The pathomorphology of chronic alcohol-associated myocardial changes

Forensic cases of sudden cardiac death were reviewed from the point of view of a history of alcohol consumption. A group of known cases of chronic alcoholism and another group of cases known to have been normal social drinkers without evidence of chronic alcoholism were selected. Cases with evidence of hypertension, ischemic or coronary heart disease, as well as cases with positive toxicological findings, were excluded. Applying the same criteria, cases of sudden death from other causes without a known history of alcohol consumption were selected to form a control group. With particular reference to histological myocardial changes, which are often documented in association with alcohol consumption, no noteworthy differences were found between the two major groups despite the significantly much lower frequency in the control group.     

Vitreous humor carbohydrate-deficient transferrin concentrations in the postmortem diagnosis of alcoholism

Deaths from the effects of alcohol intoxication are encountered routinely in forensic practice. In an important number of cases difficulty may arise in interpreting the significance of results obtained in the autopsy. In clinical practice biochemical markers, particularly serum gamma-glutamyl-transpeptidase (GGT), alanine aminotransferase (ALT), aspartate transaminase (AST), carbohydrate-deficient transferrin (CDT), and erythrocyte mean corpuscular volume are used to diagnose heavy alcohol consumption. CDT is used as a reliable and specific marker. In postmortem diagnosis, because of the difficulty in interpreting blood alcohol levels and relatively non-specific pathological features, biochemical compounds have been studied for use as possible markers. The aim of this study was to evaluate the usefulness of the postmortem determination of CDT in vitreous humor as a confirmation of antemortem alcoholism. CDT levels were studied in 66 male cadavers with a mean age of 55.9 years (S.D. 17.0, range 22-87 years) with a mean postmortem interval of 17.9 h (S.D. 11.4, range 4-72 h). Cases were assigned to two diagnostic groups according to the antemortem diagnosis of alcoholism. Statistically significant differences were found for CDT and ALT concentrations between the two diagnostic groups. The highest vitreous humor levels of CDT and ALT were obtained in the group of cases with a previous diagnosis of alcoholism. Our results suggest that vitreous humor CDT levels are useful in cases where the postmortem diagnosis of alcoholism is hindered by the non-specificity of data.     

Attitudes toward Domestic Violence in Korean and Vietnamese Immigrant Communities: Implications for Human Services

The present study examined the effects of gender, ethnicity, acculturation level, age, and education level of Korean and Vietnamese Americans on their attitudes toward domestic violence. The sample consisted of 229 Koreans and 184 Vietnamese, recruited from ethnic communities and college campuses in southern California. Participants completed a brief questionnaire, which included the Revised Attitudes toward Wife Abuse Scale (RAWA) and the Marin and Marin Acculturation Scale as well as demographic variables. Gender, education, and acculturation level emerged as significant predictors of attitudes toward domestic violence. More specifically, men as well as those who were less acculturated and less educated were more likely to endorse pro-violence attitudes. While there were no significant ethnic differences in the global attitude toward domestic violence between the two immigrant groups, there were specific inter-ethnic differences on select items of the RAWA scale.     

Road aggression among drinking drivers: Alcohol and non-alcohol effects on aggressive driving and road rage

This study specified aggressive driving (AD) and road rage (RR) and examined a number of alcohol and non-alcohol effects on and the reciprocity between the two behaviors in a drinking driving population. The sample contained 431 clients (79 percent men) who volunteered to complete a self-report survey from fifty alcoholism and substance abuse treatment facilities across New York State. All subjects were undergoing alcoholism treatment because of a drinking driving-related reason. Structural equation modeling with the LISREL program was employed to estimate the reciprocal effects between AD and RR. The results demonstrated that AD and RR were two separate behaviors that simultaneously influenced each other. Additionally, AD and RR, as problem behaviors, tended to be affected mostly by other problem behaviors, such as alcohol problems, impaired driving, and feelings of depression, rather than general situations or behaviors, such as the frequency of alcohol use, driving after drinking, and the experience of stressful life events. The findings convey a message to the criminal justice field as well as alcoholism and substance abuse treatment professionals that addressing the problem of road aggression requires special attention to persons with alcohol problems and especially those with multiple drinking driving offenses.     

