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Alcoholism is a dependency on alcoholic beverages characterized by craving (a strong need to drink), loss of control (being unable to stop drinking despite a desire to do so), physical dependence, tolerance (increasing difficulty in becoming drunk), and withdrawal symptoms. It can also be described as an addiction to alcoholic beverages that results in a consumption of alcohol in circumstances that damage one's ability to pursue one's other desires.

"King Alcohol and his Prime Minister" circa 1820

Biological Cause of Alcoholism

The consumption of alcohol causes a release of endorphins into our system. Endorphins are one of our body's learning mechanisms - they act as a reward system to encourage the behaviors and sensations that were just performed and experienced, encouraging us to do them again. They function by increasing the strength of neural pathways that have recently been used. Over time this builds up a craving that results in uncontrolled drinking.

People with a more active endorphin release system get a heavier dose of this encouragement and are therefore more susceptible to alcoholism. This mechanism for addiction is identical to those for opiates and thrill seeking behaviors like gambling.

Alcoholism as a Disease

The American Psychiatric Association no longer recognizes the existence of "alcoholism" as a diagnostic category. With the publication of the DSM-III in 1980, two separate syndromes of alcohol dependence and alcohol abuse replace the earlier category. Although the word "alcoholism" survives in popular usage and in the literature of certain groups such as Alcoholics Anonymous, the medical community recognizes the term through those two syndromes. [1] The World Health Organization also dropped the diagnostic category "alcoholism" in 1979, replacing it with the diagnostic categories "alcohol dependence" and "harmful use" (ICD-9, ICD-10). [2]

Although acceptance of the disease model is declining, the American Hospital Association, the American Public Health Association, the National Association of Social Workers, and the American College of Physicians classify "alcoholism" as a disease.

The American Psychiatric Association recognizes alcohol abuse disorder and alcohol dependence disorder as two separate substance related disorders. The idea that alcoholism is a disease is more in congruence with the beliefs of Alcoholics Anonymous than the consensus of the scientific community.

In a 1992 JAMA article, the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published this definition for alcoholism: "Alcoholism is a primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic."

It must be borne in mind that the National Council on Alcoholism and Drug Dependence is an organization founded by AA member Marty Mann in order to promote AA's views of alcohol and alcoholism, rather than to further scientific research.

The causes for alcohol abuse and dependence cannot be easily explained. However, the unscientific prejudice the roots are from moral or ethical weakness on the part of the sufferer has been largely altered. A recent poll found that 90% of Americans currently believe that "alcoholism" is a disease.

Effects

Today, alcohol abuse and alcohol dependence are major public health problems in North America, costing the region's inhabitants an estimated US$170 billion annually. Alcohol abuse and alcohol dependence are life-threatening problems that sometimes end in death, particularly through liver, pancreatic, or kidney disease, internal bleeding, brain deterioration, alcohol poisoning, and suicide. Heavy alcohol consumption by a pregnant mother can also lead to fetal alcohol syndrome in the fetus, an uncurable and damaging condition.

Additionally, alcohol abuse and alcohol dependence are major contributing factors for head injuries, motor vehicle accidents (MVA), violence and assaults, neurological, and other medical problems ( cirrhosis, etc.).

Of the one half of the North American population who consume alcohol, it has been estimated by some that 10% are alcohol abusers and alcohol dependents, and 6% consume more than half of all alcohol.

Stereotypes of alcohol abusers and alcohol dependents are often found in fiction and popular culture: for example the "town drunk," or the stereotype of Russians and the Irish as alcoholics. In modern times, the recovery movement has led to more realistic portraits of abusers and dependents and their problems, such as in Charles R. Jackson's The Lost Weekend, or the films Days of Wine and Roses, and My Name is Bill W.

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 can be quite severe and dangerous, with death reported in extreme cases.

Screening

Several tools may be used to detect the habitual abuse of alcohol. The CAGE questionnaire, developed by Dr. John Ewing and named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.

Two "yes" responses for a male and one "yes" response for a female indicate that the respondent 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 (Eye-opener) to steady your nerves or to get rid of a hangover?

Another screening questionnaire is the Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization.

The Alcohol Dependence Data Questionnaire [3] is a more sensitive diagnostic test than the CAGE test. The Alcohol Dependence Data Questionnaire serves to distinguish a diagnosis of alcohol dependence from one of alcohol abuse.

Blood tests

Although there is no blood test specific for alcohol abuse or alcohol dependence, prolonged heavy alcohol consumption may lead to several abnormalities, including:

Macrocytosis (enlarged MCV)¹
Elevated GGT²
Moderate elevation of AST and ALT and an AST:ALT ratio of 2:1.
High carbohydrate-deficient transferrin²

Medical effects

The long-term effects of alcohol dependency can include:

pancreatitis, or inflammation of the pancreas (but the acute and chronic form)
heart disease, including coronary artery disease and dilated cardiomyopathy
polyneuropathy, or damage to the nerves leading to poor sensation or pain
cirrhosis of the liver, a chronic disease characterized by destruction of liver cells and loss of liver function, and its numerous complications, including bleeding from esophageal varices
depression, insomnia, anxiety, and suicide
hypertension (high blood pressure)
increased incidence of many types of cancer, including breast cancer, head and neck cancer, esophageal cancer and colorectal cancer
nutritional deficiency of folic acid, thiamine (vitamin B1) and several others
Wernicke-Korsakoff syndrome, a neuropsychiatric disorder caused by thiamine deficiency that results from poor nutrition in alcoholics
Personality changes toward others, especially those who are close
significant damage to occupational, social, and interpersonal areas, including sexual dysfunction

Treatments

Treatments for alcohol dependence include detoxification programs run by medical institutions. These may involve stays for a number of weeks in specialized hospital wards where drugs may be used to avoid withdrawal symptoms, which in severe cases may lead to death.

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 abstinence planning. The standard pharmocopoeia of antidepressants, 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 alcohol dependents 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 alcohol dependents in treatment. The metabolic aspects of such dependence are often overlooked, resulting in poor treatment outcomes. See: [4]

In the mid-1930s, the mutual-help group-counselling approach to treatment began and has become very popular. Alcoholics Anonymous is possibly the best-known example of this movement.

Some programs attempt to help problem drinkers before they become dependents. These programs focus on harm-reduction and reducing alcohol intake as opposed to cold-turkey approaches. One such program is called Moderation Management.

Social impact

File:Daddydontdrink.jpeg

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

The social problems arising from alcohol abuse 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. Alcohol dependence affects not only the addicted but can profoundly impact the family members around them. Children of alcohol dependents can be affected even after they are grown; the behaviors commonly exhibited by such children are collectively known as Adult Children of Alcoholics Syndrome. Al-Anon/Alateen, a group modelled after Alcoholics Anonymous, offers aid to friends and family members of alcohol dependents.

Many people incorrectly assume that once an alcohol dependent stops drinking, all is well. However, many people who have stopped drinking still refer to themselves as "alcoholics" or "recovering alcoholics." Thought patterns may also continue to be impaired as in the Dry drunk syndrome.

Social dependence versus physical dependence

Symptoms of a person's dependence on alcohol may include, but are not limited to, a feeling of necessity in regard to consumption of alcohol, or an inability to resist alcohol if offered. Though these symptoms often arise from a physical dependence on the substance, it is not uncommon for individuals, especially teenagers and adolescents between the ages of fifteen and twenty, to rely on alcohol as a means of social interaction. If a person cannot refuse alcohol in the presence of others, insists on drinking alcohol excessively for fear of alienation and neglect, or feels they cannot socially interact with others unless under the influence then this person is considered socially dependent on the substance.

These traits can be noticed in individuals with no history of alcohol consumption who relocate (such as students attending a new university) whereby an individual begins to consume alcohol in order to associate and relate to others. Social dependence, though not physically threatening in early stages, can lead to physical dependence if the person cannot control their urges and moreso their reasons for drinking.

It should be noted that use of the term 'urges' are not merely to express a sense of want for the taste of alcohol, but could also be an urge that is stimulated by an individuals satisfaction in what is often referred to as "the buzz." It is a sense of euphoria brought on in people bearing a low tolerance to alcohol in about 2-3 standard drinks in a short period of time. Individuals bearing a higher tolerance to alcohol usually still crave "the buzz". Over time, the amount of alcohol needed to achieve the same affect increases as tolerance increases.

A persons "social dependence" is defined by the Prevention Research Institute from Kentucky (www.askpri.com) as a condition that a person experiences and re-experiences in a social setting. It reflects the habitual experiences one has as they enjoy "partying" with the same people.

Alcohol politics and public health

Because alcohol abuse affects society as a whole, governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. The World Health Organization, the European Union and other regional bodies are working on alcohol action plans and programs.

Organisations working with alcohol abusers include:

Alcoholics Anonymous (AA)
IOGT International (IOGT)
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 alcohol withdrawal syndromes caused by alcohol withdrawal:

Tremulousness - "the shakes"
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 unpleasant but never fatal, alcohol withdrawal can kill (by uncontrolled convulsions or delirium tremens) if it is not properly managed. 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 is substituted to block the alcohol withdrawal syndrome. The benzodiazepine dosage is then tapered slowly over a period of days or weeks.

External links

References

1. Tonnesen H, Hejberg L, Frobenius S, Andersen JR. Erythrocyte mean cell volume--correlation to drinking pattern in heavy alcoholics. Acta Med Scand. 1986;219(5):515-8. (Medline abstract)

2. Schwan R, Albuisson E, Malet L, Loiseaux MN, Reynaud M, Schellenberg F, Brousse G, Llorca PM. The use of biological laboratory markers in the diagnosis of alcohol misuse: an evidence-based approach. Drug Alcohol Depend. 2004 Jun 11;74(3):273-9. (Medline abstract)

3. Ewing, John A. “Detecting Alcoholism: The CAGE Questionaire” JAMA 252: 1905-1907, 1984

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 ==External links==
 * [http://atoz.iqhealth.com/HealthAnswers/encyclopedia/HTMLfiles/2790.html Alcohol dependence at iqhealth.com]
+* [http://www.al-hikmah.org/alcohol-abuse-and-alcoholism.asp Alcohol Abuse and Alcoholism (Alcohol Dependence)]
 * [http://www.mental-health-matters.com/disorders/dis_details.php?disID=4 Mental Health Matters: Alcohol Addiction]
 * [http://www.psychforums.com/forums/viewforum.php?f=152 Psych Forums: Alcohol Addiction Forum]