INFORMATION ON ALCOHOL ADDICTION
 |  |  |  |
DEFEAT ADDICTIONS.ORG
 | |  | |  | |  | |  | |  | |  | |  |
The factual and independent addiction recovery resource!
 | |  | |  | |  | |  | |  | |  | |  |
 | |  | |  | |  | |  | |  | |  | |  | |  |
Copyright 2008-2009 Defeat Addictions. All Rights Reserved.
Printable PDF Files
To view PDF files download your free copy of Adobe Reader.
Alcohol Video
Alcoholism can take on a variety of definitions, depending on the context in which it is being discussed. In common and
historical usage, alcoholism typically constitutes any condition that results in the continued consumption of alcoholic
beverages, despite negative personal and social consequences. Medical definitions describe alcoholism as a disease
influenced by genetic, psychological, and social factors any of which may precipitate on-going difficulty in controlling
overall alcohol consumption. More generally, alcoholism may also point to concerns such as a preoccupation with or
compulsion toward the consumption of alcohol, and/or an impaired ability to recognize the overall negative effects of
excessive alcohol consumption. Although not all of these definitions specify current and on-going use of alcohol as a
qualifier, some do, as well as remarking on the long-term effects of consistently heavy alcohol use, including
dependence and symptoms of withdrawal.
While the ingestion of alcohol is, by definition, necessary to develop alcoholism, the use of alcohol does not predict
the development of alcoholism. The degree, quantity, frequency and regularity of alcohol consumption influencing
the development of alcoholism varies greatly from person to person. In addition, although the biological mechanisms
underpinning alcoholism are uncertain, some risk factors, including social environment, emotional health and genetic
predisposition, have been identified.
Definitions and Terminology
The definitions of alcoholism and related terminology vary significantly between the medical community, treatment
programs, and the general public.
Definitions
In medicine, alcoholism is defined as a primary, chronic disease characterized by impaired control over drinking,
preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking.
Outside the medical field, alcoholism can also refer to the continued excessive or compulsive consumption of alcoholic
beverages.
Terminology
Many terms are applied to a drinker's relationship with alcohol. Use, misuse, heavy use, abuse, addiction, and
dependence are all common labels used to describe drinking habits, 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. The introduction of politics and religion further muddles the issue and exacerbates
ambiguity. Use refers to simple use of a substance. An individual who drinks any alcoholic beverage is using alcohol.
Misuse, problem use, 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 because 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 is often avoided because it can cause confusion
due to audiences that do not necessarily 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. Within the
field of psychiatry, alcohol dependence is the term referring to alcoholism. As a result, a diagnosis of alcohol
dependence does not necessarily indicate the presence of physical dependence.
The precise definition of addiction is debated, but in general it refers to any condition which causes a person to
continue 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.
Remission is often used to refer to a state where an alcoholic is no longer showing symptoms of alcoholism. The
American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of
alcoholism are no longer evident, regardless of whether or not the person is still drinking. They further subdivide those
in remission into early or sustained, and partial or full. Others (most notably Alcoholics Anonymous) use the term
recovery to describe those who have completely stopped consumption of alcohol.
Epidemiology
Substance use disorders are a major public health problem facing many countries. "The most common substance of
abuse/dependence in patients presenting for treatment is alcohol." In the United Kingdom, the number of 'dependent
drinkers' was calculated as over 2.8 million in 2001.
Within the medical community, there is broad consensus regarding alcoholism as a disease state. Outside the medical
community, there is considerable debate regarding the Disease Theory of Alcoholism. Proponents argue that any
structural or functional disorder having a predictable course, or progression, 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
Multiple tools are available to those wishing to conduct screening for alcoholism. Identification of alcoholism may be
difficult because there is no detectable physiologic difference between a person who drinks frequently and a person
with the condition. Identification involves an objective assessment regarding the damage that imbibing alcohol does to
the drinker's life compared to the subjective benefits the drinker perceives from consuming alcohol. While there are
many cases where an alcoholic's life has been significantly and obviously damaged, there are always borderline cases
that can be difficult to classify. Addiction Medicine specialists have extensive training with respect to diagnosing and
treating patients with alcoholism.
