Alcohol potentiates most meds or drugs
Alcohol potentiates most meds or drugs
Inpatient hospital stay decreased
AHRQ Stats: Hospital Care for Mental Health/Substance Use
The proportion of hospital stays for mental health/substance use increased by 20 percent from 2005 to 2014, representing nearly 6 percent of all hospital stays by 2014. (AHRQ, Healthcare Cost and Utilization Project Statistical Brief #225: Trends in Hospital Inpatient Stays in the United States, 2005-2014.)
Today’s Headlines:
- AHRQ Evidence Report Compares Risks and Benefits of Blood Clot Prevention Approaches
- Study Estimates Costs of Zika Virus Epidemic in the United States
- Quality Reports Help Moms Prepare for Childbirth
- Patient Outcomes Better When Primary Care Practices Establish Patient-Centered Culture
- New AHRQ Views Blog Post
- Featured Case Study: St. Jude Children’s Research Hospital Uses AHRQ Survey To Promote Patient Safety
AHRQ Evidence Report Compares Risks and Benefits of Blood Clot Prevention Approaches
A new report from AHRQ compares the effectiveness of strategies to prevent venous thromboembolism in people getting hip or knee replacements and people being treated for hip fractures. Few studies have directly compared different types of blood thinners and mechanical interventions such as compression stockings or compression pumps. The report authors concluded that more research is needed to determine the most effective strategy for preventing harmful blood clots after hip or knee replacement and hip fracture surgeries. AHRQ has previously done other work in this area, including developing a guide to assist health care organizations and a video and tools to help patients in preventing blood clots.
Study Estimates Costs of Zika Virus Epidemic in the United States
A Zika virus outbreak that infects 2 percent of the population of six southern states will cost approximately $2 billion in medical costs, lost productivity and other related costs, according to a new study partially funded by AHRQ. The article in the journal PLOS Neglected Tropical Diseases examined the potential cost of various scenarios in the six states at the greatest risk of suffering a Zika epidemic — Alabama, Florida, Georgia, Louisiana, Mississippi and Texas. Researchers forecast how overall direct medical costs, the proportion of direct medical costs expected to be covered by Medicaid, costs of lost productivity and total costs to society could vary with different virus attack rates and other factors. The study also identified the primary determinants of infection-related costs. This information could help guide future data collection and infection control efforts. Access the abstract.
Quality Reports Help Moms Prepare for Childbirth
Timely hospital quality information can help expectant mothers make decisions about labor and delivery and communicate more effectively with providers about their care preferences and concerns, according to the authors of a new AHRQ study. The authors used a randomized controlled trial to test the use of email and texts to deliver pertinent information timed to the specific week of the pregnancy. The biweekly messages directed the mothers to a website that provided videos and articles about quality information, tools to help them communicate with their providers, and ratings of local hospitals and pregnant women’s experiences at the hospitals. Participants became better informed about medical procedures, such as cesarean sections and episiotomies; discussed the information with family; and sought further information. They used the material to prepare for visits to doctors and midwives and to create a birth plan. The authors found that the timed dissemination of information was successful in getting the women to use it to inform and improve their care. The article, “Increasing the Use of Comparative Quality Information in Maternity Care: Results From a Randomized Controlled Trial,” was published in the journal Medical Care Research and Review. Access the abstract.
Patient Outcomes Better When Primary Care Practices Establish Patient-Centered Culture
Patients with diabetes and/or cardiovascular disease had better physical functioning and were less likely to report being depressed if treated at primary care practices with well-developed patient-centered cultures, according to new research partially funded by AHRQ. The study was published in the June issue of the Journal of General Internal Medicine. Researchers surveyed 16 primary care practices and analyzed patient-reported outcomes of more than 4,300 patients. The researchers defined a patient-centered culture as one in which practice team members made greater efforts to engage patients while better coordinating their work with one another. They concluded that the growing movement toward more accountable care delivery and the increasing number of people with chronic illnesses underscored the need for primary care practices to engage patients in their own care. This research was funded as part of AHRQ’s Comparative Health System Performance Initiative, which studies how health care delivery systems promote evidence-based practices and patient-centered outcomes research in delivering care. Access the abstract.
New AHRQ Views Blog Post
Featured Case Study: St. Jude Children’s Research Hospital Uses AHRQ Survey To Promote Patient Safety
St. Jude Children’s Research Hospital uses AHRQ’s Hospital Survey on Patient Safety Culture to obtain employee feedback on ways to improve medical care and safety for the approximately 8,000 patients who receive care each year. Based on the survey feedback, the Memphis-based hospital launched a hospitalwide initiative this year to improve handoffs, starting with shift changes. Access the impact case study.
