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Encyclopedia > 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. Bottles of cachaça, a Brazilian alcoholic beverage. ... The Scream, the famous painting commonly thought of as depicting the experience of mental illness. ... Contagious redirects here. ... Drug abuse has a wide range of definitions, all of them relating to the use, misuse or overuse of a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. ... The cigarette is the most common method of smoking tobacco. ...


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. The social environment or social context is a group of identical or similar social positions and social roles. ... Mental health, mental hygiene and mental wellness are all terms used to describe the absence of mental illness. ... A genetic predisposition is a genetic effect which influences the phenotype of an organism but which can be modified by the environmental conditions. ... Addiction is chronic disorder proposed to be precipitated by a combination of genetic, biological/pharmacological and social factors. ... Psychology (ancient Greek: psyche = soul and logos = word) is the study of mind, thought, and behaviour. ... Santorio Santorio (1561-1636) in his steelyard balance, from Ars de statica medecina, first published 1614 Metabolism (from μεταβολισμος(metavallo), the Greek word for change), in the most general sense, is the ingestion and breakdown of complex compounds, coupled with the liberation of energy, and the consequent generation of waste... Neurochemistry is a branch of neuroscience that is heavily devoted to the study of neurochemicals. ...

Contents


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. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ...


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. Addiction is chronic disorder proposed to be precipitated by a combination of genetic, biological/pharmacological and social factors. ...


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] Epidemiology is the scientific study of factors affecting the health and illness of individuals and populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. ...


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. The American Psychiatric Association is a professional organization of psychiatrists whose members are American and international physicians who are trained in psychiatry. ...


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. Outside the medical community, there is considerable debate over whether or not alcoholism should be considered a disease. ...


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 Use Disorders Identification Test (AUDIT) is a simple ten-question test developed by the World Health Organization to determine if a persons alcohol consumption may be harmful. ...


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. Driving under the influence, drunk driving, or drink-driving, is the act of operating a motor vehicle (and sometimes a bicycle or similar human-powered vehicle) after having consumed alcohol (ethanol) or other drugs, to the degree that mental and motor skills are impaired. ...


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. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ...


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 is the enlargement of red blood cells with near-constant haemoglobin concentration, and is defined by a mean corpuscular volume (MCV) of greater than 100 femtolitres (the precise criterion varies between laboratories). ... The mean corpuscular volume, or MCV, is a measure of the average red blood cell volume that is reported as part of a standard complete blood count. ... Gamma glutamyl transferase (GGT or GGTP, or Gamma-GT) (EC 2. ... Aspartate transaminase (AST) also called Serum Glutamic Oxaloacetic Transaminase (SGOT) or aspartate aminotransferase (ASAT) (EC 2. ... Alanine transaminase or ALT is an enzyme (EC 2. ... Carbohydrate-Deficient Transferrin (CDT) Carbohydrate-deficient transferrin (CDT) is a laboratory test used to help detect heavy ethanol consumption. ...

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

The long term health effects caused by the consumption of large amounts of alcohol (both by alcoholics and non-alcoholics) may include: To meet Wikipedias quality standards, this article or section may require cleanup. ... The relationship between alcohol consumption and health has been the subject of formal scientific research since at least 1926, when Dr. Raymond Pearl published his book, Alcohol and Longevity asserting that drinking alcohol in moderation is associated with greater longevity than either abstaining or drinking heavily. ...

