Alcoholism

What is Alcoholism?

Alcoholism is an excessive consumption of alcohol that persists or recurs over time. It is a leading cause of accidents, illness, social or interpersonal difficulties, and poor work performance or absences. Alcoholism is a chronic disorder, and occurs in two forms: alcohol abuse (problem drinking) and alcohol dependence (addiction).Alcohol abuse is drinking that creates a hazard (such as when driving), or when the individual continues to drink despite awareness of the physical, psychological, social, or occupational problems it creates. Abuse may progress to dependence, and the line between them is not always clear.

Alcohol dependence is characterized by loss of control, that is, the inability to stop or limit drinking. The person becomes intoxicated more and more frequently. The individual may be impaired while carrying out regular activities and responsibilities, or may give up important activities and relationships because of drinking. Physical effects include the brain's adaptation to alcohol, where increasing amounts are required to produce the same level of intoxication; this is referred to as alcohol tolerance. Once tolerance has developed, the individual cannot suddenly stop or reduce drinking without precipitating symptoms of withdrawal. This usually begins within 48 hours, and includes tremor, sweating, weakness, nausea, vomiting, headache, anxiety, and depressed mood. Transient hallucinations or "bad dreams" and, in some cases, seizures may accompany withdrawal. These symptoms usually disappear within several days to a week. Severe cases, however, may progress to "D.T.'s" (delirium tremens), a more serious withdrawal syndrome of confusion, disorientation, fever, and terrifying hallucinations. Delirium tremens usually runs a course of several days, but can be life threatening in some cases.

Alcoholism has three main drinking patterns. Some alcoholics drink excessively daily. Others do so only on weekends. In the third pattern, lengthy periods of sobriety are interrupted by drinking binges, which may last weeks or months.

Alcoholism also may be associated with the abuse/dependence of other substances. Why some people can drink in moderation and others become alcoholics is poorly understood.

Alcoholism probably has no single cause and may not even be a single disorder. At least two types of alcoholism have been described. One type tends to occur at an early age, and is especially common in males with alcoholic parents. Another form is relatively mild, occurs in both men and women, and appears later in life. In some cases, alcoholism may result when an individual drinks to relieve chronic pain or symptoms of emotional illness.

Alcoholism is a common mental disorder. Alcohol abuse occurs in approximately eight percent of the adult US population at some time in their lives, with alcohol dependence occurring in five percent of the population.

How is it diagnosed?

• History is not always dependable, as alcoholics may deny or conceal their drinking. But an accurate history is needed to distinguish between alcohol abuse and dependence. Standard questionnaires are commonly used to obtain a history.
• Physical exam could be normal, show an enlarged fatty liver, or a small hard (cirrhotic) liver. High blood pressure may be present. A tremor, disturbed gait or mental status could be noted.
• Tests: An elevated blood glutamyl transferase is a good indicator for alcoholism. An elevated blood alcohol level without signs of intoxication indicates alcohol tolerance. Other blood tests can detect the effects of alcohol on the liver and bone marrow, with elevated liver enzymes, high blood lipids, and an anemia showing large red blood cells (macrocytic).

How is Alcoholism treated?

The first aim of treatment is alcohol detoxification. If the individual has a high tolerance to alcohol, this may be best done in the hospital where drugs can be given to ease withdrawal. Any nutritional deficiencies or other complications are also treated.

The next aim of treatment is to prevent relapse by helping the individual cope with the impulse to drink. Both inpatient and outpatient programs are available, offering a variety of treatment modalities.

The initial, intensive phase, whether in or out of the hospital, usually is completed in less than a month, and generally is followed by less intensive long-term treatment. The treatment commonly uses behavioral methods such as relaxation training, social skills training, and aversive conditioning, in which the sight, smell, or taste of alcohol is associated with an unpleasant sensation such as nausea or a mild electric shock.

Medications

Information	Brand	Generic	Label	Rating
	Zoloft	Sertraline
	Paxil	Paroxetine
	Neurontin	Gabapentin
	Lioresal	Baclofen

Luvox (Fluvoxamine), Celexa (Citalopram), Prozac (Fluoxetine), Depakote (Divalproex), Zofran (Ondansetron), Atarax (Hydroxyzine), Tegretol (Carbamazepine), Topamax (Topiramate), BuSpar (Buspirone), Revia (Naltrexone), Xanax (Alprazolam), Valium (Diazepam), Ativan (Lorazepam)

Various forms of psychotherapy also may be employed including individual, group, marital, and family therapy. Drug treatment may help some individuals resist the impulse to drink. A narcotic antagonist can be used in alcoholism, to diminish the pleasurable effects of alcohol. In addition to professional treatment, alcoholics usually are referred to self-help groups like Alcoholics Anonymous (AA). The long-term support that self-help groups provide can be crucial in preventing relapse. An alternative is Rational Recovery, which is a self-help group based on cognitive rather than spiritual principles.

What might complicate it?

Alcoholism can damage virtually any organ system. The gastrointestinal tract is often first to show toxic effects such as gastritis and gastrointestinal bleeding. After years of heavy drinking, liver damage may occur (alcoholic hepatitis, cirrhosis), along with an increased risk of liver cancer. The pancreas also may be affected by chronic pancreatitis.

• Prolonged, excessive use of alcohol is toxic to the nervous system. In addition to acute impairment of alcohol intoxication and withdrawal, brain function also may be chronically impaired; poor memory is a common finding, which may improve with abstinence. If drinking continues, however, irreversible atrophy of the brain may occur, with long-term and short-term memory impairment. Dementia may develop, with loss of higher brain functions such as judgment, abstract thinking, language, etc.
• Personality changes may be seen, and sometimes a psychosis develops. Other parts of the brain may be damaged as well, resulting in disturbances of balance and coordination.
• Prolonged heavy drinking can also be toxic to nerves, resulting in a painful peripheral neuropathy.
• Heavy drinking may result in cardiovascular disorders of high blood pressure, abnormal heart rhythms (arrhythmias), and damage to heart muscle (cardiomyopathy).
• Excessive alcohol intake can lead to anemia. It may alter hormone levels, interfere with blood clotting, impair immunity, and result in nutritional deficiencies.
• There are often disastrous psychosocial consequences, such as loss of relationships and employment. Accidents, violence, and suicide can be consequences of alcoholism.
• Heavy drinking during pregnancy can result in fetal alcohol syndrome.

Predicted outcome

A high percentage of alcoholics will relapse, regardless of the type of treatment, and usually within six months. This does not mean that treatment has failed, but rather that it must be ongoing. Relapses may occur a number of times, but eventually the cycle may stop as the individual restructures his or her life, replacing alcohol with other sources of gratification. The earlier in the course of alcoholism the treatment is begun, the better the prognosis.

Alternatives

Another cause of altered mental state can be diabetic ketoacidosis, in which the breath has a fruity odor of acetone, which sometimes is confused with alcohol; low blood sugar can also have a disturbed mental state. Alcoholism often is accompanied by or confused with other substance abuse.

Appropriate specialists

Psychiatrist, psychologist, gastroenterologist, cardiologist and neurologist.

Last updated 18 December 2011