An ambiguous term, for some implying a disease, for others a severe form of alcohol dependence. It is also used as a term of opprobrium relating to anyone who has continuing difficulties associated with excessive alcohol consumption. A major limitation of the term is that it suggests a dichotomy between abstinence and moderate drinking, on the one hand, and excessive and uncontrolled drinking, on the other. Alcohol abuse can be found in all social classes, though there is evidence that those suffering from anxiety or depression are most susceptible, with a recent notable increase in the disease among housewives and the young and long-term unemployed.
Alcoholism is the consumption of or preoccupation with alcoholic beverages to the extent that this behavior interferes with the alcoholic's normal personal, family, social, or work life. The chronic alcohol consumption caused by alcoholism can result in psychological and physiological disorders.
While alcohol use is required to trigger alcoholism, the biological mechanism of alcoholism is uncertain. For most people, moderate alcohol consumption poses little danger of addiction. Other factors must exist for alcohol use to develop into alcoholism. In addition, an alcoholic can develop multiple forms of addiction to alcohol simultaneously such as psychological, metabolic, and neurochemical.
Terminology
Many terms are applied to a drinker's relationship with alcohol. Use, misuse, heavy use, abuse, addiction, and dependence are all common labels used to describe drinking habits, but the actual meaning of these words can vary greatly depending upon the context in which they are used.
Use refers to simple use of a substance. An individual who drinks any alcoholic beverage is using alcohol.
Misuse and heavy use do not have standard definitions, but suggest consumption of alcohol beyond the point where it causes physical, social, or moral harm to the drinker.
The term abuse has a variety of possible meanings.
Dependence also has multiple definitions, but is not as commonly used as abuse outside of the medical profession. Physical medicine considers dependence to be the body's physical adaptation to the persistent presence of alcohol.
The precise definition of addiction is debated, but in general it refers to any condition which causes a person to continue behaviors demonstrated as harmful to that person. Some conditions which contribute to alcoholism include physical dependence, neurochemical conditioning, and a person's perception that alcohol benefits them psychologically or socially.
Remission is often used to refer to a state where an alcoholic is no longer showing symptoms of alcoholism. American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of alcoholism are no longer evident, regardless of whether or not the person is still drinking. Others (most notably Alcoholics Anonymous) use the term exclusively to describe those who have completely stopped consumption of alcohol.
Epidemiology
Substance use disorders are the major public health problem facing many countries. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol."
There is considerable debate regarding the Disease Theory of Alcoholism.
Identification and diagnosis
Identification of alcoholism may be difficult because there is no detectable physiological difference between a person who drinks a lot and a person who can't control his or her drinking. Identification involves an objective assessment regarding the damage that imbibing alcohol does to the drinker's life compared to the subjective benefits the drinker perceives from consuming alcohol.
Genetic predisposition testing
At least one genetic test exists for an allele that is correlated to alcoholism and opiate addiction. Those who possess the A1 allele (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin releasing drugs like alcohol. Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism.
Screening
Several tools may be used to detect a loss of control of alcohol use. Another common theme is a score or tally that sums up the general severity of alcohol use. The Alcohol Dependence Data Questionnaire is a more sensitive diagnostic test than the CAGE test. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use. The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses, driving under the influence being the most common. The Alcohol Use Disorders Identification Test (AUDIT) is a screening questionnaire developed by the World Health Organization. The [[Paddington Alcohol Test] (PAT) was designed to screen for alcohol related problems amongst those attending Accident and Emergency departments. A number of free websites provide anonymous self-screening for harmful or hazardous alcohol use, including AlcoholScreening.org and Down Your Drink.
DSM diagnosis
The DSM-IV diagnosis of alcohol dependence represents another approach to the definition of alcoholism. According to the DSM-IV, an alcoholism diagnosis is:
“...maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; continued use despite knowledge of physical or psychological sequelae.”
Urine and blood tests
There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC). These tests do not differentiate alcoholics from non-alcoholics; High carbohydrate deficient transferrin (CDT)
Effects
The primary effect of alcoholism is to encourage the sufferer to drink at times and in amounts that are damaging.
It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption are described in Alcohol consumption and health, but may include cirrhosis of the liver, pancreatitis, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources.
Social effects
The social problems arising from alcoholism can be significant. Drinking at inappropriate times and behavior caused by reduced judgment can earn criminal convictions, such as drunk driving or public disorder.
A study quantified the cost to the UK of all forms of alcohol misuse as £18.5–20 billion annually (2001 figures).
Alcohol withdrawal
Alcohol withdrawal differs significantly from withdrawal from other drugs in that it can be directly fatal. Heavy consumption of alcohol reduces the production of GABA, which is a neuroinhibitor. An abrupt stop of alcohol consumption can induce a condition where neither alcohol nor GABA exists in the system in adequate quantities, causing uncontrolled firing of the synapses.
Treatments
Treatments for alcoholism are quite varied because there are multiple perspectives for the condition itself.
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.
The effectiveness of alcoholism treatments varies widely.
Detoxification
Detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects to offset the withdrawal symptoms.
Detoxes are performed in multiple ways. A third option is to defer treatment until symptoms occur, which is safe only with relatively mild alcohol users.
Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. Detoxification may or may not be necessary depending upon an individual's age, medical status, and history of alcohol intake. For example, a young man who binge drinks and seeks treatment one week after his last use of alcohol may not require detoxification before beginning treatment for alcoholism.
Group therapy and psychotherapy
After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills.
The mutual-help group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety. Many organizations have been formed to provide this service, including Alcoholics Anonymous, LifeRing Secular Recovery, Rational Recovery, Smart Recovery, and Women For Sobriety.
Rationing and moderation
Rationing and moderation programs do not mandate complete abstinence. Since one of the effects of alcohol is to reduce a person's judgment, each drink makes it more difficult to decide that the next drink is a bad idea.
While most alcoholics are unable to limit their drinking in this way, moderate drinking works for some people, and it may avoid the physical, financial, and social costs of other treatments - particularly in the early phase of recovery. Research by the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicates that nearly 18% of such individuals in the US whose drinking habit began more than one year earlier are now drinking in moderation.
Medications
Although not necessary for treatment of alcoholism, a variety of medications may be prescribed as part of treatment. Some may ease the transition to sobriety, while others cause physical hardship to result from the use of alcohol. Acetaldehyde itself is the cause of many hang over symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast acting and long lasting uncomfortable hang over. 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. 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..." It is used for both acute alcohol withdrawal and medium to long-term detoxification.
Pharmacological extinction
See also: Sinclair MethodPharmacological extinction is the use of opioid antagonists like naltrexone combined with normal drinking habits in order to eliminate the craving for alcohol. By having the alcoholic go about their normally drinking habits (limited only by safety concerns), and while preventing the endorphins from being released by the alcohol, the pull to drink is eliminated over a period of about three months. The effects persist after the drug is discontinued, but the addiction can return if the person drinks without first taking the drug.
There is a lot of professional resistance to this treatment for two reasons. Studies have demonstrated that controlled drinking for alcoholics was not a useful treatment technique. Experimental evidence indicates that the presence of naltrexone causes the drinking of alcohol to have a reverse effect on alcoholism, decreasing the alcoholic's attachment to alcohol consumption when they drink instead of increasing it.
Nutritional therapy
Preventative treatment of alcohol complications includes long-term use of a multivitamin as well as such specific vitamins as B12 and folate.
While nutritional therapy is not a treatment of alcoholism itself, it treats the difficulties that can arise after years of heavy alcohol use. Many alcohol dependents have insulin resistance syndrome, a metabolic disorder where the body's difficulty in processing sugars causes an unsteady supply to the blood stream. While the disorder can be diminished by a hypoglycemic diet, this can affect behavior and emotions, side-effects often seen among alcohol dependents in treatment.
Societal impact
The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs. Alcohol use is a major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. For instance, heavy alcohol consumption by a pregnant woman can lead to fetal alcohol syndrome, an incurable and damaging condition.
Today, alcohol use and alcohol dependence are major public health problems on many continents, including North America where dependence costs the region's inhabitants as much as 170 billion dollars annually by some estimates. Of the 50% of the North American population who consume alcohol, it has been estimated that 10% are heavy alcohol users and alcohol dependents, and 6% account for more than half of all the alcohol consumption in the region.
Stereotypes
Stereotypes of alcoholics are often found in fiction and popular culture. Common examples include the 'town drunk' or the portrayal of certain nationalities as alcoholics. In modern times, the recovery movement has led to more realistic depictions of problems that stem from heavy alcohol use. Jackson and Charles Bukowski describe their own alcohol addiction in their writings.
Politics and public health
Because alcohol use disorders are perceived as impacting society as a whole, governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. The World Health Organization, the European Union and other regional bodies are working on alcohol action plans and programs.
Organizations working with those suffering from alcoholism include:
Alcoholics Anonymous (AA) International Organisation of Good Templars (IOGT) LifeRing Secular Recovery (LifeRing) Moderation Management (MM) Rational Recovery (RR) Secular Organizations for Sobriety (SOS) Smart Recovery (Self Management And Recovery Training - SMART) Women For Sobriety (WFS) Narcotics Anonymous (NA), Alcohol is a drug, although not a narcotic. The Economic Cost of Alcohol Abuse The Free Press, New York, 1977 ISBN 0-02-903080-3 Royce, James E.
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