DOING YOUR OWN RESEARCH

DOING YOUR OWN RESEARCH

If reading this book has raised your level of interest and you want more specific information, or you want the straight story about a new develop­ment, there is no substitute for doing your own research.

Reading both scholarly review articles and original research papers is much easier than most people believe. In fact, one of the first steps in writing this book was gathering such research. Much of the library work for the first edition was done by two college students, neither of whom had any previous experience using a medical library. Should you decide to investigate for yourself, here are some suggestions about where to begin.

Public libraries are not likely to have the sorts of journals and books you will need. Because there is such a vast amount of medical literature pub­lished, most universities with a medical school have a separate library just to house all this information. Find a medical library at a nearby medical school. If for some reason you cannot get to a medical school, check to sec if there is a college or university biology department nearby and use the

library they use.

Next, go to the library and make friends with the reference librarian, because you will need his or her help until you are familiar with the library and the search mechanisms. The most efficient way of searching the literature is to use MEDLINE or PubMed, databases of the National Library of Medicine, a US government institution that allows you  

search almost all the published medical literature on any subject you can think of related to health. You can search by author, title, subject, key­word, institution, and many other descriptors.

In most cases you will find far more information than you need. A good place to start is with reviews. Reviews are documents that consoli­date and summarize the research and literature available in a given area, and they are usually written in less technical language. Reading several recent reviews about the topic you are researching will help you form a base of knowledge about the subject. Practice using MEDLINE by start­ing out with simple concepts; for example, search for marijuana articles. There are hundreds of them, and many of the titles will be so technical that they might seem indecipherable. So tell the computer to select mari­juana review articles. This will reduce the number markedly.

If you have read Buzzed, then you know that one of the active ingredi­ents in marijuana is THC. Try searching for THC and you will get more articles. Refine your search by asking for reviews of THC and you will get articles different from those you did when you searched for marijuana in general. Play with the database and have fun. Search for all kinds of com­binations of keywords, like THC and learning, or THC and adolescent. You will soon have an idea of the enormous amount of information there is about just this chemical. Understand, though, that no one study tells the whole story.

As a final note, we caution you not to accept everything you read as directly applicable to the human condition. Often scientists employ very high levels of a chemical to test for toxic effects in animals, and sometimes the chemical levels they use in/on animals are hundreds or thousands of times higher than a human would ever use, taking into account the weight of the human compared to the animal. Consequently, some of the toxic effects seen in animals may not apply to humans. On the other hand, ani­mal experiments cannot reveal many subtle effects of chemicals, particu­larly psychological ones, and thus animal studies almost certainly miss some important effects that humans will experience. So, as you read a sci­entific paper, remember that it is just a small part of the literature about a drug, and while the data may be true, it is important to understand that data in the context of everything else known about the drug.

RELAXATION AND STRESS REDUCTION

HEALTH BENEFITS OF MODERATE ALCOHOL USE

RELAXATION AND STRESS REDUCTION

It is perfectly clear that heavy drinking, either in one session or across decades, carries with it significant risks to health and safety However, alcohol is not all bad. Used in an informed and moderate way, alcohol can convey some health benefits. For example, the similarity of its actions to those of antianxiety medications such as Valium makes alcohol a potent antianxiety agent for some people. The feeling of relaxation that accom­panies an occasional drink of alcohol can help to reduce stress, and stress reduction is healthy. But remember: people who use alcohol heavily or too regularly as a way of coping with the difficulties in their lives are at con­siderable risk for becoming addicted. Ultimately, the use of alcohol for relaxation and stress reduction is a personal choice that must be made in as informed a way as possible.

PROTECTION AGAINST HEART DISEASE

There is no doubt that chronic heavy drinking damages the heart. How­ever, recent studies show that light (and perhaps moderate) drinkers have a reduced risk for coronary artery disease—a principal cause of heart attacks. Remember, though, that this research is still developing, and it is not possible to arrive at an exact "prescription" of alcohol use for cardio­vascular protection. Still, a growing number of studies suggest that an average of a half to one and a half drinks per day may significantly lower a person's risk for coronary artery disease.

A study from Harvard Medical School further supports these early findings—at least in men. A group of more than 22,000 men who ranged in age from forty to eighty-four were studied over a ten-year period. Com­pared to men who drank less than one alcoholic beverage per week on average, those who drank two to four alcoholic beverages per week were significantly less likely to die of a heart or circulatory disorder. These light-drinking men also suffered fewer cancers over the ten-year period. However, among men who drank two or more drinks per day, the death rate was 51 percent higher. This means that there is a narrow window for the possible health benefits of alcohol for men. Two drinks per week seem to be good; two drinks per day seem to be bad.