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Top posts 7-11-2017 pm
Source: Top posts 7-11-2017 pm
Top posts 7-11-2017 pm
miRNA inherited disease, DNA repair, cancer, alcoholism, obesity,heart disease
miRNA inherited disease, DNA repair, cancer, alcoholism, obesity,heart disease
Disease
Just as miRNA is involved in the normal functioning of eukaryotic cells, so has dysregulation of miRNA been associated with disease.[140] A manually curated, publicly available database, miR2Disease, documents known relationships between miRNA dysregulation and human disease.[141]
Inherited diseases
A mutation in the seed region of miR-96, causes hereditary progressive hearing loss.[142]
A mutation in the seed region of miR-184, causes hereditary keratoconus with anterior polar cataract.[143]
Deletion of the miR-17~92 cluster, causes skeletal and growth defects.[144]
Cancer
Role of miRNA in a cancer cell
The first human disease known to be associated with miRNA deregulation was chronic lymphocytic leukemia.[46] Many other miRNAs also have links with cancer[46] and accordingly are sometimes referred to as “oncomirs“. In malignant B cells miRNAs participate in pathways fundamental to B cell development like B-cell receptor (BCR) signalling, B-cell migration/adhesion, cell-cell interactions in immune niches and the production and class-switching of immunoglobulins. MiRNAs influence B cell maturation, generation of pre-, marginal zone, follicular, B1, plasma and memory B cells.[46]
A study of mice altered to produce excess c-Myc — a protein with mutated forms implicated in several cancers — shows that miRNA affects the cancer development. Mice engineered to produce a surplus of types of miRNA found in lymphoma cells developed the disease within 50 days and died two weeks later. In contrast, mice without the surplus miRNA lived over 100 days.[46] Leukemia can be caused by the insertion of a viral genome next to the 17-92 array of microRNAs, leading to increased expression of this microRNA.[46]
Another study found that two types of miRNA inhibit the E2F1 protein, which regulates cell proliferation. miRNA appears to bind to messenger RNA before it can be translated to proteins that switch genes on and off.[46]
By measuring activity among 217 genes encoding miRNAs, patterns of gene activity that can distinguish types of cancers were identified. miRNA profiling can determine whether patients with chronic lymphocytic leukemia had slow growing or aggressive forms of the cancer.[46]
A novel miRNA-profiling-based screening assay for the detection of early-stage colorectal cancer is undergoing a clinical trial. Early results showed that blood plasmasamples collected from patients with early, resectable (Stage II) colorectal cancer could be distinguished from those of sex-and age-matched healthy volunteers. Sufficient selectivity and specificity could be achieved using small (less than 1 mL) samples of blood.[145][146]
Another role for miRNA in cancers is to use their expression level for prognosis. For example, one study on NSCLC samples found that low miR-324a levels could serve as an indicator of poor survival.[147] Either high miR-185 or low miR-133b levels may correlate with metastasis and poor survival in colorectal cancer.[148]
Furthermore, specific miRNAs may be associated with certain histological subtypes of colorectal cancer. For instance, expression levels of miR-205 and miR-373 have been shown to be increased in mucinous colorectal cancers and mucin-producing Ulcerative Colitis-associated colon cancers, but not in sporadic colonic adenocarcinoma that lack mucinous components.[149] In-vitro studies suggested that miR-205 and miR-373 may functionally induce different features of mucinous-associated neoplastic progression in intestinal epithelial cells.[149]
Hepatocellular carcinoma cell proliferation may arise from miR-21 interaction with MAP2K3, a tumor repressor gene.[150] Optimal treatment for cancer involves accurately identifying patients for risk-stratified therapy. Those with a rapid response to initial treatment may benefit from truncated treatment regimens, showing the value of accurate disease response measures. Cell-free miRNA are highly stable in blood, are overexpressed in cancer and are quantifiable within the diagnostic laboratory. In classical Hodgkin lymphoma, plasma miR-21, miR-494, and miR-1973 are promising disease response biomarkers.[151] Circulating miRNAs have the potential to assist clinical decision making and aid interpretation of positron emission tomography combined with computerized tomography. They can be performed at each consultation to assess disease response and detect relapse.
A 2009 study explored miR-205 targeted for inhibiting the metastatic nature of breast cancer.[152] Five members of the microRNA-200 family (miR-200a, miR-200b, miR-200c, miR-141 and miR-429) are down-regulated in tumour progression of breast cancer.[153]
The specific microRNA, miR-506 has been found to work as a tumor antagonist in several studies.[154] In a 2014 study, a significant number of cervical cancer samples were found to have down-regulated expression of miR-506. Additionally, studies found that miR-506 works to promote apoptosis of cervical cancer cells, through its direct target hedgehog pathway transcription factor, Gli3.[155]
A 2015 study used a triple helix of three miRNAs embedded in a dextran aldehyde/dendrimer gel in a mouse model of triple negative breast cancer. mir-205 and mir-212 targeted specific RNAs, while the other miRNA stabilized the others. The treatment reduced tumor sizes by 90% with survival times of 75 days.[156][157]
MicroRNAs have the potential to be used as targets for treatment of different cancers. The specific microRNA, miR-506 has been found to work as a tumor antagonist in several studies. In a 2014 study, a significant number of cervical cancer samples were found to have downregulated expression of miR-506. Additionally, studies found that miR-506 works to promote apoptosis of cervical cancer cells, through its direct target hedgehog pathway transcription factor, Gli3.[154][155]
DNA repair and cancer
DNA damage is considered to be the primary underlying cause of cancer.[158] If DNA repair is deficient, damage can accumulate. Such damage can cause mutationalerrors during DNA replication due to error-prone translesion synthesis. Accumulated damage can also cause epigenetic alterations due to errors during DNA repair.[159][160] Such mutations and epigenetic alterations can give rise to cancer (see malignant neoplasms).
Germ line mutations in DNA repair genes cause only 2–5% of colon cancer cases.[161] However, altered expression of microRNAs, causing DNA repair deficiencies, are frequently associated with cancers and may be an important causal factor.
