Chronobiological regulation of alcohol intake.

Like other physiological functions, food intake and metabolism (including alcohol consumption) in humans and animal models may be regulated by circadian rhythm. For example, many studies of rodents have found that alcohol consumption in these nocturnal animals peaks during their active dark period. This alcohol consumption pattern can be influenced, however, by experimental manipulation. One factor that has been proposed to play a role in regulating circadian alcohol consumption pattern is the hormone melatonin, which is produced by the pineal gland. Research also indicates that the effects of lighting conditions on the alcohol consumption of animal models may be influenced by the differences among the strains of the laboratory animals used, variations in the type and administration schedule of the animals' alcohol-containing diet, disruptions of the normal circadian rhythm, concurrent use of other drugs, and properties of the light.

Alcohol abuse as a risk factor for and consequence of child abuse.

The relationship between child abuse and the use or abuse of alcohol has two aspects. First, some findings have indicated that parental alcohol abuse may be associated with the physical or sexual abuse of children. Research findings in this area remain inconsistent, however. Second, the experience of being abused as a child may increase a person's risk for alcohol-related problems as an adult. This relationship has best been demonstrated in women who had been victims of childhood abuse. Several factors most likely contribute to or influence this relationship, including coping skills; antisocial behavior; and psychological problems, such as posttraumatic stress disorder.

Alcoholism treatment in the United States. An overview.

On any given day, more than 700,000 people in the United States receive alcoholism treatment in either inpatient or outpatient settings. For many of those patients, detoxification--with or without pharmacotherapy--is the first step of treatment. The major behavioral approaches currently used in alcoholism treatment include cognitive-behavioral therapy, motivational enhancement therapy, and Alcoholics Anonymous (AA) or related 12-step programs. Clinical studies, such as the Project MATCH trial, have compared the effectiveness of these approaches. Overall, that study detected no significant differences among the three treatments in patient outcome, although certain treatment methodologies may be most appropriate for patients with certain characteristics. Pharmacotherapy with aversive or anticraving medications may supplement behavioral treatment approaches. Brief interventions that are delivered by primary health care providers also have been shown to reduce drinking levels, particularly in nondependent drinkers.

The community-reinforcement approach.

The community-reinforcement approach (CRA) is an alcoholism treatment approach that aims to achieve abstinence by eliminating positive reinforcement for drinking and enhancing positive reinforcement for sobriety. CRA integrates several treatment components, including building the client's motivation to quit drinking, helping the client initiate sobriety, analyzing the client's drinking pattern, increasing positive reinforcement, learning new coping behaviors, and involving significant others in the recovery process. These components can be adjusted to the individual client's needs to achieve optimal treatment outcome. In addition, treatment outcome can be influenced by factors such as therapist style and initial treatment intensity. Several studies have provided evidence for CRA's effectiveness in achieving abstinence. Furthermore, CRA has been successfully integrated with a variety of other treatment approaches, such as family therapy and motivational interviewing, and has been tested in the treatment of other drug abuse.

The endocrine system: an overview.

A plethora of hormones regulate many of the body's functions, including growth and development, metabolism, electrolyte balances, and reproduction. Numerous glands throughout the body produce hormones. The hypothalamus produces several releasing and inhibiting hormones that act on the pituitary gland, stimulating the release of pituitary hormones. Of the pituitary hormones, several act on other glands located in various regions of the body, whereas other pituitary hormones directly affect their target organs. Other hormone-producing glands throughout the body include the adrenal glands, which primarily produce cortisol; the gonads (i.e., ovaries and testes), which produce sex hormones; the thyroid, which produces thyroid hormone; the parathyroid, which produces parathyroid hormone; and the pancreas, which produces insulin and glucagon. Many of these hormones are part of regulatory hormonal cascades involving a hypothalamic hormone, one or more pituitary hormones, and one or more target gland hormones.

New genetic technologies in alcohol research.

Recently developed approaches to creating genetically engineered animals have expanded researchers' repertoire of methods to investigate the roles of individual genes in the development of certain behaviors and diseases, including alcoholism. For example, knockout mice, in which single mouse genes have been inactivated, have allowed scientists to assess the roles of those genes in mediating some of alcohol's effects. This approach has been further refined using conditional gene knockout technology, which allows the inactivation of a gene only in certain cells or during specific developmental periods. Alternatively, transgenic mice (i.e., mice that carry a foreign gene in addition to their own genes) have been created in which researchers can activate or inactivate the foreign gene at will. Although these genetic engineering technologies have not yet been used extensively in alcohol research, they offer great promise in analyzing the functions of genes that may be involved in determining alcohol's effects on the body and the development of alcoholism.

Apoptosis and necrosis: two types of cell death in alcoholic liver disease.

Heavy alcohol consumption over long periods of time can result in severe liver damage, including death of liver cells (i.e., hepatocytes). Two mechanisms--apoptosis and necrosis--can contribute to hepatocyte death. In apoptosis, the affected cell actively participates in the cell death process, whereas in necrosis the cell death occurs in response to adverse conditions in the cell's environment. Numerous factors that may contribute to the initiation of hepatocyte apoptosis are affected by alcohol consumption. These factors include the enzyme cytochrome P450 2E1 (i.e., CYP2E1), small molecules (i.e., cytokines) involved in cell communication, oxidative stress, and changes in iron metabolism. Similarly, alcohol consumption can influence several factors believed to be involved in hepatocyte necrosis, including depletion of the energy-storing molecule adenosine-triphosphate, reduced oxygen levels (i.e., hypoxia) in the liver, oxidative stress, and bacterial molecules called endotoxins.