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What is 'addiction'? What does it say about us, our social arrangements and our political preoccupations? Where is it going as an idea and what is at stake in its ongoing production? Drawing on ethnographic research, interviews and media and policy texts, this book traces the remaking of addiction in contemporary Western societies.

Background: Contrary to the popular belief concerning the aphrodisiac effects of alcohol, there exists scientific evidence which conclude on sexual dysfunction caused by chronic alcohol use. There is a dearth of studies from India. Aim: The aim is to estimate the prevalence and correlates of sexual dysfunction in alcohol-dependent patients and to explore the association between sexual dysfunction and various alcohol-related variables. Materials and Methods: The study employed a cross-sectional descriptive design and recruited 84 male patients admitted for de-addiction in a tertiary care center. The evaluation was conducted using a specially designed intake proforma and tools such as Severity of Alcohol Dependence Questionnaire, Arizona Sexual Experience Scale, and International Classification of Disease, 10th revision, diagnostic criteria for research. Results: Thirty-seven percent of the patients had sexual dysfunction - the most common type being erectile dysfunction (25%), followed by dysfunction in satisfying orgasm (20%) and premature ejaculation (15.5%). Sexual dysfunction was significantly associated with the duration of alcohol dependence, amount of alcohol consumed per day, and severity of alcohol dependence. Conclusions: Sexual dysfunction is common in male patients with alcohol dependence. The study highlights the detrimental effects of alcohol on sexual function and this information can be utilized in motivational interviewing of patients with alcohol dependence syndrome.

The CAGE is a convenient test for alcohol-related disorder due to its brevity, but it is not as effective as the alcohol use disorders identification test (AUDIT). Gamma-glutamyl transferase (GGT) is an objective blood biochemical marker of excessive alcohol intake; however, it has low sensitivity. This study tested the performance of the combined use of CAGE and GGT to screen problem drinking (PD), alcohol use disorder (AUD), and alcohol dependence (AD). A total of 394 subjects composed of 91 normal controls and 303 subjects with PD were enrolled in this study. Of the PD subjects, 147 were diagnosed with AUD (77 alcohol abuse and 70 AD). A series of multiple logistic regression models for PD, AUD, and AD discrimination were used to obtain new combined CAGE and GGT scores after adjusting for age and gender (CAGE+GGT). A receiver operating characteristic curve analysis was conducted to determine how well the CAGE+GGT score discriminated between individuals with PD, AUD, and AD. The discrimination accuracy of the AUDIT for PD was significantly better than that of the CAGE or the CAGE+GGT (z=6.927, <0.0001; z=5.301, <0.0001, respectively). The CAGE and the CAGE+GGT were better than the AUDIT at discriminating AUD (z=2.535, =0.0112; z=2.894, =0.0038, respectively). The discrimination accuracy of the AUDIT for AD was significantly better than that of the CAGE and GGT (z=3.233, =0.0012; z=6.529, <0.0001, respectively), but the CAGE+GGT was comparable with the AUDIT (z=1.652, =0.0985). Our findings support the combined use of the CAGE questionnaire and serum GGT level as a sensitive and useful tool for AD screening.

Spinal cord injury (SCI) is a devastating disorder. Alcohol abuse has been recognized as hindering SCI patients from rehabilitation, thus leading to longer length of days and poorer prognosis. This article aimed to investigate the association between spinal cord injury (SCI) and alcohol dependence. Data were derived from the National Health Insurance Research Database (NHIRD). The incidence of alcohol dependence between SCI and non-SCI groups was compared. Other possible risk factors were also analyzed. Patients (N = 5670) with SCI from 2000 to 2009 were initially assessed for eligibility. After propensity score matching, 5639 first-time SCI survivors were included. The Cox proportional hazard regression model was used to assess differences in the incidence of alcohol dependence syndrome. Based on the adjusted hazard ratios (HR), the SCI group had a higher hazard for alcohol dependence syndrome compared to the non-SCI group (adjusted HR: 1.39, 95% CI: 1.03~1.86, p = 0.0305). The injury level did not have an impact on the incidence of alcohol dependence syndrome. A higher incidence of alcohol dependence syndrome was related to male patients, lower insurance levels, higher Deyo’s CCI, and psychiatric OPD times. A lower incidence of alcohol dependence syndrome was related to elder age. The incidence of alcohol dependence increased after the occurrence of SCI and was also related to age, sex, monthly income, comorbidities, and psychiatric problems. The injury level did not affect the incidence of alcohol dependence after SCI.