Among 68 sporadic colon cancers with reduced expression of the DNA mismatch repair protein MLH1, most were found to be deficient due to epigenetic methylation of the CpG island of the MLH1 gene.[162] However, up to 15% of MLH1-deficiencies in sporadic colon cancers appeared to be due to over-expression of the microRNA miR-155, which represses MLH1 expression.[163]
In 29–66%[164][165] of glioblastomas, DNA repair is deficient due to epigenetic methylation of the MGMT gene, which reduces protein expression of MGMT. However, for 28% of glioblastomas, the MGMT protein is deficient, but the MGMT promoter is not methylated.[164] In glioblastomas without methylated MGMT promoters, the level of microRNA miR-181d is inversely correlated with protein expression of MGMT and the direct target of miR-181d is the MGMT mRNA 3’UTR (the three prime untranslated region of MGMT mRNA).[164] Thus, in 28% of glioblastomas, increased expression of miR-181d and reduced expression of DNA repair enzyme MGMT may be a causal factor.
HMGA proteins (HMGA1a, HMGA1b and HMGA2) are implicated in cancer, and expression of these proteins is regulated by microRNAs. HMGA expression is almost undetectable in differentiated adult tissues, but is elevated in many cancers. HMGA proteins are polypeptides of ~100 amino acid residues characterized by a modular sequence organization. These proteins have three highly positively charged regions, termed AT hooks, that bind the minor groove of AT-rich DNA stretches in specific regions of DNA. Human neoplasias, including thyroid, prostatic, cervical, colorectal, pancreatic and ovarian carcinomas, show a strong increase of HMGA1a and HMGA1b proteins.[166] Transgenic mice with HMGA1 targeted to lymphoid cells develop aggressive lymphoma, showing that high HMGA1 expression is associated with cancers and that HMGA1 can act as an oncogene.[167] A 2003 study[168] showed that HMGA1 protein binds to the promoter region of DNA repair gene BRCA1 and inhibits BRCA1 promoter activity. They also showed that while only 11% of breast tumors had hypermethylation of the BRCA1 gene, 82% of aggressive breast cancers have low BRCA1 protein expression, and most of these reductions were due to chromatin remodeling by high levels of HMGA1 protein.
HMGA2 protein specifically targets the promoter of ERCC1, thus reducing expression of this DNA repair gene.[169] ERCC1 protein expression was deficient in 100% of 47 evaluated colon cancers (though the extent to which HGMA2 was involved is not known).[170] A 2012 study[171] showed that in normal tissues, HGMA1 and HMGA2 genes are targeted (and thus strongly reduced in expression) by miR-15, miR-16, miR-26a, miR-196a2 and Let-7a. However, each of these HMGA-targeting miRNAs are drastically reduced in almost all human pituitary adenomas studied, when compared with the normal pituitary gland. Consistent with the down-regulation of these HMGA-targeting miRNAs, an increase in the HMGA1 and HMGA2-specific mRNAs was observed. Three of these microRNAs (miR-16, miR-196a and Let-7a)[172][173]have methylated promoters and therefore low expression in colon cancer. For two of these, miR-15 and miR-16, the coding regions are epigenetically silenced in cancer due to histone deacetylase activity.[174] When these microRNAs are expressed at a low level, then HMGA1 and HMGA2 proteins are expressed at a high level. HMGA1 and HMGA2 target (reduce expression of) BRCA1 and ERCC1 DNA repair[175] genes. Thus DNA repair can be reduced, likely contributing to cancer progression.[158]
In contrast to the previous example, where under-expression of miRNAs indirectly caused reduced expression of DNA repair genes, in some cases over-expression of certain miRNAs may directly reduce expression of specific DNA repair proteins. A 2011 study[176] referred to 6 DNA repair genes that are directly targeted by the miRNAs indicated: ATM (miR-421), RAD52 (miR-210, miR-373), RAD23B (miR-373), MSH2 (miR-21), BRCA1 (miR-182) and P53 (miR-504, miR-125b). More recently, A 2014 study[177] listed multiple DNA repair genes directly targeted by these additional miRNAs: ATM (miR-100, miR18a, miR-101), DNA-PK (miR-101), ATR (mir-185), Wip1 (miR-16), MLH1, MSH2, MSH6 (miR-155), ERCC3, ERCC4 (miR-192) and UNG2 (miR-16, miR-34c). Among these miRNAs, miR-16, miR-18a, miR-21, miR-34c, miR-101, miR-125b, miR-155, miR-182, miR-185, miR-192 and miR-373 were identified[173] as over-expressed in colon cancer through epigenetic hypomethylation. Over expression of any one of these miRNAs can cause reduced expression of its target DNA repair gene.
