Alcoholism , also known as alcohol abuse ( AUD ), is a broad term for drinking alcohol causing mental or physical health problems.. This disorder was previously divided into two types: alcohol abuse and alcohol dependence. In the medical context, alcoholism is said to exist when two or more of the following conditions are present: one takes large amounts of water for long periods, having difficulty reducing, obtaining and drinking alcohol takes a lot of time, alcohol is highly desirable, the results of use in not fulfilling responsibilities , the results of use in social matters, the results of use in health problems, the results of use in risky situations, withdrawal occurs when stopped, and alcohol tolerance has occurred with use. Risk situations include drinking and driving or having unsafe sex, among others. The use of alcohol can affect all parts of the body, but mainly affects the brain, heart, liver, pancreas and immune system. This can lead to mental illness, Wernicke-Korsakoff syndrome, irregular heartbeat, liver cirrhosis and an increased risk of cancer, among other illnesses. Drinking during pregnancy can cause damage to the baby resulting in fetal alcohol spectrum disturbance. Women are generally more sensitive than men to the harmful physical and mental effects of alcohol.
Environmental and genetic factors are two components associated with alcoholism, with about half the risks attributed to each. A person with a parent or alcoholic sibling is three to four times more likely to be an alcoholic. Environmental factors include social, cultural and behavioral influences. High levels of stress, anxiety as well as low cost and easy access to alcohol increase risk. People can continue to drink some to prevent or improve withdrawal symptoms. After a person stops drinking alcohol, they may experience a low level of withdrawal that lasts for months. Medically, alcoholism is considered a physical and mental illness. Certain questionnaires and blood tests may detect people with possible alcoholism. Further information is then collected to confirm the diagnosis.
Alcoholism prevention can be tried by regulating and limiting the sale of alcohol, taxing alcohol to increase its costs and provide inexpensive treatments. Treatment may take several steps. Due to medical problems that can occur during withdrawal, alcohol detoxification should be carefully controlled. One common method involves the use of benzodiazepine drugs, such as diazepam. This can be given when admitted to a health care institution or sometimes when a person remains in a strictly supervised society. Mental illness or other addictions can complicate the treatment. After detoxification, support such as group therapy or support groups is used to help prevent a person from returning to drinking. One commonly used form of support is the Alcoholics Anonymous group. Acamprosate, disulfiram or naltrexone medications may also be used to help prevent further drinking.
The World Health Organization estimates that in 2010 there were 208 million people with alcoholism worldwide (4.1% of the population over 15 years). In the United States, about 17 million (7%) adults and 0.7 million (2.8%) of those aged 12 to 17 are affected. This is more common in men and young adults, becoming less common in middle and old age. It is the most common in Africa, at 1.1%, and has the highest rate in Eastern Europe, by 11%. Alcoholism directly resulted in 139,000 deaths by 2013, up from 112,000 deaths in 1990. A total of 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol. This often reduces one's life expectancy by about ten years. In the United States, it resulted in economic costs of $ 224 billion USD in 2006. Many terms, some insults and others informal, have been used to refer to people affected by alcoholism; expressions including tippler, drinker, dipsomaniac and souse. In 1979, the World Health Organization rejected the use of "alcoholism" for its improper meaning, preferring "alcohol dependence syndrome".
Video Alcoholism
Signs and symptoms
Initial
The risk of alcohol dependence begins at low levels of drinking and increases directly both with the volume of alcohol consumed and large drinking patterns on occasion, to the point of poisoning, sometimes called "binge drinking". Young adults are very risky involved in binge drinking.
Long-term abuse
Alcoholism is characterized by increased tolerance to alcohol - meaning that one can consume more alcohol and physical dependence on alcohol, which makes it difficult for a person to control his consumption. Physical dependence caused by alcohol can cause the affected individual to have a very strong drive to drink alcohol. This characteristic plays a role in reducing an alcoholic's ability to stop drinking. Alcoholism can have adverse effects on mental health, cause psychiatric disorders and increase the risk of suicide. The mood of depression is a common symptom of heavy alcohol drinkers.
Alerts
Warning signs of alcoholism include increased consumption of alcohol and frequent poisoning, preoccupation with drinking to the exclusion of other activities, a promise to stop drinking and failure to fulfill the promises, inability to remember what was said or done while drinking (colloquially known as "blackout"), personality changes associated with drinking, rejection or making excuses for drinking, refusal to recognize excessive drinking, dysfunction or other problems at work or school, loss of interest in personal appearance or cleanliness, marriage and economic problems, and poor health complaints, with loss of appetite, respiratory infections, or anxiety enhancement.
