Sean Dooley and Shana Druckerman of ABC News write that in her new memoir, "Lit," Karr chronicles her gut-wrenching descent into alcoholism. Now 20 years sober, Karr hid her addiction from her husband, family, and friends.

"You don’t go to the same liquor store, and you say you’re giving a party every week, and yourself the only invitee," Karr said. The denial of her addiction was so powerful, she says, she lied to herself on a daily basis.

"I couldn’t sleep through the night without a tumbler of watered-down whiskey by my bedside," Karr said. "Then I would get up in the morning, I would pick that up, get my kid on my hip, I would think, ‘Oh, it’s a shame to pour it out,’ and I would drink probably two or three ounces, at least, of alcohol. But I told myself I wasn’t a morning drinker because I never poured it in the morning."

Even a teaching job at Harvard and a beautiful baby boy weren’t enough to keep Karr from alcohol. The highlight of her day was always drinking alone on the back porch of her Cambridge home after her baby and husband had gone to bed. Intoxicated, Karr would promise herself the next morning would be different, that she would get up and accomplish all of the things she had been putting off because of her drinking.

One particularly dark Christmas morning, Karr awoke before her family to do some holiday baking, but chose instead to take a drive and drink a six-pack of beer alone.
"The worst part is, the minute you start lying to your husband or your family or your children, whoever, your friends, you get a little more lonely, and you get a little more cut off," she said. Karr attributes the feelings of isolation to the humiliation most women feel about their drinking.

Unlike their male counterparts, women who struggle with alcoholism are often tormented with guilt, thinking that they’ve failed as mothers. Even when a woman does decide to take steps to deal with her alcoholism, the challenges can be overwhelming.

According to the National Institute for Alcohol Abuse and Alcoholism, one third of alcoholics in this country are women and most don’t receive the proper treatment. However, even when women do make it to detox and rehab, studies show that as many as 90 percent of them will relapse.

For Karr, it took six tries before her wakeup call finally came. "I was ninety days sober. I was giving a poetry reading at Harvard College, and I, some students of mine, we went out to dinner after, and I ordered a martini," she said. "And the next thing I knew there was a piece of concrete hurtling at my car with me in it. And that was the last night I drank." Karr acknowledges that, like so many women struggling with alcoholism, she didn’t look the part.

"I didn’t look like somebody sleeping under a bridge. But I had this black hole in the center of me that I was pouring alcohol into," she said. "There are a lot of women who think, ‘My drinking’s just not that bad.’ Feeling like every day is a nightmare that you have to trudge through is a consequence enough. You don’t need a DWI, you don’t need to go to jail, you don’t need to lose your kids. It’s enough that the highlight of your day is sitting alone drinking."

Now, having stopped drinking and written the bestsellers "The Liar’s Club" and "Cherry," Mary Karr knows what reclaiming your life can really mean.

"The transformations that you see, I mean, I’m the least of it," she said. "There are women succeeding beyond their wildest dreams because of their sobriety."

"Oral naltrexone was approved by the Food and Drug Administration in 1994," explained Henry R. Kranzler, a professor in the department of psychiatry at the University of Connecticut Health Center and corresponding author for the study. "It was the first medication approved to treat alcohol dependence since disulfiram was approved in 1949, and its approval was based on a demonstration of efficacy using a randomized, controlled trial design. The FDA has since approved acamprosate and long-acting naltrexone."

Kranzler believes that oral naltrexone is covered by most health plans as a generic drug.
For this study, Kranzler and his colleagues used data from the MarketScan Commercial Claims and Encounters Database for 2000 to 2004 to create three groups: a naltrexone group (n=1,138) with an alcohol-related diagnosis and at least one pharmacy claim for oral naltrexone; an alcohol control group (n=3,411) with an alcohol-related diagnosis but no prescription for alcoholism-treatment medication; and a non-alcohol control group (n=3,410) with no alcohol-related diagnosis and no prescription for alcoholism-treatment medication. The two groups with an alcohol-related diagnosis were matched to each other on a variety of demographic and clinical dimensions. Healthcare expenditures were calculated for the six-month periods before and after naltrexone drug claims, and dates were matched for the two control groups.

