DOCSLIB.ORG

Alcoholic Liver Disease Your Role Is Essential in Preventing, Detecting, and Co-Managing Alcoholic Liver Disease in Inpatient and Ambulatory Settings

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Alcoholic Liver Disease Your Role Is Essential in Preventing, Detecting, and Co-Managing Alcoholic Liver Disease in Inpatient and Ambulatory Settings Preventing drinking relapse in patients with alcoholic liver disease Your role is essential in preventing, detecting, and co-managing alcoholic liver disease in inpatient and ambulatory settings Gerald Scott Winder, MD lcohol use disorder (AUD) is a mosaic of psychiatric and Assistant Professor medical symptoms. Alcoholic liver disease (ALD) in its acute Department of Psychiatry University of Michigan Health System and chronic forms is a common clinical consequence of long- Ann Arbor, Michigan A standing AUD. Patients with ALD require specialized care from pro- Jessica Mellinger, MD, MSc fessionals in addiction, gastroenterology, and psychiatry. However, Clinical Lecturer medical specialists treating ALD might not regularly consider medi- Department of Internal Medicine University of Michigan Health System cations to treat AUD because of their limited experience with the Ann Arbor, Michigan drugs or the lack of studies in patients with significant liver disease.1 Robert J. Fontana, MD Similarly, psychiatrists might be reticent to prescribe medications for Professor of Medicine AUD, fearing that liver disease will be made worse or that they will Division of Gastroenterology cause other medical complications. As a result, patients with ALD Department of Internal Medicine University of Michigan Health System might not receive care that could help treat their AUD (Box, page 24). Ann Arbor, Michigan Given the high worldwide prevalence and morbidity of ALD,2 gen- Disclosures eral and subspecialized psychiatrists routinely evaluate patients with Dr. Winder and Dr. Mellinger report no financial AUD in and out of the hospital. This article aims to equip a psychia- relationships with any company whose products are mentioned in this article or with manufacturers of trist with: competing products. Dr. Fontana receives research • a practical understanding of the natural history and categoriza- funding from Bristol Myers Squibb, Gilead, and Janssen and consults for the Chronic Liver Disease Foundation. tion of ALD • basic skills to detect symptoms of ALD • preparation to collaborate with medical colleagues in multi- disciplinary management of co-occurring AUD and ALD • a summary of the pharmacotherapeutics of AUD, with emphasis on patients with clinically apparent ALD. continued Current Psychiatry JON KRAUSE FOR CURRENT PSYCHIATRY Vol. 14, No. 12 23 Box patients who have a MELD score >15 ben- Box Key points about treating efit from transplant. To definitively deter- mine the severity of ALD, a liver biopsy is liver disease in patients required but usually is not performed in with alcoholism clinical practice. Collaborative management of medical, All patients who drink heavily or suffer substance-related, and psychiatric symptoms with AUD are at risk of developing AH; of ALD offers medical and psychiatric benefits Alcoholic liver women and binge drinkers are particu- Psychiatrists are essential for successful 4 disease monitoring and treatment of ALD. They larly vulnerable. Liver dysfunction and should be knowledgeable about its signs and malnutrition in ALD patients compromise symptoms the immune system, increasing the risk of In ALD, there is a role for AUD infection. Patients hospitalized with AH pharmacotherapy despite the risk of adverse have a 10% to 30% risk of inpatient mor- effects tality; their 1- and 2-month post-discharge More research is needed to describe (1) the efficacy of AUD pharmacotherapy for survival is 50% to 65%, largely determined preventing relapse in this population, (2) how by whether the patient can maintain sobri- Clinical Point these medications can be effectively and ety.5 Psychiatrists’ contribution to ALD safely used in ALD patients, and (3) what care A psychiatrist coordination strategies can make best use of treatment therefore has the potential to multidisciplinary management of patients with save lives. evaluating comorbid ALD and AUD a jaundiced patient ALD: alcoholic liver disease; AUD: alcohol use disorder who continues to Screening and detection of ALD drink should arrange Because of the high mortality associated with AH and cirrhosis, symptom recogni- urgent medical Categorization and clinical tion and collaborative medical and psy- evaluation features