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Alcohol Dependence
Many people enjoy drinking alcohol but for some excessive drinking become a big problem.
It is a bit of a paradox these problems are noticed first not by the sufferer but by his/her relatives or/and friends.
School and job performance deteriorates either from hangovers or from actual intoxication; child care or household responsibilities may be neglected; and alcohol-related absences become usual.
Some people become experts in finding reasons other than alcohol to explain the failures and alcohol related problems, but after a short while they only fool themselves.
It is a bit of a paradox these problems are noticed first not by the sufferer but by his/her relatives or/and friends.
School and job performance deteriorates either from hangovers or from actual intoxication; child care or household responsibilities may be neglected; and alcohol-related absences become usual.
Some people become experts in finding reasons other than alcohol to explain the failures and alcohol related problems, but after a short while they only fool themselves.
Most people realize they have an alcohol problem when they suffer the first symptoms of alcohol withdrawal and they “need to drink” to feel normal again.
Some people look for help at this point, but other just carry on.
At this point, the physical dependence to alcohol is not the major problem but denial.
An alcohol disorder is only diagnosed when these behaviors become persistent and very disabling or distressing.
Legal difficulties may arise (e.g., arrests for intoxicated behavior or for drunk driving). However denial allows the individual to continue abusing 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)
Excessive drinkers or alcohol dependents are at increased risk for accidents, violence, mood swings, depression and suicide.
Some people look for help at this point, but other just carry on.
At this point, the physical dependence to alcohol is not the major problem but denial.
An alcohol disorder is only diagnosed when these behaviors become persistent and very disabling or distressing.
Legal difficulties may arise (e.g., arrests for intoxicated behavior or for drunk driving). However denial allows the individual to continue abusing 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)
Excessive drinkers or alcohol dependents are at increased risk for accidents, violence, mood swings, depression and suicide.
Complications:
Gastrointestinal effects include gastritis, stomach or duodenal ulcers, and, in about 15% of those who use alcohol heavily, liver cirrhosis and pancreatitis.
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).
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).
Familial Pattern and Genetics
Most people suffering from alcohol dependence have a family history of alcohol abuse.
It is estimated that 40%-60% of the variance of risk is explained by genetic influences.
Close relatives of people with alcohol dependence have 4 times higher risk of developing alcohol related disorders than the rest of the population.
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.
It is estimated that 40%-60% of the variance of risk is explained by genetic influences.
Close relatives of people with alcohol dependence have 4 times higher risk of developing alcohol related disorders than the rest of the population.
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.
The ICD-10 Classification of Mental and Behavioural Disorders World Health Organization, Geneva, 1992
Diagnostic Guidelines:
A definite diagnosis of dependence should usually be made only if three or more of the following have been experienced or exhibited at some time during the previous year:
a strong desire or sense of compulsion to take alcohol;
difficulties in controlling alcohol-taking behaviour in terms of its onset, termination, or levels of use;
a physiological withdrawal state when alcohol use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for alcohol; or use of the alcohol with the intention of relieving or avoiding withdrawal symptoms;
evidence of tolerance, such that increased doses of alcohol are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);
progressive neglect of alternative pleasures or interests because of alcohol use, increased amount of time necessary to obtain or take alcohol or to recover from its effects;
persisting with alcohol use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.
Narrowing of the personal repertoire of patterns of alcohol use has also been described as a characteristic feature (e.g. a tendency to drink alcoholic drinks in the same way on weekdays and weekends, regardless of social constraints that determine appropriate drinking behaviour).
It is an essential characteristic of the dependence syndrome that either alcohol taking or a desire to take alcohol should be present; the subjective awareness of compulsion to use alcohol is most commonly seen during attempts to stop or control alcohol use.