Alcoholism

Alcoholism is a broad term for problems with alcohol, and is generally used
to mean compulsive and uncontrolled consumption of alcoholic beverages,
usually to the detriment of the drinker's health, personal relationships, and
social standing. It is medically considered a disease, specifically
a neurological disorder, and in medicine several other terms are used,
specifically "alcohol abuse" and "alcohol dependence," which have more
specific definitions.
Alcoholism is a destructive pattern of alcohol use that includes a number of symptoms, including
tolerance to or withdrawal from the substance, using more alcohol and/or for a longer time than
planned, and trouble reducing its use.

Alcoholism is a chronic, often progressive disease. A person with alcoholism

typically craves alcohol and drinks despite repeated alcohol related
problems, such as multiple drunk-driving violations, job loss, or
relationship problems. Alcoholism involves a physical dependence on alcohol,
but other factors include genetic, psychological, and cultural influences.
Alcoholism is characterized by cravings for alcohol and an inability to stop
drinking. It is accompanied by a physical dependence (meaning that the
person experiences withdrawal symptoms when not drinking) and an
increased tolerance for alcohol (meaning the person needs to drink greater
amounts to feel good). Before entering recovery, most alcoholics will
deny they have a problem. People who abuse alcohol but are not dependent
on it may have similar symptoms, but they don' t feel the same craving to
drink and usually don' t experience withdrawal symptoms.
About 18 million people in the United States abuse alcohol, and estimates
suggest that more than 70 million Americans have dealt with alcoholism in
their family. Alcohol is involved in almost half of all traffic deaths in the U.S.
Signs and Symptoms:

Alcoholism include symptoms like:

Solitary or secretive drinking

Craving for alcoholAlcohol cravings

Drinking a huge amount of alcohol without having control over

ownselfAn inability to control the amount you drink

Blackouts (not remembering events or conversations)

Getting frustrated and irritable when not able to get the drink at the
time. Irritability when you can' t get a drink at your regular time

Difficulty sustaining a relationship or a job

Nausea, anxiety and sweating on withdrawal from the alcohol.

Risk Factors:

If you have a family history of alcohol abuse, you are more likely to develop
the condition than someone without a family history. Other factors that may
increase your risk include:

Having 2 or more adverse events during childhood

Beginning to drink early, by age 16 or sooner

Drinking more than 1 - 2 drinks per day

Smoking cigarettes (particularly teenagers)

Being under a lot of stress

Having a pre-existing psychiatric disorder (such as depression or

anxiety)

Men have higher rates of alcoholism than women

Broken homes

Homeopathy

Few studies have examined the effectiveness of specific homeopathic

remedies. Professional homeopaths, however, may recommend a treatment
for alcoholism based on their knowledge and clinical experience. Before
prescribing a remedy, homeopaths take into account a person's
constitutional type. In homeopathic terms, a person's constitution is his or
her physical, emotional, and intellectual makeup. An experienced homeopath
assesses all of these factors when determining the most appropriate remedy
for a particular individual. Homeopathy alone should not be used to treat
alcoholism, but can be a supportive therapy along with counseling and
groups such as AA. The following are a few examples of remedies that an

experienced homeopath might consider for symptoms related to alcohol

abuse or withdrawal:
Arsenicum album -- for anxiety and compulsiveness, with nausea, vomiting,
and diarrhea
Nux vomica -- for irritability and compulsiveness with nausea, vomiting, and
constipation
Lachesis -- for cravings for alcohol cravings, headaches, and difficulty
swallowing
Staphysagria -- for angry individuals who tend to suppress their emotions
and may have been abused physically, sexually, or psychologically in the
past