chiatric management are critical (Table 2, Alcoholic liver damage encompasses a page 28). A psychiatrist evaluating a jaun- spectrum of disorders, including alcoholic diced patient who continues to drink should fatty liver, acute alcohol hepatitis (AH), arrange urgent medical evaluation. While and cirrhosis following varying durations gathering a history, mental health providers and patterns of alcohol use. Manifestations might hear a patient refer to symptoms of of ALD vary from asymptomatic fatty gastrointestinal bleeding (vomiting blood, liver with minimal liver enzyme eleva- bloody or dark stool), painful abdominal tion to severe acute AH with jaundice, distension, fevers, or confusion that should coagulopathy, and high short-term mor- prompt a referral to a gastroenterologist or tality (Table 1, page 26). Symptoms seen in the emergency department. Testing for uri- patients with AH include fever, abdominal nary ethyl glucuronide—a direct metabolite pain, anorexia, jaundice, leukocytosis, and of ethanol that can be detected for as long coagulopathy.3 as 90 hours after ethanol ingestion—is use- Patients with chronic ALD often develop ful in detecting alcohol use in the past 4 or cirrhosis, persistent elevation of the serum 5 days. aminotransferase level (even after pro- longed alcohol abstinence), signs of portal hypertension (ascites, encephalopathy, var- Medical management of ALD iceal bleeding), and profound malnutrition. Corticosteroids are a mainstay in pharma- Discuss this article at The survival of ALD patients with chronic cotherapy for severe AH. There is evidence www.facebook.com/ liver failure is predicted in part by a Model for improved outcomes in patients with CurrentPsychiatry for End-Stage Liver Disease (MELD) score severe AH treated with prednisolone for that incorporates their serum total biliru- 4 to 6 weeks.5 Prognostic models such as bin level, creatinine level, and international the Maddrey’s Discriminant Function, Lille normalized ratio. The MELD score, which Model, and the MELD score help determine ranges from 6 to 40, also is used to gauge the need for steroid use and identify high- Current Psychiatry 24 December 2015 the need for liver transplantation; most risk patients. Patients with active infection or bleeding are not a candidate for steroid because of their additive interactions with treatment. An experienced gastroenterolo- alcohol, cognitive and psychomotor side gist or hepatologist should initiate medical effects, and abuse potential.9,10 Many of intervention after thorough evaluation. these drugs are cleared by the liver and generally are not recommended for use in Liver transplantation. A select group of patients with ALD. patients with refractory liver failure are con- sidered for liver transplantation. Although Other agents, further considerations. transplant programs differ in their criteria Drug trials in AUD largely have been con- for organ listing, many require patients to ducted in small, heterogeneous populations demonstrate at least 6 months of verified and revealed modest and, at times, con- abstinence from alcohol and illicit drugs as flicting drug effect sizes.6,11,12 The placebo well as adherence to a formal AUD treat- effect among the AUD population is pro- ment and rehabilitation plan. The patient’s nounced.6,7,13 Despite these caveats, several psychological health and prognosis for sus- agents have been studied and validated by tained sobriety are central to candidacy for the FDA to treat AUD. Additional agents organ listing, which highlights the key role with promising pilot data are being inves- Clinical Point 1,7,10,11,13-43 of psychiatrists. tigated. Table 3 (page 30) summa- Alcohol abstinence rizes drugs used to treat AUD—those with Further considerations. Thiamine and and without FDA approval—with a focus remains central to folate often are given to patients with ALD. on how they might be used in patients with survival because Abdominal imaging and screening for HIV ALD. Of note, several of these agents do not relapse increases and viral hepatitis—identified in 10% to 20% rely on the liver for metabolism or excretion. the risk of recurrent, of ALD patients—is routine. Alcohol absti- There is no agreed-upon algorithm or severe liver disease nence remains central to survival because safety profile to guide a prescriber’s deci- relapse increases the risk of recurrent, severe sion making about drug or dosage choices liver disease. Regrettably, many physical when treating AUD in patients with ALD. symptoms of liver disease, such as portal Because liver function can vary among hypertension, ascites, and jaundice, can take patients as well as during an individual months to improve with abstinence. patient’s disease course, treatment deci- sions should be made on a clinical, collab- orative, and case-by-case basis. Treating AUD in patients with ALD That being said, the AUD treatment liter- Successful treatment is multifaceted and ature suggests that specific drugs might be includes more than just medications. Initial more useful in patients with varying sever- management often includes addressing ity of disease and during different phases of alcohol withdrawal in dependent patients.6 recovery: • Acamprosate has been found to be Behavioral interventions are effective effective in supporting abstinence
Load more

Recommended publications
  • Insights Into the Molecular Basis for Substrate Binding and Specificity of the Wild-Type L-Arginine/Agmatine Antiporter Adic
    Insights into the molecular basis for substrate binding and specificity of the wild-type L-arginine/agmatine antiporter AdiC Hüseyin Ilgüa,b,1, Jean-Marc Jeckelmanna,b,1, Vytautas Gapsysc, Zöhre Ucuruma,b, Bert L. de Grootc, and Dimitrios Fotiadisa,b,2 aInstitute of Biochemistry and Molecular Medicine, University of Bern, CH-3012 Bern, Switzerland; bSwiss National Centre of Competence in Research TransCure, University of Bern, CH-3012 Bern, Switzerland; and cComputational Biomolecular Dynamics Group, Max-Planck-Institute for Biophysical Chemistry, D-37077 Goettingen, Germany Edited by Christopher Miller, Howard Hughes Medical Institute, Brandeis University, Waltham, MA, and approved July 26, 2016 (received for review April 4, 2016) Pathogenic enterobacteria need to survive the extreme acidity of Arg-bound states (10). The two outward-open, substrate-free the stomach to successfully colonize the human gut. Enteric bacteria structures are at the reasonable and moderate resolutions of 3.2 Å circumvent the gastric acid barrier by activating extreme acid- (8) and 3.6 Å (9), respectively, and the only ones available of wild- resistance responses, such as the arginine-dependent acid resistance type AdiC (AdiC-wt). The two other structures are with bound system. In this response, L-arginine is decarboxylated to agmatine, Arg and at 3-Å resolution, and could only be obtained as a result thereby consuming one proton from the cytoplasm. In Escherichia of the introduction of specific point mutations: AdiC-N22A (10) coli,theL-arginine/agmatine antiporter AdiC facilitates the export and AdiC-N101A (11). The N101A mutation results in a defective of agmatine in exchange of L-arginine, thus providing substrates for AdiC protein unable to bind Arg and with a dramatically de- further removal of protons from the cytoplasm and balancing the creased turnover rate compared with wild-type (11).
    [Show full text]
  • Separation of Isomers <Emphasis Type="Italic">L </Emphasis>-Alanine and Sarcosine in Urine by Electrospra
    SHORT COMMUNICATION Separation of Isomers L-Alanine and Sarcosine in Urine by Electrospray Ionization and Tandem Differential Mobility Analysis-Mass Spectrometry Pablo Martínez-Lozanoa and Juan Rusb a Institute for Biomedical Technologies-National Research Council, Milan, Italy b SEADM, Valladolid, Spain Sarcosine, an isomer of L-alanine, has been proposed as a prostate cancer progression biomarker [1]. Both compounds are detected in urine, where the measured sarcosine/alanine ratio has been found to be higher in prostate biopsy-positive group versus controls. We present here preliminary evidence showing that urine samples spiked with sarcosine/alanine can be partially resolved in 3 min via tandem differential mobility analysis-mass spectrometry (DMA-MS). Based on the calibration curves obtained for two mobility peaks, we finally estimate their concentration ratio in urine. (J Am Soc Mass Spectrom 2010, 21, 1129–1132) © 2010 American Society for Mass Spectrometry rostate cancer is a leading cause of death among the tive-ion mode at the DMA entrance slit. Our nanospray male population. Sarcosine, an isomer of alanine, parameters were: capillary 360 ␮m o.d., 50 ␮m i.d., length Pwas recently proposed as a prostate cancer progres- 22 cm, driving pressure 75 mbar, and 3.8 kV. The ions sion biomarker [1]. In particular, the sarcosine/alanine entered the separation region propelled by an electric field ratio was found to be significantly higher in urine derived and against a counterflow gas (0.2 L/min). Sheath gas from biopsy-positive prostate cancer patients compared flow was kept constant, and the classification voltage was with biopsy-negative controls.
    [Show full text]
  • Nottinghamshire Primary Care Alcohol Misuse Guidelines
    Nottinghamshire Primary Care Alcohol Dependence Guidelines V5.2 Last reviewed: April Review date: August 2021 2022 Title Nottinghamshire Primary Care Alcohol Dependence Guidelines Version 5.2 Lead - Dr Stephen Willott, GP Windmill Practice, Nottingham; Clinical Lead for alcohol misuse, Nottingham Recovery Network and Public Health Department, Nottingham City Council Author / Tanya Behrendt, Senior Pharmacist (Nottingham City Locality), NHS Nottingham and Nottinghamshire CCG Nominated Apollos Clifton-Brown, Operational Manager, Nottingham Recovery Network Dr David Rhinds, Consultant Addictions Psychiatrist, Nottinghamshire Healthcare NHS Foundation Trust Lead Dr Kaanthan Jawahar, ST6 Old Age Psychiatry, Derbyshire Healthcare NHS Foundation Trust Hannah Godden, Mental Health Interface and Efficiencies Pharmacist, Nottinghamshire Healthcare NHS Foundation Trust/ NHS Nottingham and Nottinghamshire CCG Jill Theobald, Interface Efficiencies Pharmacist, NHS Nottingham and Nottinghamshire CCG Approval Date August 2019 Review Date August 2022 Section Contents Page Number i. Summary 2 1. Introduction 4 2. Scope 5 3. Aims of Community Detoxification 5 4. Identifying suitable patients 5 5. Medical risks of community detoxification 6 6. Risk reduction 6 7. Record keeping 7 8. Equipment 7 9. Preparation for home detoxification 7 10. Medication 8 11. Relapse prevention/Follow up 8 12. Reducing alcohol consumption in people with alcohol dependence 9 13. Potentially difficult situations 10 14. References and version control 10 Appendix A Diagnostic Criteria
    [Show full text]
  • Beta Alanine
    PERFORMANCE ENHANCERS FACTS AND BOTTOM LINE BETA ALANINE What is it? B-alanine is a naturally occurring amino acid (a non-essential amino acid) not used by the body to make muscle tissue. Rather, research has shown that B-alanine works by increasing the muscle content of an important compound – carnosine. In fact, the production of carnosine is limited by the availability of B-alanine. Carnosine is highly concentrated in muscle tissue where its role is primarily to soak up hydrogen ions. Does it work? B-alanine is one of the few dietary supplements that actually have good scientific evidence that it can possibly enhance performance. How does it work? When you exercise intensely the body produces hydrogen ions. The longer you exercise the more hydrogen ions you produce and this reduces the pH level in your muscles. Muscles work best in a very specific pH range and when the pH drops below that level then muscular performance also starts to decrease. Anything that helps to prevent or delay that drop in pH will help delay muscle fatigue. This is where B-alanine has proven to be very helpful. Beta-alanine increases the levels of carnosine in your slow and fast twitch muscle fibers and carnosine is a buffer that basically soaks up hydrogen ions and so reduces the drop in pH. By keeping your hydrogen ion levels lower, B-alanine allows you to train harder and longer. The bottom line is that B-alanine works by increasing the hydrogen ion buffering abilities of your muscles. What benefits does it offer? B-alanine has been shown to increase muscle strength, increase muscle mass, increase anaerobic endurance, increase aerobic endurance and increase exercise capacity.
    [Show full text]
  • Poly(L-Alanine) As a Universal Reference Material for Understanding Protein Energies and Structures TERESA HEAD-GORDON, FRANK H
    Proc. Nati. Acad. Sci. USA Vol. 89, pp. 11513-11517, December 1992 Biophysics Poly(L-alanine) as a universal reference material for understanding protein energies and structures TERESA HEAD-GORDON, FRANK H. STILLINGER, MARGARET H. WRIGHT, AND DAVID M. GAY AT&T Bell Laboratories, Murray Hill, NJ 07974 Contributed by Frank H. Stillinger, June 17, 1992 ABSTRACT We present a proposition, the "poly(L- alanine) hypothesis," which asserts that the native backbone geometry for any polypeptide or protein of M residues has a closely mimicking, mechanically stable, image in poly(L- POLY-L-ALANINE alanine) of the same number of residues. Using a molecular co mechanics force field to represent the relevant potential energy a: hypersurfaces, we have carried out calculations over a wide z range of M values to show that poly(L-alanine) possesses the w structural versatility necessary to satisfy the proposition. These w include poly(L-alanine) representatives of minima correspond- U- ing to secondary and supersecondary structures, as well as PROTEIN poly(L-alanine) images for tertiary structures of the naturally occurring proteins bovine pancreatic trypsin inhibitor, crambin, ribonuclease A, and superoxide dismutase. The suc- cessful validation of the hypothesis presented in this paper BACKBONE COORDINATES indicates that poly(L-alanine) will serve as a good reference FIG. 1. Topographic basis ofthe poly(L-alanine) hypothesis. Free material in thermodynamic perturbation theory and calcula- energy hypersurfaces are compared for a given protein and for tions aimed at evaluating relative free energies for competing poly(L-alanine) with the same number of residues. candidate tertiary structures in real polypeptides and proteins.
