PART TWO: ALCOHOLISM – THE WICKED THIEF OF LIVES

SHORT ABSTRACT:

  • Alcohol is causally associated with more than 60 different health conditions. Drinking excessive amounts of alcohol regularly for years is toxic to almost every tissue of the body.
  • Alcohol use and alcoholism statistics: 6.2% of all male deaths are attributed to alcohol, compared to 1.1% of female deaths. Men also have far greater rates of total burden attributed to alcohol than women – 7.4% for men compared to 1.4% for women. In 2014, 87.6 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 71.0 percent reported that they drank in the past year; 56.9 percent reported that they drank in the past month. In 2014, 24.7 percent of people ages 18 or older reported that they engaged in binge drinking in the past month; 6.7 percent reported that they engaged in heavy drinking in the past month.
  • Alcohol’s effects on the brain. Alcohol (like nicotine and heroin) is very lipid soluble and enters the brain rapidly. Ethanol has the capacity to displace enkephalins and endorphins at binding sites, which decreases these levels in the brain and pituitary, thus resulting in alcohol craving. Depression has also been reported to be frequently comorbid with alcoholism.
  • Alcoholism and cardiovascular diseases. Increased cardiovascular risks of heavy drinking include: alcoholic cardiomyopathy, systemic hypertension, heart rhythm disturbances in binge drinkers and hemorrhagic stroke.
  • Alcoholism and gastrointestinal diseases. Alcoholic liver disease (ALD) has been among the leading causes of cirrhosis and liver-related death worldwide for decades. Early discoveries in alcoholic liver disease identified increased levels of bacterial endotoxin in the portal circulation, suggesting a role for gut-derived toxins in ALD.
  • Alcoholism, cancer and pancreatitis. Heavy alcohol intake has been linked to increased risk of several cancers, including cancer of the colon, rectum, female breast, oral cavity, pharynx, larynx, liver, and esophagus. Women should not exceed one drink per day, and women at elevated risk for breast cancer should avoid alcohol or consume alcohol only occasionally.
  • Alcoholism and diabetes. There is a delicate balance between the harmful effects and the beneficial effects of alcohol on T2DM. Studies are conflicting.
  • Alcohol and pregnancy. Prenatal alcohol is a teratogenic agent and the primary causative factor underlying fetal alcohol spectrum disorders. Even small amounts of alcohol consumed during critical periods of fetal development may be teratogenic.
  • Treatment of alcoholism. The goal of treatment for alcoholism is abstinence. For alcoholics who are otherwise in good health, have a good social support, and motivation, the likelihood of recovery is good. Approximately 50% to 60% remain abstinent at the end of a year’s treatment and a majority of those stay dry permanently. Those with poor social support, poor motivation, or psychiatric disorders tend to relapse within a few years of treatment.

In the previous post we talked about how alcoholic beverages are produced and the science behind their aroma. I mentioned the conflicting studies about its potential positive effects and now we’re gonna talk about the negative effects of its (over)use.

Alcohol is causally associated with more than 60 different health conditions. In total, 4% of the global burden of disease is attributable to alcohol, which accounts for about as much death and disability globally as tobacco and hypertension. Treatment research shows, that early intervention in primary care is advantageous and effective, and a variety of behavioral and pharmacological interventions are available to treat alcohol dependence. (1)

At higher drinking levels, risk of death from other types of heart diseases (cardiomyopathy, arrhythmia etc.) is increased; also, there is much higher risk for neurological disorders, cancer, liver cirrhosis and traffic accidents. 

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Drinking excessive amounts of alcohol regularly for years is toxic to almost every tissue of the body. Many of the toxic effects of alcohol are due to interruption of a wide variety of metabolic functions and organ damage. Long-term alcohol use increases the risk of liver disease, heart disease, peptic ulcers, certain types of cancers, complicated pregnancies, birth defects, and brain damage. Heavy or binge drinking may even result in respiratory depression and death. Alcohol use can also cause mood changes and loss of inhibitions as well as violent or self-destructive behavior. (2)

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I’ve met people who are alcoholics. It’s not just the alcohol. It’s a complex psychological state of mind. It’s a combination of a genetic material, attempt to control certain emotions, lack of control, guilt, anger, sadness, depression, hurting others and oneself.

