-3393 Summary: animal de laboratoire modele animal alcoolisme medicament comportement anormal ethanol encephale therapeutique

Additional physician-oriented references include: ·

A case of gamma-hydroxybutyric acid withdrawal syndrome during alcohol addiction treatment: utility of diazepam administration. Author(s): Institute of Internal Medicine, Universita Cattolica, Rome, Italy. Source: Addolorato, G Caputo, F Capristo, E Bernardi, M Stefanini, G F Gasbarrini, G Clin-Neuropharmacol. 1999 Jan-February; 22(1): 60-2 03625664

·

A double-blind, placebo-controlled study of oral nalmefene for alcohol dependence. Author(s): Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Fla., USA.

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Source: Mason, B J Salvato, F R Williams, L D Ritvo, E C Cutler, R B ArchGen-Psychiatry. 1999 August; 56(8): 719-24 0003-990X ·

A pilot study exploring the effect of kudzu root on the drinking habits of patients with chronic alcoholism. Author(s): Veteran Affairs Medical Center 316, Prescott, Arizona 86313, USA. Source: Shebek, J Rindone, J P J-Altern-Complement-Med. 2000 February; 6(1): 45-8 1075-5535

·

Absorption and utilization of nutrients in alcoholism. Source: Feinman, L. Alcohol-Health-Res-World-Natl-Inst-Alcohol-AbuseAlcohol. Washington, D.C. : U.S. Department of Health and Human Services. 1989. volume 13 (3) page 206-210. ill. 0090-838X

·

Acute axonal polyneuropathy in chronic alcoholism and malnutrition. Author(s): Department of Neurology, Regionaal Ziekenhuis Heilig Hart, Leuven, Belgium. Source: Vandenbulcke, M Janssens, J Acta-Neurol-Belg. 1999 September; 99(3): 198-201 0300-9009

·

Adverse effects of paclitaxel in patients with alcohol abuse histories. Source: Henderson Martin, B Clin-J-Oncol-Nurs. 2000 Jan-February; 4(1): 11-4 1092-1095

·

Alcohol abuse among general hospital inpatients according to the Munich Alcoholism Test (MALT). Author(s): Department of Psychiatry, University Hospital RotterdamDijkzigt, The Netherlands. Source: Smals, G L van der Mast, R C Speckens, A E Schudel, W J GenHosp-Psychiatry. 1994 March; 16(2): 125-30 0163-8343

·

Alcohol abuse and alcoholism: an overview. Author(s): Penn/VA Center for Study of Addiction, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA. Source: Volpicelli, J R J-Clin-Psychiatry. 2001; 62 Suppl 20: 4-10 0160-6689

·

Alcohol abuse. Author(s): Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine, Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA. Source: Wootton, J C J-Womens-Health. 1999 April; 8(3): 417-20 1059-7115

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·

Alcoholic patients' experience and attitudes on pharmacotherapy for alcoholism. Author(s): Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA. [email protected] Source: Swift, R M Duncan, D Nirenberg, T Femino, J J-Addict-Dis. 1998; 17(3): 35-47 1055-0887

·

Alcoholism abolishes the effects of melatonin on growth hormone secretion in humans. Author(s): Centro di Alcologia-Istituto di Clinica Medica Generale e Terapia Medica, Parma, Italy. Source: Coiro, V Vescovi, P P Neuropeptides. 1998 June; 32(3): 211-4 01434179

·

Alcoholism and folate homeostasis. Source: Halsted, C.H. Bristol-Myers-Squibb-Mead-Johnson-Nutr-Symp. San Diego, Calif. : Academic Press. 1989. volume 7 page 249-266. charts.

·

Alcoholism and pancreatitis. Source: Korsten, M.A. Alcohol-Health-Res-World-Natl-Inst-AlcoholAbuse-Alcohol. Washington, D.C. : U.S. Department of Health and Human Services. 1989. volume 13 (3) page 232-237. ill. 0090-838X

·

Alcoholism treatment in the United States. An overview. Author(s): Division of Clinical and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA. Source: Fuller, R K Hiller Sturmhofel, S Alcohol-Res-Health. 1999; 23(2): 69-77

·

Alcoholism, malnutrition, vitamin deficiencies, and the skin. Author(s): Department of Dermatology, J.W. Goethe University, Frankfurt, Germany. Source: Fuchs, J Clin-Dermatol. 1999 Jul-August; 17(4): 457-61 0738-081X

·

Alcoholism--assessment and diagnosis. Author(s): Department of Psychiatry, All Judia Institute of Medical Sciences, New Delhi, India. Source: Ray, R Subbakrishna, D K Gentiana, M Neeliyara, T Desai, N G Drug-Alcohol-Depend. 1989 January; 23(1): 79-81 0376-8716

·

Alcoholism-induced bone necrosis. Source: Jacobs, B N-Y-State-J-Med. 1992 August; 92(8): 334-8 0028-7628

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Animal models of alcoholism: neurobiology of high alcohol-drinking behavior in rodents. Author(s): Department of Psychiatry, Indiana University School of Medicine, Indianapolis 46202-4887, USA.

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Source: McBride, W J Li, T K Crit-Rev-Neurobiol. 1998; 12(4): 339-69 08920915 ·

Application of herbal mixtures in rehabilitation after alcoholism. Source: Petri, G. Takach, G. Plant-Med. Stuttgart, W. Ger. : Georg Thieme Verlag. December 1990. volume 56 (6) page 692-693. 0032-0943

·

Association between the functional variant of the catechol-Omethyltransferase (COMT) gene and type 1 alcoholism. Author(s): Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, Finland. [email protected] Source: Tiihonen, J Hallikainen, T Lachman, H Saito, T Volavka, J Kauhanen, J Salonen, J T Ryynanen, O P Koulu, M Karvonen, M K Pohjalainen, T Syvalahti, E Hietala, J Mol-Psychiatry. 1999 May; 4(3): 2869 1359-4184

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·

healthfinder®, HHS's gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&pag e=0

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The United States Department of Agriculture's Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration's Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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·

Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

·

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.thedacare.org/healthnotes/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDÒHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to alcoholism; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·

Vitamins Pantothenic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B5.htm Vitamin A Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000230.html

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Vitamin B complex Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,962, 00.html Vitamin B1 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000241.html Vitamin B12 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B12.htm Vitamin C Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,904, 00.html Vitamin E Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,906, 00.html Vitamin K Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000246.html ·

Minerals Carnitine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Carnitine (L-Carnitine) Source: Integrative Medicine Communications; www.onemedicine.com

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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Carni tineLCarnitinecs.html Chromium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 18,00.html L-Carnitine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Carni tineLCarnitinecs.html Lecithin and choline Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 40,00.html Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Magnesium.htm Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890, 00.html Zinc Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Zincc s.html Zinc Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000128.html

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·

Food and Diet Complex carbohydrates Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Low_Back_Pain.htm Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Saturated Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html

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Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html

Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Diuretics: Agents that promote the excretion of urine through their effects on kidney function. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Medicament: A medicinal substance or agent. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Riboflavin:

Nutritional factor found in milk, eggs, malted barley, liver,

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kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]

Finding Medical Libraries 291

APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM's interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.53

53

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):54 ·

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

·

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM

·

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

·

California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/

54

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 293

·

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: San José PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html

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California: University of California, Davis. Health Sciences Libraries

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html

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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/

294 Alcoholism

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/

·

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm

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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/

·

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html

·

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/

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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml

Finding Medical Libraries 295

·

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke's Hospital Health Sciences Library (St. Luke's Hospital), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41

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·

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

·

National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld

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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp

Finding Medical Libraries 297

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/

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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Texas: Matustik Family Resource Center (Cook Children's Health Care System), http://www.cookchildrens.com/Matustik_Library.html

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/

Alcohol and Young Teenagers 299

APPENDIX E. ALCOHOL AND YOUNG TEENAGERS Overview Kids who drink are more likely to be victims of violent crime, to be involved in alcohol-related traffic accidents, and to have serious school-related problems. You have more influence on your child’s values and decisions about drinking before he or she begins to use alcohol. Parents can have a major impact on their children’s drinking, especially during the preteen and early teen years. Alcohol is a drug, as surely as cocaine and marijuana are. It’s also illegal to drink under the age of 21. And it’s dangerous. Kids who drink are more likely to: be victims of violent crime, have serious problems in school, and be involved in drinking-related traffic accidents. This appendix is geared to parents and guardians of young people ages 10 to 14. Keep in mind that the suggestions on the following pages are just that—suggestions. These have been developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) or the National Institutes of Health which is part of the U.S. Department of Health and Human Services. The text in this appendix is reproduced and adapted from the NIAAA’s publication titled “Make A Difference: Talk to Your Child About Alcohol.”55 If your child has alcoholrelated problems, or has trouble coping with family members who are alcoholic, we strongly recommend that you read two additional guides available from the NIAAA: ·

Keep Kids Alcohol Free: Strategies for Action http://www.alcoholfreechildren.org/gs/pubs/html/Prev.htm

You can also download this document from the NIAAA Web site at http://www.niaaa.nih.gov/publications/children.pdf.

