Alcoholism

From open-encyclopedia.com - the free encyclopedia.

Alcoholism is an addictive dependency on alcohol characterised by craving (a strong need to drink); loss of control (being unable to stop); physical dependence and withdrawal symptoms; and tolerance (increasing difficulty of becoming drunk).

King Alcohol and his Prime Minister circa 1820

Alcoholism is often seen as a "disease of affluence," being uncommon among indigenous people until they become "civilised." Alcoholism is a life-threatening problem that often ends in death, particularly through liver or kidney disease, internal bleeding, brain deterioration, alcohol poisoning, accidents and suicide.

Stereotypes of alcoholics are often found in fiction and popular culture: for example the "town drunk," or the stereotype of Russians and the Irish as alcoholics.

Alcohol dependence can be harder to break and significantly more damaging than dependence on most other addictive substances. The physical symptoms when withdrawing from alcohol are seen to be equal to those experienced during withdrawal from heroin.

Long term abusers of alcoholic beverages can suffer delirium tremens.

Contents

Screening

Several tools may be used to detect the habitual abuse of alcohol. The CAGE questionnaire is one such example that may be used to screen patients quickly in a doctor's office. Two "yes" responses indicate that the respondant should be investigated further. The questionnaire asks the following questions:

Have you ever felt you needed to cut down on your drinking?
Have people annoyed you by criticising your drinking?
Have you ever felt guilty about drinking?
Have you ever felt you needed a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

Treatments

Treatments for alcoholism include detoxification programs run by medical institutions. These may involve stays of a number of weeks in specialized hospital wards where drugs may be used to avoid withdrawal symptoms. "Cold turkey"-style self-administered withdrawal can be life threatening for an alcoholic!

After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues leading to alcohol dependence. Aversion therapies may be supported by drugs like Disulfiram, which causes a strong and prompt hangover whenever alcohol is consumed. Naltrexone may improve compliance with abstinance planning. The standard pharmocopeia of anti-depressants, anxiolytics and other psychotropic drugs treat underlying mood disorders, neuroses and psychoses associated with alcoholic symptoms.

Another treatment program is based on nutritional therapy. Many alcoholics 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 treated by a hypoglycemic diet, this can affect behaviour and emotions, side-effects often seen among alcoholics in treatment. The metabolic aspects of alcoholism are often overlooked, resulting in poor treatment outcomes. See: [1]

In the 1900s the self-help group-counselling approach to treatment became increasingly widespread and remains so today. Alcoholics Anonymous is possibly being the best-known example of this movement.

Social Impact

A Soviet poster reading "Daddy, don't drink", referring to the massive alcoholism problem in Russia

The social problems arising from alcoholism can include loss of employment, financial problems, marital conflict and divorce, convictions for crimes such as drunk driving or public disorder, loss of accommodation, and loss of respect from others who may see the problem as self-inflicted and easily avoided. Exhaustive studies, including those by author Wayne Kritsberg, show that alcoholism affects not only the addicted but can profoundly impact the family members around them. Children of alcoholics can be affected even after they are grown. This condition is usually referred to as "The Adult Children of Alcoholics Syndrome." Al-Anon, a group modelled after Alcoholics Anonymous, offers aid to friends and family members of alcoholics.

Many people incorrectly assume that once an alcoholic stops drinking, all is well. However, many people who have stopped drinking still refer to themselves as "alcoholics" or "recovering alcoholics."

Organisations working with alcoholics include:

Alcoholics Anonymous (AA)
LifeRing Secular Recovery (LifeRing)
Men For Sobriety (MFS)
Moderation Management (MM)
Rational Recovery (RR)
Secular Organizations for Sobriety (SOS)
Self-Management and Recovery Training (SMART)
Women For Sobriety (WFS)

Alcohol Withdrawal

There are several distinct but not mutually exclusive clinical syndromes caused by alcohol withdrawal:

Activation syndrome - characterized by tremulousness, agitation, rapid heart beat and high blood pressure.
Seizures - acute grand mal seizures can occur in alcohol withdrawal in patients who have no history of seizure or any structural brain disease.
Hallucinations - usually visual or tactile in alcoholics
Delirium tremens - can be severe and often fatal.

Unlike withdrawal from opioids such as heroin, which can be very unpleasant but is rarely fatal, alcohol withdrawal can kill (by uncontrolled convulsions) if it is not properly managed by a doctor. The pharmacological management of alcohol withdrawal is based on the fact that alcohol, barbiturates and benzodiazepines have remarkably similar effects on the brain and can be substituted for each other. Since benzodiazepines are the safest of the three classes of drugs, alcohol consumption is terminated and a long-acting benzodiazepine, e.g., Valium® is substituted to block the alcohol withdrawal syndrome. The benzodiazepine dosage is then tapered slowly over a period of days or weeks.

da:Alkoholisme de:Alkoholkrankheit es:Alcoholismo eo:Alkoholismo fr:Alcoolisme is:Alkahólismi it:Alcolismo he:אלכוהוליזם nl:Alcoholisme ja:アルコール依存症 pl:Alkoholizm pt:Alcoolismo ru:Алкоголизм fi:Alkoholismi sv:Alkoholism