DOCSLIB.ORG

Alcohol-Related Liver Disease: Treatment and Rehabilitation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

ALCOHOL-RELATED LIVER DISEASE: TREATMENT AND REHABILITATION Introduction For people who cope with alcoholism, the specter of recovery relative to prevention of relapse and injury to the body is ongoing. Of significance liver injury, fibrosis or cirrhosis, is always a concern and can potentially severely impact the individual affected by an alcohol use disorder. Long-term alcohol use has been strongly connected to mental and physical disease states, and in the past few decades there has been a plethora of research related to patient education, treatments, disease management, and understanding the power of addiction in peoples’ lives. The medical condition of alcohol-related cirrhosis is a major area of research and concern for all members of the interdisciplinary health team. Liver transplant is the standard treatment for severe cases of alcohol use but this treatment may be limited. Relapsing episodes of alcohol use impacts an individual’s prognosis and treatment. Overview Of Alcoholism And Liver Disease There is a great deal of misunderstanding of the nature of alcoholism. For centuries, people who drank too heavily were considered weak or foolish. While alcoholism is now treated as a disease, clinicians are still struggling to fully understand alcoholism. The quandary confronting clinicians in dealing with alcoholic patients often entails not being able to accept why someone who requires medical treatment, possibly a transplant, to live would return to the very same behavior that led them to require treatment. This is the issue often facing clinicians as they struggle to cope with the high numbers 1 ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com of people who cope with alcoholism and complications, such as alcoholic liver disease (ALD). Alcoholism may not only be a psychosocial disease but also a neurological one, and it may also have a genetic component. The question clinicians are trying to answer is what is alcoholism? One of the most highly recognized and respected organizations in the U.S., addressing issues of alcohol use and addiction is the Substance Abuse and Mental Health Services Administration (SAMHSA). Another is the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. These two organizations engage in research, public awareness, individual education, and empowerment for people who cope with addiction. Alcoholism is an addiction.32,60 Alcoholism as a Neurobiological Addiction In March 2017, the Surgeon General of the U.S., published a report entitled Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. The report explored a number of key areas regarding alcoholism and other facets of addiction including the source of addiction itself. From the very first chapter, it acknowledges the neurobiological source of addiction. It states that a significant amount of research has been conducted to provide sufficient evidence to transform the way clinicians understand substance use disorders and its effects on the brain. With this knowledge, new ways of thinking about prevention and treatment of substance use disorders may be developed. Clinicians are learning how substances such as alcohol produce changes in brain structure and function that promote and sustain addiction and contribute to relapse. We also know that there are similarities and 2 ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com differences in how the various classes of addictive substances affect the brain and behavior.60 Breakthroughs in recent research are revolutionizing the ways in which clinicians now understand substance use disorders. Once they were viewed through the lens of a moral failing or character flaw but are now understood to be chronic illnesses characterized by clinically significant impairments in health, social function, and voluntary control over substance use. The latest research has aided clinicians to understand that while mechanisms may be different, addiction has many features in common with disorders such as diabetes, asthma, and hypertension. Each one of these diseases are subject to relapse, and influenced by genetic, developmental, behavioral, social, and environmental factors. They are all similar in that those individuals who cope with them may have difficulty in complying with the prescribed treatment. The fact that health clinicians now know addiction is affected and driven by neurological changes helps to reduce the negative attitudes and stigma associated with substance use disorders, and supports the integration of treatment for substance use disorders into mainstream healthcare. The research into the neurobiology of addiction has led to the development of new and effective medications not just for alcohol use, but also opioid and nicotine use disorders. All addictive substances have powerful effects on the brain. It is these effects that result in a pleasurable feeling people experience when they