For women, however, these findings present a double-edged sword. Moderate alcohol drinking appears to reduce the risk of cardiovascular

disease in women. But studies have also shown that women who drink an average of three to nine drinks per week are significantly more likely to develop breast cancer than women who do not drink. Still, the causes of breast cancer are quite complex and much work remains to determine the exact relationship of alcohol drinking to breast cancer. Women who choose to drink moderately, for whatever reasons, should keep in close touch with the latest information related to breast cancer risks.

DIMINISHED RISK OF DEATH

There have now been several large-scale studies, in both Eastern and Western countries, indicating that light to moderate drinking may diminish the risk of death in middle-aged men. A recent study in China showed that men who drank one to two drinks per day over a six-and-a­half-year period reduced their risk of death by about 20 percent—a find­ing that is consistent with studies in European countries. The protective effect was not limited to death from heart disease—the drinkers were also less likely to die from cancer or other causes. Further, the particular type of alcoholic beverage consumed was inconsequential: Beer drink­ers, wine drinkers, and drinkers of hard liquor shared equally in the benefits, as long as their consumption was not more than an average of two drinks per day. Beyond that level the risk of death was increased by about 30 percent. Alcohol appears to have some similar protective effects in women. But, as just noted, women are also more vulnerable to some of the negative effects of alcohol, so most studies suggest no more than one drink per day for women.

The bottom line seems to be that if you want to get the medicinal effects of alcohol, you have to take it like medicine—a little at a time.

DANGEROUS INTERACTIONS WITH OTHER DRUGS

DANGEROUS INTERACTIONS WITH OTHER DRUGS

               Sedatives

Clearly the most dangerous drugs to mix with alcohol are other sedatives, or "downers," such as phenobarbital and pentobarbital. The depressing  effects of alcohol on brain function combined with the effects of the bar­biturates can cause extreme impairment, unconsciousness, or even death. One of the most famous cases in medical ethics was that of a young woman, Karen Ann Quinlan, who drank alcohol in combination with Quaaludes (methaqualone—a powerful sedative drug) and went into a coma from which she never recovered. This tragic case gained national attention because it raised the issue of whether a person should be removed from life-support machines after it becomes clear that he or she will never recover from a vegetative state.

Although few people take alcohol-sedative combinations severe enough to cause coma or death, the combination of even relatively low doses of alcohol and sedatives can be dangerous, powerfully impairing the ability to think clearly, make good decisions, or drive a car. A person who is nor­mally able to perform these tasks perfectly well at the end of an evening after having had three or four beers over the course of several hours might find that he is totally unable to perform them if even a small dose of seda­tives is added to the mix. The effects of the alcohol may be totally unex­pected in the presence of the other sedative drug.

Antianxiety Medications

Antianxiety medications, such as Valium, Librium, and so forth, fall into the general category called benzodiazepines and are used to treat anxiety, sleep disturbances, and seizures. They are also used to treat alcohol-with­drawal symptoms in detoxification clinics, These drugs are sedating and may cause severe drowsiness in the presence of alcohol, increasing the risk of household and automobile accidents.

Antibiotics

In combination with acute doses of alcohol, some antibiotics can cause nausea, vomiting, headache, or even convulsions (seizures). Among the potentially dangerous ones are Furoxone (furazolidone), Grisactin (gris­eofulvin), Flagyl (metronidazole), and Atabrine (quinacrine).

Anticoagulants (Blood Thinners)

Warfarin (Coumadin) is prescribed to decrease the blood's ability to clot.

Alcohol increases the availability of warfarin in the body and increases

the risk of dangerous bleeding. But in chronic drinkers, warfarin's action

is decreased, lessening these patients' protection from the consequences of blood-clotting disorders.

Antidepressants

Many people who are depressed use alcohol, and many alcoholics are also depressed. So, it is quite common for people to use alcohol with antide­pressant drugs. Alcohol increases the sedative effects of the tricyclic anti­depressants such as Elavil (amitriptyline). This impairs both mental and physical skills such as those necessary for driving. Chronic drinking appears to increase the action of some tricyclic antidepressants and decrease the action of others. Anyone who is on antidepressants should

consult closely with her doctor about how her medication reacts with alcohol.