55

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·

How Does Alcohol Affect the World of a Child? http://www.alcoholfreechildren.org/gs/pubs/html/Stat.htm

How to Talk to Your Child about Alcohol Trust Your Instincts Choose ideas you are comfortable with, and use your own style in carrying out the approaches you find useful. Your child looks to you for guidance and support in making life decisions—including the decision not to use alcohol. “But my child isn’t drinking yet,” you may think. “Isn’t it a little early to be concerned about drinking?” Not at all. This is the age at which some children begin experimenting with alcohol. Even if your child is not yet drinking, he or she may be receiving pressure to drink. Act Now Keeping quiet about how you feel about your child’s alcohol use may give him or her the impression that alcohol use is OK for kids. It’s not easy. As children approach adolescence, friends exert a lot of influence. Fitting in is a chief priority for teens, and parents often feel shoved aside. Kids will listen, however. Study after study shows that even during the teen years, parents have enormous influence on their children’s behavior. The bottom line is that most young teens don’t yet drink. And parents’ disapproval of youthful alcohol use is the key reason children choose not to drink. So make no mistake: You can make a difference.

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Young Teens and Alcohol: The Risks For young people, alcohol is the number one drug of choice. In fact, teens use alcohol more frequently and heavily than all other illicit drugs combined. Although most children ages 10 to 14 have not yet begun to drink, early adolescence is a time of special risk for beginning to experiment with alcohol. While some parents and guardians may feel relieved that their teen is “only” drinking, it is important to remember that alcohol is a powerful, mood-altering drug. Not only does alcohol often affect the mind and body in unpredictable ways, but teens lack the judgment and coping skills to handle alcohol wisely. As a result: ·

Alcohol-related traffic accidents are a major cause of death and disability among teens.

·

Alcohol use also is linked with youthful deaths by drowning, fire, suicide, and homicide.

·

Teens who use alcohol are more likely to become sexually active at earlier ages, to have sexual intercourse more often, and to have unprotected sex than teens who do not drink.

·

Young people who drink are more likely than others to be victims of violent crime, including rape, aggravated assault, and robbery.

·

Teens who drink are more likely to have problems with school work and school conduct.

·

An individual who begins drinking as a young teen is four times more likely to develop alcohol dependence than someone who waits until adulthood to use alcohol. The message is clear: Alcohol use is very risky business for young people. And the longer children delay alcohol use, the less likely they are to develop any problems associated with it. That’s why it is so important to help your child avoid any alcohol use.

Your Young Teen’s World Early adolescence is a time of enormous and often confusing changes for your child, which makes it a challenging time for both your youngster and you. Being tuned in to what it’s like to be a teen can help you stay closer to your child and have more influence on the choices he or she makes— including decisions about using alcohol.

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Physical Changes Most 10- to 14-year-olds experience rapid increases in height and weight as well as the beginnings of sexual development. As a result, many kids feel more self-conscious about their bodies than they did when they were younger and begin to question whether they are “good enough”—tall enough, slender enough, strong enough, attractive enough—compared with others. A young teen who feels he or she doesn’t measure up in some way is more likely to do things to try to please friends, including experimenting with alcohol. During this vulnerable time, it is particularly important to let your children know that in your eyes, they do measure up—and that you care about them deeply. Thinking Skills Most young teens are still very “now” oriented and are just beginning to understand that their actions—such as drinking—have consequences. They also tend to believe that bad things won’t happen to them, which helps to explain why they often take risks. Therefore, it is very important for adults to invest time in helping kids understand how and why alcohol-related risks do apply to them.

Social and Emotional Changes As children approach adolescence, friends and “fitting in” become extremely important. Young teens increasingly look to friends and the media for clues on how to behave and begin to question adults’ values and rules. Given these normal developments, it is perhaps not surprising that parents often experience conflict with their kids as they go through early adolescence. During this sometimes stormy time, perhaps your toughest challenge is to try to respect your child’s growing drive for independence while still providing support and appropriate limits. According to a national survey: ·

One in four eighth graders reports drinking alcohol within the past month.

·

18 percent of eighth graders say they have gotten drunk at least once in the past year.

·

75 percent of young teens say that alcohol is easy to get.

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The Bottom Line: A Strong Parent-Child Relationship You may wonder why a guide to preventing teen alcohol use is putting so much emphasis on parents’ need to understand and support their children. But the fact is, the best way to influence your child to avoid drinking is to have a strong, trusting relationship with him or her. Research shows that teens are much more likely to delay drinking when they feel they have a close, supportive tie with a parent or guardian. Moreover, if your son or daughter eventually does begin to drink, a good relationship with you will help protect him or her from developing alcohol-related problems. The opposite is also true: When the relationship between a parent and teen is full of conflict or is very distant, the teen is more likely to use alcohol and to develop drinking-related problems. This connection between the parentchild relationship and a child’s drinking habits makes a lot of sense when you think about it. First, when children have a strong bond with a parent, they are apt to feel good about themselves and therefore be less likely to cave in to peer pressure to use alcohol. Second, a good relationship with you is likely to influence your children to try to live up to your expectations, because they want to maintain their close tie with you. Here are some ways to build a strong, supportive bond with your child: ·

Establish open communication. Make it easy for your teen to talk honestly with you.

·

Show you care. Even though young teens may not always show it, they still need to know they are important to their parents. Make it a point to regularly spend one-on-one time with your child—time when you can give him or her your loving, undivided attention. Some activities to share: a walk, a bike ride, a quiet dinner out, or a cookie-baking session.

·

Draw the line. Set clear, realistic expectations for your child’s behavior. Establish appropriate consequences for breaking rules and consistently enforce them.

·

Offer acceptance. Make sure your teen knows that you appreciate his or her efforts as well as accomplishments. Avoid hurtful teasing or criticism.

·

Understand that your child is growing up. This doesn’t mean a hands-off attitude. But as you guide your child’s behavior, also make an effort to respect his or her growing need for independence and privacy.

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Tips for Communicating with Your Teen Developing open, trusting communication between you and your child is essential to helping your child avoid alcohol use. If your child feels comfortable talking openly with you, you’ll have a greater chance of guiding him or her toward healthy decision-making. Some ways to begin: ·

Encourage conversation. Encourage your child to talk about whatever interests him or her. Listen without interruption and give your child a chance to teach you something new. Your active listening to your child’s enthusiasms paves the way for conversations about topics that concern you.

·

Ask open-ended questions. Encourage your teen to tell you how he or she thinks and feels about the issue you’re discussing. Avoid questions that have a simple “yes” or “no” answer.

·

Control your emotions. If you hear something you don’t like, try not to respond with anger. Instead, take a few deep breaths and acknowledge your feelings in a constructive way.

·

Make every conversation a “win-win” experience. Don’t lecture or try to “score points” on your teen by showing how he or she is wrong. If you show respect for your child’s viewpoint, he or she will be more likely to listen to and respect yours.

Talking with Your Teen about Alcohol For many parents, bringing up the subject of alcohol is no easy matter. Your young teen may try to dodge the discussion, and you yourself may feel unsure about how to proceed. To boost your chances for a productive conversation, take some time to think through the issues you want to discuss before you talk with your child. Also, think about how your child might react and ways you might respond to your youngster’s questions and feelings. Then choose a time to talk when both you and your child have some “down time” and are feeling relaxed. Keep in mind, too, that you don’t need to cover everything at once. In fact, you’re likely to have a greater impact on your child’s drinking by having a number of talks about alcohol use throughout his or her adolescence. Think of this discussion with your child as the first part of an ongoing conversation. And remember, do make it a conversation, not a lecture! Following are some topics for discussion:

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Your Child ’s Views about Alcohol Ask your young teen what he or she knows about alcohol and what he or she thinks about teen drinking. Ask your child why he or she thinks kids drink. Listen carefully without interrupting. Not only will this approach help your child to feel heard and respected, but it can serve as a natural “lead-in” to discussing alcohol topics.

Important Facts about Alcohol Although many kids believe they already know everything about alcohol, myths and misinformation abound. Here are some important facts to share: ·

Alcohol is a powerful drug that slows down the body and mind. It impairs coordination; slows reaction time; and impairs vision, clear thinking, and judgment.

·

Beer and wine are not “safer” than hard liquor. A 12-ounce can of beer, a 5-ounce glass of wine, and 1 ounce of hard liquor all contain the same amount of alcohol and have the same effects on the body and mind.

·

On average, it takes 2 to 3 hours for a single drink to leave the body’s system. Nothing can speed up this process, including drinking coffee, taking a cold shower, or “walking it off.”

·

People tend to be very bad at judging how seriously alcohol has affected them. That means many individuals who drive after drinking think they can control a car—but actually cannot.

·

Anyone can develop a serious alcohol problem, including a teenager.

The “Magic Potion “Myth The media’s glamorous portrayal of alcohol encourages many teens to believe that drinking will make them popular, attractive, happy, and “cool.” Research shows that teens who expect such positive effects are more likely to drink at early ages. However, you can help to combat these dangerous myths by watching TV shows and movie videos with your child and discussing how alcohol is portrayed in them. For example, television advertisements for beer often show young people having an uproariously good time, as though drinking always puts people in a terrific mood. Watching such a commercial with your child can be an opportunity to

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discuss the many ways that alcohol can affect people—in some cases bringing on feelings of sadness or anger rather than carefree high spirits.

Good Reasons Not to Drink In talking with your child about reasons to avoid alcohol, stay away from scare tactics. Most young teens are aware that many people drink without problems, so it is important to discuss the consequences of alcohol use without overstating the case. For example, you can talk about the dangers of riding in a car with a driver who has been drinking without insisting that “all kids who ride with drinkers get into accidents.” Some good reasons that teens shouldn’t drink: ·

You want your child to avoid alcohol. Be sure to clearly state your own expectations regarding your child’s drinking and to establish consequences for breaking rules. Your values and attitudes count with your child, even though he or she may not always show it.