Verbal Aggression Among Male Alcoholic Patients and Their Wives in the Year Before and Two Years After Alcoholism Treatment

Our earlier reports on 88 male alcoholics and their wives showed that domestic violence decreased significantly in the first and second year following a behavioral marital therapy (BMT) alcoholism treatment program. The present study examined verbal aggression in this same sample. In the year before BMT, verbal aggression was significantly greater—being five to seven times more prevalent for clinically elevated aggression and substantially more frequent—for the alcoholic husbands and their wives than for a demographically matched, nonalcoholic comparison sample. In the two years after BMT, both alcoholic men and their wives showed significant and substantial reductions in verbal aggression as compared with the year before BMT. Despite these significant reductions from the year before BMT, verbal aggression in the two years after BMT remained significantly elevated relative to demographically similar nonalcoholic controls. As predicted, relapsed alcoholics and their wives showed more verbal aggression in the 2 years after BMT than both couples with a remitted alcoholic husband and demographically similar nonalcoholic controls, whereas remitted alcoholics and their wives had similar levels of verbal aggression to the nonalcoholic controls. Further, frequency of drinking was positively correlated with verbal aggression in the 2 years after BMT; verbal aggression was greater when the alcoholic husband drank more frequently.     

Variability in the Blood/Breath Alcohol Ratio and Implications for Evidentiary Purposes

The breath analyzer is an indispensable tool for identifying alcohol levels among drivers. While numerous studies have shown high correlations between blood and breath alcohol concentrations, most are limited by the study design. This study seeks to assess this relationship by minimizing potential measurement bias, document time from alcohol consumption to testing, and adjusting for potential confounders. A blinded study was performed using conditions closely resembling those in the field. The Draeger 7110 MKIII IL breath analyzer was used to assess breath alcohol concentrations (BrAC). Participants were 61 healthy volunteers aged 21–37 years with body mass index ≤30 and no history of alcoholism. A total of 242 valid blood/breath tests were performed in four test sets. The study results showed a high correlation coefficient between BrAC and blood alcohol concentration (BAC) levels (r = 0.983) with high sensitivity (97%) and specificity (93%). This strong association between the breath analyzer and BAC persisted even after adjustment for various stages of alcohol absorption. These results illustrate the high diagnostic sensitivity of the breath analyzer in field‐tested conditions.     

Hyperthermia deaths in Finland in 1970-86

All cases in which hyperthermia had been determined as the basic cause of death during the period 1970-86 were collected from the records of the Central Statistical Office of Finland. Of the total of 230 cases, 228 were included in the present study; the two remaining victims died abroad, and no autopsy was performed in Finland. Most of the hyperthermia deaths occurred while the decedent was taking a sauna bath; most decedents were men aged 42-62 years. An increase in the total number of hyperthermia deaths, and of male victims, was noted from the beginning of the 1970s onward; the number of female victims remained at a relatively steady level throughout, with the exception of a slight rise in 1986. Acute alcohol consumption was detected in most of the victims; in some cases there was also a reference to chronic alcoholism or recent long-term heavy drinking. The findings suggest that in addition to the acute hazardous effect of ethanol on thermoregulatory mechanisms, the long-term consumption of alcohol may have promoted fatal hyperthermia in these subjects.     

Alcohol intoxicated eyewitnesses' memory of intimate partner violence

Alcohol affects memory in many, and mostly negative, ways. This is a problem in legal contexts as many witnesses are alcohol intoxicated when taking part of the critical event. However, research is sparse regarding how, and under what circumstances, the reports of alcohol intoxicated witnesses differ from those of sober witnesses. This study investigated whether alcohol intoxicated and sober eyewitnesses differ regarding completeness, accuracy, and type of information reported, as well as whether gender influenced these variables. Eighty-seven healthy men (n = 44) and women (n = 43) received either an alcoholic beverage (0.7 g/kg) or a control (juice) in a laboratory setting before viewing a film picturing intimate partner violence. Ten minutes after viewing the film, they were interviewed. Reports by alcohol intoxicated women were less complete, but as accurate, as sober women's. In contrast, intoxicated and sober men did not differ regarding completeness or accuracy. Furthermore, compared with sober women, intoxicated women reported fewer actions but no difference was found between the groups regarding reported objects. At this moderate dose, alcohol affected women's reports more than men's, which may be because alcohol affects attention and memory consolidation more clearly at a lower dose for women than for men.     