Heart disease
The global role of miRNA function in the heart has been addressed by conditionally inhibiting miRNA maturation in the murine heart. This revealed that miRNAs play an essential role during its development.[178][179] miRNA expression profiling studies demonstrate that expression levels of specific miRNAs change in diseased human hearts, pointing to their involvement in cardiomyopathies.[180][181][182] Furthermore, animal studies on specific miRNAs identified distinct roles for miRNAs both during heart development and under pathological conditions, including the regulation of key factors important for cardiogenesis, the hypertrophic growth response and cardiac conductance.[179][183][184][185][186][187] miRNA’s in animal models have also been linked to cholesterol metabolism and regulation.[188]
miRNA-712
Murine microRNA-712 is a potential biomarker (i.e. predictor) for atherosclerosis, a cardiovascular disease of the arterial wall associated with lipid retention and inflammation.[189] Non-laminar blood flow also correlates with development of atherosclerosis as mechanosenors of endothelial cells respond to the shear force of disturbed flow (d-flow).[175] A number of pro-atherogenic genes including matrix metalloproteinases (MMPs) are upregulated by d-flow ,[175] mediating pro-inflammatory and pro-angiogenic signals. These findings were observed in ligated carotid arteries of mice to mimic the effects of d-flow. Within 24 hours, pre-existing immature miR-712 formed mature miR-712 suggesting that miR-712 is flow-sensitive.[175] Coinciding with these results, miR-712 is also upregulated in endothelial cells exposed to naturally occurring d-flow in the greater curvature of the aortic arch.[175]
Gene origin
Pre-mRNA sequence of miR-712 is generated from the murine ribosomal RN45s gene at the internal transcribed spacer region 2 (ITS2).[175] XRN1 is an exonuclease that degrades the ITS2 region during processing of RN45s.[175] Reduction of XRN1 under d-flow conditions therefore leads to the accumulation of miR-712.[175]
Mechanism
MiR-712 targets tissue inhibitor of metalloproteinases 3 (TIMP3).[175] TIMPs normally regulate activity of matrix metalloproteinases (MMPs) which degrade the extracellular matrix (ECM). Arterial ECM is mainly composed of collagen and elastin fibers, providing the structural support and recoil properties of arteries.[190] These fibers play a critical role in regulation of vascular inflammation and permeability, which are important in the development of atherosclerosis.[191] Expressed by endothelial cells, TIMP3 is the only ECM-bound TIMP.[190] A decrease in TIMP3 expression results in an increase of ECM degradation in the presence of d-flow. Consistent with these findings, inhibition of pre-miR712 increases expression of TIMP3 in cells, even when exposed to turbulent flow.[175]
TIMP3 also decreases the expression of TNFα (a pro-inflammatory regulator) during turbulent flow.[175] Activity of TNFα in turbulent flow was measured by the expression of TNFα-converting enzyme (TACE) in blood. TNFα decreased if miR-712 was inhibited or TIMP3 overexpressed,[175] suggesting that miR-712 and TIMP3 regulate TACE activity in turbulent flow conditions.
Anti-miR-712 effectively suppresses d-flow-induced miR-712 expression and increases TIMP3 expression.[175] Anti-miR-712 also inhibits vascular hyperpermeability, thereby significantly reducing atherosclerosis lesion development and immune cell infiltration.[175]
Human homolog microRNA-205
The human homolog of miR-712 was found on the RN45s homolog gene, which maintains similar miRNAs to mice.[175] MiR-205 of humans sshare similar sequences with miR-712 of mice and is conserved across most vertebrates.[175] MiR-205 and miR-712 also share more than 50% of the cell signaling targets, including TIMP3.[175]
When tested, d-flow decreased the expression of XRN1 in humans as it did in mice endothelial cells, indicating a potentially common role of XRN1 in humans.[175]
Kidney disease
Targeted deletion of Dicer in the FoxD1-derived renal progenitor cells in a murine model resulted in a complex renal phenotype including expansion of nephronprogenitors, fewer renin cells, smooth muscle arterioles, progressive mesangial loss and glomerular aneurysms.[192] High throughput whole transcriptome profiling of the FoxD1-Dicer knockout mouse model revealed ectopic upregulation of pro-apoptotic gene, Bcl2L11 (Bim) and dysregulation of the p53 pathway with increase in p53 effector genes including Bax, Trp53inp1, Jun, Cdkn1a, Mmp2, and Arid3a. p53 protein levels remained unchanged, suggesting that FoxD1 stromal miRNAs directly repress p53-effector genes. Using a lineage tracing approach followed by Fluorescent-activated cell sorting, miRNA profiling of the FoxD1-derived cells not only comprehensively defined the transcriptional landscape of miRNAs that are critical for vascular development, but also identified key miRNAs that are likely to modulate the renal phenotype in its absence. These miRNAs include miRs‐10a, 18a, 19b, 24, 30c, 92a, 106a, 130a, 152, 181a, 214, 222, 302a, 370, and 381 that regulate Bcl2L11 (Bim) and miRs‐15b, 18a, 21, 30c, 92a, 106a, 125b‐5p, 145, 214, 222, 296‐5p and 302a that regulate p53-effector genes. Consistent with the profiling results, ectopic apoptosis was observed in the cellular derivatives of the FoxD1 derived progenitor lineage and reiterates the importance of renal stromal miRNAs in cellular homeostasis.[192]
Nervous system
miRNAs appear to regulate the development and function of the nervous system.[193] Neural miRNAs are involved at various stages of synaptic development, including dendritogenesis (involving miR-132, miR-134 and miR-124), synapse formation[194] and synapse maturation (where miR-134 and miR-138 are thought to be involved).[195] Some studies find altered miRNA expression in schizophrenia, as well as bipolar disorder and major depression and anxiety disorders.[196][197][198]
Alcoholism
The vital role of miRNAs in gene expression is significant to addiction, specifically alcoholism.[199] Chronic alcohol abuse results in persistent changes in brain function mediated in part by alterations in gene expression.[199] miRNA global regulation of many downstream genes deems significant regarding the reorganization or synaptic connections or long term neuroadaptions involving the behavioral change from alcohol consumption to withdrawal and/or dependence.[200] Up to 35 different miRNAs have been found to be altered in the alcoholic post-mortem brain, all of which target genes that include the regulation of the cell cycle, apoptosis, cell adhesion, nervous system development and cell signaling.[199] Altered miRNA levels were found in the medial prefrontal cortex of alcohol-dependent mice, suggesting the role of miRNA in orchestrating translational imbalances and the creation of differentially expressed proteins within an area of the brain where complex cognitive behavior and decision making likely originate.[201]
