Alcohol dependence is a serious disease that can have far reaching consequences.
ALCOHOL abuse is defined as a pattern of drinking that results in one or more of the following situations within a 12-month period:
·Failure to fulfil major work, school, or home responsibilities
·Drinking in situations that are physically dangerous, such as while driving a car or operating machinery
·Having recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk
·Continued drinking despite having ongoing relationship problems that are caused or worsened by the drinking
Alcoholism, or alcohol dependence, is the most severe form of alcohol abuse. It is a chronic disease characterised by the consumption of alcohol at a level that interferes with physical and mental health and with family and social responsibilities. An alcoholic will continue to drink despite serious health, family, or legal problems.
Alcoholism is influenced by both genetic and environmental factors. Alcoholism is chronic – it lasts a person’s lifetime. It usually follows a predictable course and has recognisable symptoms.
Alcohol abuse and alcoholism cut across gender, race, and ethnicity. Nearly 14 million people in the United States are dependent on alcohol. More men than women are alcohol dependent or have alcohol problems. Alcohol problems are highest among young adults ages 18-29 and lowest among adults ages 65 and older.
Also, people who start drinking at an early age have a greater chance of developing alcohol problems at some point in their lives.
Alcohol’s effects vary with age. Slower reaction times, problems with hearing and seeing, and a lower tolerance to alcohol’s effects put older people at higher risk for falls, car crashes, and other types of injuries that may result from drinking. More than 150 medications interact harmfully with alcohol.
Alcohol also affects women differently than men. Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account.
In addition, chronic alcohol abuse takes a heavier physical toll on women than on men. Alcohol dependence and related medical problems, such as brain, heart, and liver damage, progress more rapidly in women.
Alcoholism, also known as alcohol dependence, is a disease that includes:
·Craving: A strong need, or compulsion, to drink
·Loss of control: The inability to limit one’s drinking on any given occasion
·Physical dependence: Includes evidence of tolerance and withdrawal
·Tolerance: The need to drink greater amounts of alcohol in order to get drunk
·Withdrawal symptoms: Nausea, vomiting, sweating, shakiness, hallucinations (visual or auditory), anxiety, and even seizures. These symptoms can occur in individuals who have been heavy drinkers over a period of time.
Alcohol abuse differs from alcohol dependence in that:
1. It does not include an extremely strong craving for alcohol
2. A person may experience some loss of control over drinking, which may lead to problems with work, home, school, relationships, or the law
3. It usually does not include signs of physical dependence
Answering the following four questions can help you find out if you or a loved one has a drinking problem:
·Have you ever felt you should cut down on your drinking?
·Have people annoyed you by criticising your drinking?
·Have you ever felt bad or guilty about your drinking?
·Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
One yes answer suggests a possible alcohol problem. A yes to more than one question indicates that it is highly likely a problem exists. In either case, it is important to consult a doctor or other healthcare provider immediately to determine if you have a drinking problem and, if so, initiate the best course of action.
Even if you answered no to all of the above questions, you may still need help. You should seek a professional if you encounter drinking-related problems with your job, relationships, health, or the law. The effects of alcohol abuse can be extremely serious, even fatal, to you and to others.
Alcohol abuse can lead to the following health problems:
·Increased incidence of cancer, particularly cancer of the larynx, oesophagus, liver, and colon
·Alcoholic hepatitis, an acute syndrome reported by patients who have ingested about 100 grams of alcohol (about eight ounces of 100-proof whiskey, 30 ounces of wine, or eight 12-ounce cans of beer) daily for over one year. Symptoms can include fever, jaundice, and enlarged liver
·Acute and/or chronic pancreatitis – inflammatory disease of the pancreas
·Cirrhosis of the liver – alcohol abuse can cause alcoholic hepatitis, which then can lead to cirrhosis, or fibrotic changes in the liver.
·Alcoholic neuropathy – degenerative changes in the nervous system affecting nerves responsible for sensation and movement
·High blood pressure
·Nutritional deficiencies – vitamin B12, folate, and thiamine
·High blood pressure
·Cessation of menses
·Foetal alcohol syndrome in the children of women who drink during pregnancy
·Increased risk of suicide
·Wernicke-Korsakoff syndrome or Wernicke’s encephalopathy: a syndrome of central nervous system changes resulting from thiamine deficiency where an individual becomes confused, loses balance while walking, and shows loss of vision.
Many people with alcohol problems don’t recognise when their drinking gets out of hand. In the past, treatment providers believed that alcoholics should be confronted about denial of their drinking problems, but now research has shown that compassionate and empathetic counselling is more effective.
Most alcoholics need help to recover from disease. In most cases, relapse rates are high. However, with support and treatment, many people are able to stop drinking and rebuild their lives.
Alcoholism treatment programmes use both counselling and medications to help a person stop drinking.
Three general steps are involved in treating the alcoholic once the disorder has been diagnosed: intervention, detoxification, and rehabilitation. Research finds that the traditional confrontational intervention – where the employer or family members surprise the alcoholic and threaten consequences if treatment is NOT effective.
Studies find that more people enter treatment if their family members or employers are honest with them about their concerns and try to help them to see that drinking is preventing them from reaching their goals.
Once the problem has been recognised, total abstinence from alcohol is required for those who are dependent; for those who are problem drinkers, moderation may be successful.
