Alcoholism
Alcoholism
Alcoholism, also known as alcohol dependence, is a disabling addictive disorder. It is characterized by compulsive and uncontrolled consumption of alcohol despite its negative effects on the drinker's health, relationships, and social standing. Like other drug addictions, alcoholism is medically defined as a treatable disease. The term "alcoholism" is a widely used term first coined in 1849 by Magnus Huss, but in medicine the term was replaced by "alcohol abuse" and "alcohol dependence" in the 1980s DSM III. Similarly in 1979 an expert World Health Organisation committee disfavoured the use of "alcoholism" as a diagnostic entity, preferring the category of "alcohol dependence syndrome". In the 19th and early 20th centuries, alcohol dependence was called dipsomania before the term "alcoholism" replaced it.
The biological mechanisms underpinning alcoholism are uncertain, however, risk factors include social environment, stress, mental health, genetic predisposition, age, ethnic group, and sex. Long-term alcohol abuse produces physiological changes in the brain such as tolerance and physical dependence. Such brain chemistry changes maintain the alcoholic's compulsive inability to stop drinking and result in alcohol withdrawal syndrome upon discontinuation of alcohol consumption. Alcohol damages almost every organ in the body, including the brain; because of the cumulative toxic effects of chronic alcohol abuse, the alcoholic risks suffering a range of medical and psychiatric disorders. Alcoholism has profound social consequences for alcoholics and the people of their lives.
Alcoholism is the cyclic presence of tolerance, withdrawal, and excessive alcohol use; the drinker's inability to control such compulsive drinking, despite awareness of its harm to his or her health, indicate that the person might be an alcoholic. Questionnaire-based screening is a method of detecting harmful drinking patterns, including alcoholism. Alcohol detoxification is conducted to withdraw the alcoholic person from drinking alcohol, usually with cross-tolerance drugs, e.g. benzodiazepines to manage withdrawal symptoms. Post-medical care, such as group therapy, or self-help groups, usually is required to maintain alcoholic abstention. Often, alcoholics also are addicted to other drugs, most often benzodiazepines, which might require additional medical treatment. The alcoholic woman is more sensitive to alcohol's deleterious physical, cerebral, and mental effects, and increased social stigma, in relation to a man, for being an alcoholic. The World Health Organisation estimates that there are 140 million alcoholics worldwide.
Total recorded yearly alcohol per capita consumption (15+), in litres of pure alcohol.
Physical symptoms
Long term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and cancer. Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption.
Women develop long-term complications of alcohol dependence more rapidly than do men. Additionally, women have a higher mortality rate from alcoholism than men. Examples of long term complications include brain, heart, and liver damage and an increased risk of breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause. Alcoholic ketoacidosis can occur in individuals who chronically abuse alcohol and have a recent history of binge drinking.
Disability-adjusted life year for alcohol use disorders per 100,000 inhabitants in 2002.
Psychiatric symptoms
Long term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are not uncommon; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia. Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time. Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence. Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia. Panic disorder can develop or worsen as a direct result of long term alcohol misuse.
The co-occurrence of major depressive disorder and alcoholism is well documented. Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes). Additional use of other drugs may increase the risk of depression.
Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder. Women with alcoholism are more likely to have a history of physical or sexual assault, abuse and domestic violence than those in the general population, which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.
Some of the possible long-term effects of ethanol an individual may develop. Additionally, in pregnant women, alcohol can cause fetal alcohol syndrome.
Treatments
Treatments for alcoholism (antidipsotropic) are quite varied because there are multiple perspectives for the condition itself. Those who approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who approach the condition as one of social choice.
Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support in order to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism typically supports an abstinence-based zero tolerance approach; however, there are some who promote a harm-reduction approach as well.
Medications
A variety of medications may be prescribed as part of treatment for alcoholism.
Antabuse (disulfiram) prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast-acting and long-lasting uncomfortable hangover. This discourages an alcoholic from drinking in significant amounts while they take the medicine. A recent 9-year study found that incorporation of supervised disulfiram and a related compound carbamide into a comprehensive treatment program resulted in an abstinence rate of over 50%.
Naltrexone is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and opiates. Alcohol releases endorphins, hence when naltrexone is in the body drinkers no longer get any pleasure from consuming alcohol. Naltrexone is used in two very different forms of treatment. The first treatment uses naltrexone to decrease cravings for alcohol and encourage abstinence. The other treatment, called pharmacological extinction, combines naltrexone with normal drinking habits in order to reverse the endorphin conditioning that causes alcohol addiction. This results in a reduced desire to drink that persists after naltrexone use is discontinued, as long as the patient always takes naltrexone before drinking. Naltrexone comes in two forms. Oral naltrexone (ReVia) is a pill that must be taken one hour before drinking to be effective. Vivitrol is a time-release formulation that is injected in the buttocks once a month.
Acamprosate (also known as Campral) is thought to stabilize the chemical balance of the brain that would otherwise be disrupted by alcoholism. The Food and Drug Administration (FDA) approved this drug in 2004, saying "While its mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse... Campral proved superior to placebo in maintaining abstinence for a short period of time..." The COMBINE study was unable to demonstrate efficacy for Acamprosate.
Topiramate (brand name Topamax), a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. In one study heavy drinkers were six times more likely to remain abstinent for a month if they took the medication, even in small doses.In another study, those who received topiramate had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received the placebo. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiness of topiramate concluded that the results of published trials are promising, however at this time, data are insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence.
Prognosis
A 2002 study by the National Institute on Alcohol Abuse and Alcoholism surveyed a group of 4,422 adults meeting the criteria for alcohol dependence and found that after one year, some met the authors' criteria for low-risk drinking, even though only 25.5 percent of the group received any treatment, with the breakdown as follows: 25 percent were found to be still dependent, 27.3 percent were in partial remission (some symptoms persist), 11.8 percent asymptomatic drinkers (consumption increases chances of relapse) and 35.9 percent were fully recovered — made up of 17.7 percent low-risk drinkers plus 18.2 percent abstainers.
In contrast, however, the results of a long term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence." Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage."
The most common cause of death in alcoholics is from cardiovascular complications. There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. This believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also very common in adolescent alcohol abusers, with 25 percent of suicides in adolescents being related to alcohol abuse. Approximately 18 percent of alcoholics commit suicide, and research has found that over 50 percent of all suicides are associated with alcohol or drug dependence. The figure is higher for adolescents, with alcohol or drug misuse playing a role in up to 70 percent of suicides.