miRNAs can be either upregulated or downregulated in response to chronic alcohol use. miR-206 expression increased in the prefrontal cortex of alcohol-dependent rats, targeting the transcription factor brain-derived neurotrophic factor (BDNF) and ultimately reducing its expression. BDNF plays a critical role in the formation and maturation of new neurons and synapses, suggesting a possible implication in synapse growth/synaptic plasticity in alcohol abusers.[202] miR-155, important in regulating alcohol-induced neuroinflammation responses, was found to be upregulated, suggesting the role of microglia and inflammatory cytokines in alcohol pathophysiology.[203] Downregulation of miR-382 was found in the nucleus accumbens, a structure in the basal forebrain significant in regulating feelings of reward that power motivational habits. miR-382 is the target for the dopamine receptor D1 (DRD1), and its overexpression results in the upregulation of DRD1 and delta fosB, a transcription factor that activates a series of transcription events in the nucleus accumbens that ultimately result in addictive behaviors.[204] Alternatively, overexpressing miR-382 resulted in attenuated drinking and the inhibition of DRD1 and delta fosB upregulation in rat models of alcoholism, demonstrating the possibility of using miRNA-targeted pharmaceuticals in treatments.[204]
Obesity
miRNAs play crucial roles in the regulation of stem cell progenitors differentiating into adipocytes.[205] Studies to determine what role pluripotent stem cells play in adipogenesis, were examined in the immortalized human bone marrow-derived stromal cell line hMSC-Tert20.[206] Decreased expression of miR-155,miR-221,and miR-222, have been found during the adipogenic programming of both immortalized and primary hMSCs, suggesting that they act as negative regulators of differentiation. Conversely, ectopic expression of the miRNAs 155,221, and 222 significantly inhibited adipogenesis and repressed induction of the master regulators PPARγ and CCAAT/enhancer-binding protein alpha (CEBPA).[207] This paves the way for possible genetic obesity treatments.
Another class of miRNAs that regulate insulin resistance, obesity, and diabetes, is the let-7 family. Let-7 accumulates in human tissues during the course of aging.[208]When let-7 was ectopically overexpressed to mimic accelerated aging, mice became insulin-resistant, and thus more prone to high fat diet-induced obesity and diabetes.[209] In contrast when let-7 was inhibited by injections of let-7-specific antagomirs, mice become more insulin-sensitive and remarkably resistant to high fat diet-induced obesity and diabetes. Not only could let-7 inhibition prevent obesity and diabetes, it could also reverse and cure the condition.[210] These experimental findings suggest that let-7 inhibition could represent a new therapy for obesity and type 2 diabetes.
Alcohol Detox and Withdrawal
Source: Alcohol Detox and Withdrawal
Alcohol Detox and Withdrawal
Alcohol Detox and Withdrawal
Alcohol addiction can ruin a person’s life, and yet many continue to abuse the drug knowingly in order to avoid withdrawal. Detox and withdrawal are infamous in the addiction community for being physically and psychologically uncomfortable experiences. If done at home without medical attention, alcohol withdrawal can even turn deadly. However, this time of bodily cleansing is the first step to getting off of alcohol and putting your life back on track. Following detox, an alcoholic is ready to enter rehab and learn the sober living skills that will help them maintain a booze-free life.
Table of Contents
A person has reached a state of alcohol dependence — the physical half of addiction — when their body experiences withdrawal symptoms once there is no more alcohol in their system. Withdrawal symptoms occur during detox, a natural bodily process that removes toxins from the system.Withdrawal is a physically and psychologically uncomfortable experience — so much so that many heavy drinkers will continue drinking, despite the negative consequences, because it helps them avoid experiencing withdrawal. Withdrawal occurs because continued and excessive alcohol use eventually interferes with the brain’s natural functions, disrupting neurotransmitters that send messages to your central nervous system.The primary neurotransmitter tied to the production of feelings like relaxation is gamma aminobutyric acid. GABA also helps produce endorphins in the brain, which present a sense of well-being. Excessive alcohol use causes a GABA imbalance, resulting in negative physical and mental symptoms of alcohol withdrawal:
- Headaches
- Heart palpitations
- Seizures
- Anxiety
- Restlessness
- Confusion
Alcohol abuse also affects dopamine, the neurotransmitter linked to the body’s reward system. This pleasure center regulates your energy, enjoyment and motivation. Dopamine also assists with the body’s sense of attention, motor coordination, cognition and mood. Alcohol releases dopamine, triggering some of these happy feelings addicts crave. And as your body begins to build higher alcohol tolerances, the brain becomes more dependent on the substance to release these neurotransmitters. So, when a long-term heavy drinker suddenly stops drinking, dopamine production stops also, causing withdrawal symptoms.
Other symptoms of alcohol withdrawal syndrome include:
- Tremors
- Nausea
- Vomiting
- Loss of appetite
- Confusion
- Irritability
- Mood swings
- Sweating
- Fever
Some alcoholics going through withdrawal may experience a very severe set of symptoms, called delirium tremens. Delirium tremens most commonly occur in those who drink in excess every day for various months and those who have abused alcohol for more than 10 years.
DT symptoms include:
- Altered mental functions
- Deep sleep
- Fear
- Seizures
- Sudden mood changes
- Excitement
The severity of withdrawal symptoms can depend on many variables, and therefore is different from addict to addict. Such factors include how long the addict was abusing alcohol, the quantity of alcohol they consume, how frequently they drink, the patient’s history with addiction to other substances, polydrug use, family addiction history, and the person’s physiological makeup, such as gender, weight and age.
It is important to contact a medical physician if you begin to feel any withdrawal symptoms after you stop using alcohol, as withdrawal symptoms can become life-threatening if not treated appropriately.