Background Alcohol consumption has been linked to a considerable burden of disease in the United Kingdom (UK), with most of this burden due to heavy drinking and Alcohol Dependence (AD). However, AD is undertreated in the UK, with only 8% of those individuals with AD being treated in England and only 6% of those individuals with AD being treated in Scotland. Thus, the objective of this paper is to quantify the deaths that would have been avoided in the UK in 2004 if the treatment rate for AD had been increased. Methods Data on the prevalence of AD, alcohol consumption, and mortality were obtained from the Adult Psychiatric Morbidity Survey, the Global Information System on Alcohol and Health, and the 2004 Global Burden of Disease study respectively. Data on the effectiveness of pharmacological treatment and Motivational Interviewing/Cognitive Behavioural Therapy were obtained from Cochrane reviews and meta-analyses. Simulations were used to model the number of deaths under different treatment scenarios. Sensitivity analyses were performed to model the effects of Brief Interventions and to examine the effect of using AD prevalence data obtained from the National Institute for Health and Clinical Excellence. Results In the UK, 320 female and 1,385 male deaths would have been avoided if treatment coverage of pharmacological treatment had been increased to 20%. This decrease in the number of deaths represents 7.9% of all alcohol-attributable deaths (7.0% of all alcohol-attributable deaths for women and 8.1% of all alcohol-attributable deaths for men). If we used lower AD prevalence rates obtained from the National Institute for Health and Clinical Excellence, then treatment coverage of pharmacological treatment in hospitals for 20% of the population with AD would have resulted in the avoidance of 529 deaths in 2004 (99 deaths avoided for women and 430 deaths avoided for men). Conclusions Increasing AD treatment in the UK would have led to a large number of deaths being avoided in 2004. Increased AD treatment rates not only impact mortality but also impact upon the large burden of disability and morbidity attributable to AD, as well as the associated social and economic burdens.

We hypothesized that cross-generational effects of alcohol exposure could alter DNA methylation and expression of the oncogene and tumor suppressor gene that drive cancer development. DNA methylation of the and genes was tested in samples from young participants (Mean age of 13.4 years). Controlling for both personal use and maternal use of substances during pregnancy, familial alcohol dependence was associated with hypomethylation of CpG sites in the promoter region and hypermethylation of the gene. The results suggest that ancestral exposure to alcohol can have enduring effects that impact epigenetic processes such as DNA methylation that controls expression of genes that drive cancer development such as and .

Alcohol dependence is a serious condition characterized by persistent desires to drink and unsuccessful efforts to control alcohol consumption despite the knowledge of dysfunction through the usage. The study at hand examined the influence of an alcohol exposure on inhibitory processes. Research provides evidence that trying to resist the temptation to drink exerts self-control, a limited resource which is used during all acts of inhibition. In line with this, studies demonstrate an impaired ability to regulate an already initiated response in alcohol-dependent and healthy subjects when confronted with alcohol-related stimuli. The related neuronal correlates in alcohol-dependent patients remain to be elucidated. The inhibition performance of 11 male alcohol-dependent patients during an alcohol exposure was compared with the task performance during a control condition. Behavioral data and neural brain activation during task performance were acquired by means of functional magnetic resonance imaging. The alcohol cue exposure led to subjectively stronger urges to drink which was accompanied by differential neural activation in amygdala and hippocampus. Moreover, the results revealed typical neural activation during inhibition performance across both conditions. Anyhow, we could not detect any behavioral deficits and only subtle neural differences between induction conditions during the performance of the inhibition task within the inferior frontal cortex. The results suggest that although the sample reports a subjectively stronger urge to drink after the alcohol cue exposure this effect was not strong enough to significantly impair task performance. Coherently, we discover only subtle differential brain activation between conditions during the inhibition task. In opposition to findings in literature our data do not reveal that an exposure to alcohol-related cues and thereby elicited cue reactivity results in impaired inhibition abilities.