Death is the full cessation of vital functions in the biological life. ... Alcohol poisoning is a serious — sometimes deadly — result of drinking excessive amounts of alcohol (ethanol). ... Pancreatitis is inflammation of the pancreas. ... The pancreas is an organ in the digestive system that serves two major functions: exocrine - producing pancreatic juice containing digestive enzymes. ... Acute pancreatitis is a rapidly-onset inflammation of the pancreas. ... Chronic pancreatitis can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. ... Heart disease is one of a number of different diseases which afflict the heart. ... Dilated cardiomyopathy or DCM (also known as congestive cardiomyopathy), is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is dilated, often without any obvious cause. ... Polyneuropathy is a neurological disorder that occurs when many peripheral nerves throughout the body malfunction simultaneously. ... A nerve is an enclosed, cable-like bundle of nerve fibers or axons, which includes the glia that ensheath the axons in myelin. ... Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function. ... The liver is the largest internal organ of the human body. ... In medicine (gastroenterology), esophageal varices are extreme dilations of sub mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. ... Clinical depression is a state of sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... Insomnia is characterized by an inability to sleep and/or to remain asleep for a reasonable period. ... Anxiety is a complex combination of emotions that includes fear, apprehension and worry, and is often accompanied by physical sensations such as palpitations, nausea, chest pain and/or shortness of breath. ... Suicide (from Latin sui caedere, to kill oneself) is the act of willfully ending ones own life. ... When normal cells are damaged beyond repair, they are eliminated by apoptosis. ... Breast cancer is cancer of breast tissue. ... Head and neck cancers are malignant growths originating in the lip and oral cavity (mouth), nasal cavity, pharynx, larynx, thyroid, paranasal sinuses, salivary glands and cervical lymph nodes of the neck. ... Esophageal cancer is malignancy of the esophagus. ... Colorectal cancer, also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. ... Many diseases in humans are thought to be directly or indirectly related to nutrition, These include, but are not limited to, deficiency diseases, caused by a lack of essential nutrients. ... Folic acid and folate (the anion form) are forms of a water-soluble B vitamin. ... Thiamine mononitrate Thiamine or thiamin, also known as vitamin B1, is a colorless compound with chemical formula C12H17N4OS. It is soluble in water and insoluble in alcohol. ... Wernicke-Korsakoff syndrome is a combination of Korsakoffs syndrome, which is characterized by confusion, severe anterograde and retrograde amnesia and confabulation; and Wernickes encephalopathy, which is characterized by nystagmus, ophthalmoplegia, coma and, if untreated, death. ... Sexual problems, also called sexual dysfunction or sexual malfunction, are defined as difficulty during any stage of the sexual act (which includes desire, arousal, orgasm, and resolution) that prevents the individual or couple from enjoying sexual activity. ...

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. Employment is a contract between two parties, one being the employer and the other being the employee. ... A marriage is a relationship between or among individuals, usually recognized by civil authority and/or bound by the religious beliefs of the participants. ... Divorce or dissolution of marriage is the ending of a marriage before the death of either spouse, which can be contrasted with an annulment, which is a declaration that a marriage is void, though the effects of marriage may be recognized in such unions, such as spousal support, child custody...


A study quantified the cost to the UK of all forms of alcohol misuse as £18.5–20 billion annually (2001 figures).[7][2]


Alcohol withdrawal

Alcohol withdrawal is significantly different from withdrawal from opiates in that the actual withdrawal mechanism can result in death. While it is possible for heroin addicts 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 results in the reduction of the production of GABA, which is a neuro-inhibitor. An abrupt stop of alcohol consumption can result in 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 refered to as delerium tremens. The term opiate refers to the alkaloids found in opium, an extract from the seed pods of the opium poppy (). It has also traditionally referred to natural and semi-synthetic derivatives of morphine. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Gaba may refer to: Gabâ or gabaa (Philippines), the concept of negative karma of the Cebuano people GABA, the gamma-amino-butyric acid neurotransmitter GABA receptor, in biology, receptors with GABA as their endogenous ligand Marianne Gaba, a US model and September 1959 Playboy centerfold Pierre Toura Gaba (1920-1998... ...


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. Barbiturates are drugs that act as central nervous system (CNS) depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. ... alprazolam 2mg tablets The benzodiazepines are a class of drugs with sedative, hypnotic, anxiolytic, anticonvulsant, amnestic and muscle relaxant properties. ...


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 abstinence-based 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. Detox, short for detoxification, in general is the removal of toxic substances. ... Diazepam (pronounced , marketed under brand names Valium, Stesolid, Seduxen Bosaurin and Apozepam)[1] is a drug which is a benzodiazepine derivative. ... Clonazepam (marketed by Roche under the trade-name Klonopin® in the United States and Rivotril® in Europe, Brazil and Canada) is a drug which is a benzodiazepine derivative. ... Barbiturates are drugs that acts as central nervous system (CNS) depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. ... Phenobarbital (also phenobarbitone) (Luminal®) is a weak acid with the chemical formula C12H12N2O3. ...


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. Group therapy is a form of psychotherapy during which one or several therapists treat a small group of clients together as a group. ... Psychotherapy is a set of techniques intended to improve mental health, emotional or behavioral issues of individuals, family members or a whole familys interactional climate. ...


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. To meet Wikipedias quality standards, this article or section may require cleanup. ... To meet Wikipedias quality standards and conform with our NPOV policy, this article or section may require cleanup. ... Self-Management and Recovery Training (SMART Recovery) is a non-profit organization (Alcohol & Drug Abuse Self-Help Network, Inc. ... Women For Sobriety (WFS), founded in 1976 by Jean Kirkpatrick, is a non-profit support group for alcoholic women. ... Rational Recovery (RR) is a source of counseling, guidance, and direct instruction on self-recovery from addiction to alcohol and other drugs through planned, permanent abstinence designed as an alternative to Alcoholics Anonymous (AA) and 12 step programs. ...


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 abstinence-based 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. Pathology (in ancient Greek pathos = pain/pation and logos = word) is the study of diseases. ...


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. Moderation Management is a group which seeks to help various levels of alcohol users, and heavy drinkers, by supporting an individually created program for each drinker, to either reduce, or eliminate, the harm ones drinking is causing to their life. ...


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. Disulfiram is a drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol). ... Disulfiram is a drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol. ... R-phrases , , S-phrases , , , Flash point −39 °C Autoignition temperature 185 °C RTECS number AB1925000 Supplementary data page Structure and properties n, εr, etc. ...


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. Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. ...


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. Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. ... Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. ... This article or section is in need of attention from an expert on the subject. ... The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ...


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. Since pharmacological extinction also requires a behavioral component to work, it is not strictly a medication therapy. Endorphins are endogenous opioid biochemical compounds. ... Antagonists In medicine and biology, a receptor antagonist is a substance that inhibits the normal physiological function of a receptor. ... The Sinclair Method is a treatment for alcoholism that involves the use of opiate antagonists such as naltrexone or nalmafene in order to decrease the craving for alcohol over time, while the person continues to consume alcohol. ...


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. GHB redirects here. ...


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. Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. ... Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. ... acamprosate ... An antidepressant is a medication used primarily in the treatment of clinical depression. ... A psychoactive drug or psychotropic substance is a chemical that alters brain function, resulting in temporary changes in perception, mood, consciousness, or behaviour. ... A mood disorder is a condition whereby the prevailing emotional mood is distorted or inappropriate to the circumstances. ... In modern psychology, the term neurosis, also known as psychoneurosis or neurotic disorder, is a general term that refers to any mental imbalance that causes distress, but (unlike a psychosis or personality disorder) does not prevent rational thought or an individuals ability to function in daily life. ... Psychosis is a generic psychiatric term for a mental state in which thought and perception are severely impaired. ...


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. The Sinclair Method is a treatment for alcoholism that involves the use of opiate antagonists such as naltrexone or nalmafene in order to decrease the craving for alcohol over time, while the person continues to consume alcohol. ... An opioid is any agent that binds to opioid receptors found principally in the central nervous system and gastrointestinal tract. ...


This technique is used to good effect in Finland[9], Pennsylvania[10], and Florida[11], and is sometimes referred to as the Sinclair Method. The Sinclair Method is a treatment for alcoholism that involves the use of opiate antagonists such as naltrexone or nalmafene in order to decrease the craving for alcohol over time, while the person continues to consume alcohol. ...


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] The structure of insulin. ... Magnified crystals of refined sugar Magnification of typical sugar In general use, non-scientists take sugar to mean sucrose, also called table sugar or saccharose, a white crystalline solid disaccharide. ... Hypoglycemia is a medical term referring to a pathologic state produced and usually defined by a lower than normal amount of sugar (glucose) in the blood. ...


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] The National Institute on Alcohol Abuse and Alcoholism (NIAAA), as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. ...


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. Pain and suffering is the legal term for the physical and emotional stress caused from an injury. ... Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ... A car accident in Yate, near Bristol, England, in July 2004. ... A thin upper lip and a smooth philtrum are signs of FAS Fetal alcohol spectrum disorder is an umbrella term used to describe fetal alcohol syndrome (FAS) and the less noticeable, but sometimes equally serious, fetal alcohol effects (FAE). ...


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] Public health is concerned with threats to the overall health of a community based on population health analysis. ... World map showing North America A satellite composite image of North America. ... The United States dollar is the official currency of the United States. ... One thousand million (1,000,000,000) is the natural number following 999,999,999 and preceding 1,000,000,001. ...


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. To meet Wikipedias quality standards, this article or section may require cleanup. ... The Three Graces, here in a painting by Sandro Botticelli, were the goddesses of charm, beauty, nature, human creativity and fertility in Greek mythology. ... Popular culture, or pop culture, (literally: the culture of the people) consists of the cultural elements that prevail (at least numerically) in any given society, mainly using the more popular media, in that societys vernacular language and/or an established lingua franca. ... The depraved inhabitants of a tavern, from a nineteenth century temperance play. ... Charles R. Jackson (born 1902—died 1968) is an American author, best known for his 1944 novel, The Lost Weekend. ... The Lost Weekend is a 1945 motion picture directed by Billy Wilder for Paramount Pictures, starring Ray Milland, Jane Wyman and Phillip Terry. ... Days of Wine and Roses is a 1962 film which tells the story of an alcoholic couple who try to overcome their addiction. ... Leaving Las Vegas is an MGM film made in 1995 with Nicolas Cage and Elisabeth Shue directed by Mike Figgis, based on a semiautobiographical novel by John OBrien. ... Charles Bukowski (August 16, 1920 – March 9, 1994), was a Los Angeles poet and novelist often mistakenly associated with Beat Generation writers because of alleged similarities of style and attitude. ... Barfly is a 1987 feature film. ...


