Alcohol Use Disorder

  1. Symptoms: no single symptom defines alcoholism; may include onset of tolerance and withdrawal; drink more frequently and in larger quantities than the average person without alcohol use disorder; have cravings; drink to control how they feel, relieve negative mood states, avoid withdrawal symptoms from previous episodes, prepare for certain activities-such as public speaking, writing, or sex;
    1. 2 general areas of symptoms:
      1. Patterns of pathological consumptions, including impaired control over use of the drug and continued in spite of mounting problems
      2. Consequences that follow a prolonged pattern of abuse, including social and occupational impairments, disruption of important personal relationships, and deteriorating medical condition
    2. Short term effects of alcohol: slurred speech, lack of coordination, unsteady gait, nystagmus (involuntary to-and-fro movement of the eyeballs induced when the person looks upward or to the side), impaired attention or memory, stupor, and coma
    3. Long term effects of alcohol: experience blackout;, may be able to continue function without passing out; interfere with job performance; financial difficulties; problems with legal authorities, including drunken driving, public intoxication, and child/spousal abuse; organ problems with the liver, pancreas, gastrointestinal system, and endocrine system; cirrhosis of the liver; heart problems; various forms of cancer; nutritional disruption; injuries and premature death
  2. Diagnosis: a form of substance dependence disorder, referred to as alcohol use disorder; mild case has 2-3 symptoms, moderate case has 4-5 symptoms, severe case has 6 or more symptoms; must fit at least 2 symptoms from any of the categories over the last 12 months:
    1. Impaired control:
      1. Taken in larger amounts or over longer periods of time than was intended
      2. Persistent desire or unsuccessful efforts to cut down or control alcohol use
      3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or a recover from its effects
      4. Craving or strong desire or urge to use alcohol
    2. Social impairment
      1. Recurrent alcohol use resulting in a failure to fulfill major role obligation at work, school, or home
      2. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
      3. Important social, occupational , or recreational activities are given up or reduced because of alcohol use
    3. Risky use
      1. Recurrent alcohol use in situations in which it is physically hazardous
      2. Continued despite knowledge of having a persistent or recurrent physical or psychological problems that is likely to have been caused by alcohol
    4. Pharmacological criteria:
      1.  Tolerance
      2. Withdrawal
  3. Course and Outcome: age of onset varies widely from childhood/early adolescence to throughout the lifespan; initial exposure leads to impaired control, evidence of social impairment, and onset of pharmacological symptoms; mortality rate is higher in men who abuse alcohol; heart disease and cancer are twice as common; likely to smoke heavily; relapse is unlikely is able to remain abstinent for at least 6 years
  4. Frequency of Disorder: 21%  of college aged men and 35% of core city men met the diagnostic criteria and had a presence of 4 or more problems in the areas of employer complaints, marital and family difficulties, medical complications, and legal problems; prevalence rate for alcoholism among males who began drinking before the age of 14 is double than found among males who began drinking at age 18 (same patterns among women); 2 out of 3 males drink regularly in western culture of those 20% develop serious problems at some point in their lives as a consequence of prolonged alcohol consumption; lifetime prevalence rate in 30% for some form of alcohol use disorder; alcohol related disorders are clearly among the most common forms of mental disorder in the US; 24% of men and women who are assigned the diagnosis of alcohol dependence have ever received treatment for these problems; men outnumber women in a ratio of 2 to 1 to chronically abuse or become alcohol dependent
  5. Etiology: any of the following or any mix of the following:
    1. Social Factors: culture; initial exposure with drugs/alcohol is likely to occur among those individuals who are rebellious and extroverted and whose parents/peer model or encourage use; parents may model alcohol dependence, adolescents with alcoholic parents are more likely to drink alcohol than those whose parents do not abuse alcohol
    2. Biological Factors: lifetime prevalence of alcoholism among the parents, siblings, and children of people with alcoholism is at least 3 to 5 time higher than the rate in the general population; males have a much higher prevalence rate; 2/3 of the variance rate of alcohol is produced by a genetic factor; other genes that alter the risk for alcohol dependence may be genes involved in personality such as those that influence novelty seeking and sensation seeking; alcohol effects several different types of neurotransmitters, it may stimulate the mesolimbic dopamine pathway directly or it may act indirectly by decreasing the activity of GABA neurons; effect exaggerated activation of the endogenous opioid system in response to alcohol stimulation;
    3. Psychological Factors: Placebo effects and expectations for alcohol fall into the categories of:
      1. Transforms experiences in a positive ways
      2. Enhances social and physical pleasure
      3. Enhances sexual performances and experiences
      4. Increases power and aggression
      5. Increases social assertiveness
      6. Reduces tension
  6. Treatment(s): treatment is a difficult task, many people do not acknowledge their difficulties and relatively small numbers seek professional help; compliance with treatment is low and dropout rates are high; detoxification (removal of the drug which takes three to six weeks), may be given medications such as benzodiazepines and anticonvulsants to minimizing withdrawal symptoms; Disulfiram (Antabuse) can block the chemical breakdown of alcohol which makes the patient violently ill after consuming any alcohol; Naltrexone (Revia) is an antagonist of endogenous opioids that has been found to be useful in the treatment of alcohol dependence following detoxification which makes the patient not feel the high they normal would; acamproste (Campral) reduces the average number of drinks per day; SSRIs; group therapy such as alcoholic anonymous; cognitive behavior therapy: coping and training skills, relapse prevention, short-term motivational therapy

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