"We found that, prior to the start of the study period, individuals treated with naltrexone had higher healthcare costs than the group with an alcohol-related diagnosis but no naltrexone treatment," said Kranzler. "However, during the period after receiving the medication, the naltrexone group showed a significantly smaller increase in healthcare expenditures (both alcohol-related and non-alcohol-related) than the group with an alcohol-related diagnosis but no naltrexone treatment." In other words, oral naltrexone seemed to reduce healthcare costs for patients with an alcohol-related diagnosis.

Kranzler said these findings have implications for two groups. "I think that the greatest applications of these results are for healthcare policy makers, treatment-program managers, insurance companies, and health-benefits managers," he said. "They also show researchers that developments in treatment can pay dividends in cost savings."
Furthermore, he added, this study shows there is a common ground between effective treatment measures and cost-savings.

"As a physician, I am interested in all treatments that can alleviate suffering and improve people’s lives, however, I am also cognizant of the need to contain healthcare costs. This study suggests that an alcoholism treatment medication can help to contain healthcare costs and that wider consideration of the economic value of such approaches is warranted."

Jacob Varghese, 40, told Biswas that he began drinking when he was nine years old. He drank cheap local liquor in school, and ended up dropping out of college. He tried to commit suicide twice, landed in rehab centers, and was reduced to begging on the streets at age 32 to fund his addiction.

"Drinking is a disease in Kerala," he told Biswas. "I lost my kin, my respect and all my money chasing alcohol. Everyone encourages you to have it—your friends, the government."

After 17 years of heavy drinking, he was dragged to the local Alcoholics Anonymous chapter by friends. Varghese has been sober for the past eight years, and is now married with children and holds down a job.

"Many of my friends have not been as lucky. So many of my drinking buddies died, and others landed up in mental asylums," he said.

Kerala has the highest per capita consumption of alcohol—more than 1.76 gallons per person a year—in the nation, overtaking traditionally hard-drinking states like Punjab and Haryana.

Shockingly, more than 40% of revenues for Kerala’s annual budget come from booze.

A state-run monopoly sells alcohol. Kerala State Beverages Corporation (KSBC) runs 337 liquor shops, all open seven days a week. Each shop caters on average to an astonishing 80,000 clients.

This fiscal year the KSBC is expected to sell $1bn (£0.6bn) of alcohol in a state of 30 million people, up from $12m when it took over the retail business in 1984.

Similarly, revenues from alcohol to the state’s exchequer have registered a100% rise over the past four years. The monopoly is so professionally run that consumers can even send text messages from their phones to a helpline number to record their grievances.

"If we delay opening any of our shops by even five minutes, clients send us text messages saying that they are waiting to buy liquor," says KSBC chief N. Shankar Reddy.

There are some 600 privately run bars in the state and more than 5,000 shops selling toddy (palm wine), the local brew. There is also a thriving black market liquor trade.

Despite a growing number of people who demand a ban on the sale and consumption of alcohol, there is an equally spirited group of hard-core drinkers who lobby for cheaper and more widely distributed liquor.

One of them is well-known actor N.L. Balakrishnan, a veteran of more than 200 films, who launched a lobby group called Forum for Better Spirit in 1983.

The forum’s manifesto asks the government to provide liquor through the state-subsided public distribution system, boost toddy production, slash prices for elderly drinkers, and supply free alcohol to drinkers over 90.

Balakrishnan, 67, says his father "initiated" him into drinking when he was four. "We used to go to the cinema together. After the show was over, he would take me to a toddy shop where he would drink. He would give me a few spoons of toddy too. It was an amazing experience," he said.

He says when his father died at the ripe age of 98 after a "lifetime of heavy drinking," he wet his lips with liquor and not holy water, as is the Hindu custom.

Balakrishnan says that on his average day out with his drinking buddies he downs 22 shots of his favorite brandy, and "never has any problems.”

"If you have willpower and have enough food to go with your drink, booze will never harm you," he says cheerily.

But drinking is killing a lot of people and exacting a heavy social cost, say doctors and activists.

Rising numbers of divorces in Kerala are linked to alcohol abuse. Johnson J. Edayaranmula, who runs the Alcohol and Drug Information Centre, a leading NGO, puts the figure as high as 80%.

And the majority of road deaths in the state—nearly 4,000 during 2008-2009—are due to drink driving, he says. Hospitals and rehab centers are packed with patients suffering from alcohol-related diseases.

The situation is so grim that the KSBC itself is planning to open a hospital specializing in treating alcohol-related problems. It also runs a campaign to combat alcohol abuse.