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. Flag of World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations, acting as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ...


Organizations working with those suffering from alcoholism include:

To meet Wikipedias quality standards, this article or section may require cleanup. ... IOGT INTERNATIONAL is an organisation of men and women of all ages who promote the ideals of temperance, peace and brotherhood. ... To meet Wikipedias quality standards and conform with our NPOV policy, this article or section may require cleanup. ... Moderation Management is a group which seeks to help various levels of alcohol users, and heavy drinkers, by supporting an individually created program for each drinker, to either reduce, or eliminate, the harm ones drinking is causing to their life. ... Rational Recovery (RR) is a source of counseling, guidance, and direct instruction on self-recovery from addiction to alcohol and other drugs through planned, permanent abstinence designed as an alternative to Alcoholics Anonymous (AA) and 12 step programs. ... What Is SOS? SOS is an alternative recovery method for those alcoholics or drug addicts who are uncomfortable with the spiritual content of widely available 12-Step programs. ... Self-Management and Recovery Training (SMART Recovery) is a non-profit organization (Alcohol & Drug Abuse Self-Help Network, Inc. ... Women For Sobriety (WFS), founded in 1976 by Jean Kirkpatrick, is a non-profit support group for alcoholic women. ... The official logo of Narcotics Anonymous Narcotics Anonymous (N.A.) is a twelve-step program designed to treat drug addiction, modeled on Alcoholics Anonymous. ... Oral medication Caffeine is the most widely used psychoactive substance in the world. ...

See also

Addiction is chronic disorder proposed to be precipitated by a combination of genetic, biological/pharmacological and social factors. ... Alcohol-related traffic crashes are defined by the US National Highway Traffic Safety Administration to include any and all vehicular (including bicycle and motorcycle) accidents in which any alcohol has been consumed, or believed to have been consumed, by the driver, a passenger or a pedestrian associated with the accident. ... Alcohol tolerance refers to a decreased response to the effects of ethanol in alcoholic beverages. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Delirium tremens (colloquially, the DTs, the horrors, the shakes or rum fits) is a condition usually associated with complete alcohol withdrawal. ... Outside the medical community, there is considerable debate over whether or not alcoholism should be considered a disease. ... Drug addiction, or dependency is the compulsive use of drugs, to the point where the user has no effective choice but to continue use. ... Infirmary of a rock festival Drunkenness, in its most common usage, is the state of being intoxicated with ethyl alcohol to a sufficient degree to impair mental and motor functioning. ... This is a list of famous people who died either through alcoholism or alcohol poisoning. ... Alcoholism has appeared in works of fiction throughout history. ... This is a list of famous people with alcohol problems. ... The trouble with this world is that everybody in it is three drinks behind, said American actor and cocktail lover Humphrey Bogart. ... Substance abuse refers to the overindulgence in and dependence on a stimulant, depressant, chemical substance, herb (plant) or fungus leading to effects that are detrimental to the individuals physical health or mental health, or the welfare of others. ... Wernicke-Korsakoff syndrome is a combination of Korsakoffs syndrome, which is characterized by confusion, severe anterograde and retrograde amnesia and confabulation; and Wernickes encephalopathy, which is characterized by nystagmus, ophthalmoplegia, coma and, if untreated, death. ... Liver function tests (LFTs or LFs), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patients liver. ... A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... Leaving Las Vegas is an MGM film made in 1995 with Nicolas Cage and Elisabeth Shue directed by Mike Figgis, based on a semiautobiographical novel by John OBrien. ... When a Man Loves a Woman is a 1994 drama film, starring Andy Garcia, Meg Ryan, Tina Majorino, Mae Whitman, Ellen Burstyn and Lauren Tom. ...

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 Double-Blind, 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

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. ...

External links

David J. Hanson, Ph. ... The Alcohol and Drugs History Society is a scholarly organization whose members study the history of a variety of illegal, regulated, and unregulated drugs such as opium, alcohol, and coffee. ...

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

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