SignificanceAlcohol-dependent subjects frequently develop emotional symptoms that contribute to the persistence of alcohol drinking. These subjects are also characterized by gastrointestinal disturbances. In this study, we showed that alcohol-dependent subjects with altered intestinal permeability had also altered gut-microbiota composition and activity and remained with high scores of depression, anxiety, and alcohol craving after a short-term detoxification program. These results are consistent with the existence of a gut–brain axis in alcohol dependence, in which the gut microbiota could alter the gut-barrier function and influence behavior in alcohol dependence. Therefore, this study opens a previously unidentified field of research for the treatment and the management of alcohol dependence, targeting the gut microbiota. Alcohol dependence has traditionally been considered a brain disorder. Alteration in the composition of the gut microbiota has recently been shown to be present in psychiatric disorders, which suggests the possibility of gut-to-brain interactions in the development of alcohol dependence. The aim of the present study was to explore whether changes in gut permeability are linked to gut-microbiota composition and activity in alcohol-dependent subjects. We also investigated whether gut dysfunction is associated with the psychological symptoms of alcohol dependence. Finally, we tested the reversibility of the biological and behavioral parameters after a short-term detoxification program. We found that some, but not all, alcohol-dependent subjects developed gut leakiness, which was associated with higher scores of depression, anxiety, and alcohol craving after 3 wk of abstinence, which may be important psychological factors of relapse. Moreover, subjects with increased gut permeability also had altered composition and activity of the gut microbiota. These results suggest the existence of a gut–brain axis in alcohol dependence, which implicates the gut microbiota as an actor in the gut barrier and in behavioral disorders. Thus, the gut microbiota seems to be a previously unidentified target in the management of alcohol dependence.

Parental alcohol misuse has detrimental effects on the entire family. In particular, the safety and general health of the children of parents with alcohol abuse/dependence are of concern to health authorities around the globe. The present study aimed to examine the impact of parental history of alcohol abuse/dependence on the age of first alcohol intake in adult patients with alcohol dependence. Questionnaire data were collected from 294 (57 females) patients with alcohol dependence (M ± SD, 42 ± 10.96 years). The majority of males (61.2%) and over half (50.9%) of females reported no history of parental alcohol abuse/dependence. Male patients with alcohol dependence were less likely to report living with both parents with alcohol abuse/dependence than female patients with alcohol abuse/dependence (p < 0.05). However, male patients who lived with both parents with alcohol abuse/dependence were younger at first alcohol intake than their female counterparts (median age: 12.00 vs. 18.00, p = 0.002) and males raised by parents without alcohol abuse/dependence (median age: 12.00 vs. 16.00, p = 0.036). Our findings suggest that age at first alcohol intake may serve as a marker of household dysfunction, including poor parental management. Our study supports the global need for systemic interventions to help alcohol abusing/dependent parents to carry out their parental responsibilities.

Context: There is a lack of literature on the relation between psychiatric comorbidities and their influence on quality of life in patients with alcohol dependence syndrome in the Indian settings. Aims: To study the relation between psychiatric comorbidity with quality of life in patients with alcohol dependence. Settings and Design: The study was carried out in a de-addiction centre of a tertiary care hospital upon randomly selected inpatients of alcohol dependence syndrome. Patients with other substance abuse except tobacco or those with severe physical impairment were excluded. Materials and Methods: Hundred in-patients were assessed between the period of August 2013 to July 2014, using a number of instruments including specially designed proforma for clinical and drinking variables, CIWA-Ar, SADD, M.I.N.I 5.0 and WHO QoL Bref. Statistics used: SPSS 19.0 was used for analysis. Significance was calculated using t-test for continuous variables and chi-square test for categorical variables. Results: Prevalence of psychiatric disorder was found to be 32% across all the tested patients, with anxiety (n = 13) and depressive disorder (n = 12) being most common. Presence of psychiatric comorbidity lead to significant lowering in overall quality, perception of general health, physical (42.12 vs 57.78, P = 0.001), psychological (40.19 vs 53.29, P = 0.002), social (43.97 vs 66.90, P = 0.000), and environment (50.47 vs 62.71, P = 0.001) domains. Conclusion: Comorbid psychiatric disorders have a significant negative impact on the quality of life in patients with alcohol dependence syndrome.