Alcohol Abuse and Liver Disease

Andrea DiMartini, James Neuberger

• Publisher: Wiley-Blackwell
• Year: 2016
• Print ISBN: 9781118887288
• eBook ISBN: 9781118887295
• Edition: 1
• Topic: Medicine
• Subtopic: Gastroenterology & Hepatology

For people with alcohol excess and liver disease, successful management must be two-fold with management of both their psychological/physical addiction to alcohol and their liver disease.  Alcohol Abuse and liver disease, with its joint focus on hepatology and psychiatry, provides both hepatologists and psychiatrists of all levels with a practical, concise and didactic guide to the investigation and clinical management of those with alcohol-related problems.

Edited by a practicing hepatologist in the UK and a practising specialist in psychiatry/substance abuse in the US, it covers areas such as:

•     Risk factors for alcoholic liver disease

•     Interaction of alcohol with other co-morbidities

•     Clinical assessment of alcohol intake

•     Detoxification and management of withdrawal

•     Psychotherapeutic and pharmaceutical interventions

•     Treatment of liver disease

Key points, management diagrams and high-quality images are all be supported by the very latest in clinical guidelines from the major hepatology and psychiatry societies such as the APA, EPA, AASLD and EASL.

With increasing emphasis on multi-disciplinary speciality care in this area, this is the ideal tool to consult in order to provide the best care possible care for what are very challenging patients to manage.

CHAPTER 1
Epidemiology of alcohol use

Ian Gilmore^1,2 and William Gilmore²

¹ Department of Medecine, University of Liverpool, Liverpool, UK

² National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia

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KEY POINTS

• Alcohol use has been established throughout the world for millennia.
• The alcohol consumed can be assessed from sales and survey data but both have limitations.
• The potential harm caused by alcohol will depend not only on the amount consumed, but also on the pattern of drinking, gender, age, other comorbidities, and other behavioural, cultural, and genetic factors.
• The amount of alcohol consumed depends on both availability and cost.
• Trends in alcohol consumption levels over time have varied considerably between countries.
• While many countries have seen a fall in cases of cirrhosis and deaths from alcohol in recent years, some, such as the United Kingdom, have seen a rise.

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Introduction

Alcohol is our drug of choice, not just in the western world but globally. Its use defines societies and often divides them. This complexity of attitudes and behaviors can be traced back to the earliest times of civilization. Written reference to alcohol is as old as writing itself – the cuneiform scripts of Sumerians around 3000 BC – but the wild grapevine was indigenous to current wine-producing countries of Europe and Asia several hundred thousand years earlier and has been cultivated since 6000 BC at least. Neolithic man cultivated barley and it is likely that beer consumption has just as long a history. Inebriation likewise is as ancient as the availability of alcoholic beverages, and in Babylon in 1800 BC it was found necessary to regulate price and availability in “wineshops” or taverns [1]. The Hebrews found the Promised Land fertile for viniculture, and the result was an early temperance or prohibition movement amongst rebel Rechabites who “will drink no wine.” But, overall, wine consumption became a positive and symbolic ritual of God’s natural gifts in Judaism and early Christianity. However, the New Testament exhorts temperance as a virtue, and St. Paul clearly understood the physical harms associated with alcohol when he stated that drunkenness barred the gates of Heaven and desecrated the body. Chinese literature shows a similar timeline, and an imperial edict around 1000 BC recognized that alcohol in moderation was a gift from heaven.

Medieval life was generously lubricated by alcohol and beer drunk in volumes 10-fold greater than today – although it may have been considerably weaker. The principle of distillation was probably known several thousand years ago but was only recognized again in the Middle Ages, initially mainly for the preparation of remedies for ailments. It crept into popular consumption in the sixteenth century, when grain-distilled whisky started in Ireland and spread to Scotland. In England in the seventeenth century it was the spread of juniper-flavored white spirit from Holland, gin, that became the rage, encouraged by an Act of Parliament of 1690 for the “encouraging of the distillation of brandy and gin from corn.” However, this was more to do with antagonism towards France and protection of British grain production by William of Orange than of the virtues of alcohol. The seventeenth century American colonies demonstrated the accelerated move of a new society towards regulation and taxation.

The eighteenth century has been much parodied in the United Kingdom as in Hogarth’s Gin Lane, and certainly the plethora of Parliamentary Acts and Repeals laid testament to the societal consequences of the ready availability of cheap, strong liquor. The prohibitive taxes introduced in 1736 had to be withdrawn in the face of bootlegging, riots, and smuggling. In hindsight, much of the concern over the next century was about the poorer classes taking up heavy drinking, hitherto a diversion of the landed gentry, and the consequences for productivity and industrialization. In the United States the influential physician William Rush, perhaps the father of modern psychiatry, introduced the concept of alcoholism as an illness and addiction rather than a sin. However, in the eighteenth and nineteenth centuries the power of organized religion in combating the evil of drink and the virtue of abstinence was at its peak. In many countries there was in addition the ebb and flow of regulation and taxation.

The destructive power of alcohol to the national effort was obvious to Lloyd George in Britain during the First World War (although he was no doubt influenced by his Welsh chapel upbringing), and stringent restrictions on availability contributed to the decline in consumption that was reversed only after the World War II. In the second half of the twentieth century, developed countries fell under the influence of large national, and later multinational, producers of alcoholic drinks who discovered the power of marketing developed by motor car, tobacco, and soft drink manufacturers. Increasing globalization has seen developing countries move from local, often unregulated and unmeasured consumption to joining the party with international, heavily marketed products, and it has been only the Islamic religion that has halted alcohol’s progress in those parts of the world.

Why monitor alcohol use?

Per capita consumption has been shown to be a relatively reliable proxy measure of the number of heavy drinkers in a population, which can help predict the magnitude of harm associated with alcoho...

Table of contents

• Cover
• Title page
• Table of Contents
• List of Contributors
• Preface
• CHAPTER 1: Epidemiology of alcohol use
• CHAPTER 2: Epidemiology of alcohol-related liver disease
• CHAPTER 3: Alcoholism: diagnosis and natural history in the context of medical disease
• CHAPTER 4: Alcohol and other substance misuse
• CHAPTER 5: Risk factors for alcohol-related liver disease
• CHAPTER 6: Mechanisms of alcohol toxicity
• CHAPTER 7: Extrahepatic manifestations of alcohol excess
• CHAPTER 8: Patterns of alcohol-associated liver damage
• CHAPTER 9: Cofactors and alcohol-related liver disease
• CHAPTER 10: Impact of alcohol and liver disease on prescribing
• CHAPTER 11: Psychiatric examination of liver transplant patients with alcohol use disorders
• CHAPTER 12: Abnormal liver tests in the context of alcohol excess
• CHAPTER 13: Biochemical determination of alcohol consumption
• CHAPTER 14: The role of histology
• CHAPTER 15: General assessment and management
• CHAPTER 16: Brief alcohol interventions
• CHAPTER 17: Alcohol withdrawal syndrome: diagnosis and treatment
• CHAPTER 18: Psychosocial treatments of alcohol use disorders
• CHAPTER 19: Pharmacologic interventions
• CHAPTER 20: Treatment of extrahepatic manifestations of alcohol abuse
• CHAPTER 21: Treatment of liver disease
• CHAPTER 22: Treatment of alcoholic hepatitis
• CHAPTER 23: Liver transplantation in people with alcohol-related liver disease
• CHAPTER 24: Future directions: the need for early identification and intervention for patients with excessive alcohol use
• Index
• End User License Agreement