Presence of alcohol in suicide victims

A number of studies have established a strong connection between acute inebriation, alcohol addiction and suicides, as the last act of alcoholism or an act of desperation in an alcoholic's family, an act of escape from restraints in state of depression or as a way of self-destruction.In recent years in average 600 people per year committed suicide. Slovenia is a country with extremely high and variable suicide tendencies and harmful alcohol use levels, as well as a high level of alcohol-related troubles.The aim of our research was to ascertain some typical features, especially those connected to the inebriation of suicide victims from a wider Ljubljana region. Autopsies were carried out on the victims in the period between 1995 and 1999.There were 508 (31.2%) suicides among all the analyzed violent deaths; 73.2% of them were men. The average age of the victims was 46.5 years. Most suicides were committed at home (50.0%). 25.4% were completely sober in the moment of the act, while in all other cases inebriation was established, the average value being 9.57 g/kg. Men were drunk in 87.1% of cases, women only in 12.9% and the given alcohol levels were substantially higher with men (0.65:0.26 g/kg). The share of inebriated persons decreases with age—reaching its peak in the 35–54 age group. Regarding the method, the predominant ones are intoxication and the use of firearms, which is a typical way of committing suicide among men, while women rather choose jumping from great heights and drowning.Alcohol was present in as many as 55.7% of suicides with intoxication and in 68.8% of all suicides committed by using firearms, while the highest alcohol levels were found in those who died from cutting their veins (2.01 g/kg).Based on this and on other research, more effort should be focused on alcohol abuse prevention, making all people aware of the consequences of alcohol abuse, the possibilities of treatment and their availability as well as possible co-morbid depressions. Simultaneously, due to an established link, the national alcohol policy and strategy for prevention of suicides should be professionally harmonized.     

Comparing Women and Men Arrested for Domestic Violence: A Preliminary Report

This study uses criminal justice data to compare women and men arrested for domestic violence on their levels of violence, reported victimization, general criminality, and substance abuse. Participants were 45 women and 45 men convicted of domestic violence between 1996 and 1998. Results indicate that women were less likely than men to have a history of domestic violence offenses and nonviolent crimes. They were also more likely to report that they had been injured or victimized by their partner at the time of their arrest. However, in other ways, women and men were similar: they were equally likely to have used severe violence and inflicted severe injuries on their victims; to have previously committed violence against nonintimates; and to have been using drugs or alcohol at the time of their arrest. The implications for treatment for women arrested for domestic violence are discussed.     

The frequency of alcohol,illicit and licit drug consumption in the general driving population in South-East Hungary

In the framework of the DRUID (Driving under the Influence of Drugs, Alcohol, and Medicines) EU-6 project, a roadside survey was performed in South-East Hungary to determine the incidence of alcohol and the most frequent illicit and licit drug consumption (amphetamines, THC, illicit and medical opiates, cocaine, ketamine, benzodiazepines, zopiclone and zolpidem) in the general driving population. All 3110 drivers stopped between 01 January 2008 and 31 December 2009 were checked for alcohol, and among them 2738 persons (87.7%) participated in the further examinations, on a voluntary basis. Licit and illicit drugs were determined from their oral fluid samples by GC–MS analysis.Illicit drugs were detected in 27 cases (0.99%), licit drugs in 85 cases (3.14%), and alcohol (cut off: 0.1 g/l) was found in 4 (0.13%) cases. Illicit drug consumption was the highest among men of the ages 18–34, during the spring, and on the week-end nights. With respect to licit drugs, the highest incidence was found among women over the age of 50, during the summer, and on the week-days. All alcohol positive cases were men over the age of 35. In comparison to international European averages, the alcohol and illicit drug consumption was low, but the licit drug consumption was over the European average.     

Alcohol-related battering: Developing treatment strategies

There is a strong association between alcohol and battering. The purpose of this paper is to examine the relationship between alcohol and battering in order to develop appropriate intervention strategies. First,studies demonstrating a correlation between alcohol and battering are reviewed. This is followed by a summary of the intoxicated aggression literature using Graham's (1980) conceptual system. It is tentatively concluded that the role of physiological and cognitive changes brought on by alcohol, the interaction of alcohol and frustration in producing aggression, and needs for personal power in men who drink and then aggress are all promising explanations for the alcohol-battering link. With this in mind, the applicability of disease model-based treatment for alcoholism, cognitive-behavioral-based treatments for alcoholism and battering, and feminist-based treatment for battering are each considered. Finally, a model for incorporating an alcohol component to a batterer treatment program is introduced.     

Is Domestic Violence Learned? The Contribution of Five Forms of Child Maltreatment to Men's Violence and Adjustment

On the basis of a learning-theory approach to the intergenerational transmission of violence, researchers have focused almost exclusively on violent men's childhood experiences of physical abuse and witnessing family violence. Little consideration has been given to the coexistence of other forms of child maltreatment or the role of family dysfunction in contributing to violence. This study shows the relationships between the level of child maltreatment (physical abuse, psychological maltreatment, sexual abuse, neglect, and witnessing family violence), childhood family characteristics, current alcohol abuse, trauma symptomatology, and the level of physical and psychological spouse abuse perpetrated by 36 men with a history of perpetrating domestic violence who had attended counseling. As hypothesized, a high degree of overlap between risk factors was found. Child maltreatment, low family cohesion and adaptability, and alcohol abuse was significantly associated with frequency of physical spouse abuse and trauma symptomatology scores, but not psychological spouse abuse. Rather than physical abuse or witnessing family violence, childhood neglect uniquely predicted the level of physical spouse abuse. Witnessing family violence (but not physical abuse) was found to have a unique association with psychological spouse abuse and trauma symptomatology. These results present a challenge to the understanding of domestic violence obtained from learning theory.     