Jacob Varghese says it is a "societal problem,” which could mean that drinking liquor is almost a social rite of passage, taken very seriously. But he also cites high unemployment, easy access to alcohol, and the fact that drinking has become a "part of upwardly mobile living.”

Most activists believe that prohibition is not the solution, as it just drives buyers and sellers underground.
"The solution possibly lies in introducing drinks with mild alcohol content. And since drinking is also a cultural problem, people need to be made aware of the havoc that alcohol can wreak on their lives," says Edayaranmula.

"This paper assesses the validity of the severity ranking of the 11 criteria and the overall severity score with respect to known AUD correlates, including alcohol consumption, psychological functioning, family history, antisociality, and early initiation of drinking, in a representative population sample of U.S. past-year drinkers (n=26,946). The unadjusted mean values for all validating measures increased steadily with the severity threshold score, except that legal problems, the criterion with the highest score, was associated with lower values than expected.

“After adjusting for the total number of criteria endorsed, this direct relationship was no longer evident. The overall severity score was no more highly correlated with the validating measures than a simple count of criteria endorsed, nor did the two measures yield different risk curves. This reflects both within-criterion variation in severity and the fact that the number of criteria endorsed and their severity are so highly correlated that severity is essentially redundant," wrote D.A. Dawson and colleagues of the National Institute on Alcohol Abuse and Alcoholism.

The researchers concluded: "Attempts to formulate a scalar measure of AUD will do as well by relying on simple counts of criteria or symptom items as by using scales weighted by IRT measures of severity."

The UK’s Guardian reports that the alcohol-related costs to the city’s NHS alone is around the £23m mark, with an estimated half the number of visitors to A&E at the weekend attending because of alcohol-induced problems such as falls.

"Alcohol is a major issue in our A&E departments at both Leeds General Infirmary and St James’s – the weekends and out of hours are particularly bad,” said Kevin Reynard of Leeds Teaching Hospitals Trust.

"I don’t think we ever go through the working week without having to tell the parents of a young person that their son or daughter has died as a result of an incident involving alcohol. When I first started out as a junior doctor, cirrhosis of the liver was almost unheard of among people in their 20s, now it’s commonplace."

Anna Di Bassio, an A&E matron, added: "Friday and Saturday nights are challenging to say the least. There is disruption to the department. Staff trying to get on with their work can be severely disrupted."

Counselors also heard from NHS Leeds about the social issues coming from alcohol misuse, including a rise in the number of domestic violence cases. They were also told of problems with drunk or rowdy behavior, violent crime such as assaults, increasing hospital admissions, concerns over the safety of children, and that deprived areas like Armley and Middleton had twice as many people needing NHS support than in more affluent communities.

Data provided by the NHS showed Leeds was “significantly worse” than the national average when it comes to deaths from alcoholic liver disease, alcohol-related admissions in men, binge drinking, and benefit claimants whose main reason for claiming was alcoholism.

Counselors heard of a number of initiatives and support programs currently being run in Leeds to help alleviate these issues. They also spoke of their frustration over supermarkets selling cheap alcohol and the lack of a statutory minimum price for alcohol.

Meeting chairman counselor Mark Dobson said: "We’ve heard some stark messages today—there are clearly major issues to be tackled in Leeds."

The reports were the third session of the scrutiny board’s ongoing inquiry aimed at considering the role of the council and its partners in dealing with public health—the other issues being considered by the board are improving sexual health, reversing the rise in obesity, and reducing the level of smoking.

The UK’s Times Online reports that the research will also claim that it will reduce crime and days lost from work, thus helping to strengthen the economy.

The greatest impact will be among heavy drinkers of strong cider and lager as well as own-brand supermarket spirits rather than those who drink a glass of wine at home.

The research by a team from the University of Sheffield comes ahead of the publication later this year of a Scottish draft bill which will set out the planned level for minimum pricing on alcohol sold in shops—reportedly 40 pence per 10ml unit.

If this were adopted by the Scottish Parliament, Scotland would be the first country in Europe to pursue such a policy. The bill is thought to include a ban on promoting cheap drinks.

The stated aim of the legislation, which is struggling to win sufficient support among opposition parties at Holyrood, is to challenge Scotland’s drink culture, a problem which costs the Scottish economy £2.25 billion a year in health, social services, crime, and lost days from work.

