Changes in cigarette smoking and coffee drinking after alcohol detoxification in alcoholics.

AIMS: To assess the changes in cigarette smoking and coffee drinking after alcohol detoxification in alcoholics. DESIGN: Evaluation at admission and an average 16 days following discharge. SETTING: Alcohol detoxification inpatient programme. PARTICIPANTS: Seventy-three alcohol dependent (DSM-III-R) inpatients. MEASUREMENTS: Average number of cigarettes and of cups of coffee per day; urine cotinine level. Smokers were classified as moderate on the basis of consuming fewer than 30 cigarettes per day at the time of admission; heavy smokers were those who smoked 30 cigarettes per day or more. FINDINGS: As a group, the smokers (N = 58) did not significantly change their cigarette consumption and there was no change in urine cotinine level. Heavy smokers (N = 34), however, significantly decreased their cigarette consumption, but urine cotinine was unchanged. Moderate smokers (N = 24) significantly increased their cigarette consumption but urine cotinine was not significantly changed. All patients--non-smokers, moderate and heavy smokers--significantly increased their coffee intake. CONCLUSIONS: The results suggest that heavy smokers may react to alcohol cues and thus reduce smoking activity when sober. Moderate smokers may increase their smoking rate to cope with alcohol abstinence. These changes appear only to reflect a behavioural adjustment, without modification of patients' nicotine-seeking. Alcoholics may increase their coffee intake to cope with alcohol abstinence.

Joint influence of alcohol, tobacco, and coffee on biological markers of heavy drinking in alcoholics.

BACKGROUND: Recent reports suggest that gamma-glutamyl transferase (GGT) decreases with coffee intake. The aim of this study was to examine the joint influence of alcohol, tobacco, cotinine, coffee, and caffeine on biological markers of heavy drinking in an alcoholic population. METHODS: Subjects were 160 alcohol-dependent inpatients. Biological assessments, performed at admission, were plasma levels of GGT, apolipoprotein AI, aspartate aminotransferase, and mean corpuscular volume (MCV), and urine cotinine and caffeine indexes. Years of alcohol abuse and of smoking, alcohol and coffee intake, and smoking rate were estimated in a semistructured interview, and Fagerström Tolerance Questionnaire was completed by inpatients. RESULTS: Coffee intake, but not caffeine, correlated negatively with biological markers of heavy drinking, after controlling for alcohol and tobacco intake. Years of smoking correlated positively to MCV, after controlling for alcohol and coffee intake. CONCLUSIONS: Concerning the effect of coffee, the most likely hypothesis is that noncaffeine coffee fractions have a protective effect on liver cells. Concerning the effect of smoking, one can propose that the increase of MCV with smoking could be a consequence of carbon monoxide inhalation, leading to hypoxemia, or of folate deficiency.

Frontal dysfunction in neurologically normal chronic alcoholic subjects: metabolic and neuropsychological findings.

BACKGROUND: Neuropsychological and imaging studies suggest that frontal dysfunction may occur in apparently normal chronic alcoholic subjects. METHODS: To investigate this issue further, we performed neuropsychological and fluorodeoxy-glucose-PET studies in 17 chronic alcoholics without patent neurological and psychiatric complications. RESULTS: Metabolic abnormalities were found in the mediofrontal and in the left dorsolateral prefrontal cortex, but not in the orbitofrontal cortex. Neuropsychological testing revealed significantly reduced verbal fluency and impaired performance on the Stroop test. The mediofrontal hypometabolism correlated with the reduction in verbal fluency and the time necessary to perform the interference condition of the Stroop test. The left dorsolateral prefrontal hypometabolism correlated with the number of errors on the Stroop test. CONCLUSION: These data indicate that circumscribed frontal dysfunctions may occur in chronic alcoholic subjects before clinically obvious neurological complications, and may account for some of the alcohol-related neuropsychological and behavioural impairments.

How useful is aminolevulinic acid dehydratase as a marker of recent alcohol intake?