Although alcohol detox takes a fairly standard amount of time — about a week — alcohol withdrawal is different for every person who goes through it. For some, the process lasts days. For others, it lasts months.The process is triggered when an addict stops drinking alcohol. As the liver metabolizes ethanol and moves the drug through a person’s system, withdrawal symptoms will begin. It takes 30 minutes – two hours for the body to absorb one serving of alcohol into the bloodstream. Alcohol can be detected in the urine 12 – 24 hours after consumption, however, because the liver can only metabolize about .25 ounces per hour.
Most alcohol detox programs last anywhere from a few days to more than a week, with withdrawal symptoms usually subsiding within seven or more days of the program. However, alcohol cravings and other minor side effects may continue for some time after detox.
Alcohol Withdrawal Symptoms
Alcohol withdrawal symptoms are known to come in three different stages: minor, moderate and severe. Minor withdrawal symptoms — such as headaches, slight tremors and nausea — are subject to start anywhere from six to 12 hours after a person’s last drink. More moderate side effects of withdrawal — such as vomiting, sweating, confusion and fever — may follow within 12 to 24 hours. Those who experience severe withdrawal may begin to feel these symptoms — called delirium tremens — within 48 – 72 hours after discontinued alcohol use.
Delirium tremens are a potentially fatal medical emergency, although awareness of this serious complication of alcohol withdrawal has helped to lower the rate of fatalities. Research shows 5 percent of the roughly 2 million Americans who seek alcohol addiction treatment each year experience DTs, also known as alcohol withdrawal delirium. The mortality rate for DTs can range from 3 – 15 percent each year.
Alcohol Withdrawal Symptoms
- Disorientation
- Confusion
- Vivid Hallucinations
- Extreme Tremors
- Autonomic hyperactivity including shortness of breath, sweating, dry mouth , and palpitations
- Rapid heart rate or tachycardia
- Agitation
Scientists are still determining what causes DTs. Although former research pointed to vitamin deficiencies, more recent studies show the brain releases glutamate during alcohol withdrawal to compensate for the alcohol’s enhancement of gamma aminobutyric acid in the brain. Glutamate is a type of excitatory neuron, which may explain the autonomic hyperactivity and other DT symptoms.Fatal complications from delirium tremens include oversedation, respiratory arrest, cardiac arrhythmias and aspiration pneumonitis, which occurs when a person inhales toxic substances into the lungs, resulting in infection.
You may be at risk for delirium tremens if you:
- Are middle aged or a senior citizen
- Experienced seizures during previous alcohol withdrawal
- Have a co-occurring mental illness
- Have abnormal liver function
- Experience intense alcohol cravings
- Have abused alcohol for a longer period of time
- Have experienced DTs before
Delirium tremens can be difficult to diagnose, as some of the DT symptoms are similar to those of acute alcohol withdrawal, such as hallucinations. However, acute alcohol withdrawal is rarely deadly, while alcohol withdrawal delirium can be lethal in up to 15 percent of cases. If you undergo detox at an accredited detox facility with experienced addiction professionals, such as those at The Recovery Village, you have a greater chance of experiencing a safe alcohol withdrawal. Delirium tremens often require advanced pharmacotherapy, and in extreme cases may even require a stay in a hospital’s intensive care unit.
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Alcohol withdrawal and detox can be deadly in certain circumstances, so it’s incredibly important for those detoxing from alcohol to do so in a medical facility.Alcohol withdrawal can cause many deadly symptoms, including:
- Heart palpitations
- Heart arrhythmia
- Kidney dysfunction
- Liver dysfunction
- Seizure
- Seizure-related head injury
- Delirium
- Hallucinations
- Increased heart rate
- High blood pressure
- Hyperventilation
Detox can be dehydrating to the body as it uses any means — most notably vomiting, diarrhea and sweating — to expel alcohol and its toxins. Alcohol in and of itself is also a dehydrating substance. Combining an alcohol user’s pre-existing dehydration with withdrawal-related dehydration can easily induce seize and prove lethal.
If an alcoholic experiences a seizure during withdrawal, they could die from hitting their head during the seizure. Also, it’s possible for a person to vomit while seizing and aspirate, or breath in the vomit, effectively choking themselves to death.
Detoxification is the natural bodily process of removing toxins from the system. Any time you consume alcohol, the body naturally begins to detoxify, using the liver to metabolize ethanol from your system. Alcoholics and those who constantly drink never truly detoxify from the substance because they are always adding more into their system. When an addict chooses to get clean, however, the first thing they must do is stop drinking alcohol and let the body detoxify.Detox can occur in many settings, including:
- At home
- At a hospital
- In prison
- At a free medical clinic
- At a detox center
- In alcohol addiction rehab
There are two ways to detox — cold turkey, or all at once, or from lowering dosage over time, called tapering. Most people who choose to detox on their own at home resort to cold turkey, because they liken it to ripping the bandaid off. However, cold turkey detox can be dangerous, as the onset of withdrawal symptoms is more severe. In the face of the symptoms, the addict may end up relapsing and putting themselves in danger of alcohol poisoning.
Professional medical detox is the safest option when it comes to stopping drinking. At The Recovery Village, we monitor patients 24/7 to ensure their pain during withdrawal is managed, their vitals are at healthy levels and they are not experiencing any life-threatening symptoms. You may have many questions during this time, which our staff of highly-experienced addiction professionals are always happy to answer.
