Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

5. Alcohol 95Bone marrow recovery with resolution of leukopenia usually occurs after 1–2weeks of abstinence.Alcohol also affects both thrombotic and coagulation functions. In particular,the cascade of clotting proteins is impeded as a result of diminished productionof the vitamin K–dependent clotting factors (prothrombin, VII, IX,and X). Fibrinolysis, and occasionally disseminated intravascular coagulationmay also occur. Transient thrombocytopenia is found after consumption oflarge quantities of alcohol, especially in binge drinkers (Hardin, 2001).Endocrine SystemAlcohol interferes with gonadal function even in the absence of cirrhosis byinhibiting normal testicular, pituitary, and hypothalamic function. Testicularatrophy, low testosterone levels, decreased beard growth, diminished spermcount, and a loss of libido result. However, testicular atrophy does not occur inall male alcoholics but is associated with alcohol dehydrogenase polymorphismin the testes, as reflected by the genetic variant of an increased frequency of theADH21 allele (Yanauchi et al., 2001).Thyroid dysfunction is common in alcoholics. Consistent findings indicatereduced thyroxine, and total and free triodothyronine concentrations in earlyabstinence. A blunted thyroid stimulation test is found in one-third of alcoholicsduring detoxification and into the early weeks of abstinence. A direct toxiceffect of alcohol on the thyroid is likely, which in turn induces a compensatoryactivation of the hypothalamic–pituitary (HP) axis (Hermann, Heinz, &Mann, 2002).Alcohol intoxication activates the HP axis and results in elevated glucocorticoidlevels. Elevated levels of these stress hormones may contribute toalcohol’s pleasurable effects. With chronic alcohol consumption, however, tolerancemay develop to alcohol’s HP axis–activating effects. Chronic alcoholconsumption, as well as chronic glucocorticoid exposure, can result in prematureaging (Spencer & Hutchison, 1999).Musculoskeletal SystemAcute alcoholic myopathy (rhabdomyolysis) may cause painful, tender swellingof one or more large muscle groups. Diagnosis depends on a high index of clinicalsuspicion, elevation of serum creatine phosphokinase, and myoglobinuria.Chronic alcoholic myopathy may accompany alcoholic polyneuropathy, presentingas painless, progressive muscle weakness and wasting.The development of osteoporosis in middle-age men is uncommon exceptin male alcoholics, where decreased bone mass has been documented (Turner,2000). In women, improvement in bone mass has been shown with moderatealcohol use, especially in postmenopausal women (Laitinen et al., 1993).