Physical
Short-term effects
Drinking enough to cause a 0.03-0.12% blood alcohol concentration (BAC) usually leads to overall improvement in mood and possible euphoria (feelings of "pleasure"), increased confidence and sociability, decreased anxiety, redness, appearance red on the face and impaired assessment and good muscle coordination. BAC 0.09% to 0.25% caused lethargy, sedation, balance problems, and blurred vision. BAC 0.18% to 0.30% causes great confusion, speech impairment (eg lisp utterance), shocking, dizziness and vomiting. A BAC of 0.25% to 0.40% causes fainting, unconsciousness, anterograde amnesia, vomiting (deaths can occur by inhaling vomiting (lung aspiration) while subconscious and respiratory depression (potentially life-threatening) A BAC of 0, 35% to 0.80% leads to coma (unconscious), life-threatening respiratory depression and potentially fatal alcoholic toxicity With all alcoholic beverages, drinking while driving, operating an aircraft or heavy equipment increases the risk of accidents, many countries have penalties because driving drunk.
Long-term effects
Drinking more than one drink a day for women or two drinks for men increases the risk of heart disease, high blood pressure, atrial fibrillation, and stroke. The risk is greater in younger people due to binge drinking, which can result in violence or accidents. About 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol every year. Alcoholism reduces a person's life expectancy by about ten years and alcohol use is the leading cause of premature death in the United States. There is no professional medical association that suggests people who are not drinkers should start drinking wine. Long-term alcohol abuse can cause a number of physical symptoms, including liver cirrhosis, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of cardiovascular disease, malabsorption, alcoholic liver disease, and some cancers. Damage to the central nervous system and peripheral nervous system may result from continued alcohol consumption. A wide variety of immunologic defects can occur and there may be generalized skeletal vulnerability, in addition to the recognized tendency for unintentional injury, resulting in a tendency for fractures.
Women develop long-term complications of alcohol dependence faster than men. In addition, women have a higher mortality rate than alcoholism than men. Examples of long-term complications include brain, heart, and liver damage and an increased risk of breast cancer. In addition, heavy drinking over time has been found to have a negative effect on reproductive function in women. It produces reproductive dysfunctions such as anovulation, decreased ovarian mass, menstrual cycle problems or irregularities, and early menopause. Alcohol ketoacidosis can occur in individuals who chronically abuse alcohol and have a recent history of binge drinking. The amount of alcohol that can be biologically processed and the effect is different between the sexes. The same dose of alcohol consumed by men and women generally results in women who have high blood alcohol concentration (BAC), since women generally have a higher body fat percentage and therefore lower volume of alcohol distribution than men, and because the stomach of a man tend to metabolize alcohol more quickly.
Psychiatry
Long-term alcohol abuse can cause a variety of mental health problems. Severe cognitive problems are common; about 10 percent of all dementia cases are associated with alcohol consumption, making it the second leading cause of dementia. Excessive use of alcohol leads to malfunctioning of the brain, and psychological health may be further affected over time. Social skills are significantly impaired in people suffering from alcoholism because of the neurotoxic effects of alcohol on the brain, especially the area of ​​the brain's prefrontal cortex. Social skills harmed by alcohol abuse include disturbances in observing facial emotions, prosodic perception problems and mind deficit theories; the ability to understand humor is also undermined by alcohol abusers. Psychiatric disorders often occur in alcoholics, with as many as 25% suffering from severe psychiatric disorders. The most common psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but usually improve or disappear with continued abstinence. Psychosis, confusion, and organic brain syndrome can be caused by alcohol abuse, which can lead to misdiagnosis such as schizophrenia. Panic disorder may develop or worsen as a direct result of long-term alcohol abuse.
Major depressive events and alcoholism are well documented. Among those with comorbid occurrences, differences are commonly made between depressive episodes that transmit with alcohol abstinence ("substance-induced"), and major episodes of depression and do not transmit with abstinence ("independent" episodes). Additional use of other drugs may increase the risk of depression. Psychiatric disorders differ depending on sex. Women who have an alcohol use disorder often have psychiatric diagnoses that occur together such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or personality threshold disorder. Men with alcohol use disorder more often have a diagnosis along with narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorder, or attention deficit/hyperactivity disorder (ADHD) disorder. Women with alcoholism are more likely to experience physical or sexual abuse, harassment and domestic violence than women in the general population, which can lead to higher psychiatric disorders and a greater dependence on alcohol.
Social effects
Serious social problems arise from alcoholism; This dilemma is caused by pathological changes in the brain and the intoxicating effects of alcohol. Alcohol abuse is associated with an increased risk of committing a crime, including child abuse, domestic violence, rape, robbery and assault. Alcoholism is associated with job loss, which can cause financial problems. Drinking on time and inappropriate behavior caused by a reduction in judgment may result in legal consequences, such as criminal charges for drunk driving or public disruption, or civil penalties for torturous behavior, and may result in criminal penalties. The behavior of an alcoholic and a mental disorder during a hangover can greatly affect the people around him and cause isolation from family and friends. This isolation can lead to marital and divorce conflicts, or contribute to domestic violence. Alcoholism can also lead to the neglect of a child, with continuous permanent damage to the emotional development of children of alcoholics. For this reason, children of alcoholic parents can develop a number of emotional problems. For example, they can be afraid of their parents, because of their unstable mood behavior. In addition, they can develop a lot of shame for their inability to free their parents from alcoholism. As a result of this failure, they develop a poor self-image, which can lead to depression.
Alcohol withdrawal
Just as substances similar to sedative-hypnotic mechanisms, such as barbiturates and benzodiazepines, withdrawal from alcohol dependence can be fatal if not managed properly. The main effect of alcohol is increased stimulation of GABA receptors A , which encourages central nervous system depression. With heavy alcohol consumption repeatedly, these receptors are insensitive and decrease in number, resulting in tolerance and physical dependence. When alcohol consumption is stopped too suddenly, one's nervous system suffers from uncontrolled synapse burning. It can cause symptoms that include anxiety, life-threatening seizures, delirium tremens, hallucinations, tremors and possibly heart failure. Other neurotransmitter systems are also involved, especially dopamine, NMDA and glutamate.
Severe acute withdrawal symptoms such as delirium and seizure tremens are rare after 1 week post-discontinuation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period 3-6 weeks after cessation of anxiety increase, depression, and sleep disturbances, it is common; fatigue and tension can last up to 5 weeks as part of the post-acute withdrawal syndrome; about a quarter of alcoholics experience anxiety and depression for up to 2 years. The symptoms of post-acute withdrawal have also been shown in animal models of alcohol dependence and withdrawal. Sound effects also occur in alcoholics where each further withdrawal syndrome is more severe than previous episodes of withdrawal; This is due to the neuro adaptation that occurs as a result of the abstinence period followed by re-exposure to alcohol. Individuals who have multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals with no previous episode history of alcohol withdrawal. Sound effects cause persistent functional changes in the brain's neural circuitry as well as gene expression. Kindling also results in the intensification of psychological symptoms of alcohol withdrawal. There are decision tools and questionnaires that help guide physicians in evaluating alcohol withdrawal. For example, CIWA-Ar estimates alcohol withdrawal symptoms to guide therapeutic decisions that allow for efficient interview while at the same time maintaining clinical utility, validity, and reliability, ensuring proper care for withdrawal patients, who may be in danger of death.
Maps Alcoholism
Cause
The complex mix of genetic and environmental factors affects the risk of developing alcoholism. Genes that affect alcohol metabolism also affect the risk of alcoholism, and may be indicated by a family history of alcoholism. One paper has found that alcohol use at an early age may affect gene expression that increases the risk of alcohol dependence. Individuals who have a genetic predisposition for alcoholism are also more likely to start drinking at an earlier age than the average. Also, a younger age of drinking onset is associated with an increased risk of developing alcoholism, and about 40 percent of alcoholics will drink excessively by their late teenagers. It is not entirely clear whether these associations are causal, and some researchers have been known to disagree with this view.
Severe childhood trauma is also associated with a general increase in the risk of drug dependence. Lack of peer and family support is associated with an increased risk of developing alcoholism. Genetics and adolescents are associated with increased sensitivity to the neurotoxic effects of chronic alcohol abuse. Cortical degeneration due to neurotoxic effects increases impulsive behavior, 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 central nervous system damage induced by alcohol. The use of marijuana is associated with later problems with alcohol use. Alcohol use is associated with increased possible use of tobacco, marijuana, and other illegal drugs.
Availability
Alcohol is the most widely used recreational drug, widely consumed, and widely misused. Beer alone is the most widely consumed alcoholic beverage in the world; this is the third most popular drink overall, after water and tea. It is estimated some people as the oldest fermented beverage.
Gender differences
Based on combined data from SAMHSA 2004-2005 National Survey on Drug & amp; Health, previous years of alcohol dependence or harassment among people aged 12 or over varying by alcohol use: 44.7% of heavy drinkers in the last month, beverage drinkers 18.5%, 3.8% drinkers did not eat parties, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or abuse in the past year. Men have a higher rate than women for all drink sizes in the past month: any alcohol use (57.5% vs 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10 , 5% vs 3.3%), and males were twice as likely as women to meet criteria for alcohol dependence or abuse in the past year (10.5% vs 5.1%).
