Alcoholism

The continuous or excessive use of alcohol (ethanol) with associated pathologic results. Alcoholism is characterized by constant or periodic intoxication, although the pattern of consumption varies markedly. Individuals admitted for the first time to an alcoholism treatment center typically have been consuming approximately 34 oz (80100 g) of pure alcohol per day, corresponding to about seven to nine drinks or bottles of beer or glasses of wine. Studies have shown that problem drinking in these populations starts at about 2 oz/day (60 g/day), that is, four to five drinks per day, and that these are consumed in rapid succession, leading to intoxication on three or more days per week. Individuals who consume these levels of alcohol have also a greater than average risk of developing alcoholic liver cirrhosis. However, the levels should not be taken as absolute, since they can vary greatly in different individuals, according to body weight and other factors. The symptoms and consequences associated with severe alcohol consumption also vary greatly; that is, in some individuals only a few may be present. These may consist of the development of physical dependence manifested as a state of physical discomfort or hyperexcitability (tremors or shakes) that are reduced by continued consumption; the development of tolerance to the effects of alcohol, which leads individuals to increase their consumption; accidents while intoxicated; blackouts, characterized by loss of memory of events while intoxicated; work problems, including dismissal; loss of friends and family association; marital problems, including divorce; financial losses, including bankruptcy or continual unemployment. Medical problems can include gastric ulcers, pancreatitis, liver disease, and brain atrophy. The last is often associated with cognitive deficiencies, as shown by the inability to comprehend relatively simple instructions or to memorize a series of numbers. See also Cognition. Almost without exception, individuals seeking an early treatment for their alcohol problems have very good probabilities of recovery. The lesser the number of presenting problems described above, the better the chances of favorable outcome, and so an early identification of problem drinking by family, friends, employers, or physicians becomes very important. The types of intervention vary greatly, progressing from self-monitoring techniques to intensive outpatient and inpatient programs to Alcoholics Anonymous groups. The exact mechanisms of the pharmacological actions of alcohol are not known. Alcohol can act as a stimulant at lower doses and as a depressant at higher doses. Even at very low doses alcohol can impair the sensitivity to odors and taste. Also, low doses are known to alter motor coordination and time and space perception, important aspects of car driving. Some effects are already seen at levels of 0.05%. Pain sensitivity is diminished with moderate doses. In some individuals, alcohol is known to diminish feelings of selfcriticism and to inhibit fear and anxiety, effects which are probably related to an alcoholinduced sociability. These effects act, no doubt, as psychological reinforcers for the use of alcoholic beverages. It is generally accepted that alcohol affects the nerve cell by preventing the production and propagation of electric impulses along a network consisting of axons and synapses. A major finding in the mid-1980s was that some of the neurologic effects of alcohol can be quickly reversed by new experimental drugs. Studies have shown that alcohol enhances the actions of an inhibitory brain neurotransmitter referred to as gamma-aminobutyric acid (GABA). Benzodiazepines, such as diazepam, are anxiety-reducing and sedative drugs