Ant/diabetic Medications

Orinase (tolbutamide) is given orally to help lower blood sugar in diabetic patients. Acute alcohol drinking prolongs the action of this drug, and chronic drinking decreases its availability in the body. Alcohol can also cause nausea and headache when taken with some drugs of this class.

Antihistamines

Antihistamines such as Benadryl (diphenhydramine) are available with­out a prescription and are used to treat allergic symptoms and sometimes insomnia. They have sedative effects that may be intensified by alcohol, increasing the probability of accidents. In older persons these drugs can

cause excessive dizziness and sedation, and their combination with alco­hol may be particularly dangerous.

Ant/psychotic Medications

Drugs such as Thorazine (chlorpromazine) are used to treat psychotic symptoms such as delusions and hallucinations. Acute alcohol drinking can increase the sedative effects of these drugs, resulting in impaired coordination and potentially fatal suppression of breathing.

Antiseizure Medications

One of the most widely used drugs prescribed to treat epilepsy (seizures) is Dilantin (phenytoin). Acute alcohol drinking increases the availability of Dilantin in the body and increases the probability of side effects. Chronic drinking may decrease the availability of Dilantin, dangerously hampering its effectiveness and increasing the patient's risk of seizures.

Heart Medications

There are many medications used to treat disease of the heart or circula­tory system. Acute alcohol drinking can interact with some of these to cause dizziness or fainting upon standing up. These drugs include the angina medicine nitroglycerin and the blood pressure medication Apre­soline. In addition, chronic alcohol drinking reduces the effectiveness of the blood pressure medication Inderal (propranoloh.

Narcotic Pain Relievers

These drugs (e.g., morphine, Darvon, codeine, Demerol) are prescribed for moderate to severe pain, such as after surgery or dental work. The combi­nation of any of these drugs with alcohol magnifies the sedative effects of both, increasing the risk of death from overdose. This is one of the most common drug combinations to cause accidental overdose deaths.

Nonnarcotic Pain Relievers

Some nonprescription pain relievers such as aspirin, Advil, and Aleve can cause stomach bleeding and prevent the blood from clotting normally Alcohol can worsen these side effects. In addition, aspirin may increase the availability of alcohol within the body, thereby increasing the intoxi­cating effect of a given drink. As we stated before, the combination of Tylenol (acetaminophen) and alcohol can result in the formation of chem­icals that can cause liver damage. This can occur even when the pain reliever is used in recommended doses and even if it is taken after drinking as a treatment for hangover.

CYNTHIA KUHN

Children Of Alcoholic Parents

            CHILDREN AND ADOLESCENTS

By far, alcohol is the drug used most often by high school students. Although most seniors cannot buy alcohol legally, 80 percent of them have tried alcohol and about one in five report that they have drunk heav­ily (more than five drinks in a row) in the past two weeks. This is actually good news, because the number of teens drinking heavily has declined somewhat in recent years. But that's not the end of the story. Recent stud­ies show that among students who engaged in heavy drinking, half had consumed ten or more drinks in one episode and a quarter had consumed fifteen. So, while heavy drinking at the "low" end of the scale (about five drinks in an episode) has declined recently, the rates of extreme heavy drinking have remained high.

The story among college students is not as simple as the media sometimes portray. Reports of "binge drinking" among college students can be mis­leading. First, the term hinge drinking is a bad one. Many people think of an alcohol binge as a period of several days during which a person stays drunk nearly all the time. This, of course, is a very dangerous pattern of drinking but is not what is meant by the media when they report on binge drinking among college students. In that context, binge drinking refers to a man haying five or more drinks in one sitting or a woman having four or more—clearly enough to put a person at risk for trouble, but hardly a binge in the traditional sense. We prefer to think of the four- or five-drink level as "high-risk drinking"—a more descriptive term. About 40 percent of college stu­dents report this level of high-risk drinking in the past two weeks, but there are also a significant number of college students who don't drink at all—about 20 to 25 percent depending upon the college. So it's important for students to know that, while a lot of students drink, not everybody on campus gets drunk every weekend, and a solid number of students don't drink at all. Still, there are often negative consequences for those who do. Nearly 600,000 college students suffer unintentional alcohol-related inju­ries each year, and more than 1,800 die from those injuries. In addition, 25 percent of college students report negative academic consequences related to their drinking each year, and more than 150,000 develop a health prob­lem related to alcohol use. Clearly, college drinking remains highly preva­lent and continues to take a toll on students' lives.

The problems associated with underage drinking are well known, and in recent years research has continued to show that alcohol affects the brain of younger people very differently from the way it affects that of adults. Part of this may be related to brain development. For example, we know that the brain does not finish developing until a person is in his midtwenties and that one of the last regions to mature is the frontal lobe area, which is intimately involved with the ability to plan and make com­plex judgments. Young brains also have rich resources for acquiring new memories and seem to be "built to learn." It is no accident that people in our society are educated during their early years, when they have more capacity for memory and learning. However, with this greater memory capacity come additional risks associated with the use of alcohol. Studies using animals have shown that when the brain is young, it is more sus­ceptible to some of the dangerous effects of alcohol, especially on learn­ing and memory function. And one study in humans showed that people in their early twenties were more vulnerable to the effects of alcohol on learning than were people just a few years older, in their late twenties. So it appears that children and adolescents who drink are powerfully impairing the brain functions on which they rely so heavily for learning. This is already indicated by very detailed cellular studies on learning-re­lated brain regions. In these studies (which, of course, can only be done using brain tissue from animals), it is clear that alcohol decreases the ability of brain circuits to change in the ways they must for learning to  basic cellular functioning occur far more strongly when the alcohol expo‑sure occurs during adolescence, compared to adulthood. In other words,it appears that adolescence is not only a time when single doses of alcohol affect the brain differently but also a time of enhanced vulnerability to the long-term effects of repeated alcohol exposure—even down to the level of individual brain cells. This adds to a strong and growing scientific literature that tells us that adolescents should hold off on drinking.

Another very good reason for teens to hold off on drinking is that there is a very strong relationship between the age at which one starts to drink and the likelihood of developing dependence on alcohol. People who start

drinking in their early to midteens are far more likely to develop alcohol

dependency, and to experience recurring episodes of dependency, than

are people who start drinking at age twenty-one or older. There are cer­tainly a number of reasons for this increased risk, and not all of them are biological, but it is clear from animal studies that adolescents develop tol­erance to some of alcohol's effects more rapidly than adults. In humans this could lead to a greater motivation to drink repeatedly. So, although it has always been controversial, our current state laws requiring a person to be twenty-one to drink make good sense from this perspective.

Most parents tend to be clueless when it comes to their children's drinking. For example, while 52 percent of tenth graders report having drunk alcohol in the past year, only 10 percent of parents of tenth graders believe that their child has consumed alcohol in that period. Interestingly, parents report believing that about 60 percent of tenth graders have con­sumed alcohol within the past year. So parents actually tend to overesti­mate the proportion of kids who drink—they just don't think it's their kids who are drinking! There are similar gaps between older teens' reported drinking and parents' beliefs about their drinking. Parents of twelfth graders are starting to see the light, but they still underestimate their kids' drinking significantly. The important message for parents is that alcohol is out there and its use is getting thrust at their children from many angles. Talk to your children about them.

WİLKİE WİLSON

Acohol Dependence

It is important to distinguish between alcohol dependence and alcohol abuse. Generally, alcohol abuse refers to patterns of drinking that give rise to health problems, social problems, or both. Alcohol dependence (often called alcoholism) refers to a disease that is characterized by abnormal seeking and consumption of alcohol that leads to a lack of control over drinking. Dependent individuals often appear to crave alcohol. They seem driven to drink even though they know that their drinking is causing problems for them. The signs of physical depen­dence begin within hours after an individual stops drinking. They include anxiety, tremors (shaking), sleep disturbances, and, in more extreme cases, hallucinations and seizures. Until a chronic drinker actually stops drinking, it is quite difficult to make a definitive assess­ment of alcohol dependence. But for most practical purposes, this for­mal diagnosis is unnecessary, because the social and medical problems that most alcoholics experience should be recognizable to health profes­sionals. See the section "How to Spot a Problem Drinker" on page 55 for some general guidelines.

PRENATAL EXPOSURE

The dangers of prenatal alcohol exposure have been noted since the time of Aristotle in ancient Greece. However, it was not until 1968 that formal reports began to emerge. The early studies of fetal alcohol syndrome (FAS) described gross physical deformities and profound mental retarda­tion among children of heavy-drinking alcoholic mothers. Although this was a very important set of findings, at first there was no evidence that women who drank more moderately were placing their children at risk. In fact, for many years, pregnant women were often encouraged to have a glass of wine with dinner or take a drink now and then during pregnancy to help them fall asleep or just to relax.

It took a while for the effects of moderate prenatal drinking to be noticed, because the children have none of the very obvious defects asso­ciated with the full-blown fetal alcohol syndrome. However, it is now clear that there is a less severe, but very well documented, pattern of defi­cits associated with more moderate prenatal drinking—a pattern described as fetal alcohol effects (FAE). School-age children with FAS or FAE are frequently described as hyperactive, distractible, and impulsive, with short attention spans—behaviors similar to those observed in chil­dren with attention deficit disorder (ADD). However, the FAS and FAR children differ from ADD children in that they are more intellectually

impaired. In recent years the term fetal alcohol spectrum disorders (FASD) has emerged as an umbrella term to include the full range of neurological, cognitive, behavioral, and learning disabilities associated with prenatal alcohol exposure.

The impairments of intelligence and behavior in people with FASD appear to persist into adulthood and are probably lifelong, resulting in IQ scores markedly below average, often well into the moderately retarded range. Those with PAS scored worse than those with RAE, but both were significantly below normal, hampered in reading and spell­ing and most profoundly deficient in mathematical skills. More import­ant, the FAE patients did not perform any better than the FAS patients on academic achievement tests, though their IQs were somewhat higher. What all this means is that even moderate drinking during pregnancy can create permanent intellectual disabilities. Some studies using animal models of FAE even suggest that just one drink per day impairs the function of brain areas related to learning in the adult offspring.

The bottom line is that there is no identified safe level of drinking during pregnancy. The smart decision for a woman is simply not to drink if she is pregnant or thinks that she might be.

What about Social Drinkers

     What about "Social Drinkers"?

It is important to define exactly what we mean when we say that someone is a social drinker. The most consistent definition, looking across the liter­ature on alcohol use and treatment, would be this: someone who drinks regularly but does not get drunk when he drinks or have any of the clini­cal signs of addiction to alcohol. People who fit this pattern of drinking generally do not have nearly as severe deficits in mental functioning as those who drink heavily.

Among social drinkers, the pattern of alcohol consumption plays a very important role in determining whether the person will develop deficits in mental functioning. The more alcohol he drinks during each drinking session, the higher the likelihood that mental deficits will develop. Consider two people who each drink five drinks per week, on average. The first person has one drink on each of the five days of the week, and the second person has four drinks on each Saturday night and one in the middle of each week. The second person will be more likely to develop the kinds of deficits in the aforementioned abilities for chronic alcoholics. This is a particularly important point for young people, because heavy drinking on weekends is a typical pattern for

many high school and college students as well as for young people in the work world.

It is difficult to say what amount of drinking over time will result in deficits in mental function. There have been many studies addressing this issue in different groups of people, and it's very hard to boil all of these down to a clear and concise statement of risk. However, when all the complexities of the research are taken into consideration, it is rea­sonable to estimate that people who drink three or more drinks per day on average are at substantial risk of developing permanent deficits in certain cognitive abilities. This is not to say that drinking less is per‑fectly safe—indeed, we know that there are health risks associated with drinking less—but in terms of causing irreversible cognitive deficits, three drinks per day appears to be something of a threshold.

Tolerance

Development across Several Drinking Sessions

Tolerance means that after continued drinking, consuming an identical amount of alcohol produces a lesser effect—in other words, more alcohol is necessary to produce the original effect. The development of tolerance indicates that alcohol exposure has changed the brain. In some ways it is less sensitive to the alcohol, but in other ways it may remain quite sensi­tive. The brain effects that produce the high may diminish, while the effects that are toxic to the brain cells themselves may remain the same. Another problem is that as tolerance develops, the drinker may drink more each time to get the high. As we just learned, such a drinking pat­tern is more likely to produce deficits in mental functioning over time. Also, because the brain is the organ of addiction, the tolerant person who increases her drinking runs a greater risk of addiction. Finally, although the brain may need more alcohol to produce the high, the liver and other internal organs are dealing with more and more alcohol, and they are at risk for permanent damage.

Development within One Drinking Session

Although tolerance to most alcohol effects develops gradually and over several drinking sessions, it has also been observed even within a single drinking session. This is called acute tolerance and means that the intoxi­cation is greatest soon after the beginning of drinking. Acute tolerance does not develop to all the effects of alcohol, but it does develop to the feeling of being high. So, the drinker may drink more to maintain the feeling of being high, while the other intoxicating effects of alcohol (those that interfere with driving, mental function, and judgment) continue to build, placing the drinker at greater and greater risk.