The bill’s supporters claim that the price of alcohol has fallen by almost 70 percent relative to disposable income while consumption has risen by more than a fifth, leaving Scotland with one of the worst alcohol-related death and illness rates in the world.

Alcohol is also a cause of around 3,000 murders, serious assaults, and attempted murders a year in Scotland, as well as hundreds of rapes and attempted rapes.

The study indicates that minimum pricing and a promotions ban would save 70 lives in the first year after implementation, rising to 370 lives a year after a decade. That would mean deaths from drinking in Scotland would fall by five percent in the first year and more than 25 percent by the tenth year.

In terms of price, it has been estimated that the cost of a bottle of own-label supermarket vodka would rise from the present £7 to around £10.50, while the price of strong supermarket cider would rise from below £3 for three liters to more than £6.50. An average bottle of wine would cost at least £3.60 and a six-pack of lager £4.80.

However, the Scotch Whisky Association cautions that it would also affect Scotland’s internationally recognized drink, with the price of a bottle of whisky rising to £11.20. Other critics say evidence from abroad suggests the policy would not work and that it would not address the problems that lead people to drink too much.

Nicola Sturgeon, the Scottish Health Secretary, said: “It’s now widely recognized that excessive alcohol consumption across society, fanned by rock-bottom pricing, is one of the biggest threats to Scottish public health.”

She added: “But it’s clear that to bring about a real, lasting culture change we’ve got to be bolder. That’s why the Scottish government is bringing forward a radical package of measures in the Alcohol Bill.”

"Cytokines are proteins which mediate and regulate the inflammatory reaction in infectious and autoimmune diseases," explained Pilar A. Sáiz, associate professor of psychiatry at the University of Oviedo, Spain and corresponding author for the study.

"Clinical observation of increased circulating levels of pro-inflammatory cytokines such as IL-1 and TNFα in patients with alcohol liver disease suggests that they might play a role on the pathogenesis of the disease. Additionally, these cytokines act in the central nervous system affecting the functionality of the serotoninergic and dopaminergic systems, which have been also related to the pathophysiology of AD, and with the brain reward systems involved in alcohol reinforcement."

Sáiz and her colleagues recruited 200 (169 males, 31 females) AD patients from an outpatient detoxification unit, as well as 420 (216 males, 204 females) healthy individuals without a history of drug/alcohol/psychiatric problems (known as "controls"), from the north of Spain. All of the Spanish Caucasian participants were genotyped for four polymorphisms—IL-1α -889 C/T, IL-1ß +3953 C/T, IL-1RA (86bp)n, and TNFα -308A/G—and assessed at baseline and again at six months for alcohol intake, addiction severity, and biomarkers of alcohol intake.

"We found that AD male patients and healthy control male patients differed in the genotype frequencies of the IL-1RA polymorphism owing to an excess of the A1/A1 genotype in the AD males," said Sáiz. "On the other hand, analysis of the IL-1 gene complex revealed a higher frequency of the IL-1a -889C / IL-1b +3953C / IL-1RA A2 haplotype in the control group than among the AD patients, as well as in the abstainers after six months of follow-up compared to the non-abstinent patients."

A haplotype is a combination of alleles at multiple loci that are transmitted together on the same chromosome, Sáiz explained. Prior research has suggested that the study of single polymorphisms may miss more complex haplotype effects, she added.

"In short, this haplotype seemed to exert a protective effect and was related to better outcomes," said Sáiz. "These findings provide further tentative evidence of the role of the IL-1 gene complex in AD as well as evidence that the nature of the associations may be direct, gender-specific, or involve haplotype effects."

She cautioned readers to remember, however, that AD is influenced by both genetic and environmental factors. "We are talking about a multifactorial polygenic disorder caused by a combination of small variations in different genes, often in concert with environmental factors," she said. "In spite of great efforts, the exact genes related to the pathophysiology of alcoholism are yet unknown. Our work represents a small piece of the puzzle."

The chairman of the body which carried out the study said the figures showed for the first time how much alcohol abuse impacted on the work of surgeons. A total of 3,461 people died in surgery in 2008.

The report found that alcohol was implicated in the deaths of 194 patients, representing about one in 15 of all surgical deaths. Of the 194 patients, alcohol played a significant role in 147 patients—with alcohol either contributing to the deaths of 112 patients or causing the death of 35 patients. Acute alcohol intoxication was implicated in the deaths of 31 patients.

