Fetal alcohol effects in alcoholic veteran patients.

Fetal alcohol syndrome is often associated with severe physical and neuropsychiatric maldevelopment. On the other hand, some offspring of women who drank during pregnancy appear to be affected in minimal ways and function relatively well within society. We questioned whether this effect of prenatal alcohol in the adult is generally minimal. To bear on this, we determined whether we could distinguish alcohol-exposed from nonexposed individuals in a population of male veterans, selected because of both their accepted level of function within society (e.g., honorable discharge from the military) and their admission to an alcohol treatment unit (thus, a greater likelihood of parental alcoholism, because of its familial aggregation). Consecutively admitted alcoholics (cases; n = 77) with likely maternal alcohol ingestion during their pregnancy or the first 10 years of life were matched with alcoholics with no maternal alcohol exposure during these periods (controls; n = 161). Each subject completed questionnaires regarding personal birthweight, alcohol, drug, educational and work histories, and family (including parental) alcohol and drug histories. We measured height, weight, and head circumference; checked for facial and hand anomalies; and took a frontal facial photograph, from which measurements of features were made. Data were analyzed by univariate statistics and stepwise logistic regression. No case had bona fide fetal alcohol syndrome. With univariate statistical analyses, the cases differed from the controls in 10 variables, including duration of drinking, width of alae nasae, being hyperactive or having a short attention span, and being small at birth. By stepwise logistic regression, the variables marital status, small size at birth, duration of drinking, and the presence of a smooth philtrum were marginally (the first two) or definitely (the last two) significant predictors of case status. Analysis of only the 37 cases in whom maternal prenatal drinking was the most likely yielded a marginal association for small size at birth (odds ratio = 3.1, p = 0.08) and a significant association for the presence of a smooth philtrum (odds ratio = 11.9, p = 0.005). Predictability was poor in all regression models. Based on the presence of this single physical finding (smooth philtrum), we estimate that the prevalence of manifestations of fetal alcohol exposure (fetal alcohol effects) is 6 to 13% in adult male veteran children (not necessarily nonveteran offspring) of women who drank alcohol during pregnancy. Thus, in our study of adult veterans, most individuals who were born to women who drank during pregnancy could not be differentiated from normal individuals, and those who were affected were distinguished by a single, nonspecific physical finding.

Family history models of alcoholism: age of onset, consequences and dependence.

The association of a family history of alcoholism to susceptibility to alcoholism has been well documented over the past 3 decades. The classification of a family history of alcoholism commonly involves the division of subjects into family history positive and negative groupings. However, diverse definitions are used to define positive family histories. These diverse definitions of family alcoholism impede the comparison of results from different studies. The present study evaluates several classification schemes and compares them with a new method for the analysis of family patterns of alcoholism (FPA). A sample of 220 male alcoholic veteran inpatients were assessed for age of onset of alcoholism, consequences of drinking and the severity of their dependence. Multiple regression equations were estimated for several dichotomous family history models and each model was evaluated against a comparable FPA model that included the same family members. Comparisons of the classification models with the equivalent FPA analysis model facilitated comparisons of the contribution of each family history designation to changes in amount of explained variance. In all instances, the FPA analyses explained more variance than did the comparable dichotomous family history models. In addition, the FPA analyses reveal the relative explanatory power of each family member and indicate that maternal relatives often have a more important contribution than has been indicated previously.

Alcohol use by alcoholics with and without a history of parental alcoholism.

The association between parental history of alcoholism and the nature of alcoholism was assessed using a more reliable measure of family history (Family Tree Questionnaire) and a more comprehensive inventory of alcoholism (Alcohol Use Inventory) than used in earlier studies. Parental alcoholism was associated with more severe alcoholism on most parameters of alcohol use (age of onset, quantity, frequency, preoccupation, and sustained use) and alcohol-related problems (social, vocational, physical, cognitive, and loss of control). The association between parental history of alcoholism and more severe alcoholism in the probands was independent of age of onset of alcoholism, current age, socioeconomic background, and marital status. Parental history positive (PH+) alcoholics were more reliant on alcohol to manage their moods but did not differ significantly from parental history negative (PH-) alcoholics in the use of alcohol to improve sociability or mental functioning or to cope with marital problems. Surprisingly, the degree of concern, guilt, and worry over the negative consequences of drinking was not significantly different for PH+ alcoholics although the negative consequences were clearly much more severe for this group. While the data are inconclusive about the reasons for more severe alcoholism in PH+ alcoholics, greater reliance on ethanol to manage moods and a relative insensitivity to negative consequences could theoretically account for the vulnerability to more severe alcoholism found in PH+ alcoholics.

Alcohol consumption and chronic obstructive pulmonary disease.

This study examined the relationship between lifetime alcohol consumption and respiratory symptoms in 195 subjects (including 111 alcoholics) and FEV1 level in 165 subjects (including 91 alcoholics). After adjustment for age and cigarette smoking status, using multiple logistic regression, lifetime alcohol consumption was a significant predictor of chronic cough and chronic phlegm, but not of any wheeze or persistent wheeze. Multiple linear regression analysis indicated that lifetime alcohol consumption was also a predictor of lower levels of FEV1 in a model that included age, pack-years of cigarette smoking, and an interaction between alcohol consumption and pack-years. The interaction between smoking and alcohol consumption was in a direction opposite to the independent effects of alcohol and smoking, suggesting a protective effect of alcohol with heavier amounts of smoking. Additional study is needed to further assess the relationship between respiratory symptoms and alcohol consumption, and between pulmonary function and alcohol consumption.