To test the hypothesis that craving for alcohol in the alcohol-dependent individual is mediated by a limbic circuit involving the caudate nuclei, regional cerebral blood flow was measured with [99mTc]HMPAO SPECT during control and craving conditions in 9 alcohol-dependent subjects. In all subjects, blood flow in the head of the right caudate nucleus increased during the craving condition, and these blood flow increases were strongly correlated with the experimentally induced increases in craving for alcohol. These new findings suggest a functional role for the limbic striatum in the mediation of craving and impaired control over alcohol consumption.

OBJECTIVE:To determine if regional cerebral blood flow (rCBF) in the left and right hemithalami or the left and right heads of the caudate nucleus is abnormal in women with fibromyalgia (FM).METHODS:Resting-state rCBF in the hemithalami and left and right heads of the caudate nucleus of 10 untreated women with FM and 7 normal control women was measured by single-photon-emission computed tomography. Pain threshold levels at tender and control points also were assessed in both the women with FM and the controls.RESULTS:The rCBF in the left and right hemithalami and the left and right heads of the caudate nucleus was significantly lower in women with FM than in normal controls (P = 0.01, P = 0.003, P = 0.01, and P = 0.02, respectively). Compared with controls, the women with FM also were characterized by significantly lower cortical rCBF (P = 0.001) and lower pain threshold levels at both tender points (P = 0.0001) and control points (P = 0.0001).CONCLUSION:The findings of low rCBF and generalized low pain thresholds support the hypothesis that abnormal pain perception in women with FM may result from a functional abnormality within the central nervous system.

We recently proposed that alcoholics suffer from a functional defect within the basal ganglia/limbic striatum or its modulation by dopaminergic projections from the ventral tegmentum, and that inhibition of striatal output caused by the prodopaminergic effects of alcohol ingestion induces or exacerbates craving and impaired control over alcohol consumption in alcoholic individuals. To test this hypothesis, 16 subjects with a diagnosis of alcohol dependence or abuse were studied in a double-blind, placebo-controlled experiment in which the effects of the D-2 antagonist haloperidol on measures of craving and impaired control were assessed before and after administration of a priming dose of alcohol. Subjects were pretreated with 0.015-0.025 mg/kg haloperidol (experimental condition) or 2 ml normal saline (control condition), and subsequently consumed 0.4-0.6 g/kg ethanol as their preferred alcohol-containing beverage. Significant increases in subjectively rated craving for alcohol and perceived difficulty resisting additional alcohol consumption occurred following the priming dose of alcohol when subjects were pretreated with saline. In contrast, no significant changes in reported ability to resist additional alcohol occurred when subjects were pretreated with haloperidol, and reported levels of craving decreased relative to baseline following haloperidol pretreatment. Subjects also consumed about 25% less optionally available alcohol when pretreated with haloperidol than when pretreated with saline. These findings support the hypothesis that craving and impaired control are induced or exacerbated by the prodopaminergic effects of alcohol consumption.

OBJECTIVE:To determine whether breath alcohol values (BrAV) attained following mouthwash use pose a realistic threat to the accuracy of blood alcohol determinations by breath analysis. DESIGN:Nonrandomized, open-label trial. SETTING:Outpatient research office. PARTICIPANTS:Ten normal subjects; convenience sample. INTERVENTIONS:Breath alcohol measurements were made 2, 4, 6, 10, and 15 minutes following rinsing of the mouth with Listerine (26.9% alcohol) [corrected], Scope (18.9% alcohol), and Lavoris (6.0% alcohol) using the Alco-Sensor III intoximeter. MAIN OUTCOME MEASURES:Breath alcohol values over time. RESULTS:Breath alcohol values following mouthwash use decayed exponentially (r2 > or = .98, P < .001) from mean values 2 minutes following mouthwash use of 52.8 mmol/L (240 mg/dL) for Listerine, 37.4 mmol/L (170 mg/dL) for Scope, and 7.9 mmol/L (36 mg/dL) for Lavoris to mean and maximum values after 10 minutes that were well below the usual driving-while-intoxicated range (> or = 17.6 mmol/L [80 mg/dL]) for all three brands. The nonalcoholic mouthwash ingredients did not significantly affect the BrAVs attained. CONCLUSION:The decay of BrAVs following mouthwash use is sufficiently rapid that mouthwash use would not pose a realistic threat to the accuracy of blood alcohol determinations by breath analysis under normal circumstances. Use of mouthwash immediately prior to breath testing, as might occur in the car or workplace in a mistaken attempt to hide the smell of alcohol or other substances, may, however, significantly increase the measured BrAV.