SASM chairman John Orr said, "This year, we report for the first time on alcohol abuse. It is well known that alcohol abuse has a significant impact on NHS Scotland. Now we can see for the first time that it also impacts on the work of surgeons."

Dr. Brian Keighley, chairman of the BMA in Scotland, said the figures highlighted the human cost of alcohol misuse in Scotland and demonstrated the need for planned legislation on minimum alcohol pricing.

"Scotland is awash with alcohol and the consequences are crippling the health service. The scale of the problem needs radical solutions,” Keighley said. "A wide ranging strategy is essential, but alongside public health education and awareness raising, a central part of this strategy is to introduce minimum price per unit of alcohol. Legislation on price is the only proven way to help change behavior and end the heavy drinking culture that is blighting our health service,” he added.

The report also found that 30% of surgical patients who died had a healthcare-associated infection which was a factor in their deaths, a 1% rise from the 2007 figures.
 

“There is an increasing demand on our service from children aged nine and up—it’s a growing problem,” The Sun quoted Hall as saying. “At one stage this year we were treating six children under the age of 10.”

“All the evidence shows that children are starting to drink earlier, they are drinking more and the results are getting worse—w e now have kids dying of liver failure,” Hall added. He believes parents drinking in front of their kids may be setting a bad example.

“Drinking used to be done in pubs but now you get a lot more people drinking wine at home. When children see drunkenness, the whole attitude of that child changes dramatically.”

Counselor Francesca Martin, who works with children and families affected by alcoholism, explained why many kids start drinking. “They have a lot of problems one way or the other. A lot of them would admit to feeling quite vulnerable when they are drunk. Sometimes it can be about sex. They can’t remember what happened the night before, where they have been and who they have been with.”
 

Alcoholism and alcohol abuse have always been rampant in the American military. Heavy drinking is commonly said to be central to the soldier’s lifestyle, with the depressive drug serving double duty for its ability to both foster camaraderie and soothe mental pain. However, alcohol abuse and alcoholism are becoming more and more problematic among the enlisted, even by military standards.

Binge drinking (consuming at least five alcoholic beverages in a drinking session, at least once a week) is widespread, especially in the Army and Marine Corps. A 2007 Pentagon report stated that the rate of binge drinking in the Army increased by 30 percent from 2002 to 2005. The episodes frequently result in disorderly conduct, reduced productivity, illness, and addiction. Also, alcohol abuse is usually associated with the disconcerting rise in mental illness among soldiers, which includes a skyrocketing suicide rate.

New data from the United States Army shows that the percentage of active-duty soldiers seeking treatment for alcohol dependency has nearly doubled since 2003. Six years ago, 6 out of every 1,000 soldiers looked for help in dealing with their alcohol problems. New estimates (as of March 31, 2009), put the number at 11 per 1,000. In the years prior to 2003, the statistic remained relatively stable, indicating that the recent spike is unusual.

Many attribute the current rise in alcohol abuse to the drawn-out nature of the wars in Iraq and Afghanistan. The troops who have been repeatedly sent back to the areas are thought to be running low on mental endurance and therefore are turning to alcohol as an escape. Adm. Michael Mullen, chairman of the Joint Chiefs of Staff, has even gone on record about the increasing number of soldiers seeking treatment, saying, “I’m sure there are many factors for the rising numbers … but I can’t believe the stress our people are under after eight years of combat isn’t taking a toll.”

The Army is not the only military branch seeing a problematic rise in alcohol-related issues. The Marine Corps has reported that the number of their soldiers who have tested positive for drug or alcohol problems grew 12 percent between 2005 and 2008. Also, there were almost as many drunken-driving offences filed against Marines in the first half of 2009 as there were in all of 2008.

The Army’s vice chief of staff, General Peter Chiarelli, attributes the alarming trends in part to a lack of proper discipline. Chiarelli visited six Army installations in 2009 and discovered hundreds of cases where soldiers had failed blood-alcohol tests but were not treated or processed for possible discharge, which is the requirement. He said this could be due to commanders trying to maintain sufficient personnel for the continuous deployments into war zones. He warned that this needs to stop and emphasized the importance of treatment for substance abuse problems.

Alcohol’s easy availability and social acceptability in the military make it an ever-present temptation. Various campaigns to curb alcohol abuse within the armed forces have been unsuccessful overall, despite their success in diminishing other kinds of substance abuse.