Genetic predisposition testing
Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut indicate that alcoholism does not have a single
cause—including genetic—but that genes do play an important role "by affecting processes in the body and brain that
interact with one another and with an individual's life experiences to produce protection or susceptibility." They also
report that less than a dozen alcoholism-related genes have been identified, but that more likely await discovery.
At least one genetic test exists for an allele that is correlated to alcoholism and opiate addiction. Human dopamine
receptor genes have a detectable variation referred to as the DRD2 TaqI polymorphism. Those who possess the A1
allele (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin
releasing drugs like alcohol. Although this allele is slightly more common in alcoholics and opiate addicts, it is not by
itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is contradictory.
Some writers posit that alcohol was discovered to be a replacement for polluted drinking water in early urban societies.
In these conditions, alcohol's antibacterial properties offset its health risk, and the slow death of cirrhosis of the
liver was preferred to an early death from waterborne disease. This caused a selection pressure on the genes of
humans who had abandoned the hunter-gatherer lifestyle towards people with genes which were not prone to over
consumption and drunkenness. Over generations, the descendants of these first farmers and urban dwellers became
dominated by individuals who could drink more beer more often. This theory explains why some groups who continued
a predominately hunter-gatherer culture, such as Native Americans or Australian Aborigines, have such high rates of
alcoholism today .
Screening
Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self reports in
questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.
DSM diagnosis
The DSM-IV diagnosis of alcohol dependence represents 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 with one another. According to
the DSM-IV, an alcohol dependence diagnosis 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
There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC).
These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few
recognizable effects on the body, including:
Effects
The primary 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. It is common for a person
suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects
associated with alcohol consumption are described in Alcohol consumption and health, but may include cirrhosis of
the liver, pancreatitis, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional
deficiencies, sexual dysfunction, and death from many sources.
Social effects
The social problems arising from alcoholism can be significant. Being drunk or hung over during work hours can
result in loss of employment, which can lead to financial problems including the loss of living quarters. Drinking at
inappropriate times, and behavior caused by reduced judgment, can lead to legal consequences, such as criminal
charges for drunk driving or public disorder, or civil penalties for tortious behavior. An alcoholic's behavior and mental
impairment while drunk can profoundly impact surrounding family and friends, possibly leading to marital conflict and
divorce, or contributing to domestic violence. This can contribute to lasting damage to the emotional development of
the alcoholic's children, even after they reach adulthood. The alcoholic could suffer from loss of respect from others
who may see the problem as self-inflicted and easily avoided.
Alcohol withdrawal
Alcohol withdrawal differs significantly from withdrawal from other drugs in that it can be directly fatal. While it is
possible for heroin addicts, for instance, to die from other health problems made worse by the strain of withdrawal,
an otherwise healthy alcoholic can die from the direct effects of withdrawal if it is not properly managed. Heavy
consumption of alcohol reduces the production of GABA, which is a neuroinhibitor. An abrupt stop of alcohol
consumption can induce a condition where neither alcohol nor GABA exists in the system in adequate quantities,
causing uncontrolled firing of the synapses. This manifests as hallucinations, shakes, convulsions, seizures, and
possible heart failure, all of which are collectively referred to as delirium tremens. All of these withdrawal issues can
be safely controlled with a medically supervised detox.
Treatments
Treatments for alcoholism are quite varied because there are multiple perspectives for the condition itself. Those who
approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who
approach the condition as one of social choice.
Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social
support in order to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage
a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. An example of
this kind of 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
abstinence-based zero tolerance approach; however, there are some who promote a harm-reduction approach as well.
Effectiveness
The effectiveness of alcoholism treatments varies widely. When considering the effectiveness of treatment options,
one must consider the success rate based on those who enter a program, not just those who complete it. Since
completion of a program is the qualification for success, success among those who complete a program is generally
near 5%. It is also important to consider not just the rate of those reaching treatment goals but the rate of those
relapsing. Results should also be compared to the roughly 75% rate at which people will quit on their own. Based on
information from Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism, the February 2007
issue of Newsweek reported that "A year after completing a rehab program, about a third of alcoholics are sober, an
additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely
relapsed."
Detoxification
Detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that
have similar effects to offset the withdrawal symptoms. Benzodiazepines are the most common family of drugs used for
this, followed by barbiturates.
Detoxes are performed in multiple ways. The first takes into consideration the varying degrees of tolerance. In it, a
standard dose of the benzodiazepine is given every half hour until light sedation is reached. Once a baseline dose is
determined, the medication is tapered over the ensuing 3-10 days. Another option is to give a standard dose of
benzodiazepine based on history and adjust based on withdrawal phenomenon. A third option is to defer treatment
until symptoms occur, which is safe only with relatively mild alcohol users.
Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. After detox
is complete, relapse is likely without further treatment. These rehabilitations (or 'rehabs') may take place in an inpatient
or outpatient setting. Detoxification may or may not be necessary depending upon an individual's age, medical status,
and history of alcohol intake. For example, a young man who binge drinks and seeks treatment one week after his last
use of alcohol may not require detoxification before beginning treatment for alcoholism.
Group therapy and psychotherapy
After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying
psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills. The mutual-help
group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety. Many
organizations have been formed to provide this service, including Alcoholics Anonymous, LifeRing Secular Recovery,
Rational Recovery, Smart Recovery, Al-Anon/Alateen, and Women For Sobriety.
Rationing and moderation
Rationing and moderation programs such as Moderation Management do not mandate complete abstinence. While
most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 U.S. study by
the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol
dependent more than one year prior returned to low-risk drinking.
Medications
Although not necessary for treatment of alcoholism, a variety of medications may be prescribed as part of treatment.
Some may ease the transition to sobriety, while others cause physical hardship to result from the use of alcohol. In
most cases, the desired effect is to have an alcoholic abstain from drinking.
Antabuse (disulfiram) prevents the elimination of (acetaldehyde), a chemical the body produces when breaking down
ethanol. Acetaldehyde itself is the cause of many hang over symptoms from alcohol use. The overall effect is severe
discomfort when alcohol is ingested: an extremely fast acting and long lasting uncomfortable hang over. This
discourages an alcoholic from drinking in significant amounts while they take the medicine. Heavy drinking while on
antabuse can cause severe illness and death.
Naltrexone is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and
opiates. It also appears to act on glutamate neurotransmission.[citation needed] Naltrexone is used in two very
different forms of treatment. The first treatment uses naltrexone to decrease cravings for alcohol and encourage
abstinence. The other treatment, called pharmacological extinction, combines naltrexone with normal drinking habits in
order to reverse the endorphin conditioning that causes alcohol addiction. Naltrexone comes in two forms. Oral
naltrexone, originally but no longer available as the brand ReVia, is a pill form and must be taken daily to be effective.
Vivitrol is a time-release formulation that is injected in the buttocks once a month.
Acamprosate (also known as Campral) is thought to stabilize the chemical balance of the brain that would otherwise be
disrupted by alcoholism. The Food and Drug Administration (FDA) approved this drug in 2004, saying "While its
mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse...
Campral proved superior to placebo in maintaining abstinence for a short period of time..." While effective alone, it is
often paired with other medication treatments like naltrexone with great success. Acamprosate reduces glutamate
release. The COMBINE study was unable to determine the presence of efficacy for Acamprosate.
Sodium oxybate is the sodium salt of gamma-hydroxybutyric acid (GHB). It is used for both acute alcohol withdrawal
and medium to long-term detoxification. This drug enhances GABA neurotransmission and reduces glutamate levels.
It is used in Italy in small amounts under the trade name Alcover.
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 our neurons are
bathed in endorphins following that action. Conversely, we receive negative reinforcement when we perform that action
and yet do not get our endorphins. By having the alcoholic go about their normal drinking habits (limited only by safety
concerns), and while preventing the endorphins from being released by the alcohol, the pull to drink is eliminated 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 also highly unusual in that it works better if the patient does not go through detoxification before starting it.
