Alcohol dependence syndrome

The harmful use of alcohol results in 2.5 million deaths each year.
320,000 young people between the age of 15 and 29 die from alcohol-related causes, resulting in 9%
of all deaths in that age group.

http://www.who.int/substance_abuse/facts/en/
The harmful use of substances such as psychoactive drugs, tobacco or
alcohol has becoming the global problem nowadays to both individual
and to social development. The health problems associated with the
misuse of alcohol consumption especially, have reached the alarming
levels compromising wide range of diseases, health conditions and high
risk behaviour associated with mental disorders, road traffic injuries,
and unsafe sexual behaviour. According to the statistic from WHO, 2.5
million death each year resulted from the harmful use of alcohol and
320 000 young people between age of 15 and 29 die from alcohol
related causes, contributing 9% of all deaths in that age group.
Besides, there has been a greater increase to the psychiatric diagnosis
of alcohol dependence syndrome, which is the most severe stage group
of drinking problems which started with binge drinking and alcohol
abuse.
Alcohol dependence syndrome can be defined as a group of
physiological, behavioural and cognitive phenomena where the
consumption of alcohol takes a higher priority for that individual than
the other activities. The main features for the individual with the
dependence syndrome are the strong desire to drink alcohol, and
returning to take alcohol after a period of abstinence. This would result
more rapid and severe reappearance of other features of the syndrome
such as narrowing of the drinking repertoire, appearance of withdrawal
symptoms and drinking to relieve the withdrawal symptoms. There are
several symptoms which can be seen in those which has developed the
alcohol dependence syndrome such as having difficulties in controlling
the alcohol taking behaviour in terms of its onset, termination or the
limits of consumption, spending long time in drinking without taking
meals, memory failure, trembling, morning nausea and vomiting,
morning drinking, hallucination and restlessness without drinking.
There are wide range of complications arise in those with the alcohol
dependence syndrome covering from medical, psychiatric, prenatal,
social, occupational, financial and forensic. For example, in terms of
psychiatric complications, alcohol can induce mood disorder, psychotic
disorder, risk of deliberate self harm and suicide in that individual.
Those are dealing with the psychological aspect of that person and
without specific investigation method, it is sometimes misdiagnosed.
Alcohol had greater effect on the brain for which, most of the alcohol
dependence syndrome can presented with ataxia, confusion, or even
short term memory loss associated with the development of Wernicke
Korsakoff syndrome. The syndrome is a brain disorder resulted of
Thiamine deficiency due to the heavy and long term alcohol use.
Without treatment, the symptoms will be worse and can be life

threatening. However, some symptoms especially the loss of memory

and thinking skills can be permanent while other disorder related to
alcohol abuse can also occur.
During my psychiatry attachment, I had been interviewing patient with
Korsakoff syndrome. He had been diagnosed with alcohol dependence
syndrome as well for the past 20 years. However, this patient had poor
insight in what has going on with him and do not realize about his
conditions due to his long history of heavy alcohol consumption. His
first drink was at age 14 years old and since then, he thinks the
consumption level has been increasing. However, he denied any
withdrawal symptoms. Then, he got divorced and separated from his
children after they got married for ten years. This had so much impact
on his life and his drinking habits becoming worst since then. He had
been drinking as one of his coping strategy. During the interview, he
answered as I dont know for most of our questions which are mostly
regarding his life in the past and his family.

Alcohol dependence syndrome is a group of physiological, behavioural, and

cognitive phenomena in which drinking alcohol takes on a higher priority for a
given individual than other activities. A characteristic feature of the dependence
syndrome is the strong desire to take alcohol. Return to drinking alcohol after a
period of abstinence leads to a more rapid and severe reappearance of other
features of the syndrome.
(http://www.elu.sgul.ac.uk/rehash/guest/scorm/107/package/content/alcohol_dep
endence_syndrome.htm)

The Tenth Revision of the International Classification of Diseases and Health Problems (ICD-10) defines the dependence
syndrome as being a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class
of substances takes on a much higher priority for a given individual than other behaviours that once had greater value. A central
descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take the
psychoactive drugs (which may or not have been medically prescribed), alcohol, or tobacco. There may be evidence that return
to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than
occurs with nondependent individuals.
The harmful use of alcohol is a global problem which compromises both individual and social development. It
results in 2.5 million deaths each year. It also causes harm far beyond the physical and psychological health of
the drinker. It harms the well-being and health of people around the drinker. An intoxicated person can harm
others or put them at risk of traffic accidents or violent behaviour, or negatively affect co-workers, relatives,
friends or strangers. Thus, the impact of the harmful use of alcohol reaches deep into society.
Harmful drinking is a major determinant for neuropsychiatric disorders, such as alcohol use disorders and
epilepsy and other noncommunicable diseases such as cardiovascular diseases, cirrhosis of the liver and
various cancers. The harmful use of alcohol is also associated with several infectious diseases like HIV/AIDS,
tuberculosis and sexually transmitted infections (STIs). This is because alcohol consumption weakens the
immune system and has a negative effect on patients adherence to antiretroviral treatment.

A significant proportion of the disease burden attributable to harmful drinking arises from unintentional and
intentional injuries, including those due to road traffic accidents, violence, and suicides. Fatal injuries
attributable to alcohol consumption tend to occur in relatively younger age groups.

Elements of the Alcohol Dependence Syndrome:

A strong desire or subjective awareness of a compulsion to drink alcohol.

A narrowing of the drinking repertoire.

Giving a priority to drinking alcohol over other activities.

An increase in the tolerance to alcohol (increase alcohol intake to reach same

results).

Appearance of withdrawal symptoms (tremors, sweating, nausea and vomiting,

tachycardia, hypertension, agitation, headache, insomnia, tiredness and fits).

Drinking to relieve withdrawal symptoms.

A rapid reinstatement of a drinking pattern after a period of abstinence.

Prognosis:
After appropriate management, 30-40% of alcohol-dependent patients have either a
successful abstinence or controlled drinking. The mortality rate for people with alcohol
dependence syndrome is 2-3 times higher than normal people.