Disability one year after head injury. Role of alcohol needs to be examined.
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Biomedical subjects
Publications and source records attributed to E B Ritson.
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Alcohol dependence is not a unitary or homogeneous disorder. There is substantial evidence to suggest that in both community and particularly in clinical samples, additional psychopathology is common. Although estimates of additional psychopathology differ according to the samples studied and the instruments used to classify disorders, up to two-thirds of clinical samples of patients with alcohol dependence are likely to have a lifetime diagnosis of another psychiatric disorder. Affective disorder and antisocial personality disorder appear to be the most commonly and consistently reported additional disorders. Women more than men appear to suffer from additional psychopathology, including secondary and primary depression, although this evidence is weakened by there being fewer studies carried out on mixed gender populations. Having an additional psychiatric diagnosis appears to alter the course of alcohol dependence: it may hasten the development of dependence on alcohol and may bring individuals to the attention of treatment agencies more quickly. More recent studies have examined the relationship between alcohol dependence and affective disorder in the current episode. There is consistent evidence to suggest that a diagnosis of depression in the current episode may change to one of alcohol dependence alone, once detoxification or abstinence has been achieved. The prognosis of those who continue to be depressed remains unclear.
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Patients presenting to an Emergency Department were assessed by a standard questionnaire and clinical examination as to the contribution that alcohol made to their presentation and the perception of their alcohol use. Patients under the influence of alcohol are more than twice as likely not to fill in simple questionnaires and not to perceive their alcohol consumption as different from non-drinking fellows. Emergency Departments are not the optimal site for the education and motivation of drinking patients to alter their future habits.
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The excise duty on alcoholic beverages was increased in March 1981, causing the cost of alcohol to rise faster than other prices for the first time in 30 years. For this reason 463 "regular drinkers" in the Lothian region whose drinking habits had been established in 1978-9 were reinterviewed in 1981-2. Overall, their alcohol consumption had fallen by 18% and associated adverse effects by 16%. Heavy drinkers and suspected dependent drinkers both reduced their consumption at least as much as light or moderate drinkers and suffered considerably fewer adverse effects as a result. Increasing the excise duty on alcoholic beverages can therefore be an effective public health measure. Factors related to rising unemployment were responsible for about 20% of the overall reduction in consumption.
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