Erythroycte delta aminolevulinic acid dehydratase (ALAD) has been suggested as a marker for detecting recent alcohol intake. Unlike other markers, ALAD activity decreases after alcohol intake. Review of the literature suggests that the main interest in this marker is because it increases rapidly after withdrawal. The present study investigated the changes in erythrocyte ALAD and serum gamma-glutamyltransferase activities after alcohol withdrawal in 120 alcoholics. Our data showed that ALAD is less sensitive than GGT as an indicator of recent alcohol intake (56% and 84% abnormal, respectively). The increase in ALAD activity was greater between day 12 and 18 after withdrawal (11%) than between day 1 and 12 after withdrawal (5%). There were as many patients returning to normal values 12 and 18 days after withdrawal, for GGT as for ALAD. Thus, our results contradict the claim that ALAD rises rapidly after withdrawal. ALAD shows no advantage over GGT as a marker of recent alcohol intake.

[Depression and smoking]. / Dépression et tabagisme.

Lifetime history of major depressive disorder is more than double in ever smokers than in never smokers. Conversely, adjusted odds ratios of nicotine dependence are significantly elevated for major depressive disorder alone (3,11) or associated with an anxiety disorder (4,38). There is also a significant relationship between depressive symptoms' severity (CES-D) and ever smoking. A history of major depressive disorder is associated with a lower chance to quit smoking. One of the reasons is that smokers who try to quit smoking experience more withdrawal symptoms--including a depressive mood--and relapse more frequently if they have a history of major depressive disorder. Few trials experimenting the usefulness of antidepressants in smoking cessation were published. Only a limited trial concerning doxepin showed a significant action on withdrawal symptoms and abstinence rate at 4 weeks. Other trials with fluoxetine and moclobemide failed to show clearly a significant effect on abstinence rate, perhaps because the medication was initiated too soon before quit day. The nature of the association between smoking and depression has been explored in recent studies, which used a cohort follow-up or the evaluation of a female twin population. The conclusions were that there is probably no causal relationship but rather that the association arises largely from common familial factors that are probably genetic, at least in women. Concurrently, tobacco smoke has monoamine oxidase inhibitory properties, and smokers have lower monoamine oxidase activity than no smokers. Hence, it is possible that smoking has antidepressant properties. While smoking prevalence regularly decreases, one can assume that the relative risk of depressive disorder will increase in smokers.

Smoking and coffee intake following alcohol withdrawal in alcoholic inpatients.

The aim of this study was to assess alcoholic inpatients' smoking and coffee intake variation following withdrawal. Only moderate smokers (less than 30 cigarettes/day) showed a significant increase of cigarette consumption after alcohol withdrawal. However, their urinary cotinine level did not vary, suggesting a behavioral, and not biological, compensation through smoking following alcohol withdrawal. Heavy smokers (30 cigarettes/day or more) showed no significant clinical or biological variation of smoking behavior. Coffee consumption increased after alcohol withdrawal in all patients, irrespective of smoking habits.

[Alcohol withdrawal syndrome and delirium tremens. Their treatment]. / Syndrome de sevrage alcoolique et delirium tremens. Leur traitement.

The clinical picture of alcohol withdrawal syndrome lies somewhere on a continuum that ranges from slight morning tremor to genuine delirium tremens. The diagnosis, usually easy, may be beset with several traps: alcoholism may be unrecognized, or a diagnosis other than withdrawal syndrome may be wrongly made, or again a complication may be either overlooked or erroneously suspected. An acute withdrawal syndrome normally regresses in less than one week, but a subacute withdrawal syndrome, which presents as signs of residual hyperexcitability of the central nervous system, must be recognized, as it may persist for several months. Beside delirium tremens, with its mandatory and well-established treatment, prevention of alcohol withdrawal syndrome and treatment of its initial stages raise no problems, as it consists above all of psychotherapy combined by such tranquillizers as febarbamate or a benzodiazepine taken in well-specified dosage.

