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. 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 neuro-chemical) and they all must be treated in order to effectively treat the condition.
Long term physical health effects
Death from many sources, primarily alcohol toxemia.
Pancreatitis, or inflammation of the pancreas (both the acute and chronic form).
Heart Disease.
Polyneuropathy, or damage to the nerves leading to poor sensation of pain and impaired mobility.
Cirrhosis of the liver, a chronic disease characterized by destruction of liver cells and loss of liver function, and its numerous complications, including bleeding from esophageal varices.
Depression, insomnia, anxiety, and suicide.
Increased incidence of many types of cancer, including breast cancer, head and neck cancer, esophageal cancer and colorectal cancer.
Nutritional deficiency of folic acid, thiamine (vitamin B1) and several others.
Wernicke-Korsakoff syndrome, a neuro-psychiatric disorder caused by thiamine deficiency that results from poor nutrition in some alcoholics.
Sexual dysfunction.
Alcohol Withdrawal
There are several distinct but not mutually exclusive alcohol withdrawal syndromes caused by alcohol withdrawal.
Tremulousness - "the shakes".
Activation syndrome - characterized by tremulousness, agitation, rapid heart beat and high blood pressure.
Seizures - acute grand mal seizures can occur in alcohol withdrawal in patients who have no history of seizure or any structural brain disease.
Hallucinations - usually visual or tactile in alcoholics.
Delirium - can be severe and often fatal.
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.
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:
Have you ever felt you needed to cut down on your drinking?
Have people annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
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?
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.
Treatment
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 neuro-chemical), 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.
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.