The risks during detox include dehydration and delirium tremens. As the body uses vomiting, diarrhea and sweating to expel the toxins of alcohol, it’s easy for patients become unknowingly dehydrated. Severe dehydration can lead to seizures, which can easily become lethal, especially if they occur in a home environment. Delirium tremens can lead to cardiac arrhythmia and respiratory failure, which can also be fatal if uncaught and left untreated.
When detoxing at a medical facility, doctors can also administer medications that will make your withdrawal experience more pleasant. The U.S. Food and Drug Administration has approved three medications to help treat alcohol dependence:
- Naltrexone
- Disulfiram (Antabuse or Antabus)
- Acamprosate (Campral)
Naltrexone helps block opioid receptors located within the rewards center of the brain that alcohol actives. As a result, the medication can help reduce alcohol cravings and, therefore, relapse.
Disulfiram causes a sensitivity to ethanol, spurring typical hangover symptoms immediately after a person consumes alcohol. This motivates the abuser to avoid alcohol.
Acamprosate helps aid long-term withdrawal symptoms, such as anxiety, insomnia and restlessness. This medication is recommended for patients suffering from a more severe addiction to alcohol.
Following detox, you will be ready to begin treatment for alcohol addiction. The Recovery Villageoffers many different treatment options including inpatient and outpatient rehab. Rehab is a proven-successful treatment method for alcohol addiction because it addresses both the physical side of the disease (detox) as well as the psychological side (using therapy and counseling to understand why a person first began abusing alcohol, and what their triggers for abuse are).
Drug and alcohol abuse
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Effect of Drugs and Alcohol on the Immune System
Effect of Drugs and Alcohol on the Immune System
The immune system is a network of cells, tissues, and organs that work together to defend the body against disease, infection and viruses. If this system is damaged, reduced or does not work as efficiently as it should, a person will become sick with illness from infections or viruses. Drugs and alcohol are known to inhibit the immune system which means that those who abuse substances will find it takes longer and they are affected by infections much longer than other people.
When the immune system is deficient and a person abuses drugs or alcohol, they have an increased risk of contracting certain diseases such as pneumonia, respiratory infections, blood-borne viruses such as HIV or Hepatitis and sexually transmitted diseases. Additionally, if they have a predisposition to cancer, heart disease or kidney disease, these conditions are more likely to occur.
Effect of Binging on the Immune System
Exhaustion as a result of binging on drugs or alcohol can be a significant cause of illness. When a person binge drinks, they may cause their body to go into toxic shock from the large amount of alcohol in their bloodstream. Secondary infections or damage to the liver can have life-long consequences.
Binging on drugs such as methamphetamine, cocaine or heroin can cause people to become dehydrated and ill. The impact of dehydration, mental and physical exhaustion, sleeplessness and lack of food can have a long term impact on a persons’ health. The immune system will be at a high risk of being overrun with infection and disease and anecdotal evidence suggests that many people will have flu-like symptoms after a binge.
Alcohol and the Immune System
Alcohol is known to cause long-term serious consequences for a persons body and mind. There are many diseases that are known to be caused by alcohol consumption which is chronic or dangerous. Alcohol also impedes the ability of the immune system to fight infection and disease. Excessive alcohol consumption or long term alcohol abuse can lead to immune deficiency in two ways – nutritional deficiency and reducing white blood cells.
Alcohol impairs the normal digestion of nutrients due to damage caused to the cells in the digestive tract and by interfering with the secretion of enzymes needed for digestion. Alcohol can also impede the ability of the liver to store important vitamins. It has also been shown that drinking too much can prevent the body from absorbing enough protein.
When consumed in excess, alcohol can reduce the ability of white cells to kill germs. High doses of alcohol suppress the ability of the white blood cells to multiply and inhibit the action of killer white cells on cancer cells. This can lead to the development of life threatening conditions such as liver cancer or liver disease.
Marijuana and the Immune System
Smoking marijuana, or any substance, can have a negative effect on the immune system. It has been found to cause damage to sensitive cells in the lungs and increase the risk of contracting diseases and bacterial infections. Marijuana is known to contain more carcinogenic chemicals than tobacco smoke and because of the way the drug is inhaled deeply and held for longer than cigarette smoke, these chemicals can cause severe respiratory damage. Some research has suggested that the active chemical in marijuana, THC, impairs the immune system from fighting disease. However, this research is not conclusive and further testing is required.
The inhaled smoke from marijuana is often combined with tobacco which is known to cause significant damage to lungs, including the leading cause of lung cancer and emphysema. Pulmonary infections, pneumonia, respiratory infections and cancer are all real risks associated with smoking marijuana. Chronic bronchitis, impairment of air passages, inflammation of lungs and development of abnormalities in the bronchial lining and lungs are also commonly associated issues.
Methamphetamine and the Immune System
The dangers of methamphetamine are well known, however the drug has potentially a very serious impact on the effectiveness of the immune system. Research is suggesting that the drug may increase a person’s susceptibility to infection by crippling immune function. This may also be deadly if a person is already infected with a life threatening disease like hepatitis or HIV and cause cancers to spread quicker in the body.
Methamphetamine is also known to dry out mucus membranes, particularly in the mouth and rectum which can increase a persons’ exposure to infection and disease. The drug can cause people to have significant weight loss, chronic insomnia and respiratory problems which all expose a persons immune system to deficiency and attack by disease.
MDMA, Club Drugs and the Immune System
MDMA use has long been anecdotally linked to infection of influenza and bacterial infections. There is, however, no scientific evidence to support that the use of MDMA or other club drugs cause these infections or suppress the immune system. What is known, however, is that exhaustion and dehydration associated with the use of these drugs in nightclubs, at festivals and other music events does increase the risk of being infected with influenza or developing a cold. This is because these side effects lower the body’s ability to fight infection until normal energy and water levels of the body are returned.