[Alcohol, sleep and biological rhythms]. / Alcool, sommeil et rythmes biologiques.

Alcohol reduces sleep latency but notably alters sleep structure: sleep is fragmented, particularly at the end of the night. Slow wave sleep duration is enhanced in the first part of the night and REM sleep duration and density are diminished. Alcohol withdrawal provokes inverse effects in alcoholic patients: sleep onset is delayed, slow wave sleep durations diminished and REM sleep duration is enhanced. REM sleep is associated with motor inhibition failure. Sleep remains disturbed in long term evaluations. Alcohol promotes the occurrence of sleep apneas and hypopneas. This effect persists in alcoholics after alcohol withdrawal. Sleep disturbances in alcoholism can be partly understood as the expression of amplitude diminution and phase advance of biological rhythms. Thus, the chronobiologic characteristics of alcoholics resemble those of depressives or the elderly.

[Lipids and lipoproteins in chronic alcoholism. Outcome after alcohol withdrawal]. / Les lipides et les lipoprotéines chez l'alcoolique chronique. Evolution après sevrage.

The plasma lipids and lipoproteins changes observed in chronic alcoholic subjects and their modifications after cessation of drinking were studied in 379 patients admitted for alcohol withdrawal. The modifications were evaluated after one month (n = 348), 6 months (n = 56) and one year (n = 29) of abstinence. A significant decrease of HDL-cholesterol and apo A-I levels was noted after one year. HDL-cholesterol, apo A-I and apo B showed a biphasic variation with significant post-withdrawal changes which became less pronounced after 6 months of abstinence. The authors insist on the need for a prolonged post-withdrawal monitoring of plasma lipoproteins and apolipoproteins levels to evaluate the consequences of cessation of major chronic alcohol abuse. This study shows that the variations of plasma lipids and lipoproteins levels observed in heavy drinkers are similar to those observed in moderate drinkers, whereas the incidence of cardiovascular diseases seems to be higher in the former than in the latter.

Abstention from alcohol in dilated cardiomyopathy: complete regression of the clinical disease but persistence of myocardial perfusion defects on exercise thallium-201 tomography.

This case report describes a 43-year-old man with dilated cardiomyopathy reversed by abstention from alcohol over 1 year but with persistence of previous myocardial perfusion defects on exercise thallium-201 tomography. This suggests that despite the near normalization of left ventricular function, a permanent myocardial disease seems to persist.

Tianeptine and its main metabolite pharmacokinetics in chronic alcoholism and cirrhosis.

The effect of chronic alcoholism (with or without associated moderate cirrhosis) on the disposition of the antidepressant tianeptine, which is devoid of substantial first-pass metabolism, was examined in 21 patients and 11 age-matched controls. Pharmacokinetic parameters for tianeptine and its C5 acid analogue metabolite (MC5 metabolite) were estimated by non-compartmental analysis. The area under the curve (AUC) for tianeptine, following a 12.5mg single oral dose, was decreased by 31% in chronic alcoholics and increased by only 14% in cirrhotics, compared to controls. These changes did not attain statistical significance. The trend of changes in the AUC for the MC5 metabolite was similar to that observed for the parent drug. No statistical difference was found in the terminal half-life for both tianeptine and its MC5 metabolite between patients and controls. On the basis of this study, it appears unnecessary to modify the proposed dosage regimen used in clinical trials (tianeptine sodium salt 12.5mg 3 times daily) in chronic alcoholics with or without associated moderate cirrhosis.

Tianeptine and amitriptyline. Controlled double-blind trial in depressed alcoholic patients.

