Alcohol dependence (alcoholism) is a condition in which a person becomes physically dependent on alcohol Table 01. Physical or psychological repercussions from drinking, rather than the amount of alcohol consumed or frequency with which a person drinks, define alcohol abuse and dependence. With increased consumption, a person can develop a tolerance to alcohol, and will require greater quantities of alcohol to achieve a "high" feeling. A person with alcohol dependence may also experience symptoms of withdrawal with reduced alcohol intake.
Alcohol abuse is the most common psychiatric disease in the US, with an estimated 13.7% to 23.5% of the general population experiencing problems with abuse or dependence during their lifetimes Table 02. Most people who have alcohol problems are employed and have families. Only 5% are stereotypical "Skid Row" drinkers. More men than women are affected by alcohol abuse, however the prevalence in women is rising. Professionals and executives, people under the age of 25, and elderly people are also at risk for alcohol abuse.
Table 1. Continuum of Alcohol Abuse Severity
Classification Behavior Social drinker Amount consumed and setting appear socially acceptable, but person has a propensity to overindulge or occasionally use alcohol to cope with stress Heavy social drinker Drinks in socially acceptable settings, but actively seeks occasions to drink, usually more than 2 drinks per day Problem drinker Heavy drinker, gets drunk, exhibits medical, legal, social, psychological consequences of excessive alcohol consumption; may have made attempts to cut down; variably functional Alcohol-dependent Tries to consume same excessive amount of alcohol regardless of mood or setting; alcohol is given top priority in all situations; tolerance develops and symptoms of withdrawal may be noted during the workday when alcohol levels drop; individual is aware of his compulsion, but is difficult to reach Severely deteriorated Constant state of intoxication; the person doesn't care for self or surroundings; many hospitalizations for detoxification and medical care after alcohol-related trauma or organ damage occur
Table 2. Racial and Gender Difference In Alcohol Abuse and Related Problems
Race or gender Comments White Largest number with alcohol problems Double the rate of driving under the influence of alcohol White women have higher rates of alcohol abuse and dependence than women of other races Black Higher rates of abstinence and lower rates of heavy use (especially in women) Higher rates of alcohol-related disease, injury, psychological problems, and homicide Greater alcohol-related problems among the socioeconomically deprived Hispanic Great diversity in drinking patterns among different groups Lower rates of use among women Heavier use and greater alcohol-related problems after age 30 American Indian and Native Alaskan Great diversity in drinking patterns among tribal groups Highest prevalence of AA-D among all racial groups Highest consumption between ages 25 and 45 (75% of traumatic deaths and suicides are related to alcohol) Asian Lowest levels of alcohol consumption, alcohol abuse and dependence, and related problems Female Few studies prior to 1980; lower rates of heavy drinking and alcohol-related problems than men; heavier drinking among younger age groups (21-35 years), those living with heavy-drinking partner or spouse, those unmarried living with significant others, and those who are unemployed or employed part-time. Increased rates of drinking as gender roles approximate those in men. Heavy drinking tends to develop following medical or psychiatric illness
Alcohol depresses the central nervous system, altering thinking, judgment, and behavior. People with alcohol problems crave a drink, and are not able to limit their intake. With increased consumption, the alcoholic loses his or her ability to think clearly and maintain normal coordination.
Alcohol abuse is thought to occur when drinking repeatedly interferes with school, work, household responsibilities, and relationships with family and friends. Some people with alcohol problems are arrested for drinking and driving, or for displaying intoxicated behavior.
Alcohol abuse can seriously endanger physical health Table 03. Liver, pancreas, and brain damage can occur with alcohol abuse, as can gastrointestinal inflammation, ulceration, and diarrhea. Chronic alcohol abuse is associated with an increased incidence of pneumonia and tuberculosis, and alcoholics are 10 times more likely to have cancer. Sleep, memory, and sexual performance disturbances can occur in alcoholics as well.
Alcohol abuse and dependence create a number of social and psychological problems: it is associated with the spread of sexually transmitted diseases, as well as increased rates of domestic abuse, violent crime, and suicide Table 04.
Table 3. Medical Illness Associated With Chronic Alcohol Abuse
Disorder Illness Metabolic Alcoholic ketoacidosis, alcoholic hypoglycemia, water and salt disorders Neurologic Chronic problems with thinking such as Wernicke's encephalopathy and Korsakoff's psychosis, alcoholic cerebellar degeneration, and central pontine myelinolysis leading to problems walking and other motor activities, acute and chronic dementia, alcoholic peripheral neuropathy Muscular Acute and chronic alcoholic muscle weakness Gastrointestinal Fatty liver, alcoholic hepatitis, alcoholic cirrhosis, alcoholic pancreatitis, poor pancreatic function, gastroesophageal reflux, esophageal carcinoma, erosive gastritis, chronic diarrhea, malabsorption, esophageal varices leading to bleeding into the GI tract Metabolic-endocrine High cholesterol, high levels of uric acid, low testosterone levels, impotence, testicular atrophy, gynecomastia, irregular menstrual periods, reversible Cushing's syndrome Blood Anemia due to poor production of blood cells or slow intestinal bleeding, poor white cell production, destruction of platelets, blood too thin to clot properly. Cardiac Decreased cardiac function, arrhythmias, dilated cardiomyopathy, high blood pressure Pulmonary Increased incidence of pneumonia, increased incidence of tuberculosis Other Increased incidence of severe intestinal infections, fetal alcohol syndrome, vitamin deficiency syndromes, trauma, sexual dysfunction, insomnia
Table 4. Social Problems Associated With Alcohol Abuse and Dependence in the United States
Accidental death and injury 50% of fatal car crashes 25-fold increased risk of falls or drowning 50% of fire-related burns or deaths 20% to 30% of trauma seen in emergency rooms Crime Frequently involved in violent crime Suicide Involved in up to 35% of suicides Economic cost $148 billion annually (estimated); 15% for health care and treatment Other Associated with increased rates of spouse or child abuse and increased spread of sexually transmitted diseases
Genetic, environmental, and sociocultural factors are all thought to contribute to alcohol abuse and dependence. The cause for alcohol abuse is not completely understood; biological, societal, psychological, and behavioral theories have been proposed as possible reasons. Studies of twins and of adopted children reveal that there is some genetic link to alcoholism. However, children also learn about and establish attitudes towards drinking by observing parents and peers, suggesting that social factors also play a role.
Some studies indicate that people who abuse alcohol do not become intoxicated as easily as non-abusers. Some research shows that the brains of alcohol abusers tend to be less sensitive to the effects of the alcohol than non-abusers' brains. Therefore, alcohol abusers need to drink more than the average person in order to become intoxicated, which may lead to the physical problems of dependence.
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