    [Show full text]
  • Alcohol Use Disorder
    Section: A B C D E Resources References Alcohol Use Disorder (AUD) Tool This tool is designed to support primary care providers (family physicians and primary care nurse practitioners) in screening, diagnosing and implementing pharmacotherapy treatments for adult patients (>18 years) with Alcohol Use Disorder (AUD). Primary care providers should routinely offer medication for moderate and severe AUD. Pharmacotherapy alone to treat AUD is better than no therapy at all.1 Pharmacotherapy is most effective when combined with non-pharmacotherapy, including behavioural therapy, community reinforcement, motivational enhancement, counselling and/or support groups. 2,3 TABLE OF CONTENTS pg. 1 Section A: Screening for AUD pg. 7 Section D: Non-Pharmacotherapy Options pg. 4 Section B: Diagnosing AUD pg. 8 Section E: Alcohol Withdrawal pg. 5 Section C: Pharmacotherapy Options pg. 9 Resources SECTION A: Screening for AUD All patients should be screened routinely (e.g. annually or when indicators are observed) with a recommended tool like the AUDIT. 2,3 It is important to screen all patients and not just patients eliciting an index of suspicion for AUD, since most persons with AUD are not recognized. 4 Consider screening for AUD when any of the following indicators are observed: • After a recent motor vehicle accident • High blood pressure • Liver disease • Frequent work avoidance (off work slips) • Cardiac arrhythmia • Chronic pain • Rosacea • Insomnia • Social problems • Rhinophyma • Exacerbation of sleep apnea • Legal problems Special Patient Populations A few studies have reviewed AUD in specific patient populations, including youth, older adults and pregnant or breastfeeding patients. The AUDIT screening tool considered these populations in determining the sensitivity of the tool.
    [Show full text]
  • The Hematological Complications of Alcoholism
    The Hematological Complications of Alcoholism HAROLD S. BALLARD, M.D. Alcohol has numerous adverse effects on the various types of blood cells and their functions. For example, heavy alcohol consumption can cause generalized suppression of blood cell production and the production of structurally abnormal blood cell precursors that cannot mature into functional cells. Alcoholics frequently have defective red blood cells that are destroyed prematurely, possibly resulting in anemia. Alcohol also interferes with the production and function of white blood cells, especially those that defend the body against invading bacteria. Consequently, alcoholics frequently suffer from bacterial infections. Finally, alcohol adversely affects the platelets and other components of the blood-clotting system. Heavy alcohol consumption thus may increase the drinker’s risk of suffering a stroke. KEY WORDS: adverse drug effect; AODE (alcohol and other drug effects); blood function; cell growth and differentiation; erythrocytes; leukocytes; platelets; plasma proteins; bone marrow; anemia; blood coagulation; thrombocytopenia; fibrinolysis; macrophage; monocyte; stroke; bacterial disease; literature review eople who abuse alcohol1 are at both direct and indirect. The direct in the number and function of WBC’s risk for numerous alcohol-related consequences of excessive alcohol increases the drinker’s risk of serious Pmedical complications, includ- consumption include toxic effects on infection, and impaired platelet produc- ing those affecting the blood (i.e., the the bone marrow; the blood cell pre- tion and function interfere with blood cursors; and the mature red blood blood cells as well as proteins present clotting, leading to symptoms ranging in the blood plasma) and the bone cells (RBC’s), white blood cells from a simple nosebleed to bleeding in marrow, where the blood cells are (WBC’s), and platelets.
    [Show full text]
  • Amino Acid Chemistry
    Handout 4 Amino Acid and Protein Chemistry ANSC 619 PHYSIOLOGICAL CHEMISTRY OF LIVESTOCK SPECIES Amino Acid Chemistry I. Chemistry of amino acids A. General amino acid structure + HN3- 1. All amino acids are carboxylic acids, i.e., they have a –COOH group at the #1 carbon. 2. All amino acids contain an amino group at the #2 carbon (may amino acids have a second amino group). 3. All amino acids are zwitterions – they contain both positive and negative charges at physiological pH. II. Essential and nonessential amino acids A. Nonessential amino acids: can make the carbon skeleton 1. From glycolysis. 2. From the TCA cycle. B. Nonessential if it can be made from an essential amino acid. 1. Amino acid "sparing". 2. May still be essential under some conditions. C. Essential amino acids 1. Branched chain amino acids (isoleucine, leucine and valine) 2. Lysine 3. Methionine 4. Phenyalanine 5. Threonine 6. Tryptophan 1 Handout 4 Amino Acid and Protein Chemistry D. Essential during rapid growth or for optimal health 1. Arginine 2. Histidine E. Nonessential amino acids 1. Alanine (from pyruvate) 2. Aspartate, asparagine (from oxaloacetate) 3. Cysteine (from serine and methionine) 4. Glutamate, glutamine (from α-ketoglutarate) 5. Glycine (from serine) 6. Proline (from glutamate) 7. Serine (from 3-phosphoglycerate) 8. Tyrosine (from phenylalanine) E. Nonessential and not required for protein synthesis 1. Hydroxyproline (made postranslationally from proline) 2. Hydroxylysine (made postranslationally from lysine) III. Acidic, basic, polar, and hydrophobic amino acids A. Acidic amino acids: amino acids that can donate a hydrogen ion (proton) and thereby decrease pH in an aqueous solution 1.
    [Show full text]
  • Vol. 81 Friday, No. 73 April 15, 2016 Pages 22173–22510
    Vol. 81 Friday, No. 73 April 15, 2016 Pages 22173–22510 OFFICE OF THE FEDERAL REGISTER VerDate Sep 11 2014 19:00 Apr 14, 2016 Jkt 238001 PO 00000 Frm 00001 Fmt 4710 Sfmt 4710 E:\FR\FM\15APWS.LOC 15APWS mstockstill on DSK4VPTVN1PROD with FEDWS II Federal Register / Vol. 81, No. 73 / Friday, April 15, 2016 The FEDERAL REGISTER (ISSN 0097–6326) is published daily, SUBSCRIPTIONS AND COPIES Monday through Friday, except official holidays, by the Office PUBLIC of the Federal Register, National Archives and Records Administration, Washington, DC 20408, under the Federal Register Subscriptions: Act (44 U.S.C. Ch. 15) and the regulations of the Administrative Paper or fiche 202–512–1800 Committee of the Federal Register (1 CFR Ch. I). The Assistance with public subscriptions 202–512–1806 Superintendent of Documents, U.S. Government Publishing Office, Washington, DC 20402 is the exclusive distributor of the official General online information 202–512–1530; 1–888–293–6498 edition. Periodicals postage is paid at Washington, DC. Single copies/back copies: The FEDERAL REGISTER provides a uniform system for making Paper or fiche 202–512–1800 available to the public regulations and legal notices issued by Assistance with public single copies 1–866–512–1800 Federal agencies. These include Presidential proclamations and (Toll-Free) Executive Orders, Federal agency documents having general FEDERAL AGENCIES applicability and legal effect, documents required to be published Subscriptions: by act of Congress, and other Federal agency documents of public interest. Assistance with Federal agency subscriptions: Documents are on file for public inspection in the Office of the Email [email protected] Federal Register the day before they are published, unless the Phone 202–741–6000 issuing agency requests earlier filing.
    [Show full text]
  • Identifying Addiction
    IDENTIFYING ADDICTION What To Look For And Where To Go For Help Addiction comes in many shapes and sizes, but in South Africa, it manifests most often in drug and alcohol abuse. The South African Depression and Anxiety Group (SADAG) lists alcohol, marijuana, cocaine, tik and heroin as the substances most often used, and which account for the vast majority of our addicts. Unlike many other countries, South Africa doesn’t have regular representative surveys into substance abuse, so it’s really difficult to gauge just how extensive the problem is. The only stats readily available concern those addicts admitted to facilities for treatment. These show us that there was a worrying increase in admitted addicts between 2016 and 2017 (the most recent figures available) – from 8 787 to 10 047. So why do we have such a problem with substance abuse in our country? What is it that drives people to addiction? www.kaelo.co.za the same way that diabetes damages our pancreas, Identifying How People and cardiovascular disease damages our heart, addiction The Signs Of Become damages the brain, hijacking the way in which we recognise Addiction Addicts pleasure, and promoting Although many addicts – at compulsive behaviour. least in the early stages of Addiction actually alters the their addition – try their best brain, and it does this in two Although no one is immune from to conceal the signs and distinct ways. Firstly, it subverts the scourge of addiction, there symptoms of their addiction, the way our brain registers are definitely certain people there are tell-tale symptoms to pleasure, and secondly, it more at risk of developing an look out for.
    [Show full text]
  • A Structured and Linguistic Approach to Understanding Recovery and Relapse in AA
    1 A Structured and Linguistic Approach to Understanding Recovery and Relapse in AA SHAWN BAILEY, YUE ZHANG, and ARTI RAMESH, SUNY Binghamton JENNIFER GOLBECK, University of Maryland, College Park LISE GETOOR, University of California, Santa Cruz Alcoholism, also known as Alcohol Use Disorder (AUD), is a serious problem affecting millions of people worldwide. Recovery from AUD is known to be challenging and often leads to relapse at various points after enrolling in a rehabilitation program such as Alcoholics Anonymous (AA). In this work, we present a structured and linguistic approach using hinge-loss Markov random fields (HL-MRFs) to understand recovery and relapse from AUD using social media data. We evaluate our models on AA-attending users extracted from: i) the Twitter social network and predict recovery at two different points—90 days and 1 year after the user joins AA, respectively, and ii) the Reddit AA recovery forums and predict whether the participating user is currently sober. The two datasets present two facets of the same underlying problem of understanding recovery and relapse in AUD users. We flesh out different characteristics in both these datasets: i)inthe Twitter dataset, we focus on the social aspect of the users and the relationship with recovery and relapse, and ii) in the Reddit dataset, we focus on modeling the linguistic topics and dependency structure to understand users’ recovery journey. We design a unified modeling framework using HL-MRFs that takes the different characteristics of both these platforms into account. Our experiments reveal that our structured and linguistic approach is helpful in predicting recovery in users in both these datasets.
    [Show full text]
  • Personal Habits and Indoor Combustions Volume 100 E a Review of Human Carcinogens
    PERSONAL HABITS AND INDOOR COMBUSTIONS volume 100 e A review of humAn cArcinogens This publication represents the views and expert opinions of an IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, which met in Lyon, 29 September-6 October 2009 LYON, FRANCE - 2012 iArc monogrAphs on the evAluAtion of cArcinogenic risks to humAns CONSUMPTION OF ALCOHOLIC BEVERAGES Consumption of alcoholic beverages was considered by previous IARC Working Groups in 1987 and 2007 (IARC, 1988, 2010). Since that time, new data have become available, these have been incorporated into the Monograph, and taken into consideration in the present evaluation. 1. Exposure Data fruit, vegetables or parts of palm trees, by a fairly simple production process. 1.1 Types and ethanol content of 1.1.2 Ethanol content of alcoholic beverages alcoholic beverages Percentage by volume (% vol) is used to indi­ 1.1.1 Types of alcoholic beverages cate the ethanol content of beverages, which is The predominant types of commercially also called the French or Gay-Lussac system. produced alcoholic beverages are beer, wine and Alcohol content differs according to the main spirits. Basic ingredients for beer are malted beverage type and may also vary by country. barley, water, hops and yeast. Wheat may be Commonly, 4–5% vol are contained in beer, used. Nearly all wine is produced from grapes, about 12% vol in wine and about 40% vol in although wine can be also made from other fruits distilled spirits. However, lower or higher ethanol and berries. Spirits are frequently produced from content in alcoholic beverages is also possible.
    [Show full text]