engage in their initial use of alcohol or other substances, and these feelings motivate people to use those substances repeatedly, despite the risks for significant harm. The previous model for addressing substance use disorders was the criminal justice model. People were arrested and incarcerated for their use of alcohol 3 ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com and other drugs. This has led to what many term as the war on drugs but it has never been successful, and certainly does not address the neurobiological model, which informs clinicians on how addiction develops in an individual. ALD: Variables and Long-term Outcomes Alcoholic liver disease is predominantly observed in males; this does not imply women do not contract ALD but they do in far lower numbers. In fact, the male to female ratio of patients with alcoholic liver cirrhosis has been reported as 9:1. A nationwide study in the U.S., that assessed patients discharged from the hospital following a diagnosis of ALD found that 4.5 per 100,000 persons had acute alcoholic hepatitis. The male to female ratio was 1.83:1. In persons who have contracted chronic alcoholic hepatitis with cirrhosis, the male to female ratio is 2.64:1.61 Studies have also revealed a male predominance in the prevalence of NAFLD. An American study revealed that 58.9% of patients with NAFLD were male. Subsequently, a study was conducted in Japan which revealed that the male prevalence rates in NAFLD was 41.0% and 17.7% for females, respectively. Similar trends were observed in a study conducted in China. One of the most common causes for alcoholic liver disease or ALD is excessive consumption of alcohol. Alcoholic liver disease in turn may lead to advanced liver cirrhosis. Alcohol-related cirrhosis is the second most common indication for liver transplantation, after cirrhosis caused by viral hepatitis. Unfortunately, the high incidence of patients returning to heavy drinking is approximately 20% - 30% even after they receive the transplant.30 This is a subject of some controversy in the medical community, as there are so many people waiting for liver transplants. Some 4 ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com believe there must be protocols in place that put an emphasis on who receives transplants for ALD. The high relapse rate is crucial because alcoholic recidivism has a negative impact on post-transplant compliance and long-term outcomes of liver transplant recipients. When a person receives a new liver but then relapses back into drinking, this is strongly associated with increased damage to the transplanted liver and long-term outcomes may be poor for the patient. Thus, in evaluating candidates for liver transplant, there is a need for the clinician and patient to be clear and try to determine the risk of post- transplant relapse of alcohol use in patients with alcoholic liver disease.30 Alcohol-related Liver Disease Alcohol has been reported to substantially contribute to the global burden of disease and is responsible for significant disability-adjusted life-years and deaths. Moreover, alcohol has a negative effect on socio-economic activities and the annual cost of excessive social drinking has been estimated to be an excessive amount in high-income countries.8,32,60,61 Development of ALD The development of liver disease from alcohol ingestion depends on several factors. The first step is the person must reach a threshold regarding the duration of use and daily intake of alcohol. For someone drinking on a daily basis for 10–12 years with doses in excess of 40-80 g/day for males and of 20–40 g/day for females, these are the recognized thresholds. The truth is not all alcoholic beverages have the same content, and the threshold is different depending on the type of beverage. As an example, daily drinking of 3–6 cans (12 oz. each) of beer/day for males or 1.5–3 cans of beer/day 5 ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com for females for 10 years or longer can cause ALD.62 Even if a person has reached the threshold mentioned here, it does not imply they will develop liver disease. In fact, only 10–35% of heavy, long-term alcohol drinkers will develop alcoholic hepatitis and only 8–20% will develop cirrhosis. As implied by these statistics, host attributes (i.e., gender and polymorphism(s) of alcohol-metabolizing enzymes) and coexisting external factors (i.e., obesity and hepatitis C infection) combine to determine the likelihood of developing associated liver disease.62 The risk of serious liver disease always increases when the consumption of alcohol increases and in the presence of Hepatitis C infection. There are studies which reveal that women develop liver disease after exposure to lower quantities of alcohol and over shorter time periods. The correct diagnosis of ALD can usually be made on a clinical basis in conjunction with blood tests, and a liver biopsy is not usually required.
Recommended publications
  • Nottinghamshire Primary Care Alcohol Misuse Guidelines

