Concurrent cocaine withdrawal is associated with reduced severity of alcohol withdrawal

Epidemiological and sociodemographic factors associated with complicated alcohol withdrawal syndrome

OBJECTIVES

To analyse the influence of epidemiological and sociodemographic factors in complicated alcohol withdrawal syndrome (AWS).

MATERIAL AND METHODS

A multicentre, observational prospective study was conducted on consecutively added patients with AWS hospitalised in internal medicine departments. We recorded sociodemographic, epidemiological, clinical and progression data. Complicated AWS was defined as that which progressed with seizures or delirium tremens.

RESULTS

We studied 228 episodes of AWS in 219 patients. The mean age was 54.5 years (SD, 11.5), and 90.8% were men. AWS was the cause for hospitalisation in 39.9% of the patients. Some 27.1% of the cases presented seizures, and 32.4% presented delirium tremens. The daily quantity of alcohol ingested was 17.8 standard drink units (SD, 21.4), with 16.6 years of dependence (SD, 11.3). The pattern of alcohol abuse was regular in 82.8% of the patients. Some 38.4% of the patients were married or had a partner, and 45.6% had children. Some 72.7% of the patients were unemployed or retired. Some 68.5% had only completed primary studies. Some 4.8% consumed cannabis, 5.2% consumed cocaine and 3% consumed opioids. The independent variables related to complicated AWS were consumption of a drug other than alcohol (OR, 5.3; 95% CI 1.5-18.7), low education level (OR, 3.4; 95% CI 1.6-7.3) and hospitalisation for AWS (OR, 2.9; 95% CI 1.5-5.6). The model's receiver operating characteristic area was 0.718 (95% CI 0.643-0.793).

CONCLUSIONS

Concomitant drug abuse and a low educational level could help identify patients at risk of complicated AWS.

Concurrent cocaine withdrawal alters alcohol withdrawal symptoms

This study compares alcohol withdrawal severity during outpatient detoxification in alcohol dependent subjects (ALC) and in subjects dependent on both alcohol and cocaine (ALC/COC). Subjects included 123 ALC and 66 ALC/COC subjects. Baseline demographic and drug use variables, alcohol withdrawal symptoms, and the total amount of oxazepam taken during alcohol detoxification were compared between the two groups. Compared to ALC subjects, ALC/COC subjects were younger, more likely to be African-American, and had less severe histories of alcohol dependence. However, alcohol withdrawal symptom severity did not differ significantly between the two groups. Nevertheless, controlling for differences in alcohol use history, ALC/COC subjects still received less oxazepam than did ALC subjects to treat alcohol withdrawal symptoms. Despite similar intensity of alcohol withdrawal symptoms, ALC/COC subjects received less oxazepam to treat alcohol withdrawal symptoms compared to ALC subjects. Both subject and clinician factors may explain the difference in oxazepam use.

Effects of concurrent use of alcohol and cocaine

The combination of alcohol and cocaine is popular among drug users, perhaps because of more intense feelings of 'high' beyond that perceived with either drug alone, less intense feelings of alcohol-induced inebriation and tempering of discomfort when coming down from a cocaine 'high'. A review is presented of the medical literature on psychological and somatic effects and consequences of combined use of alcohol and cocaine in man. The search was carried out with Medline, the Science Citation Index/Web of Science and Toxline. Exclusion and inclusion criteria for this search are identified. There is generally no evidence that the combination of the two drugs does more than enhance additively the already strong tendency of each drug to induce a variety of physical and psychological disorders. A few exceptions must be noted. Cocaine consistently antagonizes the learning deficits, psychomotor performance deficits and driving deficits induced by alcohol. The combination of alcohol and cocaine tends to have greater-than-additive effects on heart rate, concomitant with up to 30% increased blood cocaine levels. Both prospective and retrospective data further reveal that co-use leads to the formation of cocaethylene, which may potentiate the cardiotoxic effects of cocaine or alcohol alone. More importantly, retrospective data suggest that the combination can potentiate the tendency towards violent thoughts and threats, which may lead to an increase of violent behaviours.

A review of the effects of moderate alcohol intake on psychiatric and sleep disorders

In this chapter we discuss the effects of moderate ethanol consumption on the treatment of psychiatric and sleep disorders. A review of the literature on the interactions of ethanol with neurotransmitters and psychotropic medications suggests that although ethanol affects the clinical course of psychiatric and sleep disorders by different mechanisms, it does so principally through perturbations it causes in the balance of central nervous system neurotransmitter systems, which may modify the clinical course of primary psychiatric and sleep disorders and undermine the therapeutic response to psychotropic medications. Neurotransmitter responses may also be manifested clinically by rebound phenomena, akin to a subsyndromal withdrawal, which affect sleep and precipitate anxiety and mood symptoms. In addition, ethanol also modifies the clearance and disposition of a variety of psychotropic metabolites and interferes with their clinical effectiveness. We recommend that most psychiatric patients, and all patients with sleep disorders, should abstain from even moderate ethanol use, as this may adversely affect their clinical course and response to treatment.

Neuropsychological differences between alcohol-dependent and cocaine-dependent patients with or without problematic drinking

The present study evaluated differences among three groups of substance abusers, abstinent for 1-5 months. One group was composed of 17 alcohol-dependent patients. The other two groups were composed of cocaine-dependent patients who scored below (n = 29) or above (n = 18) the median Michigan Alcoholism Screening Test (MAST) score for the cocaine-dependent group in total. The Shipley Institute of Living Scale was administered to all subjects. An ANOVA, with age as a covariate, revealed that the cocaine-dependent group with lower MAST scores exhibited statistically significant impairments on the Shipley abstraction subtest and on total IQ relative to the two other groups. There were no group differences on the verbal subtest. The abstraction and IQ deficits in the lower MAST score cocaine-dependent group could not be explained by decreased verbal abilities, a greater duration or frequency of cocaine use, or by a higher prevalence of Antisocial Personality Disorder. However, a chi 2 analysis revealed that this group contained more individuals who used cocaine in its 'freebase' or smoked form. Since the two cocaine-dependent groups were comparable in demographic and psychological characteristics, but had different levels of cocaine exposure, the results suggest that the decrements in abstraction scores reflect a cocaine-related effect.

Quantitative electroencephalographic differences associated with alcohol, cocaine, heroin and dual-substance dependence

Resting electroencephalographic (EEG) activity was evaluated in 88 drug-dependent inpatients, abstinent 1-6 months, and 14 non-drug-dependent controls. The patients were assigned to one of four groups using DSM-III-R criteria: alcohol-dependent (n = 12), cocaine-dependent (n = 21), heroin-dependent (n = 19), or dual alcohol- and cocaine-dependent (n = 36). The analysis revealed significant differences between the five subject groups in high- and low-frequency beta power, but not in other frequency bands. Beta power was significantly greater in the alcohol-dependent and cocaine-dependent groups relative to non-drug-dependent controls. These group differences did not correlate with quantity/frequency measures of alcohol or cocaine use, family history, personality, mood, or demographic characteristics. The similar increases in EEG beta found in alcohol- and cocaine-dependent patients do not suggest a direct drug effect. Rather, they suggest the existence of a common premorbid variable or a complex interaction between alcohol/drug use and other variables.