Genetic variation
The genetic differences that exist between different racial groups affect the risk of developing alcohol dependence. For example, there are differences between African, East Asian and Indo-racial groups in how they metabolize alcohol. This genetic factor partially explains the different levels of alcohol dependence among racial groups. Alcohol dehydrogenase alleles ADH1 B * 3 cause faster alcohol metabolism. The ADH1 B * 3 allele is found only in African and Native American descent. African Americans and Native Americans with this allele have a lower risk of developing alcoholism. Native Americans, however, have a much higher level of alcoholism than the average; it is not clear why this happened. Other risk factors such as cultural environmental effects such as trauma have been proposed to explain the higher levels of alcoholism among Native Americans compared to the level of alcoholism in whites.
A genome association study of more than 100,000 human individuals identifies the gene variant of KLB , which encodes a transmembrane protein? -A variety, which is strongly associated with alcohol consumption. Protein? -Klotho is an important element in cell surface receptors for hormones involved in appetite modulation for simple sugars and alcohols.
Diagnosis
Definition
Abuse, use of problems, abuse, and excessive use of alcohol refers to alcohol abuse, which can cause physical, social, or moral harm to the drinker. The Dietary Guidelines for Americans define "moderate use" because no more than two alcoholic drinks a day for men and no more than one alcohol per day for women. Some drinkers can drink more than 600 ml of alcohol per day during heavy drinking periods. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, will be achieved by consuming five drinks for men or four for woman for two hours. According to the NIAAA, men may be at risk of alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5 ounces of distilled beverage. Despite this risk, a 2014 report in the National Survey on Drug and Health Use found that only 10% of "heavy drinkers" or "party drinkers" defined under the criteria above also met the criteria for alcohol dependence, while only 1.3% of drinkers non-party meets criteria. A conclusion drawn from this study is that evidence-based policy strategies and clinical prevention services can effectively reduce binge drinking without the need for addiction treatment in many cases.
Alcoholism
The term alcoholism is commonly used among lay people, but the word is not well defined. The WHO calls alcoholism the term long-term use and variable meaning, and the use of the term is disliked by the WHO's 1979 expert committee. The Big Book (from Alcoholics Anonymous) states that once a person is an alcoholic, they are always an alcoholic, but do not define what is meant by the term alcohol in this case. context. In 1960, Bill W., co-founder of Alcoholics Anonymous (AA), said:
- We never call alcoholism a disease because, technically, it is not a disease entity. For example, there is no such thing as heart disease. Conversely there are many separate heart disease, or a combination of them. It is something like that with alcoholism. We do not want to go wrong with the medical profession by calling alcoholism a disease entity. We always call it disease, or disease - a much safer term for us to use. In the context of professional and research, the term "alcoholism" sometimes includes alcohol abuse and alcohol dependence, and is sometimes considered equivalent to alcohol dependence. Talbot (1989) observes that alcoholism in the classic disease model follows a progressive development: if a person continues to drink, his condition will worsen. This will cause harmful consequences in their life, physically, mentally, emotionally and socially.
Johnson Typology
Johnson (1980) explores the emotional development of an addict's response to alcohol. He sees this in four phases. The first two are considered "normal" drinks and the latter two are seen as "ordinary" alcoholic beverages. The four phases of Johnson consist of:
- Learn the mood swings. Someone is introduced to alcohol (in some cultures this can happen at a relatively young age), and the person enjoys the happy feeling he or she produces. At this stage, there is no emotional cost.
- Look for mood swings. Someone will drink to regain the feeling of euphoria experienced in phase 1; drinking will increase as more intoxication is needed to achieve the same effect. Again at this stage, there are no significant consequences.
- In the third stage there are physical and social consequences, namely hangovers, family problems, work issues, etc. Someone will continue to drink excessively, ignoring the problem.
- The fourth stage can be detrimental, because Johnson cites it as the risk of premature death. As people now drink to feel normal, they block the feelings of guilt, regret, anxiety, and the embarrassment they experience when conscious.
Milam & amp; Phase of physical deterioration Ketcham
Other theorists like Milam & amp; Ketcham (1983) focuses on the physical deterioration that causes alcohol consumption. They describe the process in three stages:
- Adaptive stage - The person will not experience any negative symptoms, and they believe they have the capacity to drink alcohol without any problems. Physiological changes occur with increased tolerance, but these will not be seen by drinkers or others.
- Dependent stage - At this stage, symptoms accumulate gradually. Drunk symptoms of excessive drinking may be confusing with withdrawal symptoms. Many addicts will retain their drink to avoid getting sick from drinking, drinking small amounts regularly. They will try to hide their drinking problems from others and will avoid dirty poisoning.
- Stage of deterioration - Various organs damaged by long-term drinking. Medical treatment at the rehabilitation center will be needed; otherwise, pathological changes will lead to death.
DSM and ICD
In psychology and psychiatry, DSM is the most common global standard, while in medicine, the standard is the ICD. The terms they suggest are similar but not identical.
The diagnosis of alcohol dependence DSM-IV is 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 against each other. According to DSM-IV, the diagnosis of alcohol dependence is: "the use of maladaptive alcohol with clinically significant disturbances as manifested by at least three of the following in a period of one year: tolerance, withdrawal, taken in greater or greater amounts over a longer time of intended, failed desires or attempts to reduce or control the use of, much of the time spent obtaining, using, or recovering from use, social, occupational, or recreational activities provided or reduced, ongoing use in spite of knowledge of physical symptoms or psychological. "Regardless of the inherent ignorance of the term, there is an attempt to define how the word
AA describes alcoholism as a disease involving physical allergies (where "allergies" have different meanings than those used in modern medicine.) And mental obsessions. Doctors and addiction specialists William D. Silkworth MD writes on behalf of AA that "Alcoholics suffer" a desire (physical) beyond mental control. "A 1960 study by E. Morton Jellinek is considered the foundation of modern disease theory, alcoholism, Jellinek's definition of limiting the use of the word alcoholism for those who exhibit a particular natural history.The modern medical definition of alcoholism has been revised many times since then.The Medical Association uses the word alcoholism to refer to certain chronic primary diseases.
Social barriers
Social attitudes and stereotypes can create barriers to detection and treatment of alcohol abuse. This is more of a barrier for women than men. The fear of stigmatization can cause women to deny that they are suffering from medical conditions, to hide their drinking, and to drink alone. This pattern, in turn, causes families, doctors, and others to be less likely to suspect that a woman they know is an alcoholic. Conversely, reducing the fear of stigma can cause men to admit that they suffer from medical conditions, to display their drink in public, and drink in groups. This pattern, in turn, leads families, doctors, and others to be more likely to suspect that a man they know is an alcoholic.
Screening
Some tools can be used to detect the loss of alcohol use control. These tools are mostly self-reports in the form of questionnaires. Another common theme is scores or calculations that summarize the general severity of alcohol use.
The CAGE questionnaire, named for four questions, is one example that can be used to filter patients quickly in a doctor's office.
Two "yes" answers indicate that the respondent should be investigated further.
The questionnaire asked the following questions:
- Have you ever felt necessary C ut taken?
- Have people A notify you by criticizing your drink?
- Have you ever felt G guilty about drinking?
- Have you ever felt the need for a first beverage in the morning ( E ye-opener) to calm your nerves or get rid of a hangover?
- The CAGE questionnaire has shown great effectiveness in detecting alcohol related problems; However, he has limitations on people with alcohol-related problems that are less severe, white women and college students.
Other tests are sometimes used to detect alcohol dependence, such as the Alcohol Addiction Data Questionnaire, which is a more sensitive diagnostic test than the CAGE questionnaire. It helps to distinguish the diagnosis of alcohol dependence from one of the heavy alcohol use. The Michigan Alcohol Filtering Test (MAST) is a screening tool for alcoholism that is widely used by courts to determine appropriate penalties for people convicted of alcohol-related offenses, driving under the most common influence. The Alcohol Interference Disorder Identification Test (AUDIT), a screening questionnaire developed by the World Health Organization, is unique in that it has been validated in six countries and used internationally. Like the CAGE questionnaire, it uses a set of simple questions - high scores that get deeper inquiry. The Paddington Alcohol Test (PAT) is designed to screen for alcohol-related problems among those attending the Accident and Emergency department. This is in accordance with the AUDIT questionnaire but is given in one-fifth of the time. Certain blood tests may also indicate the possibility of alcoholism.
Genetic predisposition test
Psychiatric geneticist John I. Nurnberger, Jr., and Laura Jean Bierut stated that alcoholism has no cause - including genetics - but genes play an important role "by affecting processes in the body and the brain that interact with one another and with an individual's life experience for produce protection or vulnerability ". They also report that fewer than a dozen alcohol-related genes have been identified, but it is more likely to await discovery. At least one genetic test exists for alleles that correlate with alcohol and opiate addiction. The human dopamine receptor gene has a detectable variation called DRD2 TaqI porforphism. Those with A1 alleles (variations) of these polymorphisms have a small but significant tendency toward opiate addiction and drugs that release endorphins such as alcohol. Although this allele is slightly more common in alcoholics and opium, it is not in itself an adequate predictor of alcoholism, and some researchers argue that the evidence for DRD2 is contradictory.
