Alcoholism

Alcoholism

Overview
Alcoholism is a broad term for problems with alcohol
Ethanol
Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug and one of the oldest recreational drugs. Best known as the type of alcohol found in alcoholic beverages, it is also used in thermometers, as a...

, and is generally used to mean compulsive
Compulsive behavior
Compulsive behavior is behavior which a person does compulsively—in other words, not because they want to behave that way, but because they feel they have to do so....

 and uncontrolled consumption of alcoholic beverage
Alcoholic beverage
An alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...

s, usually to the detriment of the drinker's health, personal relationships, and social standing. It is medically considered a disease
Disease Theory of Alcoholism
The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterized by altered brain structure and function. The existence of alcoholism as a disease is accepted by some within the medical and scientific communities, although critics...

, specifically a neurological disorder
Neurological disorder
A neurological disorder is a disorder of the body's nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord, or in the nerves leading to or from them, can result in symptoms such as paralysis, muscle weakness, poor coordination, loss of sensation, seizures,...

, and in medicine several other terms are used, specifically "alcohol abuse
Alcohol abuse
Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...

" and "alcohol dependence
Alcohol dependence
Alcohol dependence, as described in the DSM-IV, is a psychiatric diagnosis describing an entity in which an individual uses alcohol despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship.-Definition and diagnosis:According to the DSM-IV criteria for...

" which have more specific definitions. In 1979 an expert World Health Organisation committee discouraged the use of "alcoholism" in medicine, preferring the category of "alcohol dependence syndrome".
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Encyclopedia
Alcoholism is a broad term for problems with alcohol
Ethanol
Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug and one of the oldest recreational drugs. Best known as the type of alcohol found in alcoholic beverages, it is also used in thermometers, as a...

, and is generally used to mean compulsive
Compulsive behavior
Compulsive behavior is behavior which a person does compulsively—in other words, not because they want to behave that way, but because they feel they have to do so....

 and uncontrolled consumption of alcoholic beverage
Alcoholic beverage
An alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...

s, usually to the detriment of the drinker's health, personal relationships, and social standing. It is medically considered a disease
Disease Theory of Alcoholism
The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterized by altered brain structure and function. The existence of alcoholism as a disease is accepted by some within the medical and scientific communities, although critics...

, specifically a neurological disorder
Neurological disorder
A neurological disorder is a disorder of the body's nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord, or in the nerves leading to or from them, can result in symptoms such as paralysis, muscle weakness, poor coordination, loss of sensation, seizures,...

, and in medicine several other terms are used, specifically "alcohol abuse
Alcohol abuse
Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...

" and "alcohol dependence
Alcohol dependence
Alcohol dependence, as described in the DSM-IV, is a psychiatric diagnosis describing an entity in which an individual uses alcohol despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship.-Definition and diagnosis:According to the DSM-IV criteria for...

" which have more specific definitions. In 1979 an expert World Health Organisation committee discouraged the use of "alcoholism" in medicine, preferring the category of "alcohol dependence syndrome". In the 19th and early 20th centuries, alcohol dependence in general was called dipsomania
Dipsomania
Dipsomania is a historical term describing a medical condition involving an uncontrollable craving for alcohol. It was used in the 19th century to describe a variety of alcohol-related problems, most of which are most commonly conceptualized today as alcoholism, but it is occasionally still used to...

, but that term now has a much more specific meaning. People suffering from alcoholism are often called "alcoholics". Many other terms, some of them insulting
Pejorative
Pejoratives , including name slurs, are words or grammatical forms that connote negativity and express contempt or distaste. A term can be regarded as pejorative in some social groups but not in others, e.g., hacker is a term used for computer criminals as well as quick and clever computer experts...

 or informal
Slang
Slang is the use of informal words and expressions that are not considered standard in the speaker's language or dialect but are considered more acceptable when used socially. Slang is often to be found in areas of the lexicon that refer to things considered taboo...

, have been used throughout history. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 estimates that there are 140 million people with alcoholism worldwide.

Alcoholism is called a "dual disease" since it big cut includes both mental
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

 and physical
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 components. The biological mechanisms that cause alcoholism are not well understood. Social environment
Social environment
The social environment of an individual, also called social context or milieu, is the culture that s/he was educated or lives in, and the people and institutions with whom the person interacts....

, stress, mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...

, family history
Genetic predisposition
A genetic predisposition is a genetic affectation which influences the phenotype of an individual organism within a species or population but by definition that phenotype can also be modified by the environmental conditions. In the rest of the population, conditions cannot have that effect...

, age, ethnic group, and gender all influence the risk for the condition. Long-term alcohol abuse produces changes in the brain's structure and chemistry such as tolerance and physical dependence
Physical dependence
Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of withdrawal result from abrupt discontinuation or dosage reduction...

. These changes maintain the person with alcoholism's compulsive inability to stop drinking and result in alcohol withdrawal syndrome
Alcohol withdrawal syndrome
-Protracted withdrawal:A protracted alcohol withdrawal syndrome occurs in many alcoholics where withdrawal symptoms continue beyond the acute withdrawal stage but usually at a subacute level of intensity and gradually decreasing with severity over time. This syndrome is also sometimes referred to...

 if the person stops. Alcohol damages almost every organ in the body, including the brain. The cumulative toxic effects of chronic alcohol abuse can cause both medical and psychiatric problems.

