Alcoholism
Alcoholism is common, serious, and expensive. Physicians confront cirrhosis, cardiomyopathy, pancreatitis, and gastrointestinal bleeding due to alcoholism on a daily basis. Wernicke encephalopathy and Korsakoff psychosis are important causes of chronic disability as well. Fetal alcohol syndrome is a leading cause of mental retardation. In addition, suicide and homicide are important consequences of alcoholism.
Alcohol affects virtually every organ system in the body and, in high doses, can cause coma and death. It affects several neurotransmitter systems in the brain, including opiates, gamma-aminobutyric acid (GABA), glutamate, serotonin, and dopamine. Increased opiate levels help explain the euphoric effect of alcohol, while its effects on GABA cause anxiolytic and sedative effects.
Incidence of Alcoholism:
Alcoholism
The World Health Organization examined mental disorders in primary care offices and found that alcohol dependence or harmful use was present in 6% of patients. In Britain, 1 in 3 patients in community-based primary care practices had at-risk drinking. Alcoholism is more common in France than it is in Italy, despite virtually identical per capita alcohol consumption.
Alcohol use is the third leading cause of preventable death in the US (after smoking and obesity). Annually, 100,000 deaths are attributable to alcohol at a cost of $166 billion. Almost half of these deaths are attributable to alcohol-related injury.
Below are the statistically significant relative risks from a study by the American Cancer Society for men and women who consume 4 or more drinks daily. A drink is defined as one 12-oz (360ml) beer, one 3 - 4 oz (90-120 ml) glass of wine, or one mixed drink containing 1 oz (30ml) of spirits:
• Cirrhosis: Risk for men is 7.5 and for women is 4.8.
• Injuries: Risk for men is 1.3.
• Ear, nose, and throat cancer, esophagus cancer, liver cancer: Risk for men is 2.8 and for women is 3.
• Coronary artery disease: Risk for men is 0.6 and for women is 0.6.
• Stroke: Risk for men is 0.7.
Predisposing Factors of Alcoholism:
1. Genetic factors: Male children of alcohol-dependent people are 4 times more likely to develop drinking problems. There are also some ethnic groups that have a greater prevalence of alcohol abuse, including Native Americans, Native Australians, Inuits and some groups of Hispanic men. This pattern has raised further concern about a genetic origin for alcoholism.
2. Environmental factors: On average, 10% of male children who are raised in a household without parental alcohol abuse will become alcohol dependent. When an alcohol abusing father is present in the household, this alcohol dependency rate rises to 25%. When an alcohol dependent mother is present in the household, the rate of childhood alcoholism is raised to 33%.
3. Psychiatric illness: an uncommon (but in most cases) treatable cause of addictive drinking.
4. Social standards of alcohol consumption: the prevalance of alcohol dependence and problems correlates with the general level of alcohol use in a society.
Natural History of Alcoholism:
The prevalence of alcohol consumption in Australia is approximately 90%, of which 30% will develop alcohol abuse-related problems. With continued abuse of alcohol, the patient will develop tolerance to alcohol, requiring greater volumes to achieve intoxication. The patient will experience a persistent desire to abstain from alcohol abuse but efforts are often unsuccessful due to the addictive process. A great deal of time will be spent trying to obtain alcohol, use alcohol and recover from its effects, resulting in progressive social withdrawal. Any efforts to abstain from alcohol are usually met with alcohol withdrawal symptoms which limit the likelihood of individual success.
The patient may even continue using alcohol, despite the development of physical disease associated with their alcohol abuse. Patients not infrequently run a course of complete social withdrawal and death from the complications of alcohol abuse, unless efforts are made to curb the habit of alcohol abuse.
Prognosis of Alcoholism:
Alcoholism is a major social, economic, and public health problem. Alcohol is involved in more than half of all accidental deaths and almost half of all traffic fatalities. Additional deaths are related to the long-term medical complications as a result of alcoholism. Only 15% of those with an alcohol dependence problem seek treatment for the disease.
Relapse after treatment is very common, so as a result support groups and networks are very important to help in recovery and to ensure slips don’t become complete reversals of progress made. Treatment programs (such as Alcoholics Anonymous or AA) have indicated varing success rates, but those who stick with programs indicate full recovery.
Investigation of Alcoholism:
Blood tests are taken from patients with patterns of alcohol abuse to assess levels of recent and long-term alcohol consumption. The blood alcohol level can be measured by breath or blood sample, giving indication of recent alcohol consumption. The measurement of certain enzymes produced by the liver such as GGT (gamma-glutamyl transpeptidase) can allow the assessment of longer term drinking as the levels of this enzyme are increased with long-term drinking habits.
Treatment Overview of Alcoholism:
1. Psychological treatment of problem drinking: This is most important component to beating the habit of alcohol abuse. The involvement of others with a similar problem in group therapy, affords the patient understanding and support by people who have suffered the same addiction as themselves. Groups such as Alcoholics Anonymous are invaluable in providing this service. Family and relationship counselling should also be considered as the decline in social functioning will always impact upon close relationships.
2. Medical therapy for alcohol dependence: Certain drugs are available to assist patients abstinence from alcohol abuse. They should not be used in isolationt Some wotk to provide an “anti-craving” effect. Others work to cause adverse physical symptoms when alcohol is consumed. The latter should only be used once the patient has decided to complete cease using alcohol, as continued use of alcohol with these medications could have serious consequences.
3. Treatment of alcohol intoxication: Extreme intoxication with alcohol, or any grade of intoxication where the patient cannot be cared for, will require admission to hospital. Here the patient will recieve supportive therapy such as fluid and anti-nausea drugs until the effect of alcohol subsides. The patient may also be given sedatives to assist their coping with withdrawal symptoms.
Drugs used in the treatment of this disease:
• Disulfiram (Antabuse)
• Acamprosate calcium (Campral)
• Naltrexone hydrochloride (Revia)