As the name of the post says – it is a thief of lives. We’re not just talking about dying, but also about jobs lost, friends and family members lost, failed marriages, disregarded hopes and dreams, destroyed finances and crushed spirits.

When all is lost, if we have our health and our spirit, we can bounce back sooner or later.

When all is lost, if we don’t have our health, but we do have our spirit, we can fight as hard as we can and even win!

When all is lost, if we don’t have our health and our spirit…There is no force in the world that could help.

I am an eternal optimist and someone who believes in the strength and abilities of people to fight and win and inspire others. And yet, somehow, I open the newspaper (actually, web news feeds) and read headlines about a drunk driver killing himself and someone else on the road. I read about alcoholics jumping off of bridges, beating their wives or husbands, leaving their families…

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There are times, though, when I read about alcoholics who have been sober for 10 years or more and talk to the press, to the people, of what it needs to be done, how other people should start their recovery and their journey to rebuilding their lives, about how should people fight. Those are true heroes and an inspiration to others who are suffering, all around the world.

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ALCOHOLISM DEFINITION

Alcohol is a psychoactive substance with dependence-producing properties. (3) Alcoholism is defined as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic. (4)

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ALCOHOL USE AND ALCOHOLISM STATISTICS

The harmful use of alcohol is a particularly serious threat to men. It is the leading risk factor for death in males ages 15–59, mainly due to injuries, violence and cardiovascular diseases. Globally, 6.2% of all male deaths are attributed to alcohol, compared to 1.1% of female deaths. Men also have far greater rates of total burden attributed to alcohol than women – 7.4% for men compared to 1.4% for women.

Men outnumber women four to one in weekly episodes of heavy drinking – this is probably the reason for their higher death and disability rates. They also have much lower rates of abstinence compared to women. Lower socioeconomic status and educational levels result in a greater risk of alcohol-related death, disease and injury – a social determinant that is greater for men than women. (5)

This map shows the average recorded world alcohol consumption in 2010:

 

map-alcoholism

Image Source: WHO

The World Health Organization reports that: “in 2014, 87.6 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 71.0 percent reported that they drank in the past year; 56.9 percent reported that they drank in the past month. In 2014, 24.7 percent of people ages 18 or older reported that they engaged in binge drinking in the past month; 6.7 percent reported that they engaged in heavy drinking in the past month.” (5)

Alcohol isn’t going anywhere. People buy it (or even make it at home) and people drink it. So, we should concentrate on the consequences of its (over)use. I’m sure almost everyone knows first hand what alcohol does to the brain. We’ve heard lectures in our schools, we’ve heard about and even seen drunk people drive and we’ve been at parties ourselves.

ALCOHOL’S EFFECTS ON THE BRAIN

Alcohol (like nicotine and heroin) is very lipid soluble and enters the brain rapidly. Alcoholics are not all alike; they experience different subsets of symptoms, and the disease has different origins for different people. (6)(7)

Alcoholism’s effects on the brain are diverse and are influenced by an extensive range of variables:

  • the amount of alcohol consumed,
  • the age at which the person began drinking,
  • the duration of drinking;
  • the patient’s age,
  • level of education,
  • gender,
  • genetic background and family history of alcoholism;
  • neuropsychiatric risk factors such as alcohol exposure before birth, and
  • general health status.

Overall physical and mental health is an important factor because comorbid medical, neurological, and psychiatric conditions can interact to aggravate alcoholism’s effects on the brain and behavior. (6)

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Ethanol has the capacity to displace enkefalins and endorphins at binding sites, which decreases these levels in the brain and pituitary, thus resulting in alcohol craving. At a psychological level a recognizable cluster of personality traits associated with alcoholism are developed, including a low tolerance for stress, feelings of inadequacy, impaired impulse control, isolation and negative image of self.

