The consumption of, or preoccupation with, alcoholic beverages to the extent that this behavior interferes with the alcoholic drinker’s normal personal, family, social, or work life, and may lead to physical or mental harm is alcoholism. Chronic alcohol consumption can result in many psychological and physiological disorders. It is one of the world’s most costly drug use problems, excluding nicotine addiction.
Alcohol use is required to trigger alcoholism. However, the majority of the population can drink alcoholic beverages with no danger of suffering from alcoholism. The exact biological mechanism of this condition is unknown. There may be possible factors that must exist for alcohol use to develop into alcoholism. These are the following: a person’s social environment, emotional health and genetic predisposition. Several forms of addiction to alcohol may occur simultaneously in an individual such as psychological, metabolic and neurochemical and they all must be treated in order to effectively treat alcoholism.
In general, substance use disorders are the major public health problem facing many countries. 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. Over 2.8 million in 2001 was calculated to be “dependent drinkers” in the United Kingdom.
The process of identifying cases of alcoholism is difficult especially in borderline cases. The difficulty lies more on detecting the physiological difference between a person who just drinks a lot and a person who cannot control his or her drinking. Hence, an objective assessment is needed regarding the damage that the consumption of alcohol does to the drinker’s life in comparison to the perceived subjective benefits that the drinker perceives from that alcohol consumption.
The most commonly used screening tool to determine the loss of control of alcohol use is the CAGE questionnaire. This is developed by Dr. John Ewing and basically is made up of four questions that can used easily to screen patients quickly in a doctor’s office setting. If there are two “yes” answers out of the four questions signifies the need for further investigation.
CAGE questionnaire asks the following:
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 the nerves and to get rid of a hangover?
A more sensitive diagnostic test than the CAGE test is The Alcohol Dependence Date Questionnaire which serves to distinguish a diagnosis of alcohol dependence from one of heavy alcohol use. Another screening test which is widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses such as driving under the influence of it (the most common) is the Michigan Alcohol Screening Test (MAST). The DSM-IV definition for alcoholism is the one currently in general use from a diagnostic standpoint. It is defined as: 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.
Recognizable effects on the body (through urine and blood tests) for long term heavy drinking are:
1. Macrocytosis (increased MCV- mean corpuscular volume)
2. Elevated GGT (gamma glutamyl transferase)
3. Moderate elevation of AST and ALT (liver enzymes) and an AST:ALT ratio of 2:1
4. High carbohydrate deficient transferring (CDT)
There is actually no reliable tests that can differentiate between a person that drinks a lot and a person who cannot control their drinking.
Consumption of large amounts of alcohol can lead to long-tem health effects (both by alcoholics and non-alcoholics) that may include:
• death from many sources, primarily alcohol toxemia
• Acute or chronic pancreatitis(inflammation of the pancreas)
• heart disease including dilated cardiomyopathy
• polyneuropathy, or damage to the nerves (poor sensation of pain and impaired mobility)
• liver cirrhosis, a chronic disease characterized by destruction of liver cells and loss of liver function, and its complications (bleeding from esophageal varices)
• depression, insomnia, anxiety, and suicide
• increased incidence of many types of cancer (breast cancer, head and neck cancer, esophageal cancer and colorectal cancer)
• nutritional deficiency of folic acid, thiamine (vitamin B1)
• Wernicke-Korsakoff syndrome, a neuropsychiatric disorder caused by thiamine deficiency that results from poor nutrition in some alcoholics
• sexual dysfunction
Treatment options available are: detoxification (benzodiazepene and barbiturates drug class), group therapy and psychotherapy (e.g. Alcoholics Anonymous), rationing (moderation management), medications (e.g. Disulfiram, Naltrexone, Vivitrol) pharmaceutical extinction (opioid antagonists), nutritional therapy and return to normal drinking.
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