Definition:

Alcoholism is an illness marked by consumption of alcoholic beverages at a level that interferes with physical or mental health, and social, family, or occupational responsibilities. Alcoholism is divided into 2 categories: dependence and abuse.

People with alcohol dependence, the most severe alcohol disorder, usually experience tolerance and withdrawal. Tolerance is a need for markedly increased amounts of alcohol to achieve intoxication or the desired effect. Withdrawal occurs when alcohol is discontinued or intake is decreased. Alcohol dependents spend a great deal of time drinking alcohol, and obtaining it.

Alcohol abusers are "problem drinkers", that is, they may have legal problems, such as drinking and driving, or binge drinking (drinking 6 or more drinks on one occasion). People who are dependent on or abuse alcohol return to its use despite evidence of physical or psychological problems. Those with dependence have more severe problems and a greater compulsion to drink.

Alternative Names:

Alcohol dependence; Alcohol abuse

Causes, incidence, and risk factors:

Alcoholism is a type of drug addiction. There is both physical and psychological dependence with this addiction. Physical dependence reveals itself by withdrawal symptoms when alcohol intake is interrupted, tolerance to the effects of alcohol, and evidence of alcohol-associated illnesses.

Alcohol affects the central nervous system as a depressant, resulting in a decrease of activity, anxiety, tension, and inhibitions. Even a few drinks can result in behavioral changes, a slowing in motor performance, and a decrease in the ability to think clearly. Concentration and judgment become impaired. In excessive amounts, intoxication may result.

Alcohol also affects other body systems. Irritation of the gastrointestinal tract can occur with erosion of the lining of the esophagus and stomach causing nausea and vomiting, and possibly bleeding. Vitamins are not absorbed properly, which can lead to nutritional deficiencies with the long-term use of alcohol. Liver disease, called alcoholic hepatitis, may also develop and can progress to cirrhosis. The heart muscle may be affected. Sexual dysfunction may also occur, causing problems with erections in men and cessation of menstruation in women.

Alcohol affects the nervous system and can result in nerve damage and severe memory loss. Chronic alcohol use also increases the risk of cancer of the larynx, esophagus, liver, and colon. Alcohol consumption during pregnancy can cause severe birth defects. The most serious is fetal alcohol syndrome, which may result in mental retardation and behavior problems. A milder form of the condition which can still cause lifelong impairment is called fetal alcohol affects.

The social consequences of problem drinking and alcohol dependence can be as serious as the medical problems. People who abuse or are dependent on alcohol have a higher incidence of unemployment, domestic violence, and problems with the law. About half of all traffic deaths are related to alcohol use.

The development of dependence on alcohol may occur over a period of years, following a relatively consistent pattern. At first, a tolerance of alcohol develops. This results in a person being able to consume a greater quantity of alcohol before its adverse effects are noticed. Memory lapses (black-outs) relating to drinking episodes may follow tolerance. Then, people may lose control over drinking and find it difficult or impossible to stop if they try. The most severe drinking behavior includes prolonged binges of drinking with associated mental or physical complications. Some people are able to gain control over their dependence in earlier phases before a total lack of control occurs. The problem is, no one knows which heavy drinkers will be able to regain control and which will not.

Withdrawal develops because the brain has physically adapted to the presence of alcohol and cannot function adequately in the absence of the drug. Symptoms of withdrawal may include elevated temperature, increased blood pressure, rapid heart rate, restlessness, anxiety, psychosis, seizures, and rarely even death.

There is no known common cause of alcoholism. However, several factors may play a role in its development. A person who has an alcoholic parent is more likely to become an alcoholic than a person without alcoholism in the immediate family. Research suggests that certain genes may increase the risk of alcoholism but which genes or how they exert their influence is controversial. Psychological factors may include a need for relief of anxiety, ongoing depression, unresolved conflict within relationships, or low self-esteem. Social factors include availability of alcohol, social acceptance of the use of alcohol, peer pressure, and stressful lifestyles.

The incidence of alcohol intake and related problems is increasing. Data from many sources indicate that about 15% of the population in the United States are problem drinkers, and approximately 5% to 10% of male drinkers and 3% to 5% of female drinkers could be diagnosed as alcohol dependent (12.5million people).

Alcoholism is a chronic illness marked by dependence on alcohol consumption that interferes with physical or mental health, and social, family or job responsibilities. This addiction can lead to liver, circulatory and neurological problems. Pregnant women who drink alcohol in any amount may harm the fetus.

Symptoms:

Men who consume 15 or more drinks a week, women who consume 12 or more drinks a week, or anyone who consumes 5 or more drinks per occasion at least once a week are all at risk for developing alcoholism. (One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor).

The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence:

• Have you felt that you should cut down on your drinking?
• Do you ever drive when you have been drinking?
• Is someone in your family concerned about your drinking?
• Have you ever had any blackouts after drinking?
• Have you ever been absent from work or lost a job because of drinking?
• Do you have to drink more than before to achieve intoxication or the desired effect?

Some of the symptoms associated with alcoholism include

• Solitary drinking
• Making excuses to drink
• Need for daily or frequent use of alcohol for adequate function
• Lack of control over drinking, with inability to discontinue or reduce alcohol intake
• Episodes of violence associated with drinking
• Secretive behavior to hide alcohol related behavior
• Hostility when confronted about drinking
• Neglect of food intake
• Neglect of physical appearance
• Nausea and vomiting
• Shaking in the morning
• Abdominal pain
• Numbness and tingling
• Confusion

Symptoms may vary.

Alcohol withdrawal symptoms may vary from mild to severe:

• Rapid heart rate and sweating
• Restlessness or agitation
• Loss of appetite, nausea, or vomiting
• Confusion or hallucinations
• Tremors and seizures

Signs and tests:

All physicians should ask their patients about their drinking. A history may be obtained from family if the affected person is unwilling or unable to answer questions. A physical examination is performed to identify physical problems related to alcohol use.

• A toxicology screen or blood alcohol level confirms recent alcohol ingestion, which does not necessarily confirm alcoholism.
• Liver function tests can be elevated. GGPT (glutaryl transaminase) is often elevated more than other liver function tests.
• CBC (complete blood count) - MCV can be elevated (mean corpuscular volume or size of the red blood cells).
• Serum magnesium, uric acid, total protein, and folate tests may be abnormal.

Complications:

• Pancreatitis
• Heart muscle damage
• Nerve damage
• Esophageal bleeding
• Brain degeneration
• Cirrhosis of the liver
• Delirium tremens (DTs)
• Depression
• Erectile dysfunction
• Fetal alcohol syndrome in the offspring of alcoholic women
• High blood pressure
• Increased incidence of cancer
• Insomnia
• Nutritional deficiencies
• Suicide
• Wernicke-Korsakoff syndrome

Prevention:

Educational programs and medical advice about alcohol abuse have been successful in decreasing alcohol abuse and its associated problems. Alcohol dependency requires more intensive management.

Recommendation:

Women should have no more than 1 drink per day and men no more than 2 drinks per day. One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.

Healthcentral 2004

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