There seems to be an agreement, that at a point in the progression of the disease, people cross into alcohol addiction. It is at this time that alcohol becomes the organizing core around which everything else in the alcoholic’s life must relate. When this happens, alcoholics can no longer predict their behavior while drinking, or even, whether or not they will drink. These developmental changes in cognition are called “alcoholic thinking” and they cause change in character, as well as changes in rationalization, denial and frame of mind. (8)

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Depression has also been reported to be frequently comorbid with alcoholism. (9) According to a study, patients who started abusing alcohol in their teens were three times as likely to be depressed and four times as likely to have attempted suicide as patients with a later onset of alcohol abuse. (10) Another study examined the familial transmission of major depression and alcoholism among probands who had depression and alcoholism. The findings indicated that depressives without alcoholism did not transmit alcoholism, and probands with depression and alcoholism tended to transmit both depression and alcoholism. The study confirms the observation that depression and alcoholism are not expressions of the same underlying disorder. (11)

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ALCOHOLISM AND CARDIOVASCULAR DISEASES

 

Increased cardiovascular risks of heavy drinking include:

  • alcoholic cardiomyopathy – lifetime alcohol consumption is quantitatively related to structural and functional myocardial abnormalities in alcoholics. The equivalent of 120 grams alcohol/day for 20 years is  needed to see an effect, making the term “cirrhosis of the heart”suitable. Only a small proportion of alcoholics develop cardiomyopathy, a fact leading to interest in predisposing traits which might increase risk. (12)
  • Systemic hypertension (high blood pressure) – it has been found blood pressure (BP) decreases over time when alcohol intake decreases. BP also decreases in inpatient studies of alcoholics who stop drinking. Alcohol intake has also been associated with resistance to antihypertensive therapy. Some of the likely resistance may be from poor medication adherence in heavy drinkers, but there may also be true interference with the BP-lowering effects of some medications. Consuming three or more drinks of alcohol per day approximately doubles the risk of having hypertension. (13)
  • Heart rhythm disturbances in binge drinkers – within the category of arrhythmias, atrial fibrillation (AF) has been discussed to be potentially caused by alcohol for several decades. There is enough clinical and pathophysiological evidence to conclude that alcohol consumption may cause the onset of AF. (14)
  • Hemorrhagic stroke – a study has shown that there is a strong association between the frequency of alcohol consumption and stroke mortality, independent of total amount of alcohol consumption. The risk of stroke death was the highest among men who consumed alcohol >2.5 times per week. (15)

ALCOHOLISM AND GASTROINTESTINAL DISEASES

Alcoholic liver disease (ALD) has been among the leading causes of cirrhosis and liver-related death worldwide for decades. (16) ALD is a broad designation that covers a range of disorders including simple steatosis, inflammation, fibrosis, and cirrhosis. Steatosis, which is present in more than 90% of heavy drinkers, is asymptomatic and reversible with abstinence. It is the first response of the liver to alcohol abuse. With continued alcohol intake, hepatic inflammation and injury can occur, a condition known as alcoholic hepatitis (AH). The prognosis of AH is variable, with nearly 100% survival in mild cases as compared to high short-term mortality among the most severe cases. (17)

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As in other liver diseases, patients with cirrhosis are at risk for hepatic decompensation (ascites, variceal bleeding, and encephalopathy) and hepatocellular carcinoma (HCC). Obesity may potentiate the hepatotoxic effects of alcohol, likely through mechanisms similar to those that result in non-alcoholic steatohepatitis. Smoking and the pattern of alcohol use are also linked with the increased risk of ALD. Genetic factors are also important in host susceptibility to ALD. (17)