The Comparability of Male Violent Substance Abusers in Violence or Substance Abuse Treatment

The abuse of alcohol is strongly associated with violent behavior in general and domestic violence in particular. The present study examined the compara-bility of dual-problem (i.e., substance abuse and conjugal violence) men in substance abuse and violence treatment milieus. Thirty males in substance abuse treatment and 33 men in violence treatment were identified as being dual-problematic and were administered the Addiction Severity Index (ASI) to assess psychosocial and substance abuse status, the Conflict Tactics Scale (CTS) for the frequency and type of abusive behavior, the Symptoms Checklist-90 (SCL-90) for psychological distress, and the 16 Personality Factor (16PF) for personality attributes. When dual-problem men from each milieu were compared on these measures, men in the substance abuse-milieu reported not only significantly more severe substance abuse problems, but also more frequent partner sexual abuse. Few other differences emerged. Thus, while current referral procedures may be appropriate in identifying and directing more severe substance abuse problems to the appropriate treatment setting, violent men with difficulties comparable to those seen in violence treatment may also be found in substance abuse treatment. These findings emphasize the need for: (1) routine objective screening for family violence and substance abuse in these two treatment milieus; (2) informed and up-to-date staff in both settings who are sufficiently prepared for the therapeutic challenges such men may present, and (3) more study of how treatment for dual-problem men may be coordinated by the violence and substance abuse treatment communities to optimize their outcome.     

Alcohol and Violence Related Cognitive Risk Factors Associated with the Perpetration of Intimate Partner Violence

The primary aim of this study is to determine the association between alcohol, violence related cognitive risk factors, and impulsivity with the perpetration of partner violence among current drinkers. A probability sample (n = 1468) of White, Black, and Hispanic couples 18 years of age or older in the United States household population was interviewed in 1995 with a response rate of 85%. The risk factors of interest included the alcohol and violence related cognitions of approval of marital aggression, alcohol as an excuse for misbehavior, and aggressive expectations following alcohol consumption as well as impulsivity. In all, 15% (216/1468) of the respondents reported perpetration of domestic violence. In addition, 24% (7/29) of those who approved of marital violence, 11% (126/1163) of those who reported alcohol use as an excuse for misbehavior, 10% (128/1257) of those who reported aggressive expectations following alcohol consumption, and 14% (99/716) of those who reported impulsivity also reported perpetration of domestic violence. Bivariate analysis indicated that all of the cognitive risk factors were significantly more common in those who reported perpetration of intimate partner violence (IPV) (p < 0.05). However, multivariate analysis controlling for ethnicity, education, income, age, gender, and impulsivity indicated that those who reported strong or very strong expectations of aggressive behavior following alcohol consumption were 3.2 (95% CI = 1.3–7.9) times more likely to perpetrate IPV. Although all of the alcohol and violence related cognitive risk factors were associated with the perpetration of domestic violence, expectations of aggressive behavior following alcohol consumption appeared to be the strongest predictor of the perpetration of IPV among current drinkers. Therefore, alcohol expectancy may be an important factor to assess when attempting to identify and treat perpetrators of domestic violence who are also current drinkers.     

DEVELOPMENTAL PATTERNS OF ALCOHOL USE IN RELATION TO THE PERSISTENCE AND DESISTANCE OF SERIOUS VIOLENT OFFENDING AMONG AFRICAN AMERICAN AND CAUCASIAN YOUNG MEN*

This study examined the association of alcohol use with the persistence and desistance of serious violent offending among African American and Caucasian young men from adolescence into emerging adulthood. Five violence groups were defined: nonviolent, late‐onsetters, desisters, persisters, and one‐time offenders. We examined alcohol use trajectories for these groups spanning 12 through 24/25 years of age using a four‐piecewise linear growth model s 12–14, 14–18, 18–21, and 21–24/25 years of age. The persisters and desisters reported the highest levels of drinking at 13 years of age. From 14 to 18 years old, however, the late‐onsetters showed a higher rate of increase in drinking, compared with the persisters and desisters. Starting at 18 years of age, the desisters’ drinking trajectory started to resemble that of the nonviolent group, who showed the highest rate of increase in drinking during emerging adulthood. By 24/25 years of age, the persisters could not be distinguished from the late‐onsetters, but they were lower than the nonviolent and one‐timer groups in terms of their drinking. At 24/25 years old, the desisters were not significantly different from the other violence groups, although they seemed most similar to the nonviolent and one‐timer groups. We found no evidence that the association between drinking and violence differed for African Americans and Caucasians. The findings suggest that yearly changes in alcohol use could provide important clues for preventing violent offending.     

