POSITIVE HEALTH EFFECTS

POSITIVE HEALTH EFFECTS

Although we always urge caution when interpreting correlational studies, a recent large study based at the National Cancer Institute collected health data from more than 400,000 individuals in their fifties and sixties start¬ing in 1995 and following them for thirteen years. Across that time, men who drank two or three cups of coffee per day were 10 percent less likely to have died, and women were 13 percent less likely to have died. The study was not designed to answer the question of why coffee drinking was associated with better survival, but the findings are worth knowing about.

Two studies published in 2012 suggest that caffeine may also have bene¬fits for memory function when memory is challenged or in decline. In one study, individuals with "mild cognitive impairment"—a strong predictor of Alzheimer's disease—had their memory function evaluated and caf¬feine levels measured at the beginning of the study and again several years later. Those who had caffeine levels consistent with drinking about three cups of coffee were significantly less likely to have developed Alzheimer's disease than were those with no caffeine in their systems. This doesn't mean that caffeine prevents Alzheimer's disease. It could be that there was something else about the lifestyles of the people who had caffeine in their systems that helped forestall the onset of full Alzheimer's symptoms. For example, because caffeine in a stimulant it could simply have made the subjects more alert, making them more likely to engage in social or intellectual activities, both of which have been shown to promote cogni¬tive health in older people. The second recent study was a lab experiment with animals that had their memory function impaired when their brains were deprived of oxy­gen for a brief time. This condition, called "ischemia," often happens when people suffer a stroke and is known to result in memory and other cognitive deficits. Half of the mice received a dose of caffeine before the oxygen deprivation and the other half did not. Later, the mice that had received the caffeine regained their ability to form new memories 33 per­cent faster than the ones that had received no caffeine. It was as if the presence of caffeine at the time of the ischemia protected the animals' brains from suffering the full effect of the loss of oxygen. This could have been due to the caffeine disrupting the actions of adenosine in the brain. We wrote about how this action is part of why caffeine creates alertness. But when brain cells are injured or under stress, adenosine can reach dan­gerously high levels and actually damage the cells. Having the caffeine on board when the animals brains were stressed may have reduced the potential toxic effect of adenosine. Of course, this does not mean that everybody should walk around buzzed on caffeine all the time just in case they suffer a stroke or brain injury. But if it happens to be there, it might be protective.

CAFFEINE AND STRESS

CAFFEINE AND STRESS

Caffeine increases some of the normal stress responses because it increases the amount of adrenaline that is active in the body under stress­ful circumstances. Thus, it seems that caffeine users who find themselves under stress (or who use caffeine even more during stressful periods to work more effectively) may experience more of the effects that stress can produce. Adrenaline release increases blood pressure during stress, and the caffeine-induced rise adds to this. Thus, caffeine and stress together lead to greater bodily stress responses than either does alone.

CAFFEINE AND PANIC ATTACKS

In some people, caffeine can contribute to the experience of panic attacks, which generally come on suddenly and involve powerful feelings of threat and fear. The experience can be very debilitating for a brief period of time. It seems that caffeine is more likely to bring on panic attacks in people who have had them previously. However, relatively high doses of caffeine (greater than 700 milligrams) have been reported to lead to panic attacks in people who have never experienced them.

ENHANCEMENT OF PHYSICAL PERFORMANCE

Caffeine can slightly enhance physical endurance and delay fatigue asso­ciated with vigorous exercise in some people. One way that caffeine might accomplish this is by releasing fats into the blood for use as energy, enabling the body to conserve its other energy stores (in the form of stored sugars), thus allowing the athlete to sustain physical activity for a longer period of time. Caffeine may also help muscle performance during physical exercise, although the way this happens is not clear. What we do know is that caffeine dilates the bronchioles, making it easier for air to pass into the lungs. This would seem to have a beneficial effect on certain types of physical performance. Still, the most thorough studies of well-trained athletes are inconclusive. In some cases there appear to be performance-enhancing effects, and in others there are none. So the jury

remains out.

Two words of caution, though, for those who use caffeine for this pur­pose. Because caffeine causes an increased loss of water through urine production, a person exercising on caffeine may become dehydrated more rapidly during long periods of exercise such as distance running or cycling. This caution is particularly important for hot-weather exercisers. The other concern is the effects of caffeine on heart rate and heart rhythms. Strenuous exercise obviously stresses the heart, so a person with cardiovascular disease could experience problems while using caffeine to promote physical performance.

