Alcohol and substance abuse.

Alcoholic liver disease is an important cause of cirrhosis, liver-associated death, and need for liver transplant. Up to 50% of recipients use some alcohol, and perhaps 10% drink addictively.

Careful evaluation by an addiction medicine specialist is the best predictive instrument before transplant surgery, whereas the 6-month rule lacks sensitivity and specificity.

Addictive drinking, but not minor slips, is associated with increased mortality.

There is no standard therapy for alcoholism in alcoholics waiting for a transplant or for those who have undergone a transplant.

Stably abstinent, methadone-maintained opiate-dependent patients should continue methadone; are generally good candidates for liver transplant; and show low relapse rates.

Pre- and post-transplant smoking rates are high and cause significant morbidity and mortality. Transplant teams should encourage smoking cessation treatments.

Marijuana use in liver transplant recipients is common, although risks associated with this practice are unknown.

Research report’; Lucey MR, Weinrieb RM. Alcohol and substance abuse Semin Liver Dis. 2009 Feb;29(1):66-73. Epub 2009 Feb 23.

See also;

• AA and Treatment Work Better Together
• Address the drinking problem directly
• Brief-TSF can assist people cease alcohol consumption.
• Twelve Step Facilitation is designed to support people returning to their community

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Research Summary; Unsafe sex by people infected with HIV poses a grave public health risk. To examine whether alcohol use increases the likelihood of unsafe sex in people with HIV, investigators interviewed 262 patients from 2 HIV clinics. Alcohol consumption measures assessed use in the past 6 months and included drinking days, drinks per drinking day, binge drinking,* and hazardous drinking.**

• In the past 6 months, 63 percent of patients had been sexually active, 38 percent had unprotected sex (i.e., no condom), and 21 percent had multiple sex partners.
• All alcohol consumption measures were significantly associated with the likelihood of having any sex (odds ratios ranging from 1.5 to 2.9) and of having unprotected sex (odds ratios ranging from 1.4 to 2.7).
• One-third of hazardous drinkers — compared with 9 percent of nonhazardous drinkers — were having both unprotected sex and sex with multiple partners.

Heroin and cocaine use did not significantly affect the likelihood of having any or unprotected sex.

Comments by Jeffrey Samet, MD, MA, MPH:
This study demonstrates a clear association between alcohol use and unsafe sex in patients infected with HIV. As the authors note, determining the basis of this association (e.g., risk-taking personality, lowered sexual inhibitions due to alcohol) requires studies that demonstrate the relationship between the two behaviors. Nevertheless, these findings support the case for assessing alcohol use among all patients with HIV.

* 5 or more drinks per day for men, 3 or more drinks per day for women
** at least 1 binge episode, or greater than 14 drinks per week for men and greater than 7 drinks per week for women

Reference: Stein M, Herman DS, Trisvan E, et al. Alcohol use and sexual risk behavior among human immunodeficiency virus-positive persons. Alcohol Clin Exp Res. 2005; 29(5): 837-843.

From; Join Together Online

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Why ’not drinking’?

We members of Alcoholics Anonymous see the answer to that question when we look honestly at our own past lives. Our experience clearly proves that any drinking at all leads to serious trouble for the alcoholic, or problem drinker. In the words of the American Medical Association:

Alcohol, aside from its addictive qualities, also has a psychological effect that modifies thinking and reasoning. One drink can change the thinking of an alcoholic so that he feels he can tolerate another, and then another, and another.

The alcoholic can learn to completely control his disease, but the affliction cannot be cured so that he can return to alcohol without adverse consequences.

And we repeat: Somewhat to our surprise, staying sober turns out not to be the grim, wet-blanket experience we had expected! While we were drinking, a life without alcohol seemed like no life at all. But for most members of A.A., living sober is really living-a joyous experience. We much prefer it to the troubles we had with drinking.

One more note: anyone can get sober. We have all done it lots of times. The trick is to stay and to live sober. That is what this booklet is about.

Living Sober, 1975, Alcoholics Anonymous World Services, Inc

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World view change in Adult Children of Alcoholics/Al-Anon self-help groups: Reconstructing the alcoholic family.

Examined the processes through which 20 committed members (aged 29-52 yrs) of self-help groups for adult children of alcoholics experience alterations in their perceptions of family of origin.

Results suggest that world view transformation in the family of origin domain involves;

• learning to define the family as pathological,
• assigning responsibility for this pathology to a disease,
• forgiving oneself,
• accepting that one was adversely affected by the family’s problem, and
• ultimately learning to accept one’s parents’ shortcomings.

Humphreys, Keith. World view change in Adult Children of Alcoholics/Al-Anon self-help groups: Reconstructing the alcoholic family. International Journal of Group Psychotherapy. Vol 46(2), Apr 1996, 255-263.

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