Trauma in cirrhosis: an indicator of the pattern of alcohol abuse in different societies.

While some morbidities associated with the excessive use of alcohol are related to the total amount of alcohol consumed--cirrhosis being an example--other pathologies, such as trauma and those of psycho-social origin, are mainly related to the frequency of acute alcoholic intoxication rather than to the total amount consumed. The balance between these two types of alcohol-associated morbidities can provide an indication of the relative frequency of intoxication, and thus of the pattern of alcohol abuse in a population. Since trauma is highly associated with acute alcoholic intoxication, the prevalence of bone fractures was determined in cirrhotics in nine countries. The prevalence of rib and vertebral fractures on routine chest x-rays showed a 17-fold variation in the different countries, from 2% and 6% in Spain and Italy to 30% and 34% in Canada and the USA, suggesting marked differences in the pattern of alcohol abuse to intoxication. Conversely, the prevalence of cirrhosis is twice as high in Spain and Italy than in Canada and the USA. A strong positive correlation between per capita consumption and cirrhosis mortality (r = 0.86; p less than 0.01) exists among the nine countries studied, while the correlation between per capita alcohol consumption and the prevalence of trauma is not statistically significant (r = 0.40). Supporting a strong association between trauma and alcoholic intoxication, the prevalence of trauma was found to be highly correlated: r = 0.88, p less than 0.002, with the degree of concern for the psycho-social consequences of alcohol abuse in the different countries. Data indicate that trauma can be used as an objective indicator to assess the pattern of alcohol abuse in a population.

Variation in mortality from ischemic heart disease in relation to alcohol and milk consumption.

A simple correlation analysis of data for 19 Western countries confirmed previously reported findings that the rate of mortality from ischemic heart disease (IHD) varies inversely with total alcohol consumption and positively with the consumption of unfermented milk proteins. However, when milk protein consumption was held constant in a multiple-partial correlation analysis, the association between total alcohol consumption and the IHD mortality rate was reduced to non-significance. In contrast, when alcohol consumption was held constant there was little effect on the high correlation between the mortality rate and the consumption of milk proteins. Multiple regression analysis confirmed the importance of the milk factor over alcoholic beverages as a determinant of variation in IHD mortality rates. It was concluded that the inverse association between alcohol consumption and IHD mortality, observed in international comparisons, is probably largely an artifact of a negative association between alcohol and milk consumption. An hypothesis is offered respecting the component of milk which might be responsible for its apparent atherogenicity.

The role of drinking and smoking in mortality from cancer and other causes in male alcoholics.

In a prospective study of a sample of male alcoholics, age standardized rates of death from cancer and other causes were compared with expectancies based on the mortality of the general male population of Ontario and that of U. S. veterans in the Dorn Study. A typical profile of mortality due to alcoholism was found with high excess mortality from cirrhosis, pneumonia, violent causes, lung cancer, and cancers of the upper digestive and respiratory tracts. There was no evidence of the associations recently reported in the literature between alcohol use and other cancers such as those of the stomach, colon, and pancreas. Comparison with veterans whose smoking resembled that of the alcoholics revealed similar rates of death from lung cancer, considerable excess mortality among the alcoholics from cancers of the upper digestive and respiratory tracts, and no difference in overall cancer mortality. Heavy alcohol use per se increases the risk of cancer at certain sites, but it may not increase the overall risk of neoplastic disease.

Psychocultural barriers to successful alcoholism therapy in an American Indian patient. The relevance of Hallowell's analysis.

The responses of an Algonkian Indian woman during a clinical interview were found to be consistent with the pattern of emotional restraint described by A. I. Hallowell as characteristic of Northeastern Indians.

The single distribution theory of alcohol consumption. A rejoinder to the critique of Parker and Harman.

It is concluded that the central element of the theory, that the mean and rate of heavy consumption are closely related, is irrefutable, and recommendations for a prevention program are outlined.

A note on the cannabinoid content of Jamaican ganja.

There has been considerable recent interest in the study of Jamaican ganja users as a potentially valuable source of information on the effects of long-term cannabis consumption. However, reported data on the cannabinoid content of Jamaican material have been limited to those of Rubin and Comitas for a small number of samples of unknown representativeness. In the present study, the cannabinoid content was determined on 36 samples purchased from various ganja dealers at two different periods, derived from crops treated differently with respect to fertilization, and representing the range of types locally considered to differ in quality or potency. The analytical results agreed well with those of Rubin and Comitas, and indicated that samples with a delta9-THC content of 4.0% or more were apt to be comparatively rare. The median value was 2.3% by weight. Some of the variation in the THC content of the samples was clearly attributable to the different seasons in which they were purchased, and some may have been due to differences in the type of fertilizer used in cultivation. Local judgement as to the potency of samples proved generally sound, although by no means infallible.

Some factors affecting the likelihood of moderate drinking by treated alcoholics.

The 1-year outcome in alcoholics who participated in an outpatient alcoholism treatment program which stressed moderate drinking as the ultimate treatment goal was investigated. The results suggest that such an approach, in an otherwise conventional treatment program, is likely to result in a higher rate of moderate drinking and a lower rate of abstinence but not in a higher over-all recovery rate than a total-abstinence orientation.

Impressions of Jewish alcoholics.

Jews, constituting 6% of the adult population in Toronto, contributed 0.5% of all admissions to one private and one public clinic for alcoholism during a 10-year period. Their demographic, sociocultural and psychological characteristics, and several modes of adjustment to being Jewish alcoholics, are described.

Heavy alcohol consumption and physical health problems: a review of the epidemiological evidence.

A review of morbidity and mortality studies bearing on the hazards to physical health of chronic heavy alchol use indicates that such use carries a risk of premature death greatly exceeding normal expectancy. While the life style typical of many heavy drinker contributes to this risk, the effects of alcohol per se account for a substantial part of the excess mortality. The lowest level of consumption at which there is a significant increase in the death rate has yet to be determined. It is certainly below 120 g/day- the lower limit of consumption of most clinical alcoholics-and quite possibly below 35-60g: levels which appear to carry an increased likelihood of cirrhosis and certain cancers. On the other hand, the mortality experience of drinkers commonly identified as 'moderate' in the literature does not seem to differ notably from that of life-long abstainers. The relationship between heavy drinking and elevated mortality is exhibited in populations at large by the generally close covariation of cirrhosis death rates and per capita alcohol sales. There are also indications of co-variation between the latter and the excess of male over female general mortality in the middle age range.