which also enhance the effects of GABA. These effects can be reduced by experimental antagonist molecules, which interact in the brain in the same regions where GABA is found. See also Synaptic transmission. The liver is responsible for about 80% of the metabolism of alcohol. In the liver, alcohol is first oxidized to acetaldehyde and then to acetate, which is metabolized in many tissues, including the brain, heart, and muscles. A 150-lb (68-kg) person metabolizes approximately 0.4 oz (10 g) of pure alcohol per hour (about 1 oz of a distilled beverage per hour) or, if alcohol is continuously present in the bloodstream, about 810 oz (190 240 g) of pure alcohol per day, equivalent to 13001600 calories per day. Since alcoholic beverages contain negligible levels of essential nutrients, these calories are called empty calories. Many alcoholics show malnutrition due to the fact that an important part of their caloric intake is alcohol. Alcohol also impairs the absorption and the metabolism of some essential nutrients. In the presence of alcohol, about 80% of oxygen consumed by the liver is devoted to the metabolism of alcohol; as a consequence, other substances such as fats, normally oxidized by the liver, are not metabolized, leading to fat accumulation in the liver. See also Liver; Malnutrition. Alcoholic liver disease is characterized by two conditions: failure of the liver to detoxify noxious substances and to produce essential products; and increased resistance to blood flow through the liver. Alcoholic liver disease and liver cirrhosis rank among the 10 leading causes of mortality in the United States and Canada. See also Cirrhosis. There is abundant evidence that tendency to alcoholism can be of familial origin, due to environmental, cultural, and genetic factors. A Swedish study demonstrated that identical twins are twice as likely to have a common alcoholic problem as fraternal twins. In an American-Danish study, it was shown that children of alcoholic parents are more likely to develop alcoholism (18%) than children of nonalcoholic parents (4%) when both groups of children were adopted by nonrelatives within 6 weeks of birth. See also Behavior genetics; Behavioral toxicology. Pharmacotherapy for alcohol rehabilitation has been gaining wider acceptance. Specific pharmacotherapies which have received the most research attention utilize naltrexone and disulfiram. Other promising pharmacological interventions are acamprosate and buspirone. Naltrexone is an opiate receptor antagonist which blocks the effects of endogenous opioids in the brain. Research from animal studies suggests that alcohol activates endogenous opioid systems and, thereby, may contribute to the pleasurable effects produced by alcohol consumption. Consequently, naltrexone might reduce the reinforcing effects of alcohol consumed by people and decrease their incentive to drink. Disulfiram is a drug which causes an inhibition of the enzyme aldehyde dehydrogenase, leading to an increase in acetaldehyde blood levels. This rise will produce nausea, vomiting, tachycardia, difficulty in breathing, and changes in blood pressure leading to hypotension. Acamprosate may function to reduce alcohol-induced euphoria related to the effects of excitatory neurotransmitters such as N-methyl-D-aspartate and have some blocking effects on opiate receptors. Buspirone, a nonbenzodiazepine antianxiety agent, may decrease anxiety symptoms associated with a protracted alcohol withdrawal syndrome, thus reducing alcohol relapse potential. Both of these medications require further investigation to determine their effectiveness as a pharmacotherapeutic agent in the treatment of alcoholism.

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Drug-Free 4 Mths Res Programme. Lasts a Lifetime. Get funding! www.addiction-helpline.co.uk Diagnosis Directory > Health > Medical Analysis Alcohol Abuse and Alcoholism What is alcoholism? Alcoholism is also known as "alcohol dependence." It is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law. Alcoholism includes four symptoms:

Craving--A strong need, or compulsion, to drink. Impaired control--The inability to limit one's drinking on any given occasion. Physical dependence--Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a period of heavy drinking. Tolerance--The need for increasing amounts of alcohol in order to feel its effects.

Why is alcoholism now considered a disease? Alcoholism is now accepted as a disease. It is a chronic and often progressive disease. Like many diseases, it has symptoms that include a strong need to drink despite negative consequences, such as serious job or health problems. Like many diseases, it has a generally predictable course and is influenced by both genetic (inherited) and environmental factors. Related Links on MedicineNet.com

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Directory > Reference > Britannica Concise alcoholism Excessive habitual consumption of alcoholic beverages despite physical, mental, social, or economic harm (e.g., cirrhosis, drunk driving and accidents, family strife, frequently missing work). Persons who drink large amounts of alcohol over time become tolerant to its effects. Alcoholism is usually considered an addiction and a disease. The causes are unclear, but there may be a genetic predisposition. It is more common in men, but women are more likely to hide it. Treatment may be physiological (with drugs that cause vomiting and a feeling of panic when alcohol is consumed; not an effective long-term treatment), psychological (with therapy and rehabilitation), or social (with group therapies). Group therapies such as Alcoholics Anonymous are the most effective treatments. Suddenly stopping heavy drinking can lead to withdrawal symptoms, including delirium tremens. For more information on alcoholism, visit Britannica.com.

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Effective, affordable, confidential alternative to rehab or treatment. www.homerecovery.us Encyclopedia Directory > Reference > Encyclopedia alcoholism, disease characterized by impaired control over the consumption of alcoholic beverages. Alcoholism is a serious problem worldwide; in the United States the wide availability of alcoholic beverages makes alcohol the most accessible drug, and alcoholism is the most prevalent of the nation's addictions (see drug addiction and drug abuse). The understanding of alcoholism, and hence its definition, continues to change. Many terms, often with hazy differences in meaning, have been used to describe different stages and manifestations of the disease. In 1992 the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published a definition reflecting the current understanding of the disease: 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, most notably denial. Each of these symptoms may be continuous or periodic. This definition recognizes alcoholism as a disease, i.e., as an involuntary disability. It accepts a genetic vulnerability in some people and identifies the phenomenon of denial as both a psychological defense mechanism and a physiological outcome of alcohol's effect on the memory. Physical Effects Intoxication Although anyone can become intoxicated while drinking, the alcoholic is less likely to recognize the signs and control his or her intake. Intoxication is produced by alcohol as it circulates in the blood and acts to depress the central nervous system (see depressant).

