Alcoholism

Alcohol Dependence is a condition characterized by the harmful consequences of repeated alcohol use, a pattern of compulsive alcohol use, and (sometimes) physiological dependence on alcohol (i.e., tolerance and/or symptoms of withdrawal). This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing.

Complications:

School and job performance may suffer either from hangovers or from actual intoxication on the job or at school; child care or household responsibilities may be neglected; and alcohol-related absences may occur from school or job. The individual may use alcohol in physically hazardous circumstances (e.g., drunk driving or operating machinery while intoxicated). Legal difficulties may arise because of alcohol use (e.g., arrests for intoxicated behavior or for drunk driving). Individuals with this disorder may continue to abuse alcohol despite the knowledge that continued drinking poses significant social or interpersonal problems for them (e.g., violent arguments with spouse while intoxicated, child abuse). Alcohol intoxication causes significant intellectual impairment (and stupid behavior). Once a pattern of compulsive use develops, individuals with this disorder may devote substantial periods of time to obtaining and consuming alcoholic beverages. These individuals continue to use alcohol despite evidence of adverse psychological or physical consequences (e.g., depression, blackouts, liver disease, or other complications). Individuals with this disorder are at increased risk for accidents, violence, and suicide. It is estimated that 1 in 5 intensive care unit admissions in some urban hospitals is related to alcohol and that 40% of people in U.S.A. experience an alcohol-related accident at some time in their lives, with alcohol accounting for up to 55% of fatal driving events. More than one-half of all murderers and their victims are believed to have been intoxicated with alcohol at the time of the murder. Severe Alcohol Intoxication also contributes to disinhibition and feelings of sadness and irritability, which contribute to suicide attempts and completed suicides.

Only 5% of individuals with Alcohol Dependence ever experience severe complications of withdrawal (e.g., delirium, grand mal seizures). However, repeated intake of high doses of alcohol can affect nearly every organ system, especially the gastrointestinal tract, cardiovascular system, and the central and peripheral nervous system. Gastrointestinal effects include gastritis, stomach or duodenal ulcers, and, in about 15% of those who use alcohol heavily, liver cirrhosis and pancreatitis. There is also an increased rate of cancer of the esophagus, stomach, and other parts of the gastrointestinal tract. One of the most common associated general medical conditions is low-grade hypertension. There is an elevated risk of heart disease. Peripheral neuropathy may be evidenced by muscular weakness, paresthesias, and decreased peripheral sensation. Most persistent central nervous system effects include cognitive deficits, severe memory impairment, and degenerative changes in the cerebellum (leading to poor balance and coordination). One devastating central nervous system effect is the relatively rare Alcohol-Induced Persisting Amnestic Disorder (Wernicke-Korsakoff syndrome) in which there is a dramatic impairment in short-term memory. Men may develop erectile dysfunction and decreased testosterone levels. Repeated heavy drinking in women is associated with menstrual irregularities and, during pregnancy, with spontaneous abortion and fetal alcohol syndrome (leading to mentally retarded, hyperactive children). Alcohol Dependence can suppress immune mechanisms and predispose individuals to infections (e.g., pneumonia) and increase the risk for cancer.

Comorbidity:

Individuals with Alcohol Dependence are at increased risk for Major Depressive Disorder, other Substance-Related Disorders (e.g., drug addiction), Conduct Disorder in adolescents, Antisocial and Emotionally Unstable (Borderline) Personality Disorders, Schizophrenia, and Bipolar Disorder.

Associated Laboratory Findings:

The most direct test available to measure alcohol consumption is blood alcohol concentration, which can also be used to judge tolerance to alcohol. An individual with a concentration of 100 mg of ethanol per deciliter of blood who does not show signs of intoxication can be presumed to have acquired tolerance to alcohol. At 200 mg/dL, most non-alcoholic individuals would demonstrate severe intoxication. An elevation (> 30 units) of gamma-glutamyltransferase (GGT) is a sensitive laboratory test for heavy drinking. At least 70% of individuals with a high GGT level are persistent heavy drinkers (i.e., consuming 8 or more drinks daily on a regular basis). Another sensitive test for heavy drinking is an elevation (> 20 units) in carbohydrate deficient transferrin (CDT). Both GGT and CDT levels return toward normal within days to weeks of stopping drinking, thus are useful tests to monitor abstinence. The combination of GGT and CDT may have even higher levels of sensitivity and specificity in diagnosing heavy drinking than either test used alone. Another useful laboratory test for heavy drinking is an elevated mean corpuscular volume (MCV). However, the MCV is a poor method of monitoring abstinence because it takes weeks to return to normal after the individual stops drinking. Liver function tests (e.g., alanine aminotransferase [ALT] and alkaline phosphatase) can reveal liver injury that is caused by heavy drinking. High fat content in the blood also contributes to the development of fatty liver.

Prevalence:

Alcohol use is highly prevalent in most Western countries. However, in most Asian cultures, the overall prevalence of Alcohol-Related Disorders is relatively low. In Muslim countries, the Islamic religion strictly prohibits alcohol (hence the rates of Alcohol-Related Disorders are very low). In the Western countries, this disorder occurs much more commonly in males (with a male-to-female ratio of 5:1). The lifetime risk of Alcohol Dependence is approximately 15% in the general population. In any year, 5% of the general population will actively be suffering from Alcohol Dependence.

Course:

Alcohol Dependence has a variable course that is frequently characterized by periods of remission and relapse. The first episode of Alcohol Intoxication is likely to occur in the mid-teens, with the age at onset of Alcohol Dependence peaking in the 20s to mid-30s. The large majority of those who develop Alcohol Dependency do so by their late 30s.

Familial Pattern:

Alcohol Dependence often has a familial pattern, and it is estimated that 40%-60% of the variance of risk is explained by genetic influences. The risk for Alcohol Dependence is 3 to 4 times higher in close relatives of people with Alcohol Dependence. Most studies have found a significantly higher risk for Alcohol Dependence in the monozygotic twin than in the dizygotic twin of a person with Alcohol Dependence. Adoption studies have revealed a 3- to 4-fold increase in risk for Alcohol Dependence in the children of individuals with Alcohol Dependence when these children were adopted away at birth and raised by adoptive parents who did not have this disorder.

Treatment:

Follow-up studies of the typical person with an Alcohol Use Disorder show a higher than 65% 1-year abstinence rate following treatment. Even among less functional and homeless individuals with Alcohol Dependence who complete a treatment program, as many as 60% are abstinent at 3 months, and 45% at 1 year. Some individuals (perhaps 20% or more) with Alcohol Dependence achieve long-term sobriety even without treatment.