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Wernicke-Korsakoff Syndrome in Indian/Alaskan Native Women

Introduction: The word alcohol was introduced into the English language circa 1543 from the Arabic: الغول‎, "al-ġuḥl". In layman's terms, it usually refers to ethanol, also known as grain alcohol or (older) spirits of wine, or to any alcoholic beverage. An alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. Ethanol is a psychoactive drug that has a depressant effect. Alcoholic beverages can be addictive and the state of addiction to ethanol is known as alcoholism. Wernicke-Korsakoff in the United States is usually found in malnourished chronic alcoholics. Wernicke-Korsakoff syndrome in alcoholics especially is associated with atrophy of specific regions of the brain, especially the mamillary bodies. Other regions include the anterior region of the thalamus (accounting for amnesic symptoms), the medial dorsal thalamus, the basal forebrain, and median and dorsal raphe nuclei.

Indian/Alaskan Native women have the highest mortality rates related to alcoholism. Alcoholism and alcohol abuse is a leading killer of Alaskan Native women. Wernicke-Korsakoff syndrome (also called Korsakoff psychosis, alcoholic encephalopathy, Wernicke's disease, and encephalopathy - alcoholic)is a manifestation of thiamine deficiency, or beri-beri is found in Alaska Native women. The role of recent heavy drinking of alcohol as a risk factor for ischemic brain infarction in young adult Alaskan Native women is clear. Alcohol in Alaskan Native women are rooted within complex historical, cultural, political, and economic processes, and the resolution of these problems must reflect a deep understanding of such processes. Native alcohol problems emerged and continue to emerge through a collision of context and person. Ethanol consumption is harmful to the fetus the woman is carrying. Alcohol drinking, particularly drinking for intoxication, can trigger the onset of brain infarction in young adults and have dire effects in later life. For birth years 1995-1999, Fetal Alcohol syndrome (FAS) prevalence among Alaska Natives was approximately 5 per 1,000 live births – more than 15 times that of Caucasians.

CAUSES

Wernicke-Korsakoff syndrome results from thiamine deficiency. It is generally agreed that Wernicke's Encephalopathy results from severe acute deficiency of thiamine (Vitamin B1), whilst Korsakoff's Psychosis is a chronic neurologic sequela after Wernicke's Encephalopathy. As stated above, Wernicke-Korsakoff in the United States is usually found in malnourished chronic alcoholics. Wernicke-Korsakoff syndrome in alcoholics especially is associated with atrophy of specific regions of the brain, especially the mamillary bodies. Other regions include the anterior region of the thalamus (accounting for amnesic symptoms), the medial dorsal thalamus, the basal forebrain, and median and dorsal raphe nuclei.

PREVENTION AND TREATMENT


 * Commitment: culturally framed rationales for radical abstinence and a call for sobriety and sacrifice to a higher purpose than self (the People).
 * Purification: rituals of physical and emotional detoxification (fasting, purging, sweating, herbal medicines) and spiritual connection (vision quests).
 * Substitution: replacement of alcohol with other sacred substances, e.g., the "Black Drink," peyote, tobacco, sage, and cedar.
 * Identity: affirmation of personal and cultural identity ¾ connection with ancestral traditions and innate knowledge (the ancestors within).
 * Reconciliation: mending of family and social relationships.
 * Prescriptions for living: a reconstruction of values and daily lifestyle (e.g., the Code of Handsome Lake, Peyote Way, the Red Road).
 * Re-connection to community: sustained affiliation with a stable network of recovering people supported by a larger cultural community.
 * Ceremony: participation in rituals that solidify pro-recovery values and relationships.
 * Story: the transmission of life-changing ideas through the ancient oral tradition of storytelling.
 * Meaning: a worldview of oneself and one's sobriety within the context of Native history, culture, and religion. The goal is to create a Healing Forest that creates a synergy between personal and community wellness. Such a synergy is reflected in the words of Andy Chelsea, who as the Shuswap tribal chief at Alkali Lake, declared, "The community is the treatment center" (Abbott, 1998).

REFERENCES:

Abbott, P.J. (1998). Traditional and western healing practices for alcoholism in American Indians and Alaskan Natives. Substance Use and Misuse 33(13): 2605-2646. Coyhis, D. (1990). Recovery from the Heart: A Journey through the Twelve Steps: A Workbook for Native Americans. Center City, Minnesota: Hazelden. Hall, R. (1985). Distribution of the sweat lodge in alcohol treatment programs. Current Anthropology, 26(1): 134-135.

Hasin D et al (2007). "Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States". Archives of General Psychiatry 64 (7): 830. doi:10.1001/archpsyc.64.7.830. .

Examined the relationship among drug and alcohol use before intercourse, nonuse of birth control methods, and unplanned pregnancies (PRs) in 43 14-21 yr olds with unplanned PRs. Survey responses revealed that lack of knowledge of personal susceptibility to PR, norms and values that tolerate unmarried PR, social supports that do not necessarily advocate contraceptive use, intrapsychic conflict toward PR, and situational factors (e.g., alcohol and drug use) may have contributed to PR risk-taking. . (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Alcohol use as a situational influence on young women's pregnancy risk-taking behaviors. Flanigan, Beverly; McLean, Ann; Hall, Chris; Adolescence, Vol 25(97), Spr 1990. pp. 205-214. [Journal Article]

Mann K, Agartz I, Harper C, Shoaf S et al (2001). "Neuroimaging in alcoholism: ethanol and brain damage". Alcohol Clin Exp Res 25 (5 Suppl ISBRA): 104S–109S. . ^ Nixon P, Kaczmarek M, Tate J, Kerr R, Price J (1984). "An erythrocyte transketolase isoenzyme pattern associated with the Wernicke-Korsakoff syndrome". Eur J Clin Invest 14 (4): 278–81. doi:10.1111/j.1365-2362.1984.tb01181.x..

One of the most severe effects of drinking during pregnancy is fetal alcohol syndrome (FAS). FAS is a group of problems that can include Mental retardation Birth defects Abnormal facial features Growth problems Problems with the central nervous system Trouble remembering and/or learning Vision or hearing problems Behavior problems FAS lasts for a lifetime. There is no cure. Special school services can help with learning problems. Routines and consistency at home may help with behavior problems. Women can prevent FAS and other problems related to alcohol use by not drinking when they are pregnant or might get pregnant.

9/2/1997 R and R2 Fetal Alcohol Syndrome (Prevalence, Risk Factors, Prevention) http://www.epi.alaska.gov/ http://www.epi.hss.state.ak.us/bulletins/docs/rr97v1_02.pdf

Four Articles:

When you are pregnant, your baby grows inside you. Everything you eat and drink while you are pregnant affects your baby. If you drink alcohol, it can hurt your baby's growth. Your baby may have physical and behavioral problems that can last for the rest of his or her life. 11/2/1998 R and R 3 The Educational Attainment of Children with Fetal Alcohol Syndrome

http://www.epi.hss.state.ak.us/bulletins/docs/rr98v2_03.pdf Children born with the most serious problems caused by alcohol have fetal alcohol syndrome. 12/29/1993	Bulletin	39	OB/GYN Survey on FAS and Alcohol

http://www.epi.hss.state.ak.us/bulletins/docs/rr98v2_03.pdf

Alcohol abuse is a serious public health concern. Alcohol is a potent teratogen, a substance that can damage a developing fetus. There is no known safe level of alcohol use during pregnancy, so pregnant women or women who may become pregnant. 1/8/1993	Bulletin	3	Preliminary Report of Pediatrician Survey Regarding Fetal Alcohol Syndrome

http://www.epi.hss.state.ak.us/bulletins/docs/rr98v2_03.pdf

Article: New law allows DUI offenders to drive again--Ignition interlock device requires regular breath tests. Alaska Daily News (06/20/08 00:38:56) Rodney Hebert rides his bike or walks to his daily AA meetings when he can't get a ride from a friend. "They took my license away for the rest of my natural life, which is kind of a life sentence," said Hebert, 44, who has received eight DUIs since the age of 14. He said he practically started drinking when he "was a fetus" but has been sober for the last six years.

Four websites: http://www.cdc.gov/ncbddd/ http://www.nofas.org/living/strategy.aspx http://www.marchofdimes.com/pnhec/159_530.asp http://www.fasdcenter.samhsa.gov/documents/WYNK_Preventing_FASD.pdf

Alaska Fetal Alcohol Syndrome Surveillance Project (FASSP), 1995-1997 Data: State of Alaska, DHSS, DPH.

Demer, Lisa, April 12, 2008). "Mental Health System Feels Strain". Anchorage Daily News: A1.

Fetal Alcohol Surveillance System Network (FASSNet), 1995-1997 Data in: Centers for Disease Control and Prevention. Fetal Alcohol syndrome - Alaska, arizona, Colorado, and New York, 1995-1997. MMWR: 51 (20):433-435. 2002

9/2/1997 R and R2 Fetal Alcohol Syndrome (Prevalence, Risk Factors, Prevention) http://www.epi.alaska.gov/ http://www.epi.hss.state.ak.us/bulletins/docs/rr97v1_02.pdf

Healthy People 2010. U.S. Department of health and Human Services. Healthy People 2010. 2nd ed. With understanding and improving health and objectices for improving health. 2 Vols. Washington, DC: U.S. Government Printing Office. 2000

Streissguth AP. The behavioral Teratology of Alcohol: Perfances, Behavioral and Intellectual Deficits in Prenatally Exposed Children. Alcohol and Brain Development. J. W., Ed. New York: Oxford University Press. 1986

Stresissguth AP. Barr HM. Kogan J. Bookstein FL. Understanding the Occurrence of Secondary Disabilities in clients with Fetal Alcohol syndrome (FAS) and fetal Alcohol Effects (FAE), Final Report to the Centers for Disease Control and Prevention. Seattle: University of Washington, Fetal Alcohol & Drug Unit. Tech. Rep. No. 96-06, (1996)

Advisory Board on Alcoholism and Drug Abuse, Alaska Department of Health and Social Services. Ecoomic Costs of Alcohol and Other Drug Abuse in Alaska. Phase Two. Juneau: McDowell Group 2001.