Alcoholism, also known as alcohol dependence



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Alcoholism




Alcoholism, also known as alcohol dependence is a disabling addictive disorder. It is characterized by compulsive and uncontrolled consumption of alcohol despite its negative effects on the drinker's health, relationships, and social standing. Similar to other drug addictions, alcoholism is medically defined as a treatable disease. The term "alcoholism" is a widely used term first coined in 1849 by Magnus Huss, but in medicine the term was replaced by "alcohol abuse" and "alcohol dependence" in the 1980s DSM III. Similarly in 1979 an expert World Health Organisation committee disfavoured the use of "alcoholism" as a diagnostic entity, preferring the category of "alcohol dependence syndrome". In the 19th and early 20th centuries, alcohol dependence was called dipsomania before the term "alcoholism" replaced it.

The biological mechanisms underpinning alcoholism are uncertain, however, risk factors include social environment, stress, mental health, genetic predisposition, age, ethnic group, and sex. Long-term alcohol abuse produces physiological changes in the brain such as tolerance and physical dependence. Such brain chemistry changes maintain the alcoholic's compulsive inability to stop drinking and result in alcohol withdrawal syndrome upon discontinuation of alcohol consumption. Alcohol damages almost every organ in the body, including the brain; because of the cumulative toxic effects of chronic alcohol abuse, the alcoholic risks suffering a range of medical and psychiatric disorders. Alcoholism has profound social consequences for alcoholics and the people of their lives.

Alcoholism is the cyclic presence of tolerance, withdrawal, and excessive alcohol use; the drinker's inability to control such compulsive drinking, despite awareness of its harm to his or her health, indicate that the person might be an alcoholic. Questionnaire-based screening is a method of detecting harmful drinking patterns, including alcoholism. Alcohol detoxification is conducted to withdraw the alcoholic person from drinking alcohol, usually with cross-tolerance drugs, e.g. benzodiazepines to manage withdrawal symptoms. Post-medical care, such as group therapy, or self-help groups, usually is required to maintain alcoholic abstention. Often, alcoholics also are addicted to other drugs, most often benzodiazepines, which might require additional medical treatment. The alcoholic woman is more sensitive to alcohol's deleterious physical, cerebral, and mental effects, and increased social stigma, in relation to a man, for being an alcoholic. The World Health Organisation estimates that there are 140 million alcoholics worldwide

Symptoms of long term alcohol misuse


Alcoholism is characterised by an increased tolerance of and physical 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. Alcoholism can have adverse effects on mental health, causing psychiatric disorders to develop and an increased risk of suicide.

Physical symptoms


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, 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.

Women develop long-term complications of alcohol dependence more rapidly than do men. Additionally, women have a higher mortality rate from alcoholism than men. Examples of long term complications include brain, heart, and liver damage 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.


Psychiatric symptoms


Long term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are not uncommon; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia. Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time.] 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.[48] Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia. Panic disorder can develop or worsen as a direct result of long term alcohol misuse.

The co-occurrence of major depressive disorder and alcoholism is well documented. 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). Additional use of other drugs may increase the risk of depression.

Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring 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. 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, which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.

Social effects


The social problems arising from alcoholism are serious, caused by the pathological changes in the brain and the intoxicating effects of alcohol.[46][60] Alcohol abuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape, burglary and assault.[61] Alcoholism is associated with loss of employment,[62] 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[13] 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 impact 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 to child neglect, with subsequent lasting damage to the emotional development of the alcoholic's children.[12]

Prevention

The World Health Organization, the European Union and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. Targeting adolescents and young adults is regarded as an important step to reduce the harm of alcohol abuse. Increasing the age at which licit drugs of abuse such as alcohol can be purchased, the banning or restricting advertising of alcohol has been recommended as additional ways of reducing the harm of alcohol dependence and abuse. Credible, evidence based educational campaigns in the mass media about the consequences of alcohol abuse have been recommended. Guidelines for parents to prevent alcohol abuse amongst adolescents, and for helping young people with mental health problems have also been suggested.



Medications

A variety of medications may be prescribed as part of treatment for alcoholism.



Medications currently in use

Antabuse (disulfiram) prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast-acting and long-lasting uncomfortable hangover. This discourages an alcoholic from drinking in significant amounts while they take the medicine. A recent 9-year study found that incorporation of supervised disulfiram and the related compound carbamide into a comprehensive treatment program resulted in an abstinence rate of over 50 percent.

Temposil (calcium carbimide) works in the same way as Antabuse; it has an advantage in that the occasional adverse effects of disulfiram, hepatotoxicity and drowsiness, do not occur with calcium carbimide.

Naltrexone is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opiates. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence when naltrexone is in the body there is a reduction in the pleasurable effects from consuming alcohol. Naltrexone is also used in an alcoholism treatment method called the Sinclair Method, which treats patients through a combination of Naltrexone and continued drinking.

Campral (acamprosate) stabilises the brain chemistry that is altered due to alcohol dependence via antagonising the actions of glutamate, a neurotransmitter which is hyperactive in the post-withdrawal phase.

Konya Katalin

Asistenta sociala anul I

Linia maghiara

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