Identifying alcoholism is difficult because of the social stigma
Social stigma
Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...

 associated with the disease that causes people with alcoholism to avoid diagnosis and treatment for fear of shame or social consequences. The evaluation responses to a group of standardized questioning is a common method for diagnosing alcoholism. These can be used to identify harmful drinking patterns, including alcoholism. In general, problem drinking, is considered alcoholism when the person continues to drink, when they want to stop, because of social or health problems caused by drinking.

Treatment of alcoholism takes several steps. Because of the medical problems that can be caused by withdrawal, alcohol detoxification
Alcohol detoxification
Alcohol detoxification, or detox, for individuals with alcohol dependence, is the abrupt cessation of alcohol intake coupled with the substitution of alcohol with cross-tolerant drugs that have similar effects in order to prevent alcohol withdrawal...

 is carefully controlled and may involve medications such as benzodiazepines such as diazepam
Diazepam
Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...

 (Valium). People with alcoholism also sometimes have other addictions, including addictions to benzodiazepines, which may complicate this step. After detoxification, other support such as group therapy or self-help groups are used to help the person remain sober. Thombs (1999) states according to behavioural sciences alcoholism is described as a “maladaptive behaviour”. He explains this must not be confused with “misbehaviour”. Behavioural scientists explain that addicts have a behaviour pattern that may lead to destructive consequences for themselves, their families and society. This does not label addicts as bad or irresponsible. Compared with men, women are more sensitive to alcohol's harmful physical, cerebral, and mental effects.

Terminology


Misuse, problem use, abuse, and heavy use refer to improper use of alcohol which may cause physical, social, or moral harm to the drinker. Moderate use is defined by The Dietary Guidelines for Americans as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women. Some drinkers may drink more than 600 ml of alcohol per day during a heavy drinking period.

The term "alcoholism" is commonly used, but poorly defined. The WHO calls alcoholism "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO Expert Committee. The Big Book
The Big Book (Alcoholics Anonymous)
Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism is a 1939 self-help text on alcoholism, written by the founders of Alcoholics Anonymous, Bill W. & Dr. Bob...

(from Alcoholics Anonymous
Alcoholics Anonymous
Alcoholics Anonymous is an international mutual aid movement which says its "primary purpose is to stay sober and help other alcoholics achieve sobriety." Now claiming more than 2 million members, AA was founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio...

) states that once a person is an alcoholic, they are always an alcoholic, but does not define what is meant by the term "alcoholic" in this context. In 1960, Bill W.
Bill W.
William Griffith Wilson , also known as Bill Wilson or Bill W., was the co-founder of Alcoholics Anonymous , an international mutual aid fellowship with over two million members belonging to 100,800 groups of alcoholics helping other alcoholics achieve and maintain sobriety...

, co-founder of Alcoholics Anonymous (AA), said:
We have never called alcoholism a disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

 because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...

. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always called it an illness
Illness
Illness is a state of poor health. Illness is sometimes considered another word for disease. Others maintain that fine distinctions exist...

, or a malady—a far safer term for us to use.


In professional and research contexts, the term "alcoholism" sometimes encompasses both alcohol abuse and alcohol dependence, and sometimes is considered equivalent to alcohol dependence.
Talbot (1989) observes that alcoholism in the classical disease model follows a progressive course: if a person continues to drink, their condition will worsen. This will lead to harmful consequences in their life, physically, mentally, emotionally and socially.

Johnson (1980) explores the emotional progression of the addict’s response to alcohol. He looks at this in four phases. The first two are considered “normal” drinking and the last two are viewed as "typical" alcoholic drinking. Johnson's four phases consist of:
  1. Learning the mood swing. A person is introduced to alcohol (in some cultures this can happen at a relatively young age), and the person enjoys the happy feeling it produces. At this stage there is no emotional cost.
  2. Seeking the mood swing. A person will drink to regain that feeling of euphoria experienced in phase 1; the drinking will increase as more intoxication is required to achieve the same effect. Again at this stage, there are no significant consequences.
  3. At the third stage there are physical and social consequences, i.e., hangovers, family problems, work problems, etc. A person will continue to drink excessively, disregarding the problems.
  4. The fourth stage can be detrimental, as Johnson cites it as a risk for premature death. As a person now drinks to feel normal, they block out the feelings of overwhelming guilt, remorse, anxiety, and shame they experience when sober.


Other theorists such as Milam & Ketcham (1983) focus on the physical deterioration of alcohol. They describe the process in three stages:
  1. Adaptive stage - The person will not experience any negative symptoms, and believe they have capacity for alcohol. Physiological changes are happening with the increase in tolerance, but this will not be noticeable to the drinker or others.
  2. Dependent stage - At this stage, symptoms build gradually. Hangover symptoms may be confused with withdrawal symptoms. Many addicts will maintain their drinking to avoid withdrawal sickness, drinking small amounts frequently. They will try and hide their problem from others, and will avoid gross intoxication.
  3. Deterioration stage - Various organs are damaged due to long-term drinking. Medical treatment will be required; otherwise the pathological changes will cause death.


In psychology and psychiatry, the DSM is the most common global standard, while in medicine, the standard is ICD. The terms they recommend are similar but not identical.
Organization Preferred term(s) Definition
APA
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

's DSM-IV
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

"alcohol abuse
Alcohol abuse
Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...

" and "alcohol dependence
Alcohol dependence
Alcohol dependence, as described in the DSM-IV, is a psychiatric diagnosis describing an entity in which an individual uses alcohol despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship.-Definition and diagnosