What is Alcoholism?

Alcoholism is an excessive consumption of alcohol that persists or recurs over time. It is a leading cause of accidents, illness, social or interpersonal difficulties, and poor work performance or absences. Alcoholism is a chronic disorder, and occurs in two forms: alcohol abuse (problem drinking) and alcohol dependence (addiction).Alcohol abuse is drinking that creates a hazard (such as when driving), or when the individual continues to drink despite awareness of the physical, psychological, social, or occupational problems it creates. Abuse may progress to dependence, and the line between them is not always clear.

Alcohol dependence is characterized by loss of control, that is, the inability to stop or limit drinking. The person becomes intoxicated more and more frequently. The individual may be impaired while carrying out regular activities and responsibilities, or may give up important activities and relationships because of drinking. Physical effects include the brain's adaptation to alcohol, where increasing amounts are required to produce the same level of intoxication; this is referred to as alcohol tolerance. Once tolerance has developed, the individual cannot suddenly stop or reduce drinking without precipitating symptoms of withdrawal. This usually begins within 48 hours, and includes tremor, sweating, weakness, nausea, vomiting, headache, anxiety, and depressed mood. Transient hallucinations or "bad dreams" and, in some cases, seizures may accompany withdrawal. These symptoms usually disappear within several days to a week. Severe cases, however, may progress to "D.T.'s" (delirium tremens), a more serious withdrawal syndrome of confusion, disorientation, fever, and terrifying hallucinations. Delirium tremens usually runs a course of several days, but can be life threatening in some cases.

Alcoholism has three main drinking patterns. Some alcoholics drink excessively daily. Others do so only on weekends. In the third pattern, lengthy periods of sobriety are interrupted by drinking binges, which may last weeks or months.

Alcoholism also may be associated with the abuse/dependence of other substances. Why some people can drink in moderation and others become alcoholics is poorly understood.

Alcoholism probably has no single cause and may not even be a single disorder. At least two types of alcoholism have been described. One type tends to occur at an early age, and is especially common in males with alcoholic parents. Another form is relatively mild, occurs in both men and women, and appears later in life. In some cases, alcoholism may result when an individual drinks to relieve chronic pain or symptoms of emotional illness.

Alcoholism is a common mental disorder. Alcohol abuse occurs in approximately eight percent of the adult US population at some time in their lives, with alcohol dependence occurring in five percent of the population.

How is it diagnosed?

Alcoholism may be determined by a physician during a physical examination that includes a medical history and list of medications. It is sometimes difficult to diagnose because many people with alcoholism also experience denial (the refusal to recognize truth or reality). This may cause people to hide aspects of drinking or to fail to recognize that physical symptoms (such as digestive problems) may be related to drinking.

Patients suspected of having alcoholism may be asked to fill out a questionnaire, such as the CAGE questionnaire. The questionnaires include questions aimed at identifying drinking patterns and emotions that indicate alcoholism.

For example, the CAGE questionnaire includes four questions. An affirmative answer to two or more questions indicates a high likelihood of alcoholism. The questions are:

• Have you felt you should Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you felt bad or Guilty about your drinking?
• Have you ever had to drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

Blood alcohol tests are not usually performed because they only identify levels of alcohol ingested at a particular point in time, not long-term use. However, patients may be given other tests, such as liver function tests and other blood tests. People with alcoholism may have elevated liver function tests (which indicates liver damage) and anemia (low red blood cell count).

Patients suspected of having alcoholism may be referred to a substance abuse counselor or other health professional that specializes in treating addiction.

How is Alcoholism treated?

Because people with alcoholism often experience denial (the refusal to recognize truth or reality), they often begin treatment only at the insistence of friends, family members, coworkers or others. Sometimes, patients seek treatment after an intervention (an orchestrated attempt by family and friends to encourage a person to seek help for addiction).

Treatment techniques vary according to the severity of the alcohol problem and other factors. Treatment for people who abuse alcohol may involve cutting back on drinking. For those who are dependent upon alcohol, treatment must involve refraining from drinking (abstinence). Patients may be treated in an outpatient program or a residential inpatient program.

Components of alcoholism treatment programs may include:

• Detoxification. Patients withdraw from alcohol, a process which usually lasts four to seven days. Medications to minimize symptoms experienced with withdrawal (such as seizures) are usually administered.
• Medical assessment and treatment. Patients are treated for medical conditions that may be present with alcoholism, such as high blood pressure, increased blood sugar and liver and heart disease.
• Psychological treatment. Patients with mental health disorders that contribute to alcoholism, such as depression, may receive treatment for the underlying disorder. Others receive support through group and individual counseling.
• Medications. Some patients are treated with special drugs, designed remove the compulsion to drink, block the intoxicating effects of alcohol or help to prevent relapses in people who have stopped drinking alcohol.

Because relapse (using alcohol after a period of abstinence) is common, people with alcoholism often receive ongoing treatment. This may involve individual or group counseling or participation in a self-help group. One of the most popular self-help groups is Alcoholics Anonymous (worldwide fellowship of people with alcoholism whose primary goal is to advocate recovery and sobriety through a 12-step process). Members meet on a regular basis and share personal stories of their recovery in an attempt to provide support and foster sobriety.

Because family support is important to recovery, many programs offer marital counseling or couples therapy, family therapy or other services as part of treatment. Programs may also help patients find other types of services needed for recovery, such as legal assistance, job training, childcare and parenting classes.

Other therapies for patients with alcoholism may include:

• Acupuncture. The insertion of thin needles under the skin. This may reduce cravings for alcohol. Acupuncture is performed by an acupuncturist.
• Motivational enhancement therapy. Therapy aimed at helping the patient acknowledge the alcohol problem and change behavior through stages.
• Cognitive behavior therapy. Psychotherapy that relies on the recognition of distorted thinking and replacing such thinking with more realistic ideas.
• Couples therapy. Therapy attended by both the patient with alcoholism and their significant other. Involving a partner may increase the chance of successful treatment.
• Aversion therapy. Involves taking a medication that causes an adverse response, such as nausea and vomiting, when alcohol is ingested.

Medications

Luvox (Fluvoxamine), Celexa (Citalopram), Prozac (Fluoxetine), Depakote (Divalproex), Zofran (Ondansetron), Atarax (Hydroxyzine), Tegretol (Carbamazepine), Topamax (Topiramate), BuSpar (Buspirone), Revia (Naltrexone), Xanax (Alprazolam), Valium (Diazepam), Ativan (Lorazepam)

What might complicate it?

Alcoholism can damage virtually any organ system. The gastrointestinal tract is often first to show toxic effects such as gastritis and gastrointestinal bleeding. After years of heavy drinking, liver damage may occur (alcoholic hepatitis, cirrhosis), along with an increased risk of liver cancer. The pancreas also may be affected by chronic pancreatitis.

• Prolonged, excessive use of alcohol is toxic to the nervous system. In addition to acute impairment of alcohol intoxication and withdrawal, brain function also may be chronically impaired; poor memory is a common finding, which may improve with abstinence. If drinking continues, however, irreversible atrophy of the brain may occur, with long-term and short-term memory impairment. Dementia may develop, with loss of higher brain functions such as judgment, abstract thinking, language, etc.
• Personality changes may be seen, and sometimes a psychosis develops. Other parts of the brain may be damaged as well, resulting in disturbances of balance and coordination.
• Prolonged heavy drinking can also be toxic to nerves, resulting in a painful peripheral neuropathy.
• Heavy drinking may result in cardiovascular disorders of high blood pressure, abnormal heart rhythms (arrhythmias), and damage to heart muscle (cardiomyopathy).
• Excessive alcohol intake can lead to anemia. It may alter hormone levels, interfere with blood clotting, impair immunity, and result in nutritional deficiencies.
• There are often disastrous psychosocial consequences, such as loss of relationships and employment. Accidents, violence, and suicide can be consequences of alcoholism.
• Heavy drinking during pregnancy can result in fetal alcohol syndrome.

Predicted outcome

A high percentage of alcoholics will relapse, regardless of the type of treatment, and usually within six months. This does not mean that treatment has failed, but rather that it must be ongoing. Relapses may occur a number of times, but eventually the cycle may stop as the individual restructures his or her life, replacing alcohol with other sources of gratification. The earlier in the course of alcoholism the treatment is begun, the better the prognosis.

Alternatives

Another cause of altered mental state can be diabetic ketoacidosis, in which the breath has a fruity odor of acetone, which sometimes is confused with alcohol; low blood sugar can also have a disturbed mental state. Alcoholism often is accompanied by or confused with other substance abuse.

Appropriate specialists

Psychiatrist, psychologist, gastroenterologist, cardiologist and neurologist.

Last updated 25 June 2015