Clinical studies have shown this treatment to allow 78-87% of inductees to reduce their drinking below levels
dangerous to health, and allow 25% of inductees to achieve complete abstinence. Follow-up studies indicate an
overall 50% relapse rate over five years, and 2% relapse rate for those who continue to take naltrexone before
drinking.
There is a lot of professional resistance to this treatment for two reasons. Studies have demonstrated that controlled
drinking for alcoholics was not a useful treatment technique. Other studies have also shown naltrexone to be of
questionable value in supporting abstinence alone.The individual failure of these two separate treatments suggests
that their use in combination is equally ineffective. This would be the case if the two treatments were merely additive,
as for two people pushing a car. Experimental evidence indicates that the presence of naltrexone causes the drinking
of alcohol to have a reverse effect on alcoholism, decreasing the alcoholic's attachment to alcohol consumption when
they drink instead of increasing it.
Nutritional therapy
Preventative treatment of alcohol complications includes long-term use of a multivitamin as well as such specific
vitamins as B12 and folate. While nutritional therapy is not a treatment of alcoholism itself, it treats 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 diminished 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, causing
poor treatment outcomes.
Societal impact
The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to
society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs. Alcohol use is a
major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. Beyond money, there is
also the pain and suffering of the all individuals besides the alcoholic affected. For instance, alcohol consumption by a
pregnant woman can lead to Fetal alcohol syndrome, an incurable and damaging condition.
Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six per
cent of a country's GDP. One Australian estimate pegged alcohol's social costs at 24 per cent of all drug abuse costs;
a similar Canadian study concluded alcohol's share was 41 per cent. A study quantified the cost to the UK of all forms
of alcohol misuse as £18.5–20 billion annually (2001 figures).
Stereotypes
Depiction of a wino or town drunkStereotypes 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 modern times, the recovery
movement has led to more realistic depictions of problems that stem from heavy alcohol use. Authors such as Charles
R. Jackson and Charles Bukowski describe their own alcohol addiction in their writings. Films like Days of Wine and
Roses, My Name is Bill W, Arthur, Leaving Las Vegas chronicle similar stories of alcoholism.
Politics and public health
Because alcohol use disorders are perceived as impacting 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.
historical usage, alcoholism typically constitutes any condition that results in the continued consumption of alcoholic
beverages, despite negative personal and social consequences. Medical definitions describe alcoholism as a disease
influenced by genetic, psychological, and social factors any of which may precipitate on-going difficulty in controlling
overall alcohol consumption. More generally, alcoholism may also point to concerns such as a preoccupation with or
compulsion toward the consumption of alcohol, and/or an impaired ability to recognize the overall negative effects of
excessive alcohol consumption. Although not all of these definitions specify current and on-going use of alcohol as a
qualifier, some do, as well as remarking on the long-term effects of consistently heavy alcohol use, including
dependence and symptoms of withdrawal.
While the ingestion of alcohol is, by definition, necessary to develop alcoholism, the use of alcohol does not predict
the development of alcoholism. The degree, quantity, frequency and regularity of alcohol consumption influencing
the development of alcoholism varies greatly from person to person. In addition, although the biological mechanisms
underpinning alcoholism are uncertain, some risk factors, including social environment, emotional health and genetic
predisposition, have been identified.
Definitions and Terminology
The definitions of alcoholism and related terminology vary significantly between the medical community, treatment
programs, and the general public.
Definitions
In medicine, alcoholism is defined as a primary, chronic disease characterized by impaired control over drinking,
preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking.
Outside the medical field, alcoholism can also refer to the continued excessive or compulsive consumption of alcoholic
beverages.
Terminology
Many terms are applied to a drinker's relationship with alcohol. Use, misuse, heavy use, abuse, addiction, and
dependence are all common labels used to describe drinking habits, 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. The introduction of politics and religion further muddles the issue and exacerbates
ambiguity. Use refers to simple use of a substance. An individual who drinks any alcoholic beverage is using alcohol.
Misuse, problem use, 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 because 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 is often avoided because it can cause confusion
due to audiences that do not necessarily 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. Within the
field of psychiatry, alcohol dependence is the term referring to alcoholism. As a result, a diagnosis of alcohol
dependence does not necessarily indicate the presence of physical dependence.
The precise definition of addiction is debated, but in general it refers to any condition which causes a person to
continue 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.
Remission is often used to refer to a state where an alcoholic is no longer showing symptoms of alcoholism. The
American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of
alcoholism are no longer evident, regardless of whether or not the person is still drinking. They further subdivide those
in remission into early or sustained, and partial or full. Others (most notably Alcoholics Anonymous) use the term
recovery to describe those who have completely stopped consumption of alcohol.
Epidemiology
Substance use disorders are a major public health problem facing many countries. "The most common substance of
abuse/dependence in patients presenting for treatment is alcohol." In the United Kingdom, the number of 'dependent
drinkers' was calculated as over 2.8 million in 2001.
Within the medical community, there is broad consensus regarding alcoholism as a disease state. Outside the medical
community, there is considerable debate regarding the Disease Theory of Alcoholism. Proponents argue that any
structural or functional disorder having a predictable course, or progression, 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
Multiple tools are available to those wishing to conduct screening for alcoholism. Identification of alcoholism may be
difficult because there is no detectable physiologic difference between a person who drinks frequently and a person
with the condition. Identification involves an objective assessment regarding the damage that imbibing alcohol does to
the drinker's life compared to the subjective benefits the drinker perceives from consuming alcohol. While there are
many cases where an alcoholic's life has been significantly and obviously damaged, there are always borderline cases
that can be difficult to classify. Addiction Medicine specialists have extensive training with respect to diagnosing and
treating patients with alcoholism.
Genetic predisposition testing
Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut indicate that alcoholism does not have a single
cause—including genetic—but that genes do play an important role "by affecting processes in the body and brain that
interact with one another and with an individual's life experiences to produce protection or susceptibility." They also
report that less than a dozen alcoholism-related genes have been identified, but that more likely await discovery.
At least one genetic test exists for an allele that is correlated to alcoholism and opiate addiction. Human dopamine
receptor genes have a detectable variation referred to as the DRD2 TaqI polymorphism. Those who possess the A1
allele (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin
releasing drugs like alcohol. Although this allele is slightly more common in alcoholics and opiate addicts, it is not by
itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is contradictory.
Some writers posit that alcohol was discovered to be a replacement for polluted drinking water in early urban societies.
In these conditions, alcohol's antibacterial properties offset its health risk, and the slow death of cirrhosis of the
liver was preferred to an early death from waterborne disease. This caused a selection pressure on the genes of
humans who had abandoned the hunter-gatherer lifestyle towards people with genes which were not prone to over
consumption and drunkenness. Over generations, the descendants of these first farmers and urban dwellers became
dominated by individuals who could drink more beer more often. This theory explains why some groups who continued
a predominately hunter-gatherer culture, such as Native Americans or Australian Aborigines, have such high rates of
alcoholism today .
Screening
Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self reports in
questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.
DSM diagnosis
The DSM-IV diagnosis of alcohol dependence represents 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 with one another. According to
the DSM-IV, an alcohol dependence diagnosis 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
There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC).
These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few
recognizable effects on the body, including:
Effects
The primary 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. It is common for a person
suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects
associated with alcohol consumption are described in Alcohol consumption and health, but may include cirrhosis of
the liver, pancreatitis, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional
deficiencies, sexual dysfunction, and death from many sources.
Social effects
The social problems arising from alcoholism can be significant. Being drunk or hung over during work hours can
result in loss of employment, which can lead to financial problems including the loss of living quarters. Drinking at
inappropriate times, and behavior caused by reduced judgment, can lead to legal consequences, such as criminal
charges for drunk driving or public disorder, or civil penalties for tortious behavior. An alcoholic's behavior and mental
impairment while drunk can profoundly impact surrounding family and friends, possibly leading to marital conflict and
divorce, or contributing to domestic violence. This can contribute to lasting damage to the emotional development of
the alcoholic's children, even after they reach adulthood. The alcoholic could suffer from loss of respect from others
who may see the problem as self-inflicted and easily avoided.