People who worry about their weight might be interested in the issue of fat metabolism. Products based on the supposed ability of caffeine and theophylline to "burn fat" include a theophylline cream placed on the market several years ago that was supposed to melt fat away. Just rub it on the offending fat pad! Unfortunately, the effectiveness of this treat­ment hasn't been established (one big problem is probably getting the theophylline through the skin and into the fat cells).

Likewise, there is tremendous interest in whether a combination of caf­feine and exercise can help to promote the burning of fat as fuel for weight loss. Fat cells really do have adenosine receptors, and xanthines really can cause a small release of stored fat, so some foods that include caffeine have been sold as fat burners. However, the scholarly research on these prod­ucts has demonstrated only small weight-loss effects. Coffee and its cous­ins may prove to be a useful part of weight-loss programs in the future, but at this point nothing "melts" fat except old-fashioned exercise and a healthy diet.

THE BOTTOM LINE ON ADDICTION

THE BOTTOM LINE ON ADDICTION

The bottom line on addiction is that anyone with a brain can get addicted to drugs. However, most people don't, and there are a lot of reasons. First and foremost, if a person does not experiment with addictive drugs, then she won't get addicted. Second, if a person is mentally healthy, has a stable family and work life (including supportive and non-drug-using peers), and has no family history of substance abuse, she lacks some important risk factors and is less vulnerable. However, she still has a brain, and she is not immune to addiction. During the cocaine craze of the 1970s and ¹80s, plenty of constructive, highly educated, well-employed professionals became addicted to cocaine despite positive factors in their lives.

Finally, there may be some people for whom the pleasurable experience of these drugs is exceptionally high, and the drive to use the drugs is thus more compelling than for others. If these people do not try drugs, this underlying quality will not present a problem. However, if they have access to them, and if they do choose to use them, they are at significant risk. It is no accident that the rate of drug addiction among professionals in the United States is highest among medical personnel, who have easy access to such drugs.

MENTAL ILLNESS AND DRUG ADDICTION

MENTAL ILLNESS AND DRUG ADDICTION

Depression and some other mental illnesses also occur more frequently in substance users. Did the drugs cause the problem, or did the problem cause the drug use? Once someone's life has become complicated by sub­stance addiction, the turmoil that has been created can certainly contrib­ute to the development of depression. This fact makes it very difficult to understand the complicated relationship between mental illness and drug addiction. However, some recovering addicts will describe an opposite cycle: that their anxious or depressed mood led them to drink or to use other substances to deal with feelings of inadequacy or despair. Then, as time passed and substance use became more frequent, the substance use became the dominant problem. This "self-medication" process probably contributes to addiction in many people.

PATIENT CHARACTERISTICS: FAMILY THERAPY GROUPS

The essential thrust of this book is to deal with clinical events and techniques for those cases actually involved in family therapy. While Chapter 5 discusses recruitment principles that also apply to the Family Movie cases and to treatment "refusers,- and Chapter 17 presents outcomes for all four treatment conditions, the major concern is with family therapy. Thus attention will be given here to the 46 cases (21 and 25, respectively) in the combined Paid and Unpaid Family Therapy groups (although two Unpaid cases never did, in fact, attend a family therapy session). This gives a more accurate picture of the patient population with which the treatment principles have been developed. Demographics for the other groups are, of course, quite similar, and are presented elsewhere:-

Of the 46 family therapy patients, 48% were Black and 52% White. Among the Whites, 40% were of Italian, and 25% of Irish extraction. The mean age at intake was 24.7 years and ranged from age 20 to age 34. Some 24% were married and another 11% had been previously married but were unmarried at intake. All had been away from home in military service for at least a brief period in their lives; 32% had served in Vietnam and 5% had been dishonorably discharged from the military for drug use. Of the 46 patients, 61% still lived with their parent(s). Most had completed high school or an equivalency examination, 4% were in school or a training program, and 41%. were employed at intake. The average length of time during which they had used opiates was 6.7 years, while 94% had been previously treated for drug abuse (i.e., they were "repeaters- ). The socioeconomic composition of this (urban) group, as defined by Hollingshead and Redlich's

Two-Factor Index of Social Position,69 was Class III, 8%; Class IV, 66%; Class V, 26%.

Aside from their somewhat worse prognosis (mentioned above and in Appendix C), the major differences between this group and the overall DDTC patient population are probably that this group (1) was slightly younger; (2) had a slightly higher ratio of Whites to Blacks; (3 ) included fewer patients who had ever been married; and (4) included a

somewhat lower percentage of patients in a school or training pro-gram (4% vs. 18% ).

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.

SPECIAL CONSIDERATIONS FOR WOMEN

SPECIAL CONSIDERATIONS FOR WOMEN

DIFFERENT SENSITIVITY

Alcohol does not treat all people equally, and there are some big differ­ences between the effects of alcohol on women and on men. As women have taken a more visible role in our society, they have found more free­dom (and perhaps more encouragement) to drink. Consequently, drink­ing is on the rise among women in general. Surveys indicate that the percentage of women who drink alcohol has increased from 45 to 66 per­cent over the past forty years and that as many as 5 percent of women are heavy drinkers.

Women's bodies differ from men's bodies in a number of ways that make them react differently to alcohol. For one, women are generally smaller than men, and their bodies have a larger percentage of fat, which causes them to develop higher blood alcohol concentrations than men after drinking similar amounts of alcohol. There is also a chemical called alcohol dehydrogenase (ADH) that breaks down some of the alcohol in the stomach before it gets absorbed into the blood. Women under 40 years of age appear to have less of this in their stomachs, so, compared to men, more of the alcohol they drink gets absorbed into the blood. In fact, after a given dose of alcohol, a woman may achieve a blood alcohol level 25 to 30 percent higher than a man. Women should know that they will likely be considerably more impaired than their male companions if they drink comparable amounts of alcohol.

HEALTH EFFECTS

Women who drink are at significantly greater risk for liver damage than men even if they drink less alcohol or drink for a shorter period of time. This increased risk has been reported for women who drink from one and a half to three drinks of alcohol per day and may be due to the differences in the way a woman's body eliminates alcohol.

The pancreas, too, is more likely to be damaged by alcohol in women. The cells of the pancreas make chemicals that are used for digestion. When alcohol damages the pancreas cells, the digestive chemicals begin to leak out and can actually begin to digest the pancreas itself. Although this hap­pens in both women and men, women tend to develop the disease sooner.

Women are also more likely than men to develop high blood pressure due to drinking alcohol. High blood pressure is one of the major causes of

heart attack and stroke. Women who have two to three alcoholic drinks per day have a 40 percent greater risk of developing high blood pressure. The good news is that this additional risk diminishes when the woman stops drinking. Still, for women who drink even moderate amounts of alcohol, the increased risk of high blood pressure is substantial.

The risk of breast cancer is also increased in women who drink. The minimum amount of drinking that it takes to increase breast cancer risk has not been established. However, there is solid evidence that even as few as one to two drinks per day can increase a woman's risk of breast cancer. And it does not take much more drinking to push the risk up consider­ably higher. For example, one analysis indicated that women who had two to four drinks per day increased their breast cancer risk by 41 percent while another showed that women who drank three or more drinks per day on average suffered a 69 percent higher risk of getting breast cancer.

Finally, women appear to be more sensitive to the effects of chronic alcohol drinking on brain function and seem to be more likely to show deficits in cognitive function.

SOCIAL AND PSYCHOLOGICAL ISSUES

Despite the increased acceptance of drinking by women during the past several decades, a number of studies have shown that women who drink a lot meet with more disapproval of their drinking than do men. In addi­tion, the divorce rate for alcoholic women is higher than for alcoholic men. This suggests that women are less likely to leave relationships with alcoholic men than the reverse.

It is also clear that women who drink heavily are at a much higher risk for domestic violence and sexual assault than other women. One particu­larly compelling study of more than 3,000 college women found that the more alcohol a woman consumed, the higher her chances were of being sexually victimized. This might occur because a woman impaired by alcohol may have more trouble accurately interpreting a man's behavior as threatening or resisting unwanted sexual advances.

ALCOHOL AND SEX

Anyone who has ever watched a commercial for beer can tell you that your sex life will improve considerably with drinking. The truth of the

matter is that most of the effects of alcohol on sexual functioning are bad. Of course, a person may feel more suave and sexy after drinking, and he may more easily convince himself that his sexual prowess is unparalleled. But all too often the mind makes a promise that the body cant keep after a night of heavy drinking. Men, in particular, should consider the mean­ing of the term "brewer's droop."

As many as 40 to 90 percent of chronic male drinkers (depending on the study) report reduced sex drive. Chronic drinkers show reduced capacity for penile erection, decreased semen production, and lower sperm counts. In fact, in alcoholic men the testes may actually shrink (a fact generally not presented in beer commercials). In extreme cases of chronic heavy alcohol abuse among men, a feminization syndrome can develop, which involves a loss of body hair and the development of breast tissue. Although these effects are most often seen in men who drink heav­ily over a prolonged period, some sexual and reproductive functions are impaired even by lesser intake. For example, evidence is accumulating that consuming two to three drinks per day may decrease sperm counts.