There is a popular belief that the experimental administration of alcohol to individuals who have chronic, severe alcohol problems ('alcoholics') is inherently dangerous or unethical. This creates an environment in which researchers who desire to conduct a study involving the administration of alcohol to persons with severe alcohol problems must defend the relative safety and reasonableness of this practice when, in fact, scientific justification for not using this important methodologic technique in alcohol research is lacking. The primary purpose of this manuscript is to present and discuss the safety, ethical, and practical considerations of research involving administration of alcohol to subjects who have had difficulty refraining from harmful alcohol use in the natural setting. The authors also describe a study in which they monitored the short-term effects of administering 0.4-0.6 g/kg alcohol to 16 recently abstinent subjects who had chronic, severe alcohol problems. This study revealed no evidence that the administration of beverage alcohol in the experimental setting to such individuals causes an uncontrollable desire for more alcohol, precipitates immediate relapse, or creates any behavioral problems. The data also suggested that the knowledge gained from the effects of alcohol ingestion in the experimental setting might help many subjects to understand more completely their addiction or drinking behaviour. It is concluded that there is no overriding reason why alcohol cannot, with due precaution, be safely and ethically administered in the experimental setting to human subjects who suffer from alcohol problems.

Doxapram is a respiratory stimulant thought to act by stimulating medullary neurones and carotid oxygen receptors (Kato and Buckley 1964). It changes neither oxygen uptake nor CO2 production, but produces substantial hyperventilation (Calvedey et al 1983). Hyperventilation occurs during naturally occurring or pharmacologically induced panic attacks, and perhaps also in panic patients between attacks (Gorman et al 1984, 1986). In panic disorder, central respiratory centers (Woods et al 1988) or a suffocation alarm center (Klein in press) may be hyperexcitable. We report here a pilot study designed to test the possibility that in panic diserder these centers may be hypersensitive to doxapram.

Annals of the New York Academy of SciencesVolume 654, Issue 1 p. 492-495 Effect of Haloperidol on Craving and Impaired Control following Alcohol Consumption in Alcoholic Subjectsa JACK G. MODELL, Corresponding Author JACK G. MODELL Departments of Psychiatry, University of Alabama School of Medicine Birmingham, Alabama 35294-0018Address correspondence to Jack G. Modell, M. D., Department of Psychiatry, Smolian 403, UAB Station, Birmingham, AL 35294-0018; (204) 934-4301.Search for more papers by this authorJAMES M. MOUNTZ, JAMES M. MOUNTZ Departments of Nuclear Medicine, University of Alabama School of Medicine Birmingham, Alabama 35294-0018Search for more papers by this author JACK G. MODELL, Corresponding Author JACK G. MODELL Departments of Psychiatry, University of Alabama School of Medicine Birmingham, Alabama 35294-0018Address correspondence to Jack G. Modell, M. D., Department of Psychiatry, Smolian 403, UAB Station, Birmingham, AL 35294-0018; (204) 934-4301.Search for more papers by this authorJAMES M. MOUNTZ, JAMES M. MOUNTZ Departments of Nuclear Medicine, University of Alabama School of Medicine Birmingham, Alabama 35294-0018Search for more papers by this author First published: June 1992 https://doi.org/10.1111/j.1749-6632.1992.tb26010.xCitations: 2 a Supported by the National Institute of Health, Department of Research Resources Clinical Research Center Grant Numbers MO1-RR00032 (University of Alabama) and MO1-RR00042 (University of Michigan). AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume654, Issue1The Neurobiology of Drug and Alcohol AddictionJune 1992Pages 492-495 RelatedInformation

The authors report a case in which pathological lying is associated with right hemithalamic dysfunction as shown by [99mTc]HMPAO SPECT brain scanning. This association has not been demonstrated previously and is noteworthy because it supports the hypothesized roles of the thalamus and associated brain regions in the modulation of behavior and cognition.