Alcohol can pass directly into the bloodstream. The absorption rate depends principally on the concentration of the drug in the stomach and small intestine. This concentration is limited by the presence of alcohol dehydrogenase. Because women normally carry less alcohol dehydrogenase in their intestines, they usually consume less alcohol than men before showing its effects. Alcohol is not stored in the body or excreted but is metabolized in the liver at a fixed rate of between 0.25 and 0.33 oz (7.19.4 grams) per hour, varying with the individual. Thus alcohol is found in the bloodstream and signs of intoxication appear when the rate of alcohol consumption is greater than the rate at which it is metabolized in the liver. At a blood level of about .05%, alcohol impairs concentration, visual function, psychomotor performance, and reaction time. For many years the legal standard for drunkenness in most states was a blood alcohol level of .10%, but in many states it now is .08%. The lethal level, often given as .60%, may be as low as .40% in some people. Blood alcohol concentrations are measured by breath (the Breathalyzer test), blood, or urine tests. Effects of Chronic Use Alcohol abuse can result in broad range of medical problems. Alcohol can reduce production of the sex hormone testosterone in males, resulting in impotence and testicular atrophy. Alcohol has a high caloric value but a low nutritional value. Its empty calories may allow the alcoholic to feel satisfied while actually progressing toward a state of serious malnutrition. Ailments that can result from alcohol consumption include cirrhosis, a liver ailment; diseases of the digestive system; damage to the heart; lowered resistance to infection; and cancer (larynx, esophagus, liver). Women who consume alcohol during pregnancy are at risk of delivering children with fetal alcohol syndrome, a syndrome of physical, developmental, and psychological problems. Although the medical effects of alcoholism have long been known, the study of how alcohol acts on the brain to produce intoxication, dependence, and tolerance is still new. Most studies focus on the effect of alcohol on cellular communication. These have found that different regions of the brain differ in their sensitivity to alcohol. In addition, alcohol affects many different kinds of receptors (see nervous system) and neurotransmitters, such as GABA, glutamate, and serotonin, creating different effects in each case. Whatever the exact mechanism, it is accepted that chronic consumption of alcohol results in disconnection of the fibers that connect brain cells, producing memory lapses, impaired learning ability, motor disturbances, and general disorientation. Two organic brain disorders, alcoholic dementia, characterized by general loss of intellectual abilities, and Wernicke-Korsakoff's syndrome, characterized by such symptoms as loss of physical coordination, incoherence, and mental confusion, are frequently seen in alcoholics. Withdrawal Alcohol, like all addictive drugs, produces physical dependence in the habitual user. A hangover, a combination of headache, nausea, fatigue, and depression, may be a mild type of withdrawal from alcohol. Sudden abstinence by the chronic alcoholic produces a severe withdrawal syndromeincluding tremors, vomiting, and convulsions resembling those of epilepsythat is more likely to cause death than withdrawal from narcotic drugs. The final and most dangerous phase in this withdrawal pattern is delirium tremens, a toxic psychosis characterized by insomnia, hallucinations, seizures, and maniacal behavior. Treatment