Urine and blood test
There is a reliable test for actual alcohol use, a common test is the blood alcohol content (BAC). These tests do not distinguish alcoholics from non-alcohols; However, long-term heavy drinking does have some recognizable effects on the body, including:
- Macrocytosis (enlarged MCV)
- GGT is Elevated
- Medium AST and ALT elevation and AST ratio: ALT 2: 1
- Transferrin high carbohydrate deficiency (CDT)
With regard to alcoholism, BAC is useful for assessing alcohol tolerance, which in turn is a sign of alcoholism.
However, none of these blood tests for biological markers is as sensitive as the questionnaire.
Prevention
The World Health Organization, the European Union and other regional bodies, national governments and parliaments have formed an alcohol policy to reduce the danger of alcoholism. Targeting teenagers and young adults is considered an important step to reduce the danger of alcohol abuse. Increasing the age at which drug abuse such as alcohol can be bought, ban or limitation of alcohol advertising has been recommended as an additional way to reduce the danger of alcohol dependence and abuse. Credible evidence-based educational campaigns in the media about the consequences of alcohol abuse have been recommended. Guidelines for parents to prevent alcohol abuse among adolescents, and to help young people with mental health problems have also been suggested.
Management
Treatment varies because there are different perspectives of alcoholism. Those who approach alcoholism as a medical or disease condition recommend different treatments from, for example, those who approach the condition as one of the social options. Most treatments focus on helping people stop their alcohol intake, followed up with life training and/or social support to help them refuse to return to alcohol use. Because alcoholism involves many factors that drive a person to continue drinking, they must all be overcome in order to successfully prevent a recurrence. Examples of such treatments are detoxification followed by a combination of supportive therapy, presence in self-help groups, and the development of ongoing coping mechanisms. The treatment community for alcoholism usually supports a zero tolerance approach without abstinence; However, some prefer harm reduction approach.
Detoxification
Alcohol detoxification or 'detox' for alcoholics is a sudden stop of alcoholic beverages combined with drug substitutions, such as benzodiazepines, which have similar effects to prevent alcohol withdrawal. Individuals who are at risk for mild to moderate drug withdrawal symptoms may be detoxified as outpatients. Individuals at risk for severe withdrawal syndrome and those with significant or acute comorbid conditions are generally treated as hospitalized patients. Detoxification actually does not treat alcoholism, and needs to be followed up with detoxification treatment programs that are appropriate for dependence or alcohol abuse to reduce the risk of relapse. Some symptoms of alcohol withdrawal such as depression and anxiety usually take weeks or months to subside while other symptoms last longer because of long-lasting neuro-adaptations. Alcoholism has a serious adverse effect on brain function; on average it takes one year to abstain from recovering from the cognitive deficit caused by chronic alcohol abuse.
Psychological
Various forms of group therapy or psychotherapy can be used to deal with underlying psychological problems associated with alcoholism, as well as providing relapse prevention skills. This group counseling approach helps one another is one of the most common ways to help alcoholics maintain calm. Alcoholics Anonymous is one of the first organizations set up to provide counseling, non-professional, and it is still the largest. Others include LifeRing Secular Recovery, SMART Recovery, Women For Sobriety, and Secular Organizations for Sobriety. Allotment and moderation programs such as Moderation Management and DrinkWise do not mandate complete restrictions. While most alcoholics can not limit their drinking in this way, some return to moderate drinking. A 2002 US study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7 percent of people diagnosed as alcohol dependent more than a year earlier returned to low-risk beverages. However, this group showed fewer symptoms of initial dependence. A follow-up study, using the same subjects assessed in pardons in 2001-2002, examined the rate of return of drinking problems in 2004-2005. The study found that abstinence from alcohol is the most stable form of forgiveness to recover alcoholics. A long-term follow-up (60 years) of two groups of alcoholic men concluded that "a return to controlled drinking rarely persists for more than a decade without recurrence or evolution to be abstinent."
Drugs
In the United States there are four drugs approved for alcoholism: disulfiram, two forms of naltrexone, and acamprosate. Several other drugs are also used and many are being investigated. Benzodiazepines, while useful in the management of acute alcohol withdrawal, if used in the long run can lead to poor results in alcoholism. Alcoholics in chronic benzodiazepines have lower levels of abstaining from alcohol than those who do not use benzodiazepines. This class of drugs is commonly prescribed for alcoholics for insomnia or anxiety management. Initiating a recipe of benzodiazepines or hypnotic sedatives in individuals in recovery has a high rate of recurrence with one authors reporting more than a quarter of people relapse after being given hypnotic-tranquilizers. Those who are long-term users of benzodiazepines should not be withdrawn quickly, because severe anxiety and panic may occur, known as risk factors for recurrence to alcohol abuse. Taper regimes 6-12 months have been found to be the most successful, with a decrease in the intensity of withdrawal.
The Sinclair method is a method of using naltrexone or other opioid antagonists to treat alcoholism by having the person take medicine about an hour before they drink alcohol, and only then. These drugs inhibit the positive reinforcement effect of ethanol and hopefully allow people to stop drinking or drinking less.
