Alcohol addiction

Alcohol addictionAlcohol addiction (also known as alcoholism, alcohol dependence syndrome, alcohol use disorder (AUD) is an alcohol abuse that leads to mental and physical disorders.


Description


According to the definition by Magnus Huss, alcoholism is a chronic continual drinking or periodic consumption of alcohol, which is characterized by impaired control over drinking, frequent episodes of intoxication, and preoccupation with alcohol and the use of alcohol despite adverse consequences.

It was estimated that 5.9% of deaths each year are caused by the alcohol abuse. Alcohol attributes to 25% of the deaths in the age group aged 20 – 39 years.

Essential and reactive alcoholism are distinguished. The essential alcoholism is supposed to be predisposed genetically, while reactive alcoholism develops due to other disorders.

In the United Kingdom the following terms referred to drinking are used:

  • Binge drinking: Over twice the daily guidelines in one day (8 units for men, 6 units for women).
  • Low to moderate: Weekly, drinking up to 14 units for women and 21 units for men.
  • Heavy to moderate: Weekly, drinking 14–35 units for women and 21–50 units for men.
  • Very heavy drinking: Weekly consumption of 35 units or more for women, and 50 units or more for men.
  • Chronic: Sustained drinking, which is causing or is likely to cause harm.


Causes and risk factors

Numerous factors may contribute to alcohol addiction. They include

  • Biological (genetic predisposition, co-morbid psychiatric disorder or personality disorder, reinforcing effects of the drugs, withdrawal effects and craving, biochemical factors);
  • Psychological (curiosity, general rebelliousness and social non-conformity, history of alcoholism in family, teenage problems, poor impulse control, sensation-seeking, low self-esteem, concerns regarding personal autonomy, poor stress management skills, childhood trauma or loss, escape from reality, psychological distress);
  • Social factors (peer pressure, role model: imitating the ego-id).

Related: Alcohol and its harm effects

 

Alcohol

Alcohols create a group of organic compounds derived from hydrocarbons and containing one or more hydroxyl (-OH) groups. In alcoholic beverages ethanol (C2H5OH, ethyl alcohol) is found, the substance is known to be psychoactive.
Psychoactive substances are those that cause certain psychological effects and when consumed regularly lead to both psychological and physical addiction.

Influence on the body


Alcohol abuse affects all the body, but the brain, heart, liver, pancreas, and immune system  particularly suffer. As a result mental illness, Wernicke–Korsakoff syndrome, liver failure, pancreatitis, cancer are likely to develop.
As long as the absorption of thiamine (vitamin B1) is inhibited by alcohol consumption, excessive alcohol consumption leads to vitamin B1 deficiency and therefore causes Wernicke-Korsakoff’s syndrome (WKS) – the combination of the Wernicke’s encephalopathy (WE) and Korsakoff’s psychosis. These disorders are tightly connected and usually diagnosed as one condition. Classically WKS presents with the triad of confusion, ataxia (loss of balance and coordination), and nystagmus (involuntary eye movements). Affected individuals experience gait abnormalities, inability to walk or difficulties walking, diplopia (double vision), strabismus, apathy and indifference, hallucinations, confabulations (a person fills in gaps of memory with data that can be recalled at that moment), intellectual impairment, aphasia (an inability to comprehend and formulate language), apraxia (an inability to perform tasks or movements), agnosia (an inability to  recognize objects, persons, sounds etc.) and amnesia (Korsakoff dementia), insomnia, anxiety, weight loss and recurrent vomiting. Other symptoms that are associated with WE are stupor, low blood pressure (hypotension), increased heart rate (tachycardia), hypothermia, epileptic seizures and a progressive loss of hearing.

Alcohol-related nutritional deficiency causes Marchiafava-Bignami  disease. A disorder is characterized by disorientation, epilepsy, ataxia, dysarthria, hallucinations, limb paralysis, and deterioration of personality and intellectual functioning.