·

To maintain self-respect. In a series of focus groups, teens reported that the best way to persuade them to avoid alcohol is to appeal to their selfrespect—letting them know that they are too smart and have too much going for them to need the crutch of alcohol. Teens also pay attention to ways in which alcohol might cause them to do something embarrassing that might damage their self-respect and important relationships.

·

Drinking is illegal. Because alcohol use under the age of 21 is illegal, getting caught may mean trouble with the authorities. Even if getting caught doesn’t lead to police action, the parents of your child’s friends may no longer permit them to associate with your child. If drinking occurs on school grounds, your child could be suspended.

·

Drinking can be dangerous. One of the leading causes of teen injuries and death is drunk driving. Alcohol is also a major factor in other types of fatal accidents among teens, such as drownings, burns, falls, and alcohol poisoning from drinking too much, too fast. Drinking also makes a young person more vulnerable to sexual assault and unprotected sex. And while your teen may believe he or she wouldn’t engage in hazardous activities after drinking, point out that because alcohol impairs judgment, a drinker is very likely to think such activities won’t be dangerous.

·

You have a family history of alcoholism. If one or more members of your immediate or extended family has suffered from alcoholism, your child may be somewhat more vulnerable to developing a drinking problem.

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Your child needs to know that for him or her, drinking may carry special risks.

How to Handle Peer Pressure It’s not enough to tell your young teen that he or she should avoid alcohol— you also need to help your child figure out how. What can your daughter say when she goes to a party and a friend offers her a beer? Or what should your son do if he finds himself in a home where kids are passing around a bottle of wine and parents are nowhere in sight? What should their response be if they are offered a ride home with an older friend who has been drinking? Brainstorm with your teen for ways that he or she might handle these and other difficult situations, and make clear how you are willing to support your child. An example: “If you find yourself at a home where kids are drinking, call me and I’ll pick you up—and there will be no scolding or punishment.” The more prepared your child is, the better able he or she will be to handle high-pressure situations that involve drinking.

“Mom, Dad, Did You Drink When You Were a Kid?” This is the question many parents dread—yet it is highly likely to come up in any family discussion about alcohol. The reality is that many parents did drink before they were old enough to legally do so. So how can one be honest with a child without sounding like a hypocrite who advises, “Do as I say, not as I did”? This is a judgment call. If you believe that your drinking or drug use history should not be part of the discussion, you can simply tell your child that you choose not to share it. Another approach is to admit that you did do some drinking as a teenager, but that it was a mistake—and give your teen an example of an embarrassing or painful moment that occurred because of your drinking. This approach may help your child better understand that youthful alcohol use does have negative consequences.

How to Host a Teen Party The following guidelines should be considered before you host a party for your teen: ·

Agree on a guest list—and don’t admit party crashers.

·

Discuss ground rules with your child before the party.

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·

Encourage your teen to plan the party with a responsible friend so that he or she will have support if problems arise.

·

Brainstorm fun activities for the party.

·

If a guest brings alcohol into your house, ask him or her to leave.

·

Serve plenty of snacks and non-alcoholic drinks.

·

Be visible and available—but don’t join the party!

Taking Action: Prevention Strategies for Parents When talking isn’t enough—you also need to take concrete action to help your child resist alcohol. Research strongly shows that active, supportive involvement by parents and guardians can help teens avoid underage drinking and prevent later alcohol misuse. In a survey of sixth graders, over half said it would be easy for a kid their age to get alcohol at a party. And in a recent national survey, 75 percent of eighth graders said alcohol was “fairly easy” or “very easy” to get. The message is clear: Young teens still need plenty of adult supervision. Some ways to provide it:

Monitor Alcohol Use in Your Home If you keep alcohol in your home, keep track of the supply. Make clear to your child that you don’t allow unchaperoned parties or other teen gatherings in your home. If possible, however, encourage him or her to invite friends over when you are at home. The more entertaining your child does in your home, the more you will know about your child’s friends and activities.

Connect with Other Parents Getting to know other parents and guardians can help you keep closer tabs on your child. Friendly relations can make it easier for you to call the parent of a teen who is having a party to be sure that a responsible adult will be present and that alcohol will not be available. You’re likely to find out that you’re not the only adult who wants to prevent teen alcohol use—many other parents share your concern.

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Keep Track of Your Child ’s Activities Be aware of your teen’s plans and whereabouts. Generally, your child will be more open to your supervision if he or she feels you are keeping tabs because you care, not because you distrust him or her. Develop Family Rules about Teen Drinking When parents establish clear “no alcohol” rules and expectations, their children are less likely to begin drinking. While each family should develop agreements about teen alcohol use that reflect their own beliefs and values, some possible family rules about drinking are: ·

Kids will not drink alcohol until they are 21.

·

Older siblings will not encourage younger brothers or sisters to drink and will not give them alcohol.

·

Kids will not stay at teen parties where alcohol is served.

·

Kids will not ride in a car with a driver who has been drinking.

Once you have chosen rules for your family, you will need to establish appropriate consequences for breaking those rules. Be sure to choose a penalty that you are willing to carry out. Also, don’t make the consequences so harsh that they become a barrier to open communication between you and your teen. The idea is to make the penalty “sting” just enough to make your child think twice about breaking the rule. A possible consequence might be temporary restrictions on your child’s socializing. Finally, you must be prepared to consistently enforce the consequences you have established. If your children know that they will lose certain privileges each and every time an alcohol use rule is broken, they will be more likely to keep their agreements. Set a Good Example Parents and guardians are important role models for their children—even children who are fast becoming teenagers. Studies indicate that if a parent uses alcohol, his or her children are more likely to drink themselves. But even if you use alcohol, there may be ways to lessen the likelihood that your child will drink. Some suggestions: ·

Use alcohol moderately.

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·

Don’t communicate to your child that alcohol is a good way to handle problems. For example, don’t come home from work and say, “I had a rotten day. I need a drink.”

·

Instead, let your child see that you have other, healthier ways to cope with stress, such as exercise; listening to music; or talking things over with your spouse, partner, or friend.

·

Don’t tell your kids stories about your own drinking in a way that conveys the message that alcohol use is funny or glamorous.

·

Never drink and drive or ride in a car with a driver who has been drinking.

·

When you entertain other adults, make available alcohol-free beverages and plenty of food. If anyone drinks too much at your party, make arrangements for them to get home safely. Don ’t Support Teen Drinking

Your attitudes and behavior toward teen drinking also influence your child. Avoid making jokes about underage drinking or drunkenness, or otherwise showing acceptance of teen alcohol use. In addition, never serve alcohol to your child’s underage friends. Research shows that kids whose parents or friends’ parents provide alcohol for teen get-togethers are more likely to engage in heavier drinking, to drink more often, and to get into traffic accidents. Remember, too, that it is illegal in most states to provide alcohol to minors who are not family members. You can also join school and community efforts to discourage alcohol use by teens. By working with school officials and other members of your community, you can help to develop policies to reduce alcohol availability to teens and to enforce consequences for underage drinking.

Help Your Child Build Healthy Friendships If your child’s friends use alcohol, your child is more likely to drink too. So it makes sense to try to encourage your young teen to develop friendships with kids who do not drink and who are otherwise healthy influences on your child. A good first step is to simply get to know your child’s friends better. You can then invite the kids you feel good about to family gettogethers and outings and find other ways to encourage your child to spend time with those teens. Also, talk directly with your youngster about the

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qualities in a friend that really count, such as trustworthiness and kindness, rather than popularity or a “cool” style. When you disapprove of one of your child’s friends, the situation can be tougher to handle. While it may be tempting to simply forbid your child to see that friend, such a move may make your child even more determined to hang out with him or her. Instead, you might try pointing out your reservations about the friend in a caring, supportive way. You can also limit your child’s time with that friend through your family rules, such as how after-school time can be spent or how late your child can stay out in the evening. Encourage Healthy Alternatives to Alcohol One reason kids drink is to beat boredom. Therefore, it makes sense to encourage your child to participate in supervised after-school and weekend activities that are challenging and fun. According to a recent survey of preteens, the availability of enjoyable, alcohol-free activities is a big reason for deciding not to use alcohol. If your community doesn’t offer many supervised activities, consider getting together with other parents and young teens to help create some. Start by asking your child and other kids what they want to do, since they will be most likely to participate in activities that truly interest them. Find out whether your church, school, or community organization can help you sponsor a project.

Could My Child Develop a Drinking Problem? While this booklet is mainly concerned with preventing teen alcohol use, we also need to pay attention to the possibility of youthful alcohol abuse. Certain children are more likely than others to drink heavily and encounter alcohol-related difficulties, including health, school, legal, family, and emotional problems. Kids at highest risk for alcohol-related problems are those who: ·

Begin using alcohol or other drugs before the age of 15.

·

Have a parent who is a problem drinker or an alcoholic.

·

Have close friends who use alcohol and/or other drugs.

·

Have been aggressive, antisocial, or hard to control from an early age.

·

Have experienced childhood abuse and/or other major traumas.

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·

Have current behavioral problems and/or are failing at school.

·

Have parents who do not support them, do not communicate openly with them, and do not keep track of their behavior or whereabouts.

·

Experience ongoing hostility or rejection from parents and/or harsh, inconsistent discipline.

The more of these experiences a child has had, the greater the chances that he or she will develop problems with alcohol. Having one or more risk factors does not mean that your child definitely will develop a drinking problem. It does suggest, however, that you may need to act now to help protect your youngster from later problems. For example, if you have not been openly communicating with your child, it will be important to develop new ways of talking and listening to each other. Or, if your child has serious behavioral difficulties, you may want to seek help from your child’s school counselor, physician, and/or a mental health professional. Some parents may suspect that their child already has a drinking problem. While it can be hard to know for sure, certain behaviors can alert you to the possibility of an alcohol problem. If you think your child may be in trouble with drinking, consider getting advice from a health care professional specializing in alcohol problems before talking with your teen. To find a professional, contact your family doctor or a local hospital. Other sources of information and guidance may be found in your local Yellow Pages under “Alcoholism” or through one of the resources listed below.

Warning Signs of a Drinking Problem While the following behaviors may indicate an alcohol or other drug problem, some also reflect normal teenage growing pains. Experts believe that a drinking problem is more likely if you notice several of these signs at the same time, if they occur suddenly, and if some of them are extreme in nature. ·

Mood changes: flare-ups of temper, irritability, and defensiveness.

·

School problems: poor disciplinary action.

·

Rebelling against family rules.

·

Switching friends, along with a reluctance to have you get to know the new friends.

attendance,

low

grades,

and/or

recent

Alcohol and Young Teenagers 313

·

A “nothing matters” attitude: sloppy appearance, a lack of involvement in former interests, and general low energy.

·

Finding alcohol in your child’s room or backpack, or smelling alcohol on his or her breath.

·

Physical or mental problems: memory lapses, poor concentration, bloodshot eyes, lack of coordination, or slurred speech.

Action Checklist Steps you can take to improve communication with your teen: ·

Establish a loving, trusting relationship with your child.

·

Make it easy for your teen to talk honestly with you.

·

Talk with your child about alcohol facts, reasons not to drink, and ways to avoid drinking in difficult situations.

·

Keep tabs on your young teen’s activities, and join with other parents in making common policies about teen alcohol use.

·

Develop family rules about teen drinking and establish consequences.

·

Set a good example regarding your own alcohol use and your response to teen drinking.

·

Encourage your child to develop healthy friendships and fun alternatives to drinking.

·

Know whether your child is at high risk for a drinking problem; if so, take steps to lessen that risk.

·

Know the warning signs of a teen drinking problem and act promptly to get help for your child.

·

Believe in your own power to help your child avoid alcohol use.

Additional Resources Join Together 441 Stewart Street, 7th Floor Boston, MA 02116 (617) 437-1500 http://www.jointogether.org

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A national resource center for communities who are working to prevent alcohol and other drug abuse across the nation. National Council on Alcoholism and Drug Dependence 12 West 21st Street New York, NY 10010 (800) NCA-CALL http://www.ncaad.org Provides educational materials on alcohol abuse and alcoholism as well as phone numbers of local NCADD affiliates who can provide information on local treatment resources. National Institute on Alcohol Abuse and Alcoholism Scientific Communications Branch 6000 Executive Boulevard, Suite 409 Bethesda, MD 20892-7003 (301) 443-3860 http://www.niaaa.nih.gov Makes available free informational materials on many aspects of alcohol use, alcohol abuse, and alcoholism.

Other NIAAA Publications If you are interested in learning more about alcohol abuse and alcoholism, NIAAA has produced a number of booklets and other materials targeted to the public. Those publications include: ·

Alcoholism: Getting the Facts —describes what alcoholism and alcohol abuse are and offers useful information on when and where to seek help. English version: NIH Publication Number 96-4153; Spanish version: NIH Publication Number 99-4153-S.

·

Alcohol: What You Don ’t Know Can Harm You —provides information on drinking and driving, alcohol-medication interactions, interpersonal problems, alcohol-related birth defects, long-term health problems, and current research issues. English version: NIH Publication Number 994323; Spanish version: NIH Publication Number 99-4323-S.

·

How to Cut Down on Your Drinking —presents tips for those who are acting on medical advice to reduce their alcohol consumption. English version: NIH Publication Number 96- 3770; Spanish version: NIH Publication Number 96-3770-S.

Alcohol and Young Teenagers 315

·

Frequently Asked Questions concerning alcohol abuse and alcoholism and the full text of the above materials are available at NIAAA’s Web site (http://www.niaaa.nih.gov).

·

How Does Alcohol Affect the World of a Child? --This concise and easy-to-read brochure brings together a range of statistics on alcohol use by kids, its impact on their health and well being, and the broader impact of alcohol use on society. An e-copy of this publication is available for download at http://www.niaaa.nih.gov/publications/childcontent.htm

·

Make a Difference: Talk to Your Child About Alcohol --This guide describes the health risks and other problems associated with alcohol use by older children and young adolescents and offers tips to help parents and guardians establish open, trusting communication with their children. It also suggests ways for children to say no to alcohol, lists warning signs of a drinking problem, and outlines specific prevention strategies for parents and guardians. English e-copy: http://www.niaaa.nih.gov/publications/children.pdf Spanish e-copy: http://www.niaaa.nih.gov/publications/SpanParents.pdf

For more information about the Leadership initiative or any of the materials presented in this section, contact: The Leadership to Keep Children Alcohol Free 5530 Wisconsin Avenue, Sutie 1600 Chevy Chase, MD 20815 E-mail: [email protected] Telephone: 301-654-9740 Fax: 301-656-4012 www.alcoholfreechildren.org

Additional E-Sources The funding partners in this initiative offer a wealth of materials that will be useful to those who are developing prevention campaigns in their communities. Reducing Underage Drinking through Coalitions The American Medical Association and the Robert Wood Johnson Foundation are helping communities find ways to reduce underage drinking through coalitions. The coalitions focus on changing the social environment

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in order to discourage alcohol use among young people (http://www.amaassn.org/special/aos/alcohol1/about/underage.htm). The following publication is available from the Robert Wood Johnson Foundation: ·

Youth Access to Alcohol Survey. Summary Report. September 1998 This survey summarizes the attitudes and opinions of respondents on policies affecting youth access to alcohol. Many of the queries and responses relate to environmental and enforcement prevention strategies. http://www.rwjf.org/app/rw_publications_and_links/publicationsPdfs/ Youth_Access_to_Alcohol_Survey.pdf

From the National Center on Minority Health and Health Disparities, NIH, DHHS: ·

Alcoholism Studies This site describes multiple studies that NCMHD is sponsoring or cosponsoring with other agencies, including studies on minority alcohol prevention. http://www1.od.nih.gov/ORMH/mhi/research/alcoholism.html

From the Office of Research on Women’s Health, NIH, DHHS: ·

Women Of Color Health Data Book This data book contains statistics about alcohol use by adolescent and adult females of color. http://www4.od.nih.gov/orwh/WOCEnglish.pdf

From the National Highway Traffic Safety Administration, DOT 1998: ·

Youth Fatal Crash and Alcohol Facts This report documents actions that must be taken to reduce teenage alcohol-related fatalities. They include reaching the parents who ignore drinking by their underage children; increasing enforcement of laws shown to be effective in reducing fatalities; getting treatment for those hard-to-reach young people who are alcoholics or have drinking problems; and convincing young people that underage drinking, in addition to drinking and driving, is socially unacceptable. http://www.nhtsa.dot.gov/people/injury/alcohol/Fatal1998Y/Index.htm

From the Office of Juvenile Justice and Delinquency Prevention, OJP, DOJ: ·

Strategies to Reduce Underage Alcohol Use: Typology and Brief Overview This document provides a conceptual framework for understanding the

Alcohol and Young Teenagers 317

array of strategies available to prevent underage alcohol use. It also provides a simple assessment of the level of effect that might be expected from each strategy, based on existing research and evaluation. http://www.udetc.org/documents/strategies.pdf ·

Regulatory Strategies for Preventing Youth Access to Alcohol: Best Practices This document provides guidance on the best practices for shaping and implementing laws and regulations to restrict the commercial and social availability of alcohol to youth and to deter young people from attempting to purchase or consume alcohol. http://www.udetc.org/documents/accesslaws.pdf

From the Substance Abuse and Mental Health Services Administration,

DHHS: ·

Prevention Enhancement Protocols System (PEPS) – Preventing Problems Related to Alcohol Availability: Environmental Approaches This CSAP document, presented in three formats for three different audiences, provides an extensive discussion of the many approaches that communities can take to prevent alcohol use by underage youth. Suggested for broad use, the guidelines offer practical, detailed interventions along with discussions of the advantages and disadvantages of these interventions. Each format is available online. Practitioner’s Guide: http://www.health.org/govpubs/PHD822/aap.htm Reference Guide: http://www.health.org/govpubs/PHD822/aar.htm Parent and Community Guide: http://www.health.org/govpubs/PHD822/acc.htm

·

Underage Drinking Prevention – Action Guide and Planner This CSAP guide and planner suggests strategies for implementing coordinated prevention actitivies. For planning purposes, it includes a calendar that identifies themes and issues around which to organize. It also includes relevant statistics, sample letters, press releases, speeches, and other materials to adapt for local campaigns. http://www.health.org/govpubs/PHD858/index.pdf

State Contacts The following pathways will take you to directories of individual State agencies or regional offices that will be able to provide you with local resources:

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State Alcohol and Drug Abuse Agencies These agencies direct the alcohol and drug abuse programs in their States, overseeing treatment and prevention activities. National Association of State Alcohol and Drug Abuse Directors (NASADAD): http://www.nasadad.org/Features/visit1.htm Office of Juvenile Justice and Delinquency Prevention – Underage Drinking Enforcement Training Center OJJDP has awarded grants to all 50 States and the District of Columbia under the Enforcing Underage Drinking Laws initiative. The following esource takes you to the State contacts for the initiative, Enforcement of Underage Drinking Program: http://www.udetc.org/StateContacts.htm National Highway Traffic Safety Administration NHTSA has 10 regional offices, each of which offers a special focus on youth drinking and driving. Regional Offices: http://www.nhtsa.dot.gov/nhtsa/whatis/regions/Index.cfm?Fitting=No State Alcohol Control Boards and Liquor Control Agencies These organizations are responsible for licensing the alcohol industries, for collecting and auditing taxes and fees paid by the licensees, and for enforcing the laws and regulations that pertain to the alcohol beverage industries. National Alcohol Control Beverage Association (not all States are members): http://www.nabca.org/control.html

Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]

Liquor: 1. a liquid, especially an aqueous solution containing a medicinal substance. 2. a general term used in anatomical nomenclature for certain fluids of the body. [EU] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU]

Alcohol and Young Teenagers 319

Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Barbiturate: A type of central nervous system (CNS) depressant often prescribed to promote sleep. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. it includes the large intestine and small intestine. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Loneliness: The state of feeling sad or dejected as a result of lack of companionship or being separated from others. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Tranquilizers: Drugs prescribed to promote sleep or reduce anxiety; this National Household Survey on Drug Abuse classification includes benzodiazepines, barbiturates, and other types of CNS depressants. [NIH]

Alcohol: Additional Risks 321

APPENDIX F. ALCOHOL: ADDITIONAL RISKS Overview You may drink alcohol occasionally. Or, like others, you may drink moderate amounts of alcohol on a more regular basis. If you are a woman or someone over the age of 65, this means that you have no more than one drink per day; if you are a man, this means that you have no more than two drinks per day. Drinking at these levels usually is not associated with health risks and can help to prevent certain forms of heart disease. But did you know that even moderate drinking, under certain circumstances, is not risk free? And that if you drink at more than moderate levels, you may be putting yourself at risk for serious problems with your health and problems with family, friends, and coworkers? This appendix explains some of the consequences of drinking that you may not have considered. The introduction above and the following passages are adapted from various publications of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). These include Alcohol: What You Don't Know Can Harm You, AgePage-Aging and Alcohol Abuse, and Drinking and Your Pregnancy.56

Adapted from http://www.niaaa.nih.gov/publications/harm-al.htm, http://www.niaaa.nih.gov/publications/agepage.htm, and http://www.niaaa.nih.gov/publications/brochure.htm, respectively. 56

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What Is a Drink? A standard drink is: ·

One 12-ounce bottle of beer* or wine cooler

·

One 5-ounce glass of wine

·

1.5 ounces of 80-proof distilled spirits.

·

Beer ranges considerably in its alcohol content, with malt liquor being higher in its alcohol content than most other brewed beverages.

Drinking and Driving It may surprise you to learn that you don't need to drink much alcohol before your ability to drive becomes impaired. For example, certain driving skills--such as steering a car while, at the same time, responding to changes in traffic--can be impaired by blood alcohol concentrations (BACs) as low as 0.02 percent. (The BAC refers to the amount of alcohol in the blood.) A 160pound man will have a BAC of about 0.04 percent 1 hour after consuming two 12-ounce beers or two other standard drinks on an empty stomach (see the box, “What Is a Drink?”). And the more alcohol you consume, the more impaired your driving skills will be. Although most states set the BAC limit for adults who drive after drinking at 0.08 to 0.10 percent, impairment of driving skills begins at much lower levels.

Interactions with Medications Alcohol interacts negatively with more than 150 medications. For example, if you are taking antihistamines for a cold or allergy and drink alcohol, the alcohol will increase the drowsiness that the medication alone can cause, making driving or operating machinery even more hazardous. And if you are taking large doses of the painkiller acetaminophen and drinking alcohol, you are risking serious liver damage. Check with your doctor or pharmacist before drinking any amount of alcohol if you are taking any over-the-counter or prescription medications.

Interpersonal Problems The more heavily you drink, the greater the potential for problems at home, at work, with friends, and even with strangers. These problems may include:

Alcohol: Additional Risks 323

Arguments with or estrangement from your spouse and other family members; Strained relationships with coworkers; Absence from or lateness to work with increasing frequency; Loss of employment due to decreased productivity; and Committing or being the victim of violence.

Long-Term Health Problems Some problems, like those mentioned above, can occur after drinking over a relatively short period of time. But other problems--such as liver disease, heart disease, certain forms of cancer, and pancreatitis--often develop more gradually and may become evident only after long-term heavy drinking. Women may develop alcohol-related health problems after consuming less alcohol than men do over a shorter period of time. Because alcohol affects many organs in the body, long-term heavy drinking puts you at risk for developing serious health problems, some of which are described below.

Alcohol-Related Liver Disease More than 2 million Americans suffer from alcohol-related liver disease. Some drinkers develop alcoholic hepatitis, or inflammation of the liver, as a result of long-term heavy drinking. Its symptoms include fever, jaundice (abnormal yellowing of the skin, eyeballs, and urine), and abdominal pain. Alcoholic hepatitis can cause death if drinking continues. If drinking stops, this condition often is reversible. About 10 to 20 percent of heavy drinkers develop alcoholic cirrhosis, or scarring of the liver. Alcoholic cirrhosis can cause death if drinking continues. Although cirrhosis is not reversible, if drinking stops, one's chances of survival improve considerably. Those with cirrhosis often feel better, and the functioning of their liver may improve, if they stop drinking. Although liver transplantation may be needed as a last resort, many people with cirrhosis who abstain from alcohol may never need liver transplantation. In addition, treatment for the complications of cirrhosis is available.

Heart Disease Moderate drinking can have beneficial effects on the heart, especially among those at greatest risk for heart attacks, such as men over the age of 45 and women after menopause. But long-term heavy drinking increases the risk for high blood pressure, heart disease, and some kinds of stroke.

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Cancer Long-term heavy drinking increases the risk of developing certain forms of cancer, especially cancer of the esophagus, mouth, throat, and voice box. Women are at slightly increased risk of developing breast cancer if they drink two or more drinks per day. Drinking may also increase the risk for developing cancer of the colon and rectum.

Pancreatitis The pancreas helps to regulate the body's blood sugar levels by producing insulin. The pancreas also has a role in digesting the food we eat. Long-term heavy drinking can lead to pancreatitis, or inflammation of the pancreas. This condition is associated with severe abdominal pain and weight loss and can be fatal.

Aging and Alcohol Abuse Anyone at any age can have a drinking problem. Great Uncle George may have always been a heavy drinker--his family may find that as he gets older, the problem gets worse. Grandma Betty may have been a teetotaler all her life, just taking a drink “to help her get to sleep” after her husband died-now she needs a couple of drinks to get through the day. These are common stories. Drinking problems in older people are often neglected by families, doctors, and the public.

Physical Effects of Alcohol Alcohol slows down brain activity. Because alcohol affects alertness, judgment, coordination, and reaction time, drinking increases the risk of falls and accidents. Some research has shown that it takes less alcohol to affect older people than younger ones. Over time, heavy drinking permanently damages the brain and central nervous system, as well as the liver, heart, kidneys, and stomach. Alcohol's effects can make some medical problems hard to diagnose. For example, alcohol causes changes in the heart and blood vessels that can dull pain that might be a warning sign of a heart attack. It also can cause forgetfulness and confusion, which can seem like Alzheimer's disease.

Alcohol: Additional Risks 325

Mixing Drugs Alcohol, itself a drug, is often harmful when mixed with prescription or over-the-counter medicines. This is a special problem for people over 65, because they are often heavy users of prescription medicines and over-thecounter drugs. Mixing alcohol with other drugs such as tranquilizers, sleeping pills, pain killers, and antihistamines can be very dangerous, even fatal. For example, aspirin can cause bleeding in the stomach and intestines; when aspirin is combined with alcohol, the risk of bleeding is much higher. As people age, the body's ability to absorb and dispose of alcohol and other drugs changes. Anyone who drinks should check with a doctor or pharmacist about possible problems with drug and alcohol interactions.

Who Becomes a Problem Drinker? There are two types of problem drinkers--chronic and situational. Chronic abusers have been heavy drinkers for many years. Although many chronic abusers die by middle age, some live well into old age. Most older problem drinkers are in this group. Other people may develop a drinking problem late in life, often because of “situational” factors such as retirement, lowered income, failing health, loneliness, or the death of friends or loved ones. At first, having a drink brings relief, but later it can turn into a problem.

How to Recognize a Drinking Problem Not everyone who drinks regularly has a drinking problem. You might want to get help if you: ·

Drink to calm your nerves, forget your worries, or reduce depression

·

Lose interest in food

·

Gulp your drinks down fast

·

Lie or try to hide your drinking habits

·

Drink alone more often

·

Hurt yourself, or someone else, while drinking

·

Were drunk more than three or four times last year

·

Need more alcohol to get “high”

·

Feel irritable, resentful, or unreasonable when you are not drinking

·

Have medical, social, or financial problems caused by drinking

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Drinking and Your Pregnancy When you are pregnant, your baby grows inside you. Everything you eat and drink while you are pregnant affects your baby. If you drink alcohol, it can hurt your baby's growth. Your baby may have physical and behavioral problems that can last for the rest of his or her life. Children born with the most serious problems caused by alcohol have fetal alcohol syndrome. Children with fetal alcohol syndrome may: ·

Be born small.

·

Have problems eating and sleeping.

·

Have problems seeing and hearing.

·

Have trouble following directions and learning how to do simple things.

·

Have trouble paying attention and learning in school.

·

Have trouble getting along with others and controlling their behavior.

·

Need medical care all their lives.

·

Need special teachers and schools.