    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
  • (Trental) Does Not Inhibit Dipyridamole-Induced Coronary Hyperemia: Implications for Dipyridamole-Thaffium-20 1 Myocardial Imaging

    (Trental) Does Not Inhibit Dipyridamole-Induced Coronary Hyperemia: Implications for Dipyridamole-Thaffium-20 1 Myocardial Imaging

    Pentoxifyffine (Trental) Does Not Inhibit Dipyridamole-Induced Coronary Hyperemia: Implications for Dipyridamole-Thaffium-20 1 Myocardial Imaging Kenneth A. Brown and Bryan K. Slinker Cardiology Unit ofihe University of Vermont College ofMedicine, Burlington, Vermont been found to be efficacious in the treatment of inter Dipyndamole-thallium-201imagingis often performedin mittent claudication because of its unique hemorrheo patientsunableto exercisebecauseof peripheralvascular logic effects (9). Thus, many patients with peripheral disease.Manyof these patientsare taking pentoxifylline vascular disease who undergo dipyridamole-thallium (Trental),a methylxanthinederivativewhichmayimprove 201 imaging may be taking pentoxifylline at the time intermittent claudication. Whether pentoxifylline inhibits di of their study. Although in vitro data from rat fat cells pyndamole-inducedcoronaryhyperamialike other math and hippocampal slices suggest that pentoxifylline is a ylxanthinas such as theophyllina and should be stopped much weaker adenosine antagonist than theophylline prior to dipyndamole-thallium-201 imaging is unknown. (7), it is not known whetherpentoxifylline significantly Therefore,we studiedthe hyperemicresponseto dipyn damolein sevenopen-chestanesthetizeddogs after pre inhibits dipyridamole-induced coronary hyperemia in treatmentwith either pantoxifylline(0, 7.5, or i 5 mg/kg vivo and should, therefore, be stopped prior to dipyri i.v.) or theophyllina(3 mg/kg i.v.). Baseline circumflex damole-thallium-20l imaging. Hence, we studied the
  • Mechanisms of Ethanol-Induced Cerebellar Ataxia: Underpinnings of Neuronal Death in the Cerebellum

    Mechanisms of Ethanol-Induced Cerebellar Ataxia: Underpinnings of Neuronal Death in the Cerebellum

    International Journal of Environmental Research and Public Health Review Mechanisms of Ethanol-Induced Cerebellar Ataxia: Underpinnings of Neuronal Death in the Cerebellum Hiroshi Mitoma 1,* , Mario Manto 2,3 and Aasef G. Shaikh 4 1 Medical Education Promotion Center, Tokyo Medical University, Tokyo 160-0023, Japan 2 Unité des Ataxies Cérébelleuses, Service de Neurologie, CHU-Charleroi, 6000 Charleroi, Belgium; [email protected] 3 Service des Neurosciences, University of Mons, 7000 Mons, Belgium 4 Louis Stokes Cleveland VA Medical Center, University Hospitals Cleveland Medical Center, Cleveland, OH 44022, USA; [email protected] * Correspondence: [email protected] Abstract: Ethanol consumption remains a major concern at a world scale in terms of transient or irreversible neurological consequences, with motor, cognitive, or social consequences. Cerebellum is particularly vulnerable to ethanol, both during development and at the adult stage. In adults, chronic alcoholism elicits, in particular, cerebellar vermis atrophy, the anterior lobe of the cerebellum being highly vulnerable. Alcohol-dependent patients develop gait ataxia and lower limb postural tremor. Prenatal exposure to ethanol causes fetal alcohol spectrum disorder (FASD), characterized by permanent congenital disabilities in both motor and cognitive domains, including deficits in general intelligence, attention, executive function, language, memory, visual perception, and commu- nication/social skills. Children with FASD show volume deficits in the anterior lobules related to sensorimotor functions (Lobules I, II, IV, V, and VI), and lobules related to cognitive functions (Crus II and Lobule VIIB). Various mechanisms underlie ethanol-induced cell death, with oxidative stress and Citation: Mitoma, H.; Manto, M.; Shaikh, A.G. Mechanisms of endoplasmic reticulum (ER) stress being the main pro-apoptotic mechanisms in alcohol abuse and Ethanol-Induced Cerebellar Ataxia: FASD.
  • AN OPEN RANDOMIZED STUDY COMPARING DISULFIRAM and ACAMPROSATE in the TREATMENT of ALCOHOL DEPENDENCE AVINASH DE SOUSA* and ALAN DE SOUSA