Other complications include:

  • Fatty liver, cirrhosis of liver, hepatitis, liver cell carcinoma, liver failure, ascitis;
  • Gastritis, peptic ulcer, carcinoma stomach, reflux oesophagitis;
  • Mallory-Weiss syndrome;
  • Malabsorption syndrome, protein-losing enteropathy
  • Pancreatitis: acute, chronic, and relapsing;
  • Delirium tremens;
  • Suicide;
  • Acne rosacea, palmar erythema;
  • Parotid enlargement;
  • Alcoholic hypoglycaemia and ketoacidosis;
  • Cardiomyopathy, cardiac beri-beri;
  • Anaemia, thrombocytopenia;
  • Vitamin K factor deficiency;
  • Accidental hypothermia
  • Pseudo-Cushing’s syndrome, hypogonadism, gynaecomastia (in men), amenorrhoea, infertility;
  • Coronary artery disease;
  • Malnutrition, pellagra
  • Decreased immune function and proneness to infections such as tuberculosis;
  • Sexual dysfunction;
  • Alcoholic dementia, cerebellar degeneration;
  • Peripheral neuropathy and central pontine myelinosis.

 

Alcohol tolerance test

Symptoms

  • Compulsive desire/urge/craving to drink alcohol;
  • Loss of control while drinking, inability to stop drinking;
  • Drink-seeking behavior;
  • Increased tolerance to alcohol and the need to drink greater amounts of alcohol than before to reach the desirable effect (increased dosages);
  • Repeated withdrawal symptoms, including shakiness, nausea and sweating, when a person hasn’t drunk alcohol for a while;
  • Relief or avoidance of withdrawal by further consumption of alcohol beverages;
  • Avoiding social activities that are not connected with alcohol.


Stages

Alcohol addiction develops gradually via psychological and physical addiction followed by the encephalopathy.

Diagnostic criteria

The following criteria are found in the American Psychiatric Association’s Diagnostic and Statistical Manual.

A maladaptive pattern of drinking as manifested by three or more of the following during a 12-month period:

  1.  Tolerance, that is, either:
  2.  a need for markedly more alcohol to achieve intoxication
  3.  markedly diminished effect despite continued

consumption of the same amount of alcohol

  1.  Withdrawal, that is, either:
  2.  two or more signs or symptoms (autonomic hyperactivity, tremor, insomnia, nausea or vomiting, transient illusions or hallucinations, psychomotor agitation, anxiety, grand mal seizures) within several hours of stopping or reducing heavy, prolonged drinking (consuming) alcohol or a related substance (e.g., benzodiazepines) to relieve or avoid withdrawal symptoms
  3.  Alcohol is often consumed in larger amounts or over a longer period than was intended
  4.  There is a persistent desire to cut down or control drinking
  5.  A great deal of time is spent in drinking or recovering from drinking

6  Important social, occupational, or recreational activities are given up or reduced because of drinking

  1.  Drinking is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.


Diagnosis


Numerous questionnaires are used to verify alcohol addiction, including ADS (Alcohol Dependence Scale), APQ (Alcohol Problems Questionnaire), ASI (Addiction Severity Index), AUDIT (Alcohol Use

Disorders Identification), the CAGE questionnaire, CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol), LDQ (Leeds Dependence Questionnaire), MAST (Michigan Alcohol Screening Test), SADQ (Severity of Alcohol Dependence Questionnaire), SAPC (Substance Abuse Problem Checklist) and SADD (Short Alcohol Dependence Data).

The CAGE questionnaire is an easy test as long as it has only four questions:

  1. Have you ever felt like cutting down on your drinking?
  2. Have people annoyed or criticized you for drinking?
  3. Have you ever felt bad or guilty about your drinking?
  4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye opener)?

A positive answer should raise suspicion of an alcohol problem, and a score of 2 is highly suggestive of alcohol abuse. A person should seek professional medical assistance.

Blood tests for bilirubin and other hepatic function markers are necessary to estimate the body and liver condition.

Treatment


Treatment of alcoholism aims to:

  • Promote complete abstinence from alcohol and stabilize acute medical (alcohol withdrawal) and psychiatric conditions;
  • Locate the person in a suitable housing and environment;
  • Social support for recovery (help the patient to repair relationships and socialize);
  • Improve occupational functioning;
  • Promote maintenance of recovery through participation in treatment or self-help groups.

Treatment includes both pharmacological and non-pharmacological measures.