Here are some questions you may have about alcohol and drinking while you are pregnant: ·

Can I drink alcohol if I am pregnant? No. Do not drink alcohol when you are pregnant. Why? Because when you drink alcohol, so does your baby. Think about it. Everything you drink, your baby also drinks.

·

Is any kind of alcohol safe to drink during pregnancy? No. Drinking any kind of alcohol when you are pregnant can hurt your baby. Alcoholic drinks are beer, wine, wine coolers, liquor, or mixed drinks. A glass of wine, a can of beer, and a mixed drink all have about the same amount of alcohol.

·

What if I drank during my last pregnancy and my baby was fine? Every pregnancy is different. Drinking alcohol may hurt one baby more than another. You could have one child that is born healthy, and another child that is born with problems.

·

Will these problems go away? No. These problems will last for a child's whole life. People with severe problems may not be able to take care of themselves as adults. They may never be able to work.

Alcohol: Additional Risks 327

·

What if I am pregnant and have been drinking? If you drank alcohol before you knew you were pregnant, stop drinking now. You will feel better and your baby will have a good chance to be born healthy. If you want to get pregnant, do not drink alcohol. You may not know you are pregnant right away. Alcohol can hurt a baby even when you are only 1 or 2 months pregnant.

·

How can I stop drinking? There are many ways to help yourself stop drinking. You do not have to drink when other people drink. If someone gives you a drink, it is OK say no. Stay away from people or places that make you drink. Do not keep alcohol at home. If you cannot stop drinking, GET HELP. You may have a disease called alcoholism. There are programs that can help you stop drinking. They are called alcohol treatment programs. Your doctor or nurse can find a program to help you. Even if you have been through a treatment program before, try it again. There are programs just for women. For help and information You can get help from a doctor, nurse, social worker, pastor, or clinics and programs near you.

Research Directions The National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health, supports about 90 percent of the Nation's research on alcohol use and related consequences. Through this research, NIAAA and the researchers it supports make an implicit promise--that alcohol research will yield practical applications that will help those who suffer as a result of alcohol abuse and alcoholism. Today, alcohol researchers are working on the cutting edge of medical science to answer questions such as: Who is at risk for alcohol-related problems? How does alcohol affect the body, including the brain? How is the risk for alcoholism inherited? What are the health benefits and risks of moderate drinking? What therapies, including medications, show promise for treating alcohol dependence more effectively? Each new discovery made by alcohol researchers provides a piece of the answer to the ages old question of how to prevent and treat the alcohol-related troubles that plague individuals, families, and society. We see the future of alcohol research both as a challenge and as a reward: A challenge, because with more answers come more questions, and we still have far to go. A reward, because the answers we find ultimately will help diminish a public health threat that has existed for far too long.

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If you or someone you know needs help or more information, contact: Al-Anon Family Group Headquarters 1600 Corporate Landing Parkway Virginia Beach, VA 23454-5617 U.S.: (800) 356-9996 Canada: (800) 714-7498 http://www.al-anon.alateen.org Makes referrals to local Al-Anon groups, which are support groups for spouses and other significant adults in an alcoholic person's life. Also makes referrals to Alateen groups, which offer support to children of alcoholics. Locations of Al-Anon or Alateen meetings worldwide can be obtained by calling 1-888-4AL-ANON Monday through Friday, 8 a.m.-6 p.m. (e.s.t.). Free informational materials can be obtained by calling the toll-free numbers (operating 7 days per week, 24 hours per day). Alcoholics Anonymous (AA) World Services 475 Riverside Drive, 11th Floor New York, NY 10115 (212) 870-3400 http://www.alcoholics-anonymous.org Makes referrals to local AA groups and provides informational materials on the AA program. Many cities and towns also have a local AA office listed in the telephone book. Check your local phone book for listings in your area. National Council on Alcoholism and Drug Dependence (NCADD) 12 West 21st Street New York, NY 10010 Telephone: (800) NCA-CALL (800-622-2255) http://www.ncadd.org/ Provides telephone numbers of local NCADD affiliates (who can provide information on local treatment resources) and educational materials on alcoholism via the above toll-free number. National Institute on Alcohol Abuse and Alcoholism Scientific Communications Branch 6000 Executive Boulevard, Suite 409 Bethesda, MD 20892-7003 Telephone: (301) 443-3860 http://www.niaaa.nih.gov

Alcohol: Additional Risks 329

The National Institute on Aging P.O. Box 8057 Gaithersburg, MD 20898-8057 Telephone: (800) 222-2225 TTY: (800) 222-4225 Offers a variety of resources on health and aging. National Organization on Fetal Alcohol Syndrome 216 G Street, NE, Suite 750 Washington, DC 20002 Telephone: (800) 66-NOFAS http://www.nofas.org

Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Abdominal: Pertaining to the abdomen. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. it includes the large intestine and small intestine. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Tranquilizers: Drugs prescribed to promote sleep or reduce anxiety; this National Household Survey on Drug Abuse classification includes benzodiazepines, barbiturates, and other types of CNS depressants. [NIH]

Reducing Alcohol Consumption 331

APPENDIX G. REDUCING ALCOHOL CONSUMPTION Overview If you are drinking too much, you can improve your life and health by cutting down. How do you know if you drink too much? Read these questions and answer “yes” or “no”: ·

Do you drink alone when you feel angry or sad?

·

Does your drinking ever make you late for work?

·

Does your drinking worry your family?

·

Do you ever drink after telling yourself you won't?

·

Do you ever forget what you did while you were drinking?

·

Do you get headaches or have a hangover after you have been drinking?

If you answered “yes” to any of these questions, you may have a drinking problem. Check with your doctor to be sure. Your doctor will be able to tell you whether you should cut down or abstain. If you are alcoholic or have other medical problems, you should not just cut down on your drinking-you should stop drinking completely. Your doctor will advise you about what is right for you.

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How to Cut Down on Your Drinking57 If your doctor tells you to cut down on your drinking, these steps can help you: ·

Write your reasons for cutting down or stopping. Why do you want to drink less? There are many reasons why you may want to cut down or stop drinking. You may want to improve your health, sleep better, or get along better with your family or friends.

·

Set a drinking goal. Choose a limit for how much you will drink. You may choose to cut down or not to drink at all. If you are cutting down, keep below these limits: -

Women: No more than one drink a day

-

Men: No more than two drinks a day

-

A drink is: A 12-ounce bottle of beer; a 5-ounce glass of wine; or a 1 1/2-ounce shot of liquor. These limits may be too high for some people who have certain medical problems or who are older. Talk with your doctor about the limit that is right for you.

·

Write your drinking goal on a piece of paper. Put it where you can see it, such as on your refrigerator or bathroom mirror.

·

Keep a “diary” of your drinking. To help you reach your goal, keep a “diary” of your drinking. For example, write down every time you have a drink for 1 week. Try to keep your diary for 3 or 4 weeks. How different is your goal from the amount you drink now? Use the “drinking diary” below to write down when you drink. Week: # of drinks

Type drinks

of Place consumed

Mon. Tues. Wed. Thurs. Fri. Sat. Sun. 57

Adapted from the NIAAA: http://www.niaaa.nih.gov/publications/handout.htm.

Reducing Alcohol Consumption 333

Tips for Reducing Your Alcohol Intake Now you know why you want to drink less and you have a goal. There are many ways you can help yourself to cut down. Try these tips: ·

Watch it at home. Keep a small amount or no alcohol at home. Don't keep temptations around.

·

Drink slowly. When you drink, sip your drink slowly. Take a break of 1 hour between drinks. Drink soda, water, or juice after a drink with alcohol. Do not drink on an empty stomach! Eat food when you are drinking.

·

Take a break from alcohol. Pick a day or two each week when you will not drink at all. Then, try to stop drinking for 1 week. Think about how you feel physically and emotionally on these days. When you succeed and feel better, you may find it easier to cut down for good.

·

Learn how to say NO. You do not have to drink when other people drink. You do not have to take a drink that is given to you. Practice ways to say no politely. For example, you can tell people you feel better when you drink less. Stay away from people who give you a hard time about not drinking.

·

Stay active. What would you like to do instead of drinking? Use the time and money spent on drinking to do something fun with your family or friends. Go out to eat, see a movie, or play sports or a game.

·

Get support. Cutting down on your drinking may be difficult at times. Ask your family and friends for support to help you reach your goal. Talk to your doctor if you are having trouble cutting down. Get the help you need to reach your goal.

·

Watch out for temptations. Watch out for people, places, or times that make you drink, even if you do not want to. Stay away from people who drink a lot or bars where you used to go. Plan ahead of time what you will do to avoid drinking when you are tempted. Do not drink when you are angry or upset or have a bad day. These are habits you need to break if you want to drink less.

·

DO NOT GIVE UP! Most people do not cut down or give up drinking all at once. Just like a diet, it is not easy to change. That is okay. If you do not reach your goal the first time, try again. Remember, get support from people who care about you and want to help. Do not give up!