Alcoholism

.[1] In 1979 an expert World Health Organization committee discouraged the use of "alcoholism" in medicine,
preferring the category of "alcohol dependence syndrome". [2] In the 19th and early 20th centuries, alcohol
dependence in general was called dipsomania, but that term now has a much more specific meaning.[3] People
suffering from alcoholism are often called "alcoholics". Many other terms, some of theminsulting or informal,
have been used throughout history. The World Health Organizationestimates that there are 140 million people
with alcoholism worldwide.[4][5]
Alcoholism is called a "dual disease" since it includes both mental and physicalcomponents.[6] The biological
mechanisms that cause alcoholism are not well understood.Social environment, stress,[7] mental health, family
history, age, ethnic group, and gender all influence the risk for the condition. [8][9] Significant alcohol intake
produces changes in the brain's structure and chemistry, though some alterations occur with minimal use of
alcohol over a short term period, such as tolerance and physical dependence. These changes maintain the
person with alcoholism's compulsive inability to stop drinking and result in alcohol withdrawal syndrome if the

person stops.[10] Alcohol damages almost every organ in the body, including the brain. The cumulative toxic
effects of chronic alcohol abuse can cause both medical and psychiatric problems. [11]
Identifying alcoholism is difficult for the individual afflicted because of the social stigmaassociated with the
disease that causes people with alcoholism to avoid diagnosis and treatment for fear of shame or social
consequences. The evaluation responses to a group of standardized questioning is a common method for
diagnosing alcoholism. These can be used to identify harmful drinking patterns, including alcoholism. [12] In
general, problem drinking is considered alcoholism when the person continues to drink despite experiencing
social or health problems caused by drinking.[13]
Treatment of alcoholism takes several steps. Because of the medical problems that can be caused by
withdrawal, alcohol detoxificationis carefully controlled and may involve medications such
as benzodiazepines such as diazepam (Valium).[14] People with alcoholism also sometimes have other
addictions, including addictions to benzodiazepines, which may complicate this step. [15] After detoxification,
other support such as group therapy or self-help groups are used to help the person remain sober.[16][17] Thombs
(1999) states according to behavioural sciences alcoholism is described as a maladaptive behaviour. He
explains this must not be confused with misbehaviour. Behavioural scientists explain that addicts have a
behaviour pattern that may lead to destructive consequences for themselves, their families and society. This
does not label addicts as bad or irresponsible.[18] Compared with men, women are more sensitive to alcohol's
harmful physical, cerebral, and mental effects. [19]

Contents
[hide]

1 Signs and symptoms

o

1.1 Long-term misuse

1.2 Alcohol withdrawal

2 Causes

2.1 Genetic variation

3 Pathophysiology
4 Diagnosis

4.1 Terminology

4.2 Social barriers

4.3 Screening

4.4 Genetic predisposition testing

4.5 DSM diagnosis

4.6 Urine and blood tests

5 Prevention
6 Management

6.1 Detoxification

6.2 Psychological

6.3 Medications

6.4 Dual addictions

7 Epidemiology
8 Prognosis
9 History
10 Society and culture
11 Research
12 See also
13 References
14 Further reading
15 External links

Signs and symptoms

Long-term misuse
Main article: Long-term effects of alcohol

Some of the possible long-term effects of ethanol an individual may develop. Additionally, in pregnant women, alcohol can
cause fetal alcohol syndrome.

Alcoholism is characterised by an increased tolerance of andphysical dependence on alcohol, affecting an

individual's ability to control alcohol consumption safely. These characteristics are believed to play a role in
impeding an alcoholic's ability to stop drinking.[10] Alcoholism can have adverse effects on mental health,
causing psychiatric disorders and increasing the risk of suicide. The onset of depression is a common
symptom.[20][21]

Physical
Long-term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the
liver, pancreatitis,epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic
ulcers[22] and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of
developing cardiovascular disease, malabsorption, alcoholic liver disease, and cancer. Damage to the central
nervous system and peripheral nervous system can occur from sustained alcohol consumption.[23][24]
Women develop long-term complications of alcohol dependence more rapidly than do men. Additionally,
women have a higher mortality rate from alcoholism than men. [25] Examples of long-term complications include
brain, heart, and liver damage[26] and an increased risk of breast cancer. Additionally, heavy drinking over time
has been found to have a negative effect on reproductive functioning in women. This results in reproductive
dysfunction such as anovulation, decreased ovarian mass, problems or irregularity of the menstrual cycle, and
early menopause.[25] Alcoholic ketoacidosis can occur in individuals who chronically abuse alcohol and have a
recent history ofbinge drinking.[27][28]
Even though alcoholism can increase the risk of liver cancer, studies have shown that a moderate consumption
of alcohol (1 serving/day for women and 2 servings/day for men) does not affect diabetes Type II greatly.