ALCOHOLISM, CANCER AND PANCREATITIS

Heavy alcohol intake has been linked to increased risk of several cancers, including cancer of the colon, rectum, female breast, oral cavity, pharynx, larynx, liver, and esophagus. (18)

The higher the consumption of alcohol, the greater the risk for those cancers. Even the consumption of two drinks per day causes an increased risk for some cancers, such as breast cancer. (5)

Several pathogenic mechanisms contribute to alcohol-induced carcinogenesis in each type of cancer. The most commonly cited mechanisms include the effect of acetaldehyde—the first metabolite of ethanol oxidation—and oxidative stress. Increasing evidence shows that alcohol also can induce epigenetic alterations, for example, in pathological conditions such as fetal alcohol spectrum disorders. Epigenetic alterations also are a hallmark of cancer development in general. (19)

Liver cancer, or HCC, is the fifth most common cancer, with an annual incidence of 564 000 cases. According to the International Agency for Research on Cancer, it is the third most common cause of cancer-related deaths, with an annual mortality rate of 549 000. A study has shown, that while being HBV- or HCV-positive, or drinking more than four standard drinks per day increases risk for HCC up to eightfold, the combination of alcohol and either of these viruses results in a 50-fold greater risk. (20)

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Hepatitis B virus

Colorectal cancer is the third most common cancer and the second leading cause of cancer deaths for both sexes. Alcohol is a likely etiologic factor for this cancer. Several studies have indicated that epigenetic processes play a role in alcohol-related colorectal carcinogenesis. (19)

Breast cancer is the second leading cause of cancer death among women. Low doses of alcohol consumption (i.e., ≤1 drink/ day) increase the risk of breast cancer by about 4 percent, whereas heavy alcohol consumption (i.e., ≥ 3 drink/day) is associated with an increase in risk of 40 to 50 percent. (19)

Alcohol increases estrogen levels, and estrogens may exert its carcinogenic effect on breast tissue either via the estrogen receptor (ER) or directly. Other mechanisms may include acetaldehyde, oxidative stress, epigenetic changes due to a disturbed methyl transfer and decreased retinoic acid concentrations linked to an altered cell cycle. Women should not exceed one drink per day, and women at elevated risk for breast cancer should avoid alcohol or consume alcohol only occasionally. (21)

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Image Source: alcoholandcancer.eu

Tobacco and alcohol are the major risk factors of upper aerodigestive tract cancers (UADT), or head and neck cancers, including cancers of the oral cavity, pharynx, larynx, and esophagus. A study has shown that the carcinogenic effect of wine, beer and liquor consumption on the risk of UADT cancer is similar. Although the mechanism by which alcohol consumption promotes UADT carcinogenesis is mostly unknown, similar risks across types of alcoholic beverages support the hypotheses that the common ingredient, ethanol, and its metabolite, acetaldehyde, are the main carcinogenic agents in all alcoholic beverages.

Red wine contains polyphenols, such as resveratrol, which is an antioxidant with an anti-inflammatory effect, that may reduce tumor initiation and progression. In accordance to that theory, at low consumption levels, scientists in a study have observed a weaker association of UADT cancer risk among lifetime exclusive wine drinkers than exclusive drinkers of other alcoholic beverages. HOWEVER, most of the evidence on protective effects of resveratrol comes from in vitro studies with the native form of resveratrol, whereas the bioavailability of resveratrol in humans is very low due to its rapid metabolism in mammals, which makes protective effects of resveratrol by drinking red wine not probable. (22) *Sorry to disappoint!*

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Pancreatitis can be triggered by many possible causes, including gallstones, alcohol abuse, certain medications, autoimmunity, and diseases such as cystic fibrosis, or it may be of unknown etiology; however, the most frequent known cause is alcohol abuse. There is sufficient evidence to show that the pancreas has the capacity to metabolize ethanol and that the resulting metabolites and their byproducts (oxygen radicals) exert a toxic effect on the pancreas, leading to acute and chronic change. (20)

ALCOHOLISM AND DIABETES

Diabetes mellitus (DM) is recognized clinically as a complication of alcoholism, and both alcoholism and DM affect a large population worldwide. Chronic, heavy alcohol consumption, which is an independent risk factor for type 2 diabetes mellitus (T2DM), disrupts the glucose homeostasis and is linked to development of insulin resistance.