The treatment of alcoholism depends on how far the disease has progressed. Treatment typically begins with professional advice or self-motivation to abstain, often coupled with medical efforts to achieve sobriety. In the presence of withdrawal symptoms, antianxiety drugs such as benzodiazepines may be prescribed. A next step is often enrollment in a treatment program suitable to the severity of the disease and patient's social stability. Residential programs offer a supportive atmosphere and a structured environment in which the patient can begin to learn how to restructure his or her life and develop new habits. Many programs educate the family as well, alerting them to patterns within the family that may have enabled the patient to keep drinking. Because alcoholism is a chronic recurring and relapsing disease, treatment programs are usually followed by membership in a support group such as Alcoholics Anonymous. Medical treatment to help ensure continued sobriety includes self-administration of drugs such as Antabuse, which produces severe discomfort if present in the system when alcohol is consumed. Naltrexone, a drug formerly used in heroin abuse, and acamprosate are also now approved for use in the treatment of alcoholism. Naltrexone minimizes both the craving for alcohol and the high produced by its consumption. Acamprosate reduces the craving for alcohol in people who have stopped drinking. In addition to these standard treatments, many alcoholics are aided by alternative treatments such as acupuncture and hypnosis. Costs to Society Because alcohol can profoundly alter motor control and behavior (by blocking inhibitions, for example, and releasing aggressive behavior), it is one of the most dangerous drugs. A large proportion of arrests in the United States are for driving while under the influence of alcohol, and a high proportion of crimes of violence (e.g., child abuse, homicide, and suicide) are committed by people who have been drinking. In the United States, members of minority groups (with the exception of Asian Americans) are affected disproportionately by alcohol-related problems. At different stages in the course of the disease, the alcoholic may experience problems with family and friends, absenteeism and reduced productivity, accidents, violent behavior, increased tolerance and consumption, or blackouts (periods of alcohol-induced memory loss). As the disease progresses, more and more serious physical and social problems may emerge. Bibliography See P. G. Bourne and R. Fox, ed., Alcoholism (1980); E. L. Gomberg et al., ed., Alcohol: Science and Society Revisited (1982); M. Grant and B. Ritson, ed., Alcohol: The Prevention Debate (1983); M. Elkin, Families under the Influence (1984); D. Gallant, Alcoholism: A Guide to Diagnosis, Intervention, and Treatment (1987).

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alcoholism A chronic disease associated with the excessive and habitual use of alcohol; the disease, if left unattended, worsens and can kill the sufferer. Alcoholism is marked by physical dependency and can cause disorders in many organs of the body, including the liver (see cirrhosis), stomach, intestines, and brain. It is also associated with abnormal heart rhythms, with certain cancers, and, because of loss of appetite, with poor nutrition. The cause of alcoholism is very complicated and most often involves a mixture of physical, psychological, and possibly genetic factors.

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Discussions on how much is too much. www.HealthPolitics.com Medical Directory > Health > Medical Dictionary alcoholism (l'k-h-lz'm) n. 1. The compulsive consumption of and psychophysiological dependence on alcoholic beverages. 2. A chronic, progressive pathological condition, mainly affecting the nervous and digestive systems, caused by the excessive and habitual consumption of alcohol. Also called chronic alcoholism. 3. Temporary mental disturbance and muscular incoordination caused by excessive consumption of alcohol. Also called acute alcoholism.

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The noun alcoholism has 2 meanings: Meaning #1: Habitual intoxication; prolonged and excessive intake of alcoholic drinks leading to a breakdown in health and an addiction to alcohol such that abrupt deprivation leads to severe withdrawal symptoms Synonyms: alcohol addiction, inebriation, drunkenness Meaning #2: an intense persistent desire to drink alcoholic beverages to excess Synonyms: dipsomania, potomania

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CME Credit Webcast Learn New Treatment Modalities extendmed.com/alcoholtreatment Wikipedia Directory > Reference > Wikipedia alcoholism Alcoholism is the consumption of, or preoccupation with, alcoholic beverages to the extent that this behavior interferes with the drinker's normal personal, family, social, or work life, and may lead to physical or mental harm. The resulting chronic use can result in many psychological and physiological disorders. Alcoholism is one of the world's most costly drug use problems; with the exception of nicotine addiction, alcoholism is more costly to most countries than all other drug use problems combined. The biological mechanism of alcoholism is unknown. While alcohol use is required to trigger alcoholism, the majority of the population can drink alcoholic beverages with no danger of suffering from it. One of several other factors must exist for alcohol use to develop into alcoholism. These factors may include a person's social environment, emotional health and genetic predisposition. An alcoholic can develop several forms of addiction to alcohol simultaneously (psychological, metabolic, and neurochemical) and they all must be treated in order to effectively treat the condition.