Psychiatric
Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are
common; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the
second leading cause of dementia.[29] Excessive alcohol use causes damage to brain function, and
psychological health can be increasingly affected over time. [30]
Social skills are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of
alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired
by alcohol abuse include impairments in perceiving facial emotions, prosody perception problems and theory of
mind deficits; the ability to understand humour is also impaired in alcohol abusers. [31]

Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric
disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric
symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued
abstinence.[32] Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can
lead to a misdiagnosis such as schizophrenia.[33] Panic disorder can develop or worsen as a direct result of
long-term alcohol misuse.[34][35]
The co-occurrence of major depressive disorder and alcoholism is well documented. [36][37][38] Among those
with comorbid occurrences, a distinction is commonly made between depressive episodes that remit with
alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with
abstinence ("independent" episodes).[39][40][41] Additional use of other drugs may increase the risk of depression.
[42]

Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a cooccurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic
stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have a
co-occurring diagnosis of narcissistic or antisocial personality disorder,bipolar disorder, schizophrenia, impulse
disorders or attention deficit/hyperactivity disorder.[43] Women with alcoholism are more likely to have a history
of physical or sexual assault, abuse and domestic violence than those in the general population, [43] which can
lead to higher instances of psychiatric disorders and greater dependence on alcohol.

Social effects
See also: Drug-related crime
The social problems arising from alcoholism are serious, caused by the pathological changes in the brain and
the intoxicating effects of alcohol.[29][44] Alcohol abuse is associated with an increased risk of committing criminal
offences, including child abuse, domestic violence, rape, burglary and assault.[45] Alcoholism is associated
with loss of employment,[46] which can lead to financial problems. Drinking at inappropriate times, and behavior
caused by reduced judgment, can lead to legal consequences, such as criminal charges for drunk driving[47] or
public disorder, or civil penalties for tortious behavior, and may lead to a criminal sentence.
An alcoholic's behavior and mental impairment, while drunk, can profoundly affect those surrounding them and
lead to isolation from family and friends. This isolation can lead to marital conflict and divorce, or contribute
to domestic violence. Alcoholism can also lead tochild neglect, with subsequent lasting damage to the
emotional development of the alcoholic's children. [48] For this reason, children of alcoholic parents can develop
a number of emotional problems. For example, they can become afraid of their parents, because of their

unstable mood behaviors. In addition, they can develop considerable amount of shame over their inadequacy
to liberate their parents from alcoholism. As a result of this failure, they develop wretched self-images, which
can lead to depression.[49]

Alcohol withdrawal
Main article: Alcohol withdrawal syndrome
See also: Kindling (sedative-hypnotic withdrawal)
As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and benzodiazepines,
withdrawal from alcohol dependence can be fatal if it is not properly managed. [44][50] Alcohol's primary effect is
the increase in stimulation of the GABAAreceptor, promoting central nervous system depression. With repeated
heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting
in tolerance and physical dependence. When alcohol consumption is stopped too abruptly, the person's
nervous system suffers from uncontrolled synapse firing. This can result in symptoms that include anxiety, life
threateningseizures, delirium tremens, hallucinations, shakes and possible heart failure.[51][52] Other
neurotransmitter systems are also involved, especially dopamine, NMDA and glutamate.[10][53]
Severe acute withdrawal symptoms such as delerium tremens and seizures rarely occur after 1 week post
cessation of alcohol. The acute withdrawal phase can be defined as lasting between one to three weeks. In the
period of 3 6 weeks following cessation increased anxiety, depression as well as sleep disturbance is
common;[54] fatigue and tension can persist for up to 5 weeks as part of the post-acute withdrawal syndrome;
about a quarter of alcoholics experience anxiety and depression for up to 2 years. These post-acute withdrawal
symptoms have also been demonstrated in animal models of alcohol dependence and withdrawal. [55] A kindling
effectalso occurs in alcoholics whereby each subsequent withdrawal syndrome is more severe than the
previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence
followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to
develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol dependent
individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent
functional changes in brain neural circuits as well as to gene expression.[56] Kindling also results in
psychological symptoms of alcohol withdrawal becoming more intensified. [54]

Causes
A complex mixture of genetic and environmental factors influences the risk of the development of alcoholism.
[57]

Genes that influence the metabolism of alcohol also influence the risk of alcoholism, and may be indicated

by a family history of alcoholism.[58] One paper has found that alcohol use at an early age may influence

the expression of genes which increase the risk of alcohol dependence.[59]Individuals who have a genetic
disposition to alcoholism are also more likely to begin drinking at an earlier age than average. [60]
Also, a younger age of onset of drinking is associated with an increased risk of the development of alcoholism,
[60]

and about 40 percent of alcoholics will drink excessively by their late adolescence. It is not entirely clear

whether this association is causal, and some researchers have been known to disagree with this view. [61] A high
testosterone concentration during pregnancy may be a risk factor for later development of alcohol dependence.
[62]

Severe childhood trauma is also associated with a general increase in the risk of drug dependency.[57] Lack of
peer and family support is associated with an increased risk of alcoholism developing. [57] Genetics and
adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol
abuse. Cortical degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute
to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence,
there is a reversal of at least some of the alcohol induced central nervous system damage. [63]

Genetic variation
See also: Human genetic variation
Genetic differences exist between different racial groups which affect the risk of developing alcohol
dependence. For example, there are differences between African, East Asian and Indo-racial groups in how
they metabolize alcohol. These genetic factors are believed to, in part, explain the differing rates of alcohol
dependence among racial groups.[64][65] The alcohol dehydrogenase allele ADH1 B*3 causes a more rapid
metabolism of alcohol. The allele ADH1 B*3 is only found in those of African descent and certain Native
American tribes. African Americans and Native Americans with this allele have a reduced risk of developing
alcoholism.[66] Native Americans however, have a significantly higher rate of alcoholism than average; it is
unclear why this is the case.[67] Other risk factors such as cultural environmental effects e.g. trauma have been
proposed to explain the higher rates of alcoholism among Native Americans compared to alcoholism levels in
caucasians.[68][69]

Alcoholism and alcohol abuse

Alcohol dependence; Alcohol abuse; Problem drinking; Drinking problem

Last reviewed: March 20, 2011.

Alcoholism (alcohol dependence) and alcohol abuse are two different forms of problem
drinking.

Alcoholism is when you have signs of physical addiction to alcohol and continues to
drink, despite problems with physical health, mental health, and social, family, or
job responsibilities. Alcohol may control your life and relationships.

Alcohol abuse is when your drinking leads to problems, but not physical addiction.

Causes, incidence, and risk factors

There is no known cause of alcohol abuse or alcoholism. Research suggests that certain
genes may increase the risk of alcoholism, but which genes and how they work are not
known.
How much you drink can influence your chances of becoming dependent. Those at risk for
developing alcoholism include:

Men who have 15 or more drinks a week

Women who have 12 or more drinks a week

Anyone who has five or more drinks per occasion at least once a week

One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce
shot of liquor.
You have an increased risk for alcohol abuse and dependence if you have a parent with
alcoholism.
You may also be more likely to abuse alcohol or become dependent if you:

Are a young adult under peer pressure

Have depression, bipolar disorder, anxiety disorders, or schizophrenia

Have easy access to alcohol

Have low self-esteem

Have problems with relationships

Live a stressful lifestyle

Live in a culture alcohol use is more common and accepted

Alcohol abuse is rising. Around 1 out of 6 people in the United States have a drinking
problem.

Symptoms
People who have alcoholism or alcohol abuse often:

Continue to drink, even when health, work, or family are being harmed

Drink alone

Become violent when drinking

Become hostile when asked about drinking

Are not able to control drinking -- being unable to stop or reduce alcohol intake

Make excuses to drink

Miss work or school, or have a decrease in performance because of drinking

Stop taking part in activities because of alcohol

Need to use alcohol on most days to get through the day

Neglect to eat or eat poorly

Do not care about or ignore how they dress or whether they are clean

Try to hide alcohol use

Shake in the morning or after periods when they have not a drink

Symptoms of alcohol dependence include:

Memory lapses after heavy drinking

Needing more and more alcohol to feel "drunk"

Alcohol withdrawal symptoms when you haven't had a drink for a while

Alcohol-related illnesses such as alcoholic liver disease

Drug dependence

Drug dependence means that a person needs a drug to function normally. Abruptly stopping the drug
leads to withdrawal symptoms. Drug addiction is the compulsive use of a substance, despite its negative
or dangerous effects.
A person may have a physical dependence on a substance without having an addiction. For example,
certain blood pressure medications do not cause addiction but they can cause physical dependence.
Other drugs, such as cocaine, cause addiction without leading to physical dependence.
Tolerance to a drug (needing a higher dose to attain the same effect) is usually part of addiction.
See also:

Drug abuse

Drug abuse first aid

Causes
Drug abuse can lead to drug dependence or addiction. People who use drugs for pain relief may become
dependent, although this is rare in those who don't have a history of addiction.
The exact cause of drug abuse and dependence is not known. However, a person's genes, the action of
the drug, peer pressure, emotional distress, anxiety, depression, and environmental stress all can be
factors.
Peer pressure can lead to drug use or abuse, but at least half of those who become addicted have
depression, attention deficit disorder, post-traumatic stress disorder, or another mental health problem.
Children who grow up in an environment of illicit drug use may first see their parents using drugs. This
may put them at a higher risk for developing an addiction later in life for both environmental and genetic
reasons.
People who are more likely to abuse or become dependent on drugs include those who:

Have depression, bipolar disorder, anxiety disorders, and schizophrenia

Have easy access to drugs

Have low self-esteem, or problems with relationships

Live a stressful lifestyle, economic or emotional

Live in a culture where there is a high social acceptance of drug use

Commonly abused substances include:

Opiates and narcotics are powerful painkillers that cause drowsiness (sedation) and sometimes
feelings of euphoria. These include heroin, opium, codeine, meperidine
(Demerol), hydromorphone(Dilaudid), and oxycodone (Oxycontin).

Central nervous system (CNS) stimulants include amphetamines, cocaine,

dextroamphetamine, methamphetamine, and methylphenidate (Ritalin). These drugs have a
stimulating effect, and people can start needing higher amounts of these drugs to feel the same
effect (tolerance).

Central nervous system depressants include alcohol, barbiturates (amobarbital, pentobarbital,

secobarbital), benzodiazepines (Valium, Ativan, Xanax), chloral hydrate, and paraldehyde. These
substances produce a sedative and anxiety-reducing effect, which can lead to dependence.

Hallucinogens include LSD, mescaline, psilocybin ("mushrooms"), and phencyclidine (PCP or

"angel dust"). They can cause people to see things that aren't there (hallucinations) and can lead
to psychological dependence.

Tetrahydrocannabinol (THC) is the active ingredient found in marijuana (cannabis) and hashish.

There are several stages of drug use that may lead to dependence. Young people seem to move more
quickly through the stages than do adults.

Experimental use -- typically involves peers, done for recreational use; the user may enjoy
defying parents or other authority figures.

Regular use -- the user misses more and more school or work; worries about losing drug source;
uses drugs to "fix" negative feelings; begins to stay away from friends and family; may change
friends to those who are regular users; shows increased tolerance and ability to "handle" the
drug.

Daily preoccupation -- the user loses any motivation; does not care about school and work; has
obvious behavior changes; thinking about drug use is more important than all other interests,
including relationships; the user becomes secretive; may begin dealing drugs to help support
habit; use of other, harder drugs may increase; legal problems may increase.

Dependence -- cannot face daily life without drugs; denies problem; physical condition gets
worse; loss of "control" over use; may become suicidal; financial and legal problems get worse;
may have broken ties with family members or friends.

Symptoms
Some of the symptoms and behaviors of drug dependence include:

Confusion

Continuing to use drugs even when health, work, or family are being harmed

Episodes of violence

Hostility when confronted about drug dependence

Lack of control over drug abuse - being unable to stop or reduce alcohol intake

Making excuses to use drugs

Missing work or school, or a decrease in performance

Need for daily or regular drug use to function

Neglecting to eat

Not caring for physical appearance

No longer taking part in activities because of drug abuse

Secretive behavior to hide drug use

Using drugs even when alone