    AN OPEN RANDOMIZED STUDY COMPARING DISULFIRAM and ACAMPROSATE in the TREATMENT of ALCOHOL DEPENDENCE AVINASH DE SOUSA* and ALAN DE SOUSA

    Alcohol & Alcoholism Vol. 40, No. 6, pp. 545–548, 2005 doi:10.1093/alcalc/agh187 Advance Access publication 25 July 2005 AN OPEN RANDOMIZED STUDY COMPARING DISULFIRAM AND ACAMPROSATE IN THE TREATMENT OF ALCOHOL DEPENDENCE AVINASH DE SOUSA* and ALAN DE SOUSA Get Well Clinic And Nursing Home, 33rd Road, Off Linking Road, Bandra, Mumbai 400050, Maharashtra State, India (Received 11 March 2005; first review notified 6 June 2005; in final revised form 21 June 2005; accepted 2 July 2005; advance access publication 25 July 2005) Abstract — Aims: To compare the efficacy of acamprosate (ACP) and disulfiram (DSF) for preventing alcoholic relapse in routine clinical practice. Methods: One hundred alcoholic men with family members who would encourage medication compliance and accom- pany them for follow-up were randomly allocated to 8 months of treatment with DSF or ACP. Weekly group psychotherapy was also available. The psychiatrist, patient, and family member were aware of the treatment prescribed. Alcohol consumption, craving, and adverse events were recorded weekly for 3 months and then fortnightly. Serum gamma glutamyl transferase was measured at the start Downloaded from https://academic.oup.com/alcalc/article/40/6/545/125907 by guest on 27 September 2021 and the end of the study. Results: At the end of the trial, 93 patients were still in contact. Relapse (the consumption of >5 drinks/40 g of alcohol) occurred at a mean of 123 days with DSF compared to 71 days with ACP (P = 0.0001). Eighty-eight per cent of patients on DSF remained abstinent compared to 46% with ACP (P = 0.0002).
  • The Politics of Beer: Analysis of the Congressional Votes on the Beer Bill of 1933

    The Politics of Beer: Analysis of the Congressional Votes on the Beer Bill of 1933

    Public Choice https://doi.org/10.1007/s11127-017-0493-1 The politics of beer: analysis of the congressional votes on the beer bill of 1933 1 2 3 Eline Poelmans • John A. Dove • Jason E. Taylor Received: 26 June 2017 / Accepted: 4 December 2017 Ó Springer Science+Business Media, LLC, part of Springer Nature 2017 Abstract Nine days after he took office in March 1933, Franklin Roosevelt asked Con- gress to amend existing federal Prohibition policy so as to allow for the sale and con- sumption of 3.2% alcohol beer. Over the following 8 days, the so-called ‘‘beer bill’’ was proposed, debated, passed and signed into law. This study analyzes the political decision making behind one of FDR’s earliest New Deal policies. Specifically, we consider how voter preferences, representatives’ ideologies, national party affiliations, and the influence of special interests affected legislative decision making. We find that special interests and party affiliations were particularly important drivers of congressional voting behavior. Keywords Beer legalization Á Prohibition Á Special interests Á Median voter Á Representative ideology Á New Deal Á Franklin Roosevelt Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11127-017- 0493-1) contains supplementary material, which is available to authorized users. & Jason E. Taylor [email protected] Eline Poelmans [email protected] John A. Dove [email protected] 1 LICOS Centre for Institutions and Economic Performance, Faculty of Economics and Business, Campus Brussels,
  • Alcohol Effects on People; 00 Social Responsibility for the Control of the Use of Beverage; and (5) the Social Responsibility for the Treatment of Individuals

    Alcohol Effects on People; 00 Social Responsibility for the Control of the Use of Beverage; and (5) the Social Responsibility for the Treatment of Individuals

