Alcoholism, also known as
alcohol dependence, 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. 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 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, indicates 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 World Health Organisation estimates that there are 140 million alcoholics worldwide. The term "alcoholism" was split into "alcohol abuse" and "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were moved from "abuse" to "dependence". The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and ICD-9.
A 1960 study by E. Morton Jellinek is considered the foundation of the modern disease theory of alcoholism. 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. 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.
Social effects
The social problems arising from alcoholism are serious, caused by the pathological changes in the brain and the intoxicating effects of alcohol. Alcohol abuse is associated with an increased risk of committing criminal offences, including
child abuse,
domestic violence,
rape,
burglary and
assault. and about 40 percent of alcoholics will drink excessively by their late adolescence. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view. Lack of peer and family support is associated with a increased risk of alcoholism developing. Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol abuse.
Cortical degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage. The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs).
Diagnosis
Social barriers
Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol abuse. This is more of a barrier for women than men. Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic.
Screening
Several tools may be used to detect a loss of control of alcohol use. These tools are mostly
self reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.
DSM diagnosis
The
DSM-IV diagnosis of alcohol dependence represents one approach to the definition of alcoholism. In part this is to assist in the development of research protocols in which findings can be compared to one another. According to the DSM-IV, an alcohol dependence diagnosis is:
Detoxification
Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs, such as
benzodiazepines, that have similar effects to prevent
alcohol withdrawal. Individuals who are only at risk of mild to moderate withdrawal symptoms can be detoxified as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions are generally treated as inpatients. Detoxification does not actually treat alcoholism, and it is necessary to follow-up detoxification with an appropriate treatment program for alcohol dependence or abuse in order to reduce the risk of relapse.
Epidemiology
for alcohol use disorders per 100,000 inhabitants in 2002.
Alcoholism has a higher prevalence among men, though in recent decades, the proportion of female alcoholics has increased.
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. 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.
Stereotypes of alcoholics are often found in fiction and popular culture. The 'town drunk' is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia, as in the depiction of the Irish as heavy drinkers. Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.
See also
Alcoholic lung disease Alcoholism in family systems Alcohol-related traffic crashes Binge drinking High-functioning alcoholic List of countries by alcohol consumption ;Questionnaires
Alcohol Use Disorders Identification Test CAGE questionnaire CRAFFT Screening Test Paddington Alcohol Test Severity of Alcohol Dependence Questionnaire
References
Further reading
National Institute on Alcohol Abuse and Alcoholism. "Etiology and Natural History of Alcoholism". Pence, Gregory, "Kant on Whether Alcoholism is a Disease," Ch. 2, The Elements of Bioethics, McGraw-Hill Books, 2007 ISBN 0-07-313277-2. Thompson, Warren, MD, FACP. "Alcoholism." Emedicine.com, June 6, 2007. Retrieved 2007-09-02.
External links
DMOZ Alcohol abuse links and support groups at the Open Directory Project
Category:Alcohol abuse Category:Drinking culture Category:Substance-related disorders Category:Drug addiction