Alcohol withdrawal
Alcohol withdrawal differs significantly from withdrawal from other drugs in that it can be directly fatal. While it is
possible for heroin addicts, for instance, to die from other health problems made worse by the strain of withdrawal,
an otherwise healthy alcoholic can die from the direct effects of withdrawal if it is not properly managed. Heavy
consumption of alcohol reduces the production of GABA, which is a neuroinhibitor. An abrupt stop of alcohol
consumption can induce a condition where neither alcohol nor GABA exists in the system in adequate quantities,
causing uncontrolled firing of the synapses. This manifests as hallucinations, shakes, convulsions, seizures, and
possible heart failure, all of which are collectively referred to as delirium tremens. All of these withdrawal issues can
be safely controlled with a medically supervised detox.
Treatments
Treatments for alcoholism are quite varied because there are multiple perspectives for the condition itself. Those who
approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who
approach the condition as one of social choice.
Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social
support in order to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage
a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. An example of
this kind of 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
abstinence-based zero tolerance approach; however, there are some who promote a harm-reduction approach as well.
Effectiveness
The effectiveness of alcoholism treatments varies widely. When considering the effectiveness of treatment options,
one must consider the success rate based on those who enter a program, not just those who complete it. Since
completion of a program is the qualification for success, success among those who complete a program is generally
near 5%. It is also important to consider not just the rate of those reaching treatment goals but the rate of those
relapsing. Results should also be compared to the roughly 75% rate at which people will quit on their own. Based on
information from Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism, the February 2007
issue of Newsweek reported that "A year after completing a rehab program, about a third of alcoholics are sober, an
additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely
relapsed."
Detoxification
Detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that
have similar effects to offset the withdrawal symptoms. Benzodiazepines are the most common family of drugs used for
this, followed by barbiturates.
Detoxes are performed in multiple ways. The first takes into consideration the varying degrees of tolerance. In it, a
standard dose of the benzodiazepine is given every half hour until light sedation is reached. Once a baseline dose is
determined, the medication is tapered over the ensuing 3-10 days. Another option is to give a standard dose of
benzodiazepine based on history and adjust based on withdrawal phenomenon. A third option is to defer treatment
until symptoms occur, which is safe only with relatively mild alcohol users.
Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. After detox
is complete, relapse is likely without further treatment. These rehabilitations (or 'rehabs') may take place in an inpatient
or outpatient setting. Detoxification may or may not be necessary depending upon an individual's age, medical status,
and history of alcohol intake. For example, a young man who binge drinks and seeks treatment one week after his last
use of alcohol may not require detoxification before beginning treatment for alcoholism.
Group therapy and psychotherapy
After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying
psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills. The mutual-help
group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety. Many
organizations have been formed to provide this service, including Alcoholics Anonymous, LifeRing Secular Recovery,
Rational Recovery, Smart Recovery, Al-Anon/Alateen, and Women For Sobriety.
Rationing and moderation
Rationing and moderation programs such as Moderation Management do not mandate complete abstinence. While
most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 U.S. study by
the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol
dependent more than one year prior returned to low-risk drinking.
Medications
Although not necessary for treatment of alcoholism, a variety of medications may be prescribed as part of treatment.
Some may ease the transition to sobriety, while others cause physical hardship to result from the use of alcohol. In
most cases, the desired effect is to have an alcoholic abstain from drinking.
Antabuse (disulfiram) prevents the elimination of (acetaldehyde), a chemical the body produces when breaking down
ethanol. Acetaldehyde itself is the cause of many hang over symptoms from alcohol use. The overall effect is severe
discomfort when alcohol is ingested: an extremely fast acting and long lasting uncomfortable hang over. This
discourages an alcoholic from drinking in significant amounts while they take the medicine. Heavy drinking while on
antabuse can cause severe illness and death.
Naltrexone is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and
opiates. It also appears to act on glutamate neurotransmission.[citation needed] Naltrexone is used in two very
different forms of treatment. The first treatment uses naltrexone to decrease cravings for alcohol and encourage
abstinence. The other treatment, called pharmacological extinction, combines naltrexone with normal drinking habits in
order to reverse the endorphin conditioning that causes alcohol addiction. Naltrexone comes in two forms. Oral
naltrexone, originally but no longer available as the brand ReVia, is a pill form and must be taken daily to be effective.
Vivitrol is a time-release formulation that is injected in the buttocks once a month.
Acamprosate (also known as Campral) is thought to stabilize the chemical balance of the brain that would otherwise be
disrupted by alcoholism. The Food and Drug Administration (FDA) approved this drug in 2004, saying "While its
mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse...
Campral proved superior to placebo in maintaining abstinence for a short period of time..." While effective alone, it is
often paired with other medication treatments like naltrexone with great success. Acamprosate reduces glutamate
release. The COMBINE study was unable to determine the presence of efficacy for Acamprosate.
Sodium oxybate is the sodium salt of gamma-hydroxybutyric acid (GHB). It is used for both acute alcohol withdrawal
and medium to long-term detoxification. This drug enhances GABA neurotransmission and reduces glutamate levels.
It is used in Italy in small amounts under the trade name Alcover.
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 our neurons are
bathed in endorphins following that action. Conversely, we receive negative reinforcement when we perform that action
and yet do not get our endorphins. By having the alcoholic go about their normal drinking habits (limited only by safety
concerns), and while preventing the endorphins from being released by the alcohol, the pull to drink is eliminated 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 also highly unusual in that it works better if the patient does not go through detoxification before starting it.
Clinical studies have shown this treatment to allow 78-87% of inductees to reduce their drinking below levels
dangerous to health, and allow 25% of inductees to achieve complete abstinence. Follow-up studies indicate an
overall 50% relapse rate over five years, and 2% relapse rate for those who continue to take naltrexone before
drinking.
There is a lot of professional resistance to this treatment for two reasons. Studies have demonstrated that controlled
drinking for alcoholics was not a useful treatment technique. Other studies have also shown naltrexone to be of
questionable value in supporting abstinence alone.The individual failure of these two separate treatments suggests
that their use in combination is equally ineffective. This would be the case if the two treatments were merely additive,
as for two people pushing a car. Experimental evidence indicates that the presence of naltrexone causes the drinking
of alcohol to have a reverse effect on alcoholism, decreasing the alcoholic's attachment to alcohol consumption when
they drink instead of increasing it.
Nutritional therapy
Preventative treatment of alcohol complications includes long-term use of a multivitamin as well as such specific
vitamins as B12 and folate. While nutritional therapy is not a treatment of alcoholism itself, it treats 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 diminished 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, causing
poor treatment outcomes.
Societal impact
The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to
society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs. Alcohol use is a
major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. Beyond money, there is
also the pain and suffering of the all individuals besides the alcoholic affected. For instance, alcohol consumption by a
pregnant woman can lead to Fetal alcohol syndrome, an incurable and damaging condition.
Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six per
cent of a country's GDP. One Australian estimate pegged alcohol's social costs at 24 per cent of all drug abuse costs;
a similar Canadian study concluded alcohol's share was 41 per cent. A study quantified the cost to the UK of all forms
of alcohol misuse as £18.5–20 billion annually (2001 figures).
Stereotypes
Depiction of a wino or town drunkStereotypes 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 modern times, the recovery
movement has led to more realistic depictions of problems that stem from heavy alcohol use. Authors such as Charles
R. Jackson and Charles Bukowski describe their own alcohol addiction in their writings. Films like Days of Wine and
Roses, My Name is Bill W, Arthur, Leaving Las Vegas chronicle similar stories of alcoholism.
Politics and public health
Because alcohol use disorders are perceived as impacting 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.
Alcohol Addiction & Alcoholism
 | |  | |  | |  |
 | |  | |  | |  | |  | |  | |  | |  |
 |  |  |  |  |  |  |  |  |
DEFEAT ADDICTIONS.ORG
| Free Self-Treatment & Recovery Programs For |
Alcohol & Drug Addiction
God's Wrath
| If the son (Jesus Christ) shall set you free, you shall be free indeed. John 8:36 |
| Free Self-Treatment & Recovery Programs For |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |