Department of Psychiatry, University Medical School of Lübeck, Lübeck, Germany
Received 27 July 1998; in revised form 12 November 1998; accepted 12 November 1998
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ABSTRACT |
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INTRODUCTION |
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METHODS AND SAMPLE |
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It was possible to categorize the drinking pattern in 241 patients (74.8%), as the remaining patients showed irregular drinking behaviour. Thus, 64 females (mean age ± SD: 43.8 ± 8.8 years, mean duration of harmful drinking: 10.4 ± 6.8 years) and 177 males (mean age: 41.0 ± 9.9 years, mean duration of harmful drinking: 11.6 ± 8.7 years) were included in this study. All subjects underwent comprehensive clinical examination including laboratory tests (at admission and 3 weeks after admission) and tests for viral hepatitis A, B, and C. Subjects with viral hepatitis were excluded. Abdominal ultrasound was performed in 194 cases.
The life-time alcohol intake was estimated as the product of the drinking frequency, the mean alcohol intake/drinking day, duration of harmful alcohol intake, and a tolerance factor'. This tolerance factor' was estimated as the reciprocal of the ratio of reported increase of alcohol intake at the onset of harmful drinking to the index drinking period. Longer abstinence periods (> 3 months) were taken into consideration when estimating the duration of harmful drinking. Alcohol intake was calculated in g/kg. All statistical calculations were performed using the SPSS-PC program package (version 7.5).
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RESULTS |
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Severity of alcohol dependence
The frequent heavy drinkers showed more severe alcoholism according to ICD-10 criteria (World Health Organization, 1992) for alcohol dependence than the other groups. Nearly all of them (91.6%) qualified for at least three of the six ICD criteria, so that they were diagnosed as alcohol-dependent, whereas only 75% of the continuous drinkers and about 60% of the episodic drinkers fulfilled ICD-10 criteria for alcohol dependence. Each ICD-10 criterion was fulfilled by frequent heavy drinkers more often than by other groups, particularly an impaired capacity to control drinking (66.4 vs 16% in continuous and 26.4% in episodic drinkers,
2 54.1, d.f. = 2, P < 0.0001), evidence of tolerance (70.1 vs 34.6% and 26.4%,
2 36.6, d.f. = 2, P < 0.0001), and preoccupation with drinking (74.8 vs 49.4% and 41.5%,
2 20.8, d.f. = 2, P < 0.0001) respectively.
Alcohol history
The alcohol history (Table 1) revealed that frequent heavy drinkers tended to start drinking alcohol earlier than episodic drinkers and experienced their first inebriation earlier than the other groups. However, the mean duration of harmful alcohol drinking was higher in the continuous drinkers. The mean alcohol intake per drinking day in the last 6 months was much higher in the frequent heavy drinking group (290 g) than the other two groups (169 or 186 g of alcohol/drinking day).
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Alcohol-related medical disorders
The frequency of alcohol-related medical disorders was similar in all groups (Table 2). The continuous and the frequent heavy drinkers showed a history of pancreatitis and oesophageal varices more often than episodic drinkers. Furthermore, the frequent heavy drinkers' group suffered from chronic gastritis and gastrointestinal bleeding more frequently. Polyneuropathy as well as erectile dysfunction occurred more often in continuous and frequent heavy drinkers. The rates of withdrawal delirium or seizures were no different between the groups. In summary, the frequent heavy drinkers tended to show a higher number of alcohol-related disorders than episodic drinkers, but no more than continuous drinkers. In particular, more upper gastrointestinal and neurological disorders were detected in frequent heavy drinkers. Furthermore, they required emergency treatment and had a history of severe brain trauma with unconsciousness more often. They also attempted suicide more often than continuous drinkers.
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The number of alcohol-related disorders was strongly related to life-time alcohol intake (Table 3). Alcoholics with none of these disorders had an estimated life-time alcohol consumption of 4.9 ± 10.0 kg alcohol/kg body weight, those subjects with one alcohol-related disorder had drunk 6.0 ± 6.9 kg/kg, those suffering from two disorders 6.8 ± 8.9 kg/kg, and the most affected alcoholics (having three or more disorders) 12.9 ± 13.9 kg/kg (Scheffé-test, P < 0.05). There was a strong relationship between long-term alcohol intake and chronic gastritis, gastrointestinal bleeding, pancreatitis, withdrawal seizures, delirium, polyneuropathy, and severe brain injury.
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Contributing factors
In order to evaluate the influence of contributing factors, such as age, duration of harmful alcohol consumption, gender and drinking pattern as well as estimated life-time alcohol intake, on the occurrence of alcohol-related disorders, a stepwise logistic regression was performed. The statistical analysis revealed no significant contributory factor for oeso-phageal bleeding, gastric ulcer or fatty hepatitis. Life-time alcohol intake had the highest influence on the rate of withdrawal delirium, gastrointestinal bleeding, and pancreatitis, the duration of harmful alcohol consumption on brain injuries and withdrawal seizures, and age on gastrointestinal bleeding, chronic gastritis, alcoholic hepatitis, and liver cirrhosis. The drinking pattern only contributed to the rate of polyneuropathy and to a tendency to a higher number of brain injuries.
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DISCUSSION |
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Since ethanol is almost entirely detoxified in the liver (Lieber, 1998), hepatic disorders are very common in alcoholics. In about one-third of our sample, a liver disease, most often fatty hepatitis, was diagnosed. As in most other studies, the few subjects in our sample with liver cirrhosis tended to have a higher alcohol consumption than those without. Our findings of fatty hepatitis, however, revealed no relationship with the estimated life-time alcohol intake. In contrast to a similar study (Connors et al., 1986
), we did not find that frequent heavy drinkers have more liver problems than continuous drinkers, probably due to the very similar estimated life-time alcohol intake of both groups in our sample.
The alcoholics suffering from chronic gastritis, gastrointestinal bleeding, pancreatitis, and polyneuropathy had a significantly higher life-time alcohol intake than those without. Chronic gastritis and gastrointestinal bleeding occurred more often in frequent heavy drinkers than in the other groups, probably due to the damage caused by the high amounts of alcohol drunk per day. Polyneuropathy was diagnosed in about 30% of the frequent heavy and continuous drinkers. Furthermore, complications during alcohol withdrawal, particularly delirium and seizures, occurred more frequently in alcoholics with high alcohol consumption.
Our data revealed no clear gender differences in the rate of alcohol-related disorders. Thus, our results do not agree with studies suggesting a higher vulnerability to alcohol in females (Morgan and Sherlock, 1977; Loft et al., 1987
; Mezey et al., 1988
). This discrepancy may be due to the fact that our estimations, in contrast to most other investigations, considered the relative alcohol consumption per kg body weight.
The high rate of brain trauma in binge drinkers' may indicate a higher risk of severe injuries in this group, but in another study drinking measures were not found to be significantly related to injury (Treno et al., 1997). Apart from unintentional injuries, alcoholics often display violent behaviour (Romelsjö, 1995
). In view of the high suicide rate in alcoholics (Romelsjö, 1995
), the finding that the frequent heavy drinkers more frequently attempted suicide than the other groups becomes relevant in planning therapeutic intervention.
The estimated life-time alcohol intake is a rough measure, because alcohol consumption is unstable over longer periods (Skog and Duckert, 1993; Schuckit et al., 1997
). Nevertheless, our data showed internal consistency, as the subjects with a higher number of alcohol-related medical disorders had drunk significantly more than those suffering from none of these disorders. Furthermore, those subjects who suffered brain trauma with unconsciousness also reported higher alcohol consumption than those with no such history.
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CONCLUSION |
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ACKNOWLEDGEMENTS |
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FOOTNOTES |
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REFERENCES |
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