Terminology
Many terms are applied to a drinker's relationship with alcohol. Use, misuse, heavy use, abuse, addiction, and dependence are all in common use, but the actual meaning of these words can vary greatly depending upon the context in which they are used. Even within the medical field the definition can vary between areas of specialization, and the introduction of politics and religion can result in a hazardous level of ambiguity. Use refers to simple use of a substance. An individual who drinks any alcoholic beverage is using alcohol. Misuse and heavy use do not have standard definitions, but suggest consumption of alcohol beyond the point where it causes physical, social, or moral harm to the drinker. Social and moral harm are highly subjective and therefore differ from individual to individual. The term abuse has a variety of possible meanings. Within psychiatry, the DSM-IV has a specific definition involving a set of life circumstances which take place as a result of substance use. Within politics, abuse is often used to refer to the illegal use of any substance. Within the broad field of medicine, abuse sometimes refers to use of prescribed medication in excess of the prescribed dosage or to use of a prescription drug without a prescription. Within religion, abuse can refer to any use of a poorly regarded substance. The term can therefore cause confusion due to the possibility that an audience doesn't share a single definition.

Dependence also has multiple definitions, but is not as commonly used as abuse outside of the medical profession. Physical medicine considers dependence to be the body's physical adaptation to the persistent presence of alcohol. Psychological medicine considers dependence to be a person's mental reliance upon something to maintain their mental status quo. These two are occasionally differentiated as physical and psychological dependence. The precise definition of addiction is debated, but in general it refers to any condition which results in the continuation of behaviors demonstrated as harmful to that person. For alcoholism, that behavior is the consumption of alcoholic beverages. Some conditions which contribute to alcoholism include physical dependence, neurochemical conditioning, and a person's perception that alcohol benefits them psychologically or socially.

Epidemiology
Substance use disorders are the major public health problem facing many countries. In the United States today, more than 15 million Americans are estimated to suffer from alcoholism. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol."[1] In the United Kingdom, the number of 'dependent drinkers' was calculated as over 2.8 million in 2001.[2] "It is not possible to estimate the total number of alcohol dependants in [the Republic of] Ireland, but one source suggests that as many as 95,000 of the estimated 1.9 million drinkers will go on to develop a problem with alcohol."[3] Those with the condition are classified by the American Psychiatric Association as either actively having difficulties as a result of the use of alcohol, or being in early or sustained remission. The latter two groups may be further identified as being partial or full depending upon the patient's symptom profile. Remission states refer not to the quantity of alcohol being used but rather to the decrease in physical or mental symptoms resulting from such use. There is considerable debate regarding the Disease Theory of Alcoholism. Proponents argue that any structural or functional disorder should be classified as a disease. Opponents cite the inability to pin down the behavioral issues to a physical cause as a reason for avoiding classification.

Identification and diagnosis

Identification of alcoholism may be difficult because there is no detectable physiological difference between a person who drinks a lot and a person who can't control his or her drinking. As a result, identification involves an objective assessment regarding the damage that the consumption of alcohol does to the drinker's life compared to the perceived subjective benefits that the drinker perceives from that consumption. While there are many cases where an alcoholic's life has been significantly and obviously damaged, there are still a large number of borderline cases that can be difficult to classify.

Screening
Several tools may be used to detect the loss of control of alcohol use. 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 indicate that the respondent should be investigated further. The questionnaire asks the following questions: 1. Have you ever felt you needed to Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you ever felt Guilty about drinking? 4. 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?[4][5] Another screening questionnaire is the Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization. The Alcohol Dependence Data Questionnaire[6] 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 heavy alcohol use. The CAGE questionnaire, among others, has been extensively validated for use in identifying alcoholism. Its use has not been validated for diagnosis of other substance use disorders, although somewhat modified versions of the CAGE are frequently implemented for such a purpose. Another screening tool for alcoholism is the Michigan Alcohol Screening Test (MAST) [1]. This test is widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses, driving under the influence being the most common.

DSM diagnosis
The DSM-IV diagnosis of alcohol dependence represents another approach to the definition of alcoholism, one more closely based on specifics than the 1992 committee definition. In part this is to assist in the development of research protocols in which findings can be compared with one another, but the DSM definition is the one currently in general use from a diagnostic standpoint. That definition is: maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae.

Urine and blood tests

Although there are reliable tests for the actual use of alcohol, there is no test available that can differentiate between a person that drinks a lot and a person who can't control their drinking. Long term heavy drinking, however, does have a few recognizable effects on the body, including:

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

Effects
The only effect of alcoholism is to encourage the sufferer to drink at times and in amounts that are damaging. The secondary damage caused by an inability to control one's drinking manifests in many ways.