    DOC- NT RESUME ED 140 180 CG 011 461 TITLE Alcohol Education: Curriculum Guide for Grades 7-12. INSTITUTION New York State Education Dept., Albany. Bureau of Drug Education. PUB DATE 76 NOTE 144p.; For relat d document, see CG 011 462 EERS PRICE MF-$0.83 BC-$7.35 Plus Postage. DESCRIPTORS *Alcohol Education; *Alcoholic Beverages; Class Activities; Curriculum Guides; *Drinking; Drug Education; Health Education; *Learning Activities; Recreational Activities; *Secondary Education; Socially Deviant Behavior; Teaching Guides AB TRACT This curriculum guide is designed as an interdisciplinary resource on alcohol education for teachers of Grades 7-12. tevelopmental traits are discussed, and objectives and learning experiences are presented. The following topics are covered: ro the nature of alcohci;(2) factors influencing the use of alcoholic beverages; (3) alcohol effects on people; 00 social responsibility for the control of the use of beverage; and (5) the social responsibility for the treatment of individuals. A division is made between Grades 7-9 and 10-12, with each set of three grades considered separately. (Author/OLL)' Documents acquired by ERIC include many informal unpublished materials not available from other sources. ERIC makes every effort * * to obtain the best copy available. Nevertheless, items of marginal * * reproducibility are often encountered and this affects the quality * * of the microfiche and hardcopy reproductions ERIC makes available * via the ERIC Document Reproduction Service (EDRS). EDRS is not * responsible for
  • Staying Connected Is Important: Virtual Recovery Resources

    Staying Connected Is Important: Virtual Recovery Resources

    STAYING CONNECTED IS IMPORTANT: VIRTUAL RECOVERY RESOURCES • Refuge Recovery: Provides online and virtual INTRODUCTION support In an infectious disease outbreak, when social https://www.refugerecovery.org/home distancing and self-quarantine are needed to • Self-Management and Recovery Training limit and control the spread of the disease, (SMART) Recovery: Offers global community continued social connectedness to maintain of mutual-support groups, forums including a recovery is critically important. Virtual chat room and message board resources can and should be used during this https://www.smartrecovery.org/community/ time. Even after a pandemic, virtual support may still exist and still be necessary. • SoberCity: Offers an online support and recovery community This tip sheet describes resources that can be https://www.soberocity.com/ used to virtually support recovery from mental/ substance use disorders as well as other • Sobergrid: Offers an online platform to help resources. anyone get sober and stay sober https://www.sobergrid.com/ • Soberistas: Provides a women-only VIRTUAL RECOVERY PROGRAMS international online recovery community https://soberistas.com/ • Alcoholics Anonymous: Offers online support • Sober Recovery: Provides an online forum for https://aa-intergroup.org/ those in recovery and their friends and family https://www.soberrecovery.com/forums/ • Cocaine Anonymous: Offers online support and services • We Connect Recovery: Provides daily online https://www.ca-online.org/ recovery groups for those with substance use and
  • Alcohol Dependence, Withdrawal, and Relapse

    Alcohol Dependence, Withdrawal, and Relapse

    Alcohol Dependence, Withdrawal, and Relapse Howard C. Becker, Ph.D. Continued excessive alcohol consumption can lead to the development of dependence that is associated with a withdrawal syndrome when alcohol consumption is ceased or substantially reduced. This syndrome comprises physical signs as well as psychological symptoms that contribute to distress and psychological discomfort. For some people the fear of withdrawal symptoms may help perpetuate alcohol abuse; moreover, the presence of withdrawal symptoms may contribute to relapse after periods of abstinence. Withdrawal and relapse have been studied in both humans and animal models of alcoholism. Clinical studies demonstrated that alcohol­dependent people are more sensitive to relapse­ provoking cues and stimuli than nondependent people, and similar observations have been made in animal models of alcohol dependence, withdrawal, and relapse. One factor contributing to relapse is withdrawal­related anxiety, which likely reflects adaptive changes in the brain in response to continued alcohol exposure. These changes affect, for example, the body’s stress response system. The relationship between withdrawal, stress, and relapse also has implications for the treatment of alcoholic patients. Interestingly, animals with a history of alcohol dependence are more sensitive to certain medications that impact relapse­like behavior than animals without such a history, suggesting that it may be possible to develop medications that specifically target excessive, uncontrollable alcohol consumption. KEY WORDS: Alcoholism; alcohol dependence; alcohol and other drug (AOD) effects and consequences; neuroadaptation; AOD withdrawal syndrome; AOD dependence relapse; pharmacotherapy; human studies; animal studies he development of alcohol expectations about the consequences of drinking (Koob and Le Moal 2008). dependence is a complex and alcohol use.
  • Skin Manifestations of Liver Diseases