However, epidemiological and controlled clinical data on the relationship between the amount of ingested alcohol and the incidence of T2DM have been inconsistent in literature. There is a delicate balance between the harmful effects and the beneficial effects of alcohol on T2DM. While some studies have reported that moderate and sensible alcohol use decreases the risk of T2DM or heavy alcohol use increases the risk of T2DM, with the loss of glycemic control, others have suggested that there exist no effects. 

Chronic heavy consumption deteriorates glucose tolerance and insulin resistance, and this may well be one of the mechanisms involved in the malignant effect of alcohol, with regard to development of diabetes. (23)

ALCOHOL AND PREGNANCY

 

Prenatal alcohol is a teratogenic agent and the primary causative factor underlying fetal alcohol spectrum disorders. (24) Even small amounts of alcohol consumed during critical periods of fetal development may be teratogenic. For example, if a woman drinks alcohol during the period of organogenesis, a variety of skeletal and organ defects may result. When she consumes it later in gestation, especially during the period of rapid development of the brain, there may be behavioral and cognitive disorders in the absence of physical abnormalities.

Chronic alcohol consumption throughout pregnancy may result in a variety of effects, ranging from physical abnormalities to growth retardation and compromised central nervous system functioning. Evidence suggests that concentrations of alcohol that occur during binge drinking may be particularly significant, with abnormalities being unique to the period of exposure. It is recommended that women abstain from alcohol during pregnancy. (25)

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photo credit: Remko van Dokkum sign via photopin (license)

ALCOHOL AND THE IMUNE SYSTEM

 

One of the least appreciated medical complications of alcohol abuse is altered immune regulation leading to immunodeficiency and autoimmunity. The consequences of the immunodeficiency include increased susceptibility to bacterial pneumonia, tuberculosis, and other infectious diseases. In addition, the chronic alcoholic often has circulating autoantibodies, and recent investigations indicate that the most destructive complications of alcoholism, such as liver disease and liver failure, may have a component of autoimmunity. (26)

TREATMENT OF ALCOHOLISM

 

About 1.5 million adults received treatment for an AUD (Alcohol abuse disorder) at a specialized facility in 2014 (8.9 percent of adults who needed treatment). This included 1.1 million men (9.8 percent of men who needed treatment) and 431,000 women (7.4 percent of women who needed treatment). An estimated 55,000 adolescents (18,000 males and 37,000 females) received treatment for an alcohol problem in a specialized facility in 2014. (27)

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The goal of treatment for alcoholism is abstinence. For alcoholics who are otherwise in good health, have a good social support, and motivation, the likelihood of recovery is good. Approximately 50% to 60% remain abstinent at the end of a year’s treatment and a majority of those stay dry permanently. Those with poor social support, poor motivation, or psychiatric disorders tend to relapse within a few years of treatment. For these people, success is measured by longer periods of abstinence, reduced use of alcohol, better health, and improved social functioning. (28)

Treatment for alcoholism can begin only when the alcoholic accepts that the problem exists and agrees to stop drinking. He or she must understand that alcoholism is curable and must be motivated to change. Treatment has three stages:

  1. Detoxification (detox): This may be essential immediately after discontinuing alcohol use and sometimes can be a medical emergency, as detox can result in withdrawal seizures, hallucinations, delirium tremens (DT), and in some cases may result in death. A study has concluded, that anxiety persists after 3 weeks of abstinence and it represents a great risk of relapse. This is why, usually, a treatment is needed. (29)
  2. Rehabilitation: This covers counseling and medications to give the recovering alcoholic the skills needed for maintaining sobriety. This step in treatment can be done inpatient or outpatient. Both are equally effective.
  3. Maintenance of sobriety: The success of this step requires an alcoholic to be self-driven. The key to maintenance is support, which often includes regular Alcoholics Anonymous (AA) meetings and getting a sponsor. (28)