Long term physical health effects

See also: Effects of alcohol on the body and Alcohol consumption and health The long term health effects caused by the consumption of large amounts of alcohol (both by alcoholics and non-alcoholics) may include:

death from many sources, primarily alcohol toxemia pancreatitis, or inflammation of the pancreas (both the acute and chronic form) heart disease, including dilated cardiomyopathy polyneuropathy, or damage to the nerves leading to poor sensation of pain and impaired mobility 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 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 some alcoholics sexual dysfunction

Social effects
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. 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 a topic of research. Adult Children of Alcoholics (ACoA) World Service provides support for such individuals. A study quantified the cost to the UK of all forms of alcohol misuse as 18.520 billion annually (2001 figures).[7][2]

Alcohol withdrawal
There are several distinct but not mutually exclusive 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 (Lowinson), 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.

Treatments
Treatments for alcoholism are quite varied in keeping with the multiple perspectives regarding the condition itself. Those approaching the condition as a medical disease recommend differing treatment processes and goals than, for instance, those approaching the condition as one of social choice. Most treatments focus on helping people discontinue their alcohol and sedative intake, then providing life training and/or social support in order to help them resist a return to sedative use. Since alcoholism involves multiple factors which encourage a person to continue drinking (psychological/social, physical, and neurochemical), all of these factors must be addressed in order to successfully prevent a return to active alcohol use. The most common approach to treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism typically supports an abstinencebased approach, though some promote the harm-reduction approach generally used for opioid dependence.[1] The effectiveness of alcoholism treatments vary from good to counterproductive. When considering the effectiveness of treatment options it is important to consider the percentage of those who enter a program, not just those who complete it. Most programs can boast a high cure rate for those who complete it because most people only complete a program if it works for them. It is also important to consider not just the rate of those reaching sobriety but the rate of those relapsing.

Detoxification
Detoxification (a.k.a. "detox") is the process of eliminating alcohol drinking and giving the drinker's system time to re-adjust to the absence of alcohol. Drugs that have similar effects are used to ease the withdrawal symptoms, which can be deadly in extreme cases if left untreated. Often used drugs are sedative-hypnotics, such as diazepam or clonazepam or, less frequently, barbiturates such as phenobarbital. Many weeks thereafter individuals may still suffer from milder withdrawal symptoms; sleep is generally the last function to return to normal. Sedatives are used with possible approaches:

a) Sedative-loading is a process through which patients are gradually given increasing doses of the taper medication to determine the level of tolerance already present as a result of ongoing alcohol use. Once the level is determined, the medication is gradually tapered from that point. b) Patients are given doses of the taper medication depending upon the level of withdrawal symptoms present. Patients then are monitored for withdrawal symptoms and medicated as needed over the course of several days. Detoxification is not a treatment for alcoholism, but is simply a treatment of the physiologic effects of ongoing use of alcohol. It provides an initial path for an alcoholic to stop drinking in the first place. Detoxification without supplemental treatments to help the patient continue abstinence have a very high rate of relapse. Detoxification often takes place within an inpatient environment, but several programs offer outpatient detoxification.

Group therapy and psychotherapy

After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues leading to alcohol dependence, and also to provide the recovering addict with relapse prevention skills. In the mid-1930s, the mutual-help group-counseling approach to treatment began and has become very popular. Alcoholics Anonymous is the best-known example of the support group movement. Other groups that provide similar self-help and support without AA's spiritual focus include LifeRing Secular Recovery, Smart Recovery, Women For Sobriety, and Rational Recovery.

Rationing
Some programs attempt to help problem drinkers before they become dependents. These programs focus on harm reduction and reducing alcohol intake as opposed to abstinencebased approaches. Since one of the effects of alcohol is to reduce a person's judgement faculties, each drink makes it more difficult to decide that the next drink is a bad idea. As a result, rationing or other attempts to control use are increasingly ineffective if pathological attachment to the drug develops. Nonetheless, this form of treatment is initially effective for some people, and it may avoid the physical, financial, and social costs that other treatments result in, particularly in the early phase of recovery. Professional help can be sought for this form of treatment from programs such as Moderation Management.

Medications
Medications for alcoholism are most often used to supplement a person's willpower and encourage abstinence. Antabuse (disulfiram), for instance, prevents the elimination of a chemical (acetaldehyde) which cause severe discomfort when alcohol is ingested, effectively preventing the alcoholic from drinking in significant amounts while they take the medicine. Heavy drinking while on Antabuse can result in severe illness and death.