HIV/AIDS, Hepatitis and the Immune System
Illicit drug use has inherent risks that includes serious health problems such as hepatitis, HIV and AIDS. Human Immunodeficiency Virus (HIV), is the virus that causes Acquired Immune Deficiency Syndrome (AIDS). There is no cure for the disease AIDS but there are some treatments available for the virus HIV. Individuals infected with HIV are at risk of contracting other, life threatening diseases because the virus weakens a persons immune system.
Hepatitis is an inflammation of the liver, most commonly caused by a viral infection that lead to chronic disease including liver cirrhosis and liver cancer.
Drug users are at higher risks of contracting HIV and AIDS due to a lowered immune system and because some users share drug injection equipment that may be infected with the disease. The reason that these diseases can be so easily spread is because infected blood is drawn into the syringe and then injected along with the drug by the next user of the syringe.
Once a person is infected with HIV/AIDS or hepatitis, they are at risk of developing further complications because of the affect of the disease on their immune system. Cancer, pneumonia, tuberculosis, gastrointestinal problems, neurological conditions and tumors are some of the known linked diseases. Skin infections, ulcers, tetanus, septicemia, thrombosis and respiratory diseases are all common symptoms of a lowered immune system because of these diseases.
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Alcohol withdrawal
Alcohol withdrawal
Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol on a regular basis suddenly stops drinking alcohol.
Causes
Alcohol withdrawal occurs most often in adults. But, it may occur in teenagers or children.
The more you drink regularly, the more likely you are to develop alcohol withdrawal symptoms when you stop drinking.
You may have more severe withdrawal symptoms if you have certain other medical problems.
Symptoms
Alcohol withdrawal symptoms usually occur within 8 hours after the last drink, but can occur days later. Symptoms usually peak by 24 to 72 hours, but may go on for weeks.
Common symptoms include:
- Anxiety or nervousness
- Depression
- Fatigue
- Irritability
- Jumpiness or shakiness
- Mood swings
- Nightmares
- Not thinking clearly
Other symptoms may include:
- Sweating, clammy skin
- Enlarged (dilated) pupils
- Headache
- Insomnia (sleeping difficulty)
- Loss of appetite
- Nausea and vomiting
- Pallor
- Rapid heart rate
- Tremor of the hands or other body parts
A severe form of alcohol withdrawal called delirium tremens can cause:
Exams and Tests
Your health care provider will perform a physical exam. This may reveal:
- Abnormal eye movements
- Abnormal heart rhythms
- Dehydration (not enough fluids in the body)
- Fever
- Rapid breathing
- Rapid heart rate
- Shaky hands
Blood and urine tests, including a toxicology screen, may be done.
Treatment
The goal of treatment includes:
- Reducing withdrawal symptoms
- Preventing complications of alcohol use
- Therapy to get you to stop drinking (abstinence)
INPATIENT TREATMENT
People with moderate-to-severe symptoms of alcohol withdrawal may need inpatient treatment at a hospital or other facility that treats alcohol withdrawal. You will be watched closely for hallucinations and other signs of delirium tremens.
Treatment may include:
- Monitoring of blood pressure, body temperature, heart rate, and blood levels of different chemicals in the body
- Fluids or medicines given through a vein (by IV)
- Sedation using medicines until withdrawal is complete
OUTPATIENT TREATMENT
If you have mild-to-moderate alcohol withdrawal symptoms, you can often be treated in an outpatient setting. During this process, you will need someone who can stay with and keep an eye on you. You will likely need to make daily visits to your provider until you are stable.
Treatment usually includes:
- Sedative drugs to help ease withdrawal symptoms
- Blood tests
- Patient and family counseling to discuss the long-term issue of alcoholism
- Testing and treatment for other medical problems linked to alcohol use
It is important to go to a living situation that helps support you in staying sober. Some areas have housing options that provide a supportive environment for those trying to stay sober.
Permanent and life-long abstinence from alcohol is the best treatment for those who have gone through withdrawal.
Support Groups
The following organizations are good resources for information on alcoholism:
- Alcoholics Anonymous — www.aa.org
- Al-Anon Family Groups/Al-Anon/Alateen — www.al-anon.org/home
- National Institute on Alcohol Abuse and Alcoholism — www.niaaa.nih.gov
- Substance Abuse and Mental Health Services Administration — www.samhsa.gov/atod/alcohol
Outlook (Prognosis)
How well a person does depends on the amount of organ damage and whether the person can stop drinking completely. Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition.
Symptoms such as sleep changes, rapid changes in mood, and fatigue may last for months. People who continue to drink a lot may develop health problems such as liver, heart, and nervous system disease.
Most people who go through alcohol withdrawal make a full recovery. But, death is possible, especially if delirium tremens occurs.
When to Contact a Medical Professional
Alcohol withdrawal is a serious condition that may rapidly become life threatening.
Call your provider or go the emergency room if you think you might be in alcohol withdrawal, especially if you were using alcohol often and recently stopped. Call for an appointment with your provider if symptoms persist after treatment.
Go to the emergency room or call the local emergency number (such as 911) if seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur.
If you go to the hospital for another reason, tell the providers if you’ve been drinking heavily so they can monitor you for symptoms of alcohol withdrawal.
Prevention
Reduce or avoid alcohol. If you have a drinking problem, you should stop alcohol completely.