 

For a person in an early stage of alcoholism, discontinuing alcohol use may result in some withdrawal symptoms, including anxiety and poor sleep. Withdrawal from long-term dependence may bring the uncontrollable shaking, spasms, panic, and hallucinations of DTs. If not treated by a professional, people with DTs have a mortality rate of more than 10%, so detoxification from late-stage alcoholism should be attempted under the care of an experienced doctor and a brief inpatient stay at a hospital or treatment center may be necessary.

Treatment may involve one or more medications. Benzodiazepines have anxiolytic, hypnotic and anticonvulsant properties. These are the most often used medications during the detox phase, at which time they are usually tapered and then discontinued. They must be used with care, since they may be addictive. (28) (30)

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There are few medicines used to help people in recovery from alcoholism maintain abstinence and sobriety:

  • disulfiram may be used once the detox phase is complete and the person is abstinent. It inhibits alcohol metabolism so that drinking a small amount will cause nausea, vomiting, blurred vision, confusion, and breathing difficulty. This medication is most appropriate for alcoholics who are highly motivated to stop drinking or whose medication use is supervised, as the drug does not affect the motivation to drink.
  • Naltrexone, reduces the craving for alcohol. It can be given even if the individual is still drinking; however, as with all medications used to treat alcoholism, it is recommended as part of a thorough program that coaches patients new coping skills.
  • Acamprosate is another medicine that has been FDA-approved to reduce alcohol craving.

Antidepressants may be used to control any underlying or resulting anxiety or depression, but because those symptoms may disappear with abstinence, the medications are usually not started until after the detox stage is complete and there has been some period of abstinence. (28)

 

ALCOHOLISM AND NUTRITION

 

The principles and laws of good nutrition practice are applicable to the management of alcoholism at all states and in all situations. (31) Poor nutrition goes with heavy drinking and alcoholism. Because an ounce (30ml) of alcohol has more than 200 calories but no nutritional value, consuming large amounts of alcohol tells the body that it doesn’t need more food. Alcoholics are often deficient in vitamins A, B complex and C, folic acid, carnitine, magnesium, selenium and zinc, as well as essential fatty acids and antioxidants. (28) A group of investigators concluded, that flawed absorption of folic acid in chronic alcoholics is produced by poor nutrition, and not by the direct toxic effect of ethanol on the jejunum. (32) Restoring nutrients – by providing thiamine (vitamin B1) and a multivitamin, can aid recovery and are an important part of all detox programs. (28)

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SELF-HELP

 

Abstinence is the most crucial – and probably the most difficult step to recovery from alcoholism. To learn to live without alcohol, one must:

  • Avoid people and places that make drinking the norm, and find new, non-drinking friends.
  • Join a self-help group. The positive effect of self-help groups is, amongst other things, attributed to a change of a social network. One gains new abstinent friends and learns new coping strategies. If people help each other, people can also help themselves. They increase involvement in their own recovery, achieve higher social status and build self-esteem. (33)
  • Enlist the help of family and friends.
  • Replace the negative dependence on alcohol with positive dependencies, such as a new hobby or volunteer work with civic groups.
  • Start exercising. Exercise releases chemicals in the brain that provide a “natural high.” Even a walk after dinner can be tranquilizing. (28)

 

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Asking for help is not easy, but it’s brave and inspiring. You can do it!

PS: These two web sites have international helplines:

http://togetherweare-strong.tumblr.com/helpline

http://www.aa.org/

 

‘Till next time! 

 

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2 thoughts on “PART TWO: ALCOHOLISM – THE WICKED THIEF OF LIVES

  1. Thank you for wonderful post, it’s useful and I agree pregnant women mustn’t drink especially not during the period of organogenesis

    Like

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