The evidence does not support the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCA), antipsychotics, or gabapentin.
Addiction and dual dependency
Alcoholics also require treatment for other psychotropic drug addictions and drug dependence. The most common double-dependency syndrome with alcohol dependence is benzodiazepine dependence, with studies showing 10-20 percent of alcohol-dependent individuals having dependence problems and/or drug abuse problems of benzodiazepines such as valium or clonazopam. These drugs, such as alcohol, depressants. Benzodiazepines may be used legally, if prescribed by doctors for anxiety or other mood disorders, or they may be purchased as "illegal" drugs on the road through the illicit channels. The use of benzodiazepines increases the desire for alcohol and the volume of alcohol consumed by troubled drinkers. Benzodiazepine dependency requires careful dose reduction to avoid benzodiazepine withdrawal syndromes and other health consequences. Addiction to other hypnotic tranquilizers such as zolpidem and zopiclone and opiates and illicit drugs are common to alcoholics. Alcohol itself is a hypnotic and cross-tolerant sedative with other hypnotic tranquilizers such as barbiturates, benzodiazepines and nonbenzodiazepines. Dependence on and withdrawal from hypnotic tranquilizers can be medically severe and, like withdrawal of alcohol, there is a risk of psychosis or seizures if not managed properly.
Epidemiology
The World Health Organization estimates that in 2010 there were 208 million people with alcoholism worldwide (4.1% of the population over 15 years). Disturbance of substance use is a major public health problem facing many countries. "The most common substance of abuse/dependency in patients coming for treatment is alcohol." In the UK, the number of 'dependent drinkers' counted more than 2.8 million in 2001. Approximately 12% of American adults have had alcohol dependence problems at some point in their lives. In the United States and Western Europe, 10 to 20 percent of men and 5 to 10 percent of women at some point in their lives will meet the criteria for alcoholism. Estonia has the highest alcohol-related death rate in Europe by 2015 at 8.8 per 100,000 population.
In the medical and scientific community, there is widespread consensus about alcoholism as a disease state. For example, the American Medical Association considers alcohol as a drug and states that "drug addiction is a chronic and recurrent brain disease characterized by the search and use of compulsive drugs while often resulting in devastating consequences.This results from complex interactions of biological susceptibility, environmental exposure, and developmental factors (eg, the stage of brain maturity). "Alcoholism has a higher prevalence among men, although, in recent decades, the proportion of alcoholic women has increased. Current evidence suggests that in men and women, 50-60 percent of alcoholism is genetically determined, leaving 40-50 percent for environmental influences. Most alcoholics develop alcoholism during adolescence or young adulthood. 31 percent of students show signs of alcohol abuse, while six percent depend on alcohol. According to the new DSM definition of alcoholics, that means about 37 percent of students can meet the criteria.
Prognosis
Alcoholism often reduces a person's life expectancy by about ten years. The most common cause of death in alcoholics is from cardiovascular complications. There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. About 3-15 percent of alcoholics commit suicide, and research has found that more than 50 percent of all suicide cases are associated with alcohol or drug dependence. It is believed to be due to alcohol causing the physiological distortion of brain chemistry, as well as social isolation. Suicide is also very common in teenage adolescent alcoholics, with 25 percent of adolescent suicides associated with alcohol abuse. Among those who had alcohol dependence after one year, some met the criteria for low-risk drinking, although only 25.5 percent of the group received treatment, with the following details: 25 percent were found to be still dependent, 27.3 percent were in partial remission (some persistent symptoms), 11.8 percent of asymptomatic drinkers (consumption increases the likelihood of relapse) and 35.9 percent fully recovered - consisting of 17.7 percent low-risk drinkers plus 18.2 percent abstentions. In contrast, however, the result of long-term follow-up (60 years) of two groups of alcoholic men suggests that "return to controlled drinking rarely persists for more than a decade without recurrence or evolution becomes abstinence." There is also "re-dried drink, as reported in short-term studies, often a mirage."
History
Historically the name "dipsomania" was coined by German physician C. W. Hufeland in 1819 before being replaced by "alcoholism". The term now has a more specific meaning. The term "alcoholism" was first used in 1849 by Swedish physicist Magnus Huss to describe the systematic side effects of alcohol. Alcohol has a long history of usage and abuse throughout recorded history. Biblical, Egyptian and Babylonian sources record history of alcohol abuse and dependence. In some ancient cultures alcohol is adored and in others, its abuse is condemned. Alcohol abuse and excessive hangover are recognized as the cause of social problems even thousands of years ago. However, defining such drunken habits came to be known as and the ill consequences did not develop medically until the 18th century. In 1647 a Greek monk named Agapios was the first to document that chronic alcohol abuse was associated with toxicity to the nervous system and body resulting in various medical disorders such as seizures, paralysis, and internal bleeding. In 1920 the effects of alcohol abuse and chronic hangovers led to the failure of alcohol bans in the United States, a national constitutional ban on the production, import, transportation, and sale of alcoholic beverages remained in place until 1933. In 2005 alcohol dependence and abuse were estimated to cost the economy US about 220 billion dollars per year, more than cancer and obesity.