Proactive and Reactive Violence among Intimate Partner Violent Men Diagnosed with Antisocial and Borderline Personality Disorder

Personality disorder features have been an important basis of many batterer typologies (Babcock et al. J Fam Violence 15:391–409, 2000; Holtzworth-Munroe and Stuart Psychol Bull 116:476–497, 1994), most notably Antisocial and Borderline Personality Disorders. Aggression that partner violent men commit has also been found to be heterogeneous, motivated by the need to control (proactive) or enacted out of emotion (reactive). In the present study, men who were physically abusive towards their female partner (N = 124 couples) were administered the SCID-II diagnostic interview for Antisocial (ASPD) and Borderline Personality Disorder (BPD). It was hypothesized that partner violent men diagnosed with ASPD would show highest levels of proactive violence whereas men diagnosed with BPD (alone or comorbidly with ASPD) were expected to be reactively violent. Results suggest that violence perpetrated by men with different personality disorders differs in its function. Within the context of intimate relationships, BPD/comorbid men appear to use violence more reactively, while ASPD men tend to use violence both proactively and reactively. Implications for treatment are discussed.

Comparison of blood-ethanol concentration in deaths attributed to acute alcohol poisoning and chronic alcoholism

Ethanol concentrations were measured in femoral venous blood in deaths attributed to acute alcohol poisoning (N = 693) or chronic alcoholism (N = 825), according to the forensic pathology report. Among acute alcohol poisonings were 529 men (76%) with mean age 53 years and 164 women (24%) with mean age 53 years. In the chronic alcoholism deaths were 705 men (85%) with mean age 55 years and 120 women (15%) with mean age 57 years. The blood-ethanol concentrations were not related to the person's age (r = -0.17 in acute poisonings and r = -0.09 in chronic alcoholism). The distribution of blood-ethanol concentrations in acute poisoning cases agreed with a normal or Gaussian curve with mean, median, standard deviation, coefficient of variation, and spread of 0.36 g/100 mL, 0.36 g/100 mL, 0.086 g/100 mL, 24% and 0.074 to 0.68 g/100 mL, respectively. The corresponding concentrations of ethanol in chronic alcoholism deaths were not normally distributed and showed a mode between 0.01 and 0.05 g/100 mL and mean, median, and spread of 0.172 g/100 mL, 0.150 g/100 mL, and 0.01 to 0.56 g/100 mL, respectively. The 5th and 95th percentiles for blood-ethanol concentration in acute poisoning deaths were 0.22 and 0.50 g/100 mL, respectively. However, these values are probably conservative estimates of the highest blood-ethanol concentrations before death owing to metabolism of ethanol until the time of death. In 98 chronic alcoholism deaths (12%) there was an elevated concentration of acetone in the blood (>0.01 g/100 mL), and 50 of these (6%) also had elevated isopropanol (>0.01 g/100 mL). This compares with 28 cases (4%) with elevated blood-acetone in the acute poisoning deaths and 22 (3%) with elevated blood-isopropanol. We offer various explanations for the differences in blood-ethanol and blood-acetone in acute poisoning and alcoholism deaths such as chronic tolerance, alcohol-related organ and tissue damage (cirrhosis, pancreatitis), positional asphyxia or suffocation by inhalation of vomit, exposure to cold coupled with alcohol-induced hypothermia, as well as various metabolic disturbances such as hypoglycemia and ketoacidosis.     

Incidence and Correlates of Posttraumatic Stress Disorder in Australian Victims of Domestic Violence

In recent years, evidence has emerged of the significant incidence of posttraumatic stress disorder (PTSD) among victims of domestic violence. The present study examined incidence and correlates of PTSD in 100 female victims of domestic violence resident in women's shelters in Adelaide, South Australia. Forty-five women were found to meet all diagnostic criteria for PTSD. Women meeting PTSD diagnostic criteria reported having experienced higher levels of violence and were more likely to report having a spouse with an alcohol problem and having believed they would be killed by their spouse than women who did not meet criteria. Diagnosis of PTSD was also associated with higher levels of anxiety and depression.