Online Glossaries 335

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

·

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

·

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

·

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

·

On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/

·

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

·

Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html

Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to alcoholism and keep them on file. The NIH, in particular, suggests that patients with alcoholism visit the following Web sites in the ADAM Medical Encyclopedia: ·

Basic Guidelines for Alcoholism

336 Alcoholism

Alcohol dependence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm Alcoholism Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm Alcoholism - resources Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002199.htm Liver disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000205.htm ·

Signs & Symptoms for Alcoholism Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Agitation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Cessation of menses Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003149.htm Confusion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Depression Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm

Online Glossaries 337

Erythema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm GI bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003133.htm Gynecomastia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003165.htm Hallucinations Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003258.htm High blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003082.htm Hyperpigmentation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003242.htm Impotence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm Insomnia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003210.htm Jaundice Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003243.htm Memory loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003257.htm

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Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Nausea and vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Nausea and vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Numbness and tingling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Palpitations Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003081.htm Seizures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm Tachycardia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003077.htm Telangiectasia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003284.htm Tension Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Tingling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm

Online Glossaries 339

Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm ·

Diagnostics and Tests for Alcoholism Alkaline phosphatase Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003470.htm Aspartate aminotransferase Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm AST Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Blood urea nitrogen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm Cortisol level Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003693.htm Erosion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003225.htm Granulocyte Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003440.htm HDL Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003496.htm

340 Alcoholism

Hematocrit Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003646.htm Liver function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003436.htm MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003335.htm Platelet count Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003647.htm Total protein Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003483.htm Toxicology screen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003578.htm Uric acid Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003476.htm White blood cell count Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003643.htm ·

Nutrition for Alcoholism Balanced diet Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002449.htm Vitamins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002399.htm

Online Glossaries 341

·

Background Topics for Alcoholism Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Alcohol consumption Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001944.htm Alcohol use Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001944.htm Alcoholism - support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002199.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Cardiovascular Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002310.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Drug dependence - resources Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002169.htm Hepatic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002378.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm

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Peripheral Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002273.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Self-help group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002150.htm Substance abuse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001945.htm Support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002150.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

·

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

·

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

·

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

Glossary 343

ALCOHOLISM GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Acid: Common street name for LSD. [NIH] Adenoma: A benign epithelial tumour in which the cells form recognizable glandular structures or in which the cells are clearly derived from glandular epithelium. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]

Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of

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man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antidote: A remedy for counteracting a poison. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Aqueous: Watery; prepared with water. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Atrial: Pertaining to an atrium. [EU] Autonomic: Self-controlling; functionally independent. [EU] Autopsy: Postmortem examination of the body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms:

Glossary 345

round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Barbiturate: A type of central nervous system (CNS) depressant often prescribed to promote sleep. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Benzodiazepine: A type of CNS depressant prescribed to relieve anxiety; among the most widely prescribed medications, including Valium and Librium. [NIH] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bilateral: Having two sides, or pertaining to both sides. [EU] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Bisexuality: Sexual attraction or relationship between members of the same and opposite sex. [NIH] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Cachexia: A profound and marked state of constitutional disorder; general ill health and malnutrition. [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Capillaries: The minute vessels that connect the arterioles and venules. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH]

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Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiac: Pertaining to the heart. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]

Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chloral Hydrate: A hypnotic and sedative used in the treatment of insomnia. The safety margin is too narrow for chloral hydrate to be used as a general anesthetic in humans, but it is commonly used for that purpose in animal experiments. It is no longer considered useful as an anti-anxiety medication. [NIH] Chloroquine: The prototypical antimalarial agent with a mechanism that is not well understood. It has also been used to treat rheumatoid arthritis, systemic lupus erythematosus, and in the systemic therapy of amebic liver abscesses. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of

Glossary 347

abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Codeine: An opioid analgesic related to MORPHINE but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Crack: Short term for a smokable form of cocaine. [NIH] Craving: A powerful, often uncontrollable desire for drugs. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dementia: A condition of deteriorated mentality. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH]

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Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Detoxification: A process of allowing the body to rid itself of a drug while managing the symptoms of withdrawal; often the first step in a drug treatment program. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dioxins: Chlorinated hydrocarbons containing heteroatoms that are present as contaminants of herbicides. Dioxins are carcinogenic, teratogenic, and mutagenic. They have been banned from use by the FDA. [NIH] Diuretic: An agent that promotes the excretion of urine. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dopamine: A neurotransmitter present in regions of the brain that regulate movement, emotion, motivation, and feeling of pleasure. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Emetic: An agent that causes vomiting. [EU] Emphysema: A lung disease in which tissue deterioration results in increased air retention and reduced exchange of gases. The result is difficult breathing and shortness of breath. It is often caused by smoking. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU]

Glossary 349

Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethchlorvynol: A sedative and hypnotic that has been used in the shortterm management of insomnia. Its use has been superseded by other drugs. [NIH]

Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fentanyl: A medically useful opioid analog that is 50 times more potent than heroin. [NIH] Flumazenil: A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as an antidote to benzodiazepine overdoses. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Fluvoxamine: A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders. [NIH] Galanthamine: A cholinesterase inhibitor. It has been used to reverse the muscular effects of gallamine and tubocurarine and has been studied as a treatment for Alzheimer's disease and other central nervous system disorders. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH]

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Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Hallucination: A sense perception without a source in the external world; a perception of an external stimulus object in the absence of such an object. [EU] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Homicide: The killing of one person by another. [NIH] Homosexuality: Sexual attraction or relationship between members of the same sex. [NIH] Hormone: A chemical substance formed in glands in the body and carried in the blood to organs and tissues, where it influences function, structure, and behavior. [NIH] Hunger: The desire for food generated by a sensation arising from the lack of food in the stomach. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase

Glossary 351

in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hyperventilation: A state in which there is an increased amount of air entering the pulmonary alveoli (increased alveolar ventilation), resulting in reduction of carbon dioxide tension and eventually leading to alkalosis. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]

Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator

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of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. it includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intramuscular: Within the substance of a muscle. [EU] Intravenous: Within a vein or veins. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Jejunostomy: Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lethal: Deadly, fatal. [EU]

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Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Liquor: 1. a liquid, especially an aqueous solution containing a medicinal substance. 2. a general term used in anatomical nomenclature for certain fluids of the body. [EU] Lithium: Lithium. An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Loneliness: The state of feeling sad or dejected as a result of lack of companionship or being separated from others. [NIH] Lorazepam: An anti-anxiety agent with few side effects. It also has hypnotic, anticonvulsant, and considerable sedative properties and has been proposed as a preanesthetic agent. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Manic: Affected with mania. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH]

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Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Metabolite: process. [EU]

Any substance produced by metabolism or by a metabolic

Methadone: A long-acting synthetic medication shown to be effective in treating heroin addiction. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Morale: The prevailing temper or spirit of an individual or group in relation to the tasks or functions which are expected. [NIH] Motility: The ability to move spontaneously. [EU] Myopathy: Any disease of a muscle. [EU] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcissism: A psychoanalytic term meaning self-love. [NIH] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU]

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Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous sytem. [NIH] Neurotransmitter: Chemical compound that acts as a messenger to carry signals or stimuli from one nerve cell to another. [NIH] Nicotine: An alkaloid derived from the tobacco plant that is responsible for smoking's psychoactive and addictive effects; is toxic at high doses but can be safe and effective as medicine at lower doses. [NIH] NMDA: N-methyl-D-aspartate, a chemical compound that reacts with glutamate receptors on nerve cells. [NIH] Ondansetron: A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and it has reported anxiolytic and neuroleptic properties. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Palpitation: A subjective sensation of an unduly rapid or irregular heart beat. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while

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the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH]

Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH] Placebos: Any dummy medication or treatment. Although placebos originally were medicinal preparations having no specific pharmacological activity against a targeted condition, the concept has been extended to include treatments or procedures, especially those administered to control groups in clinical trials in order to provide baseline measurements for the experimental protocol. [NIH] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH]

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Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prejudice: A preconceived judgment made without adequate evidence and not easily alterable by presentation of contrary evidence. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prisons: Penal institutions, or places of confinement for war prisoners. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH]

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Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]

Pulmonary: Pertaining to the lungs. [EU] Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH] Punishment: The application of an unpleasant stimulus or penalty for the purpose of eliminating or correcting undesirable behavior. [NIH] Radar: A system using beamed and reflected radio signals to and from an object in such a way that range, bearing, and other characteristics of the object may be determined. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Sarin: An organophosphorous ester compound that produces potent and irreversible inhibition of cholinesterase. It is toxic to the nervous system and is a chemical warfare agent. [NIH]

Glossary 359

Schizophrenia: A severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, hallucinations, emotional disharmony, and regressive behavior. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Serotonin: A neurotransmitter that causes a very broad range of effects on perception, movement, and the emotions by modulating the actions of other neurotransmitters in most parts of the brain. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sociology: A social science dealing with group relationships, patterns of collective behavior, and social organization. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Soporific: 1. causing or inducing profound sleep. 2. a drug or other agent which induces sleep. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Steatosis: Fatty degeneration. [EU]

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Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Suicide: The act of killing oneself. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]

Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]

Systemic: Pertaining to or affecting the body as a whole. [EU] Tachycardia: Excessive rapidity in the action of the heart; the term is usually applied to a heart rate above 100 per minute and may be qualified as atrial, junctional (nodal), or ventricular, and as paroxysmal. [EU] Telemedicine: Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services. [NIH] Temperance: Abstinence from alcohol. [NIH] Thermoregulation: Heat regulation. [EU] Thiocyanates: Organic derivatives of thiocyanic acid which contain the general formula R-SCN. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tolerance: A condition in which higher doses of a drug are required to produce the same effect as during initial use; often is associated with physical dependence. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]

Tranquilizers: Drugs prescribed to promote sleep or reduce anxiety; this National Household Survey on Drug Abuse classification includes benzodiazepines, barbiturates, and other types of CNS depressants. [NIH]

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Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Translating: Conversion from one language to another language. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. it is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Unithiol: A chelating agent used as an antidote to heavy metal poisoning. [NIH]

Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Ventral: 1. pertaining to the belly or to any venter. 2. denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricular: Pertaining to a ventricle. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viremia: The presence of viruses in the blood. [NIH] Vitamin B12: A cobalt-containing coordination compound produced by intestinal micro-organisms and found also in soil and water. Higher plants do not concentrate vitamin B12 from the soil and so are a poor source of the substance as compared with animal tissues. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Withdrawal: A variety of symptoms that occur after chronic use of some drugs is reduced or stopped. [NIH] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]

Zalcitabine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is a potent inhibitor of HIV replication at low concentrations, acting as a chain-terminator of viral DNA by binding to reverse transcriptase. Its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy. [NIH]

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General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna

·

Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna

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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna

·

Dorland's Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna

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Dorland's Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna

·

Dorland's Pocket Medical Dictionary (Dorland's Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618

·

Melloni's Illustrated Medical Dictionary (Melloni's Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna

·

Stedman's Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition

Glossary 363

(2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna ·

Stedman's Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna

·

Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna

364 Alcoholism

INDEX A Abdomen ...............30, 196, 329, 354, 360 Abdominal...195, 210, 323, 324, 352, 355, 356 Acid.......96, 115, 137, 145, 148, 153, 156, 187, 194, 245, 277, 279, 281, 290, 340, 343, 344, 353, 360, 361 Adolescence 300, 301, 302, 304, 318, 343 Adverse .................................83, 120, 351 Alimentary............139, 319, 329, 352, 356 Amphetamine ......................................124 Anions..................................................155 Anorexia ................................................52 Antibiotic ........................................30, 359 Antibody...............112, 139, 216, 344, 353 Anticonvulsant .....................113, 345, 353 Antidepressant....112, 113, 138, 253, 345, 349, 351 Antidote .......................187, 245, 349, 361 Antigen ........................139, 194, 344, 353 Anxiety..11, 112, 113, 129, 139, 186, 244, 253, 257, 319, 329, 345, 346, 349, 353, 357, 360 Aqueous ......................154, 155, 318, 353 Assay...........................................144, 146 Asymptomatic ..............................195, 356 Atrial ....................................................360 B Bacteria .........30, 112, 276, 344, 359, 361 Benign .........................................225, 343 Benzodiazepine .....................94, 245, 349 Bilateral................................................254 Bioavailability.......................................152 Biochemical .........................................126 C Cachexia......................................155, 156 Capillaries ............................................349 Capsules..............................................279 Carbohydrate.......138, 144, 146, 278, 350 Carcinoma ...........................................118 Cardiac ........................................155, 156 Cardiovascular.....................131, 137, 343 Cerebral.................................................96 Cerebrospinal ........................................96 Chemotherapy .............................114, 355 Chloral Hydrate............................244, 346 Cholesterol ..................................276, 278 Chromosomal ......................................126 Chronic .29, 30, 41, 49, 68, 118, 125, 144, 145, 146, 148, 155, 195, 221, 253, 255, 282, 325, 346, 356, 361

Cirrhosis........................ 12, 118, 161, 323 Cocaine................. 78, 206, 210, 299, 347 Comorbidity......................................... 129 Confusion............................................ 324 Congestion.......................................... 349 Consciousness ................................... 347 Constipation ........................................ 190 Contamination....................................... 34 Cortex ......................................... 122, 133 Craving. 11, 12, 92, 98, 99, 102, 124, 128, 151, 253, 260 Cues...................................................... 99 D Degenerative ................ 42, 138, 277, 348 Dehydration......................................... 190 Dementia..................................... 181, 190 Deprivation.......................................... 128 Detoxification ... 14, 16, 32, 37, 47, 56, 94, 103, 155, 254 Diarrhea .............................................. 276 Dizziness............................................. 152 Dopamine..... 82, 112, 124, 137, 149, 343, 345, 347 E Electrophysiological ............................ 122 Emetic ................................................. 124 Emphysema ........................................ 190 Endocrinology ....................................... 41 Endogenous........................................ 128 Enzyme ......................... 82, 140, 348, 360 Epidemiological......................... 10, 38, 70 Ethanol................ 123, 143, 144, 151, 281 F Fatal .......... 10, 13, 70, 306, 324, 325, 352 Fatigue .......................................... 29, 344 Fluoxetine ..................... 95, 100, 143, 257 Flushing .............................................. 152 Fluvoxamine........................................ 143 G Galanthamine ............................. 145, 148 Gastrointestinal ........... 138, 161, 253, 349 Ginseng............................................... 253 Glucose....... 138, 254, 319, 329, 350, 351 H Hematocrit........................................... 350 Hepatitis .............................. 118, 161, 323 Hepatocellular ..................................... 118 Heredity............................................... 149 Homeostasis ....................................... 283 Homicide ............................................. 301

Index 365

Hormone.....131, 278, 283, 289, 319, 329, 351, 352 Hyperbilirubinemia...............319, 329, 352 Hypertension ...............................139, 357 Hyperventilation...................................152 Hypotension.........................................152 I Imipramine...........................................257 Immunity ................................................83 Immunization .......................138, 140, 359 Indicative ....121, 146, 149, 186, 289, 351, 354 Ingestion ........................84, 155, 279, 356 Inpatients .......................98, 105, 255, 282 Insomnia ......................244, 245, 346, 349 Insulin ..........138, 319, 324, 329, 350, 352 Intermittent.............................................96 Intestines .............................................325 Intoxication ........4, 32, 131, 153, 154, 155 Intramuscular.......................................254 Intravenous..................................139, 356 Irritants.................................139, 259, 352 J Jaundice ..............................................323 K Keratin .........................155, 156, 187, 352 L Larynx ....................................................12 Lesion ..................................................349 Leucine ................................................153 Lipid .............155, 156, 281, 319, 329, 352 Liquor...........................305, 322, 326, 332 Lithium .........................................245, 353 Lobe.....................................................122 Loneliness ...........................................325 Lorazepam.............................................94 M Malabsorption ......................................221 Manic .....................................42, 245, 353 Medicament .........................................281 Melanocytes ........................................351 Membrane .....................................30, 352 Menopause..........................139, 323, 357 Metabolite ......................................96, 279 Methadone.............................................56 Molecular .41, 84, 122, 214, 219, 220, 358 Myopathy .............................................161 N Naloxone ...............................30, 128, 354 Naltrexone ..14, 16, 30, 91, 92, 93, 94, 95, 97, 98, 99, 100, 101, 104, 105, 106, 123, 128, 143, 206, 354 Nausea ..................11, 114, 124, 152, 355 Necrosis...............................................283 Neural ..................................................277 Neuronal ................................96, 289, 355

Neuropeptides ............................ 289, 355 Neurotransmitter . 113, 114, 123, 348, 359 Nicotine ......................... 92, 102, 125, 206 O Ondansetron ................... 93, 95, 106, 123 Opiate ......................... 139, 150, 151, 354 Osteoporosis....................................... 184 Outpatients............................ 91, 101, 105 Overdose ............................................ 277 P Paclitaxel..................................... 255, 282 Pancreas.... 161, 195, 319, 324, 329, 351, 356 Pancreatitis ................. 181, 283, 323, 324 Parenteral ........................... 136, 152, 254 Parity..................................................... 44 Paroxetine........................................... 143 Perinatal................................................ 46 Phenotype................................... 114, 356 Pigments ............................. 319, 329, 352 Placebos ............................. 114, 152, 356 Plague......................... 319, 327, 329, 356 Poisoning ............................ 187, 306, 361 Potassium ........................................... 278 Preclinical.................................... 124, 128 Precursor .............................. 96, 115, 361 Predisposition ............................. 122, 123 Prenatal................................................. 33 Prevalence .................................... 50, 161 Progressive ................... 59, 118, 289, 354 Propranolol.......................................... 254 Prostate............................................... 221 Psychiatric.. 34, 42, 54, 57, 120, 129, 147, 258 Psychiatry ......................... 40, 42, 63, 357 Psychology...................................... 63, 70 Psychopathology ................ 120, 129, 205 Psychopharmacology ......................... 122 Psychotherapy .................... 105, 124, 182 Pulmonary................... 186, 289, 350, 351 Punishment ......................................... 307 R Receptor ...... 96, 112, 114, 123, 124, 149, 245, 258, 344, 349, 355 Recurrence ......................................... 126 Remission ....................... 4, 139, 254, 358 Riboflavin ............................................ 276 S Saline .................................................. 152 Sanitation ........................................ 33, 45 Schizophrenia ................. 42, 52, 133, 149 Secretion............................... 85, 283, 359 Sedentary.............................................. 41 Seizures ...................... 113, 211, 345, 359 Selenium ............................................. 278

366 Alcoholism

Serotonin 95, 96, 113, 114, 127, 143, 186, 187, 349, 355, 356, 359 Sertraline ...............................94, 101, 107 Serum ..........................118, 140, 254, 359 Spectrum .............................................361 Stomach .....138, 161, 322, 324, 325, 333, 349, 350 Suicide .................................................301 Sulfur ...........................................154, 155 Synaptic .........................................96, 124 Synergistic ...................................123, 143 Systemic ..................54, 81, 245, 345, 346 T Thermoregulation ................................276 Thiocyanates .......................................154 Thyroxine.............................................278

Tomography.................................. 96, 124 Tranquilizers ....................................... 325 Transdermal................................ 145, 150 Translating ............................................ 52 Transplantation ................................... 323 Tryptophan.......................................... 127 Tuberculosis.......................................... 46 V Venereal................................................ 46 Ventral................................................. 124 Ventricular........................................... 360 Viral............................. 118, 160, 245, 361 W Wakefulness ....................................... 351 Withdrawal . 30, 90, 94, 98, 145, 148, 194, 254, 281, 348

Index 367

368 Alcoholism

Index 369

370 Alcoholism