Society and culture
Various health problems associated with long-term alcohol consumption are generally considered to be detrimental to society, for example, money due to lost working hours, medical expenses due to hangover and organ damage from long-term use, and secondary care. costs, such as the cost of a rehabilitation facility and a detoxification center. Alcohol use is a major factor contributing to head injury, motor vehicle accidents (due to drunk driving), domestic violence, and assault. Beyond the financial costs imposed by alcohol consumption, there is also significant social cost for both alcoholics and their families and friends. For example, alcohol consumption by pregnant women can cause fetal alcohol syndrome, an incurable and destructive condition. Estimates of the economic cost of alcohol abuse, collected by the World Health Organization, vary from one to six percent of the GDP of a country. One estimate of Australia pegging the social cost of alcohol to 24% of all drug abuse costs; Similar studies in Canada concluded that alcohol was 41%. One study calculated the cost for the UK from all forms of alcohol abuse in 2001 amounting to Ã, £ 18.5 - 20 billion. All the economic costs in the United States in 2006 are estimated at $ 223.5 billion.
Alcoholic stereotypes are often found in fiction and popular culture. "Drunken city" is a stock character in Western popular culture. Drunken stereotypes may be based on racism or xenophobia, as in the Irish fictitious depiction as a heavy drinker. Studies by social psychologists Stivers and Greeley try to document the prevalence of high alcohol consumption felt among Irish people in America. Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. In Asian countries that have high gross domestic product, there is an increase in drinking compared to other Asian countries, but not as high in other countries as the United States. This is also inversely proportional to countries that have very low gross domestic product which shows high alcohol consumption. In a study conducted on Korean immigrants in Canada, they reported that liquor is even an integral part of their diet, and is the only time drinking alone should occur. They also believe that alcohol is needed at every social event because it helps start a conversation.
Caucasians had a much lower abstinence rate (11.8%) and a much higher tolerance of symptoms (3.4 Â ± 2.45 beverages) of alcohol compared to China (33.4% and 2.1 ± 1.78 drinks). Also, the more acculturation among cultures, the more influenced the culture is to adopt the practice of Caucasian drinking. Peyote, a psychoactive agent, has even shown promise in treating alcoholism. Alcohol actually replaces peyote as a native American psychoactive agent in a ritual when peyote is banned.
Research
Topiramate
Topiramate, a derivative of the natural sugar monosaccharide D-fructose, has been found to be effective in helping alcoholics stop or reduce the amount they drink. Evidence suggests that topiramate antagonizes glutamate receptors excite, inhibits dopamine release, and enhances the function of gamma-aminobutyric acid inhibition. However, a 2008 review of the effectiveness of topiramate concluded that published results of trials are promising, however, in 2008, data were insufficient to support the use of topiramate along with short weekly adherence counseling as a first-line agent for alcohol dependence. The 2010 review found that topiramate may be superior to existing pharmacotherapy options. Topiramate effectively reduces the fatigue and desperation of alcohol withdrawal as well as improves quality-of-life-rating.
Baclofen
Baclofen, a GABAB receptor agonist, is currently under investigation for the treatment of alcoholism. The systematic review of 2015 concluded that there was insufficient evidence for the use of baclofen for symptoms of withdrawal of alcoholism. There is a tentative data that supports baclofen in alcohol dependence but further trials are required in 2013.
Ondansetron
Ondansetron, a 5HT3 antagonist, seems promising as a treatment.
See also
References
External links
- Alcohol on Curlie (based on DMOZ)
- CAGE Questionnaire on NIH
- CIWA-Ar Score for Alcohol Withdrawal
- Reus, VI; Fochtmann, LJ; Bukstein, O; Eyler, AE; Hilty, DM; Horvitz-Lennon, M; Mahoney, J; Pasic, J; Weaver, M; Wills, CDs; McIntyre, J; Kidd, J; Yager, J; Hong, SH (January 1, 2018). "American Psychiatric Association Practice Guidelines for Pharmacology Treatment of Patients With Alcohol Use Disorders". The American Journal of Psychiatry . 175 (1): 86-90. doi: 10.1176/appi.ajp.2017.1750101. PMIDÃ, 29301420
Source of the article : Wikipedia
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