The purpose of this study was to quantify the extent to which subjective ratings of craving for alcohol in the alcohol-abusing or dependent person (herein, alcoholic) correlate with measurable and specific characteristics of obsessions and compulsions. The Yale-Brown Obsessive Compulsive Scale modified to reflect obsessionality and compulsivity specifically related to heavy drinking (Y-BOCS-hd) was used for this purpose. Highly significant correlations were found in the alcoholic population (n = 62) between subjectively rated craving for alcoholic beverages and several of the Y-BOCS-hd questions regarding alcohol-related thoughts and drinking behavior. Additionally, mean craving scores were considerably greater in the alcoholic population than in the matched control population (n = 62). The data suggest that craving shares specific features in common with the obsessions of obsessive-compulsive disorder and that the existence of craving is dependent on the presence of obsessive thoughts about drinking. Positive correlations between craving and measures of compulsive drinking behavior also were found; compulsive drinking behavior, however, may reflect the consequences of craving rather than a fundamental characteristic of craving itself. The data show that despite difficulties in defining the term craving, it is clearly a phenomenon that is experienced or endorsed by most alcoholic subjects and is not by most persons who do not abuse alcohol.

The purpose of the this study was to develop an instrument for measuring the obsessive and compulsive characteristics of drinking-related thought and behavior in subjects who abuse or are dependent on alcohol, and to quantify the extent to which drinking-related thought and behavior in these subjects resemble the obsessions and compulsions seen in obsessive-compulsive disorder (OCD). To achieve these goals, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was modified to reflect obsessionality and compulsivity specifically related to heavy drinking rather than to obsessions and compulsions generally. The modified Y-BOCS (Y-BOCS-hd) was administered to 62 subjects satisfying DSM-III-R criteria for alcohol abuse or alcohol dependence and 62 matched normal controls. The data showed that the Y-BOCS-hd is a sensitive and specific instrument for measuring the obsessive and compulsive characteristics of drinking-related thought and behavior in alcohol-abusing and alcohol-dependent populations, and that there are specific and quantifiable similarities between these characteristics and the obsessions and compulsions of OCD. The data also indicated that the Y-BOCS-hd may be a useful screening instrument for the presence of alcohol abuse and dependence.

The State-Trait Anxiety Inventory (STAI) was administered to 43 normal volunteers immediately before and after a positron emission tomography (PET) procedure with [18F]-2-fluoro-2-deoxy-D-glucose (18F-FDG). High traitanxious individuals had significantly higher state (situational) anxiety associated with the PET scan procedure than did low trait-anxious persons. State anxiety decreased significantly for all respondents following the PET scan procedure. No significant relationships between global or regional cortical metabolic rates and state anxiety were observed. The direct cortical metabolic effects of heightened anxiety in the scan setting, should they exist, are likely obscured in the normal variance of the 18F-FDG method.

ALCOHOL is the most widely used and misused drug in the Western world. The cost to the United States in 1990 in terms of lost production, crime, accidents, and treatment related to alcohol misuse is expected to exceed $136 billion, and alcohol intoxication is a cause or contributing factor in approximately 40 percent of all fatal automobile accidents.1 Alcohol misuse is also a problem among the nearly 700,000 general-aviation pilots in this country. ( General aviation refers to all civil-aviation operations other than those conducted for remuneration or hire; therefore, it does not include the commercial airlines or military operations.) . . .

This study investigated the possibility that a relationship between the anatomic defects observed on computed tomography (CT) and the functional defects observed on single photon emission computed tomography (SPECT) might be used as an outcome measure to predict clinical recovery from the neurologic deficits induced by stroke. Twenty-seven patients with stroke location limited primarily to cerebral cortex were included in the study: each patient underwent a cranial CT scan, 99mTc hexamethylpropyleneamineoxime SPECT cerebral perfusion scan, and an initial and 1-yr follow-up neurologic examination. A strongly positive correlation between the ratio of the SPECT to CT volume defect sizes (SPECT divided by CT) and recovery following stroke was found, such that the greater the SPECT to CT ratio, the better the subsequent recovery of neurological deficits. Discriminant function analysis revealed that the best predictor of clinical outcome following stroke was the log-transformation of SPECT divided by CT. The results suggest that the relationship between the perfusion defects and tissue loss measured by SPECT and CT imaging may have prognostic utility following stroke limited primarily to cerebral cortex.