    Skin Manifestations of Liver Diseases

    medigraphic Artemisaen línea AnnalsA Koulaouzidis of Hepatology et al. 2007; Skin manifestations6(3): July-September: of liver 181-184diseases 181 Editorial Annals of Hepatology Skin manifestations of liver diseases A. Koulaouzidis;1 S. Bhat;2 J. Moschos3 Introduction velop both xanthelasmas and cutaneous xanthomas (5%) (Figure 7).1 Other disease-associated skin manifestations, Both acute and chronic liver disease can manifest on but not as frequent, include the sicca syndrome and viti- the skin. The appearances can range from the very subtle, ligo.2 Melanosis and xerodermia have been reported. such as early finger clubbing, to the more obvious such PBC may also rarely present with a cutaneous vasculitis as jaundice. Identifying these changes early on can lead (Figures 8 and 9).3-5 to prompt diagnosis and management of the underlying condition. In this pictorial review we will describe the Alcohol related liver disease skin manifestations of specific liver conditions illustrat- ed with appropriate figures. Dupuytren’s contracture was described initially by the French surgeon Guillaume Dupuytren in the 1830s. General skin findings in liver disease Although it has other causes, it is considered a strong clinical pointer of alcohol misuse and its related liver Chronic liver disease of any origin can cause typical damage (Figure 10).6 Therapy options other than sur- skin findings. Jaundice, spider nevi, leuconychia and fin- gery include simvastatin, radiation, N-acetyl-L-cys- ger clubbing are well known features (Figures 1 a, b and teine.7,8 Facial lipodystrophy is commonly seen as alco- 2). Palmar erythema, “paper-money” skin (Figure 3), ro- hol replaces most of the caloric intake in advanced al- sacea and rhinophyma are common but often overlooked coholism (Figure 11).
  • ALCOHOLICS ANONYMOUS 1 Renewed Relevance of Alcoholics Anonymous and Adlerian Psychology

    ALCOHOLICS ANONYMOUS 1 Renewed Relevance of Alcoholics Anonymous and Adlerian Psychology

    Running head: ALCOHOLICS ANONYMOUS 1 Renewed Relevance of Alcoholics Anonymous and Adlerian Psychology ____________________ Presented to The Faculty of the Adler Graduate School ____________________ In Partial Fulfillment of the Requirement for the Degree of Master of Arts in Adlerian Counseling and Psychotherapy ____________________ By Megan Teale ____________________ Chair: Rashida Fisher MS, LPCC, LADC Reader: Jamie Hedin MA, LPC, LADC ____________________ July 2017 ALCOHOLICS ANONYMOUS 2 Abstract The incorporation of psychological approaches to the Alcoholics Anonymous (AA) is established as a sound way of improving the treatment of alcoholism. Despite mounting evidence of the clinical effectiveness of AA, and its enduring legacy as the prominent approach for healing alcoholism; there remains skepticism regarding its use as a clinical intervention. The literature on the Adlerian orientation has noted the similarity between the two methods, little investigation of the congruence between the two and the implications for an integrated treatment approach has occurred. The purpose of this literature review is to examine how Adlerian theory and positive psychology complement the philosophies and practices of AA. The results support the integration of Adlerian Psychology and AA as ideal for working with clients struggling with alcohol dependence. Furthermore, this literature review suggests that the integration of Adlerian Psychology will enhance and complement the therapeutic dynamics inherent in the AA program, improving the competence of clinicians to treat individuals living the alcoholism and participating in the 12- step programs. Keywords: Adlerian Psychology, Alcoholics Anonymous, Alcoholism, Spirituality ALCOHOLICS ANONYMOUS 3 Dedication To my husband, Eric Teale, for allowing me to turn my dreams into a reality. Thank you for supporting me through my graduate school experience.
  • TRENTAL (Pentoxifylline) Should Be Used During Pregnancy Only If the Potential Benefit Justifies the Potential Risk to the Fetus