Naltrexone has also been used because it helps curb cravings for alcohol while the person is on it. Both Antabuse and Naltrexone used to encourage abstinence, however, have been demonstrated to cause a rebound effect when the user stops taking them. Vivitrol is a time-release formulation of naltrexone that may alleviate the problems caused by intermittent usage. Approved by the Food and Drug Administration (FDA) in June 2006, Vivitrol is injected in the buttocks once a month by a health care professional. This means that the decision to continue to use the medication only needs to be made once a month rather than daily. Endorphin antagonists (e.g. naltrexone, nalphamene, noloxone) are also used in a process called pharmacological extinction, which is an attempt to reverse the conditioning which results in alcoholism. No rebound effect is demonstrated from pharmacological extinction. Sodium oxibate, the sodium salt of gamma-hydroxybutyric acid (50 to 100 milligrams per kilogram per day, in 3 or more divided doses) is used in Italy, under the trade name Alcover, both for acute alcohol withdrawal and medium to long term detoxification. Naltrexone, Vivitrol, and Acamprosate may improve compliance with abstinence planning by treating the physical aspects of cravings to drink. The standard pharmacopoeia of antidepressants, anxiolytics, and other psychotropic drugs treat underlying mood disorders, neuroses, and psychoses associated with alcoholic symptoms.

Pharmacological extinction
See also: Sinclair Method Pharmacological extinction is the use of opioid antagonists [e.g. naltrexone] combined with normal drinking habits in order to eliminate the craving to consume alcohol[8]. While standard naltrexone treatment uses the drug to curb craving and enforce abstinence, pharmacological extinction targets the endorphin-based neurological conditioning. Our behaviors become conditioned when we do something and endorphin bathes our neurons, and that conditioning is reversed when we do that thing and we don't receive the endorphins. By having the alcoholic go about their normally drinking habits (limited only by safety concerns) while preventing the endorphins released by the alcohol from rewarding the drinker's neurochemistry, the desire to drink is eliminted over a period of about three months. This allows an alcoholic to give up drinking as being sensibly unbeneficial. The effects persist after the drug is discontinued, but the addiction can return if the person drinks without first taking the drug. This treatment is highly unusual in that it works better if the patient does not go through detoxification prior to starting it. This technique is used to good effect in Finland[9], Pennsylvania[10], and Florida[11], and is sometimes referred to as the Sinclair Method. There is a lot of professional bias against this treatment for two reasons. Pendery et al in 1982[12] demonstrated that controlled drinking by alcoholics was clearly not a useful treatment technique. Many studies have also been done which demonstrate naltrexone to be of questionable value in supporting abstinence. For those who don't understand the mechanism involved, these results have been assumed to reflect the effectiveness of the two treatments in combination. This logic is faulty because it assumes that the two treatments are merely complementary, like two people pushing a car, as opposed to sequential, like turning a doorknob and then pulling on it.

The Finnish study[13] indicated, "Naltrexone was not better than placebo in the supportive groups, but it had a significant effect in the coping groups: 27% of the coping/naltrexone patients had no relapses to heavy drinking throughout the 32 weeks, compared with only 3% of the coping/placebo patients. The authors' data confirm the original finding of the efficacy of naltrexone in conjunction with coping skills therapy. In addition, their data show that detoxification is not required and that targeted medication taken only when craving occurs is effective in maintaining the reduction in heavy drinking."

Nutritional therapy
Not a treatment of alcoholism itself, but rather a treatment of the difficulties that can arise after years of heavy alcohol use: 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 behavior 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.[14]

Return to normal drinking

It has long been argued that alcoholics cannot learn to drink in moderation. The literature is heavy with research that has demonstrated the long-term failure of programs with such goals; despite this, research by the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicates that nearly 18% of such individuals in the US whose dependence began more than one year earlier are now drinking in moderation.[15]

Societal impact
The various health problems associated with long-term alcohol consumption (discussed above) are generally perceived as costing society money due to lost labor-hours, medical costs, and secondary treatment costs, as well as the pain and suffering of the indivuals affected. Additionally, alcohol use is a major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. Heavy alcohol consumption by a pregnant woman can also lead to fetal alcohol syndrome, an incurable and damaging condition. Today, alcohol use and alcohol dependence are major public health problems in North America, costing the region's inhabitants, by some estimates, as much as US$170 billion annually. Of the 50% of the North American population who consume alcohol, it has been estimated that 10% are heavy alcohol users and alcohol dependents, and 6% account for more than half of all the alcohol consumption in the region.[citation needed]

Stereotypes
Stereotypes of alcoholics are often found in fiction and popular culture. Common examples include the "town drunk," or the portrayal of certain nationalities as alcoholics; in America, for example, the Irish were viewed stereotypically as much more likely to become alcoholic. In modern times, the recovery movement has led to more realistic depictions of problems that result from heavy alcohol use, such as in Charles R. Jackson's The Lost Weekend, or the films Days of Wine and Roses, My Name is Bill W, Leaving Las Vegas and Clean and Sober (Michael Keaton, 1988). Author Charles Bukowski describes his own alcohol addiction in the movie Barfly and in his other writings.

Politics and public health

Because alcohol use disorders impact 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. Organizations working with those suffering from alcoholism include:

Alcoholics Anonymous (AA) International Organisation of Good Templars (IOGT) LifeRing Secular Recovery (LifeRing) Men For Sobriety (MFS) Moderation Management (MM) Rational Recovery (RR) Secular Organizations for Sobriety (SOS) Smart Recovery (Self Management And Recovery Training - SMART) Women For Sobriety (WFS) Narcotics Anonymous (NA), Alcohol is a drug, although not a narcotic.

See also

Addiction Adult Children of Alcoholics Alcohol-related traffic crashes Alcohol tolerance Alcoholics Anonymous Delirium tremens Disease Theory of Alcoholism Drug addiction Drunkenness List of famous deaths through alcohol List of fictional alcoholics List of famous alcoholics List of iconic drinkers Substance abuse Wernicke-Korsakoff syndrome Medical diagnostic tests used in alcoholism: liver function tests, full blood count and other Films about alcoholism: Leaving Las Vegas (1995), When a Man Loves a Woman (1994)

References
1. ^ a b Gabbard: "Treatments of Psychiatric Disorders". Published by the American

Psychiatric Association: 3rd edition, 2001, ISBN 0-88048-910-3 2. ^ a b Cabinet Office Strategy Unit Alcohol misuse: How much does it cost? September 2003 3. ^ Dr Desmond Corrigan Facts About Drug Misuse in Ireland Chapter 4 - Alcohol

4. ^ Ewing, John A. Detecting Alcoholism: The CAGE Questionnaire JAMA 252: 1905-1907, 1984 5. ^ CAGE Questionnaire (PDF) 6. ^ Alcohol Dependence Data Questionnaire (SADD) 7. ^ BBC Q&A: The costs of alcohol 19 September 2003 8. ^ Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism 9. ^ ContrAl Clinics ContrAl Results 10. ^ The Sinclair Method 11. ^ University of Pennsylvania Health System 12. ^ Pendery et al. Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study. Science. 1982 Jul 9;217 (4555):169-75 13. ^ Heinala, Pekka; Alho, Hannu; Kiianmaa, Kalervo; Lonnqvist, Jouko; Kuoppasalmi, Kimmo; Sinclair, John Targeted Use of Naltrexone Without Prior Detoxification in the Treatment of Alcohol Dependence: A Factorial DoubleBlind, Placebo-Controlled Trial J Clin Psychopharmacol 21(3):287-292, June 2001 14. ^ The Hypoglycemic Health Association of Australia 15. ^ National Institute on Alcohol Abuse and Alcoholism 2001-2002 Survey Finds That Many Recover From Alcoholism Press release 18 January 2005

External links

National Institute on Alcohol Abuse and Alcoholism (NIAAA) Stanton Peele Addiction Website A web site dedicated to exploring popular myths and controversies regarding alcoholism and addiction treatment, prevention and research. Baldwin Research Institute Independent Research on Alcoholism and Drug Addiction Alcoholics Anonymous Online Screening Test for Alcohol Abuse Alcohol Tolerance May Be Genetic health.dailynewscentral.com Drink Too Much? by David J. Hanson Alcoholics can Drink in Moderation Invited Interview from the Oxford Journal of Medicine on the use of Naltrexone to treat alcoholism Alcoholism news page - Alcohol and Drugs History Society

Further reading

Berry, Ralph E.; Boland James P. The Economic Cost of Alcohol Abuse The Free Press, New York, 1977 ISBN 0-02-903080-3 Royce, James E. and Scratchley, David Alcoholism and Other Drug Problems Free Press, March 1996 ISBN-10: 0-684-82314-4 ISBN-13: 978-0-684-82314-0