Since many alcoholics initially refuse to believe that their drinking is out of control, a trial of moderation can often be an effective way to deal with the problem. If it succeeds, the problem is solved. If not, the person is usually ready to try abstinence. Because alcoholism affects the people closely related to the alcoholic person, treatment for family members through counselling is often necessary.
Detoxification is the first phase of treatment. Withdrawal from alcohol is done in a controlled, supervised setting in which medications relieve symptoms. Detoxification usually takes four to seven days. Examination for other medical problems is necessary. For example, liver and blood-clotting problems are common. A balanced diet with vitamin supplements is important.
Complications associated with the acute withdrawal from alcohol may occur, such as delirium tremens (DT’s), which could be fatal. Depression or other underlying mood disorders should be evaluated and treated, as alcohol abuse often develops from efforts to self-treat an illness.
Alcohol recovery or rehabilitation programmes support the affected person after detoxification to maintain abstinence from alcohol. Counselling, psychological support, nursing, and medical care are usually available within these programmes. Education about the disease of alcoholism and its effects is part of the therapy.
Many of the professional staff involved in rehabilitation centres are recovering alcoholics who serve as role models. Programmes can be either inpatient, with the patient residing in the facility during the treatment, or outpatient, with the patient attending the programme while they live at home.
Research supported by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) has made considerable progress in evaluating commonly used therapies and developing new types of therapies to treat alcohol-related problems.
One large-scale study sponsored by NIAAA found that each of three commonly used behavioural treatments for alcohol abuse and alcoholism – enhancement therapy, cognitive-behavioural therapy, and 12-step therapy – reduced drinking in the year following treatment. Three years after the study ended, approximately one-third of the study participants were either still abstinent or drinking without serious problems.
Other therapies that have been evaluated and found effective in reducing alcohol problems include brief intervention for alcohol abusers (individuals who are not dependent on alcohol) and behavioural therapy.
It is also important to remember that often, other psychiatric conditions, for example depression or bipolar disorder, may coexist with alcoholism. Therefore, coexisting or underlying disorders should be recognised and treated.
Individuals suffering from other underlying psychiatric conditions may use alcohol as a form of self-medication. If this is the case, proper diagnosis of any coexisting conditions is all the more valuable.
Though several medications can help treat alcoholism, there is no “magic bullet”. No single medication is available that works in every case and/or in every person. Developing new and more effective medications to treat alcoholism remains a high priority for researchers.
Three oral medications – disulfiram (Antabuse®), naltrexone (Depade®, ReVia®), and acamprosate (Campral®) – are currently approved to treat alcohol dependence. In addition, an injectable, long-acting form of naltrexone (Vivitrol®) is available.
These medications have been shown to help people with dependence reduce their drinking, avoid relapse to heavy drinking, and achieve and maintain abstinence.
Naltrexone acts in the brain to reduce craving for alcohol after someone has stopped drinking. Acamprosate is thought to work by reducing symptoms that follow lengthy abstinence, such as anxiety and insomnia. Disulfiram discourages drinking by making the person taking it feel sick after drinking alcohol.
Other types of drugs are available to help manage symptoms of withdrawal (such as shakiness, nausea, and sweating) if they occur after someone with alcohol dependence stops drinking.
Early recognition of these symptoms and immediate treatment can prevent some of the symptoms or drastically limit severity.
Seeking help for an unwilling alcoholic
An alcoholic can’t be forced to get help except under certain circumstances, such as a violent incident that results in court-ordered treatment or medical emergency. But you don’t have to wait for someone to “hit rock bottom”. Many alcoholism treatment specialists suggest the following steps to help an alcoholic:
·Stop all “cover-ups”. Family members often make excuses or try to protect the alcoholic from the results of his or her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full consequences of drinking.
The best time to talk to the drinker about his or her drinking is shortly after an alcohol-related problem has occurred – a serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and you have a chance to talk in private.
·Be specific. Tell the family member that you are worried about his or her drinking. Use examples of the ways in which the drinking has caused problems, including the most recent incident.
·State the results. Explain to the drinker what you will do if he or she doesn’t seek help. What you say may range from refusing to go with the person to any social activity where alcohol will be served to moving out of the house. Do not make any threats you are not prepared to carry out.
·Get help. Gather information in advance about treatment options in your community. If the person is willing to get help, call immediately for an appointment with a treatment counsellor. Offer to go with the family member on the first visit to a treatment programme and/or an Alcoholics Anonymous meeting.
·Call a friend. If the family member still refuses to get help, ask a friend to talk to him or her using the steps just described. A friend who is a recovering alcoholic may be particularly persuasive, but any person who is caring and non-judgmental may help. The intervention of more than one person, more than one time, is often necessary to coax an alcoholic to seek help.
·Find strength in numbers. With the help of a healthcare professional, some families join with other relatives and friends to confront an alcoholic as a group. This approach should only be tried under the guidance of a healthcare professional experienced in group intervention.
·Get support. It is important to remember that you are not alone. Alcoholism treatment works for many people. But just like any chronic disease, there are varying levels of success when it comes to treatment. Some people stop drinking and remain sober. Others have long periods of sobriety with bouts of relapse. And still others cannot stop drinking for any length of time.
With treatment, one thing is clear – the longer a person abstains from alcohol, the more likely he or she will stay sober.
This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.
The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail firstname.lastname@example.org. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.
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