    TRENTAL (Pentoxifylline) Should Be Used During Pregnancy Only If the Potential Benefit Justifies the Potential Risk to the Fetus

    TRENTAL® (pentoxifylline) Extended-Release Tablets, 400 mg DESCRIPTION TRENTAL® (pentoxifylline) extended-release tablets for oral administration contain 400 mg of the active drug and the following inactive ingredients: FD&C Red No. 3, hypromellose USP, magnesium stearate NF, polyethylene glycol NF, povidone USP, talc USP, titanium dioxide USP, and hydroxyethyl cellulose USP in an extended-release formulation. TRENTAL is a tri-substituted xanthine derivative designated chemically as 1-(5-oxohexyl)-3, 7­ dimethylxanthine that, unlike theophylline, is a hemorrheologic agent, i.e. an agent that affects blood viscosity. Pentoxifylline is soluble in water and ethanol, and sparingly soluble in toluene. The CAS Registry Number is 6493-05-6. The chemical structure is: CLINICAL PHARMACOLOGY Mode of Action Pentoxifylline and its metabolites improve the flow properties of blood by decreasing its viscosity. In patients with chronic peripheral arterial disease, this increases blood flow to the affected microcirculation and enhances tissue oxygenation. The precise mode of action of pentoxifylline and the sequence of events leading to clinical improvement are still to be defined. Pentoxifylline administration has been shown to produce dose-related hemorrheologic effects, lowering blood viscosity, and improving erythrocyte flexibility. Leukocyte properties of hemorrheologic importance have been modified in animal and in vitro human studies. Pentoxifylline has been shown to increase leukocyte deformability and to inhibit neutrophil adhesion and activation. Tissue oxygen levels have been shown to be significantly increased by therapeutic doses of pentoxifylline in patients with peripheral arterial disease. Pharmacokinetics and Metabolism After oral administration in aqueous solution pentoxifylline is almost completely absorbed. It undergoes a first-pass effect and the various metabolites appear in plasma very soon after dosing.
  • 6.14 Alcohol Use Disorders and Alcoholic Liver Disease

    6.14 Alcohol Use Disorders and Alcoholic Liver Disease

    6. Priority diseases and reasons for inclusion 6.14 Alcohol use disorders and alcoholic liver disease See Background Paper 6.14 (BP6_14Alcohol.pdf) Background The WHO estimates that alcohol is now the third highest risk factor for premature mortality, disability and loss of health worldwide.1 Between 2004 to 2006, alcohol use accounted for about 3.8% of all deaths (2.5 million) and about 4.5% (69.4 million) of Disability Adjusted Life Years (DALYS).2 Europe is the largest consumer of alcohol in the world and alcohol consumption in this region emerges as the third leading risk factor for disease and mortality.3 In European countries in 2004, an estimated one in seven male deaths (95 000) and one in 13 female deaths (over 25 000) in the 15 to 64 age group were due to alcohol-related causes.3 Alcohol is a causal factor in 60 types of diseases and injuries and a contributing factor in 200 others, and accounts for 20% to 50% of the prevalence of cirrhosis of the liver. Alcohol Use Disorders (AUD) account for a major part of neuropsychiatric disorders and contribute substantially to the global burden of disease. Alcohol dependence accounts for 71% of all alcohol-related deaths and for about 60% of social costs attributable to alcohol.4 The acute effects of alcohol consumption on the risk of both unintentional and intentional injuries also have a sizeable impact on the global burden of disease.2 Alcoholic liver disease (ALD) is the commonest cause of cirrhosis in the western world, and is currently one of the ten most common causes of death.5 Liver fibrosis caused by alcohol abuse and its end stage, cirrhosis, present enormous problems for health care worldwide.