129 chronic alcoholic patients, withdrawn from alcohol and presenting major depression or dysthymic disorder, were treated for 4-8 weeks under double-blind conditions either with a new antidepressant, tianeptine (37.5 mg per day), or with amitriptyline (75 mg per day). Both groups presented steady improvement of the symptoms of depression during treatment, as scored on the Montgomery and Asberg Depression Rating Scale and the Hopkins Symptom Checklist self-evaluation; for the latter scale, the improvement was significantly greater in the tianeptine group. In addition to the improvement of mood, tianeptine also produced significant reduction of the somatic complaints of the depressed patients. Furthermore, tianeptine possesses anxiolytic activity, as shown by the change of the Hamilton Anxiety Rating Scale global score, similar to that produced by amitriptyline. The anxiolytic activity of tianeptine was not accompanied by any impairment of vigilance, unlike that of amitriptyline. Tianeptine produced rare, mild anticholinergic effects. The results obtained show that tianeptine is an effective anxiolytic antidepressant, with better safety than amitriptyline, suitable for use in the treatment of mood disorders following alcohol withdrawal.

Pharmacokinetic and metabolic parameters of tianeptine in healthy volunteers and in populations with risk factors.

Following oral administration in the fasting healthy subject, the mean maximum concentration of tianeptine is 334 +/- 79 ng/ml. Absorption of tianeptine from the tablet form is rapid and complete. Maximum plasma concentration is obtained by the first hour following administration (0.94 +/- 0.47 h). Absolute bioavailability is 99 +/- 29%. Tianeptine is thus rapidly and completely absorbed in the tablet form and is not subject to first-pass effect. Distribution of tianeptine in the body is characterized by the following: its rapidity, the mean distribution half-life being about 0.7 h; its limited extent, the apparent volume of distribution being about 0.8 L/kg (0.77 +/- 0.31 L/kg); and protein binding, which averages 93.8 +/- 2.4%. Elimination of tianeptine is characterized by a short mean half-life of 2 h 30 min (2.5 +/- 1.1 h) and by renal excretion of 0.4 ml/min (0.4 +/- 0.4 ml/min). Tianeptine is extensively metabolized. Major metabolites are analogs of tianeptine with a C5 and C3 lateral chain and a N-demethylated derivative. Studies have shown negligible influence on pharmacokinetic parameters of chronic alcoholism even in case of hepatic cirrhosis. In renal failure, and in the elderly, studies have revealed a 1-h prolongation of elimination half-life which suggests that the dosage should be limited to two tablets per day in such cases.

[Therapy and suggestion]. / Thérapeutique et suggestion.

Therapy and suggestion are closely related. That is clear for the ancient time: primitive medicine gives a good place to the Word. In plant, animal or mineral remedies, the suggestion is clearly preponderant. Towards the end of the 19th century, the "Ecole de Nancy" sets up a real theory of the suggestion, and Bernheim, its leader, bases hypnosis, then psychotherapy on this concept. Thereafter Coué will bring up the "conscious autosuggestion". Today, despite the progress of scientific medicine, the part of suggestion is still very important in medical therapy (with or without drugs), or in chirurgical therapy; this part is also very important in psychotherapies, whatever has been said in this field. This has to be known and used consciously in the doctor-patient relation, which is always essential in the therapeutic effectiveness.

[Current concepts on therapeutic possibilities in alcohology]. / Notions actuelles sur les possibilités thérapeutiques en alcoologie.

Therapeutic possibilities in the field of alcoholism are certainly more extensive than accepted by most general practitioners and internists whose attitude is, according to an inquiry, rather fatalistic. The actual therapy of alcoholism proves to be effective, the earlier the therapy being started the better are the results. On this account, the necessity of preventive measures and of an early treatment is to be underlined. General practitioners and internists (whose training in this area appears to be still deficient) as well as centers for nutritional hygiene and alcohology (presently about 200 consultation centers in France) may play here a cardinal role. The treatment of alcohol-addicts often justifies hospitalisation, more and more in general hospitals, where a therapeutic program, at the first place a long-term psychotherapy, is set up. The alcoholic should constantly be assisted by his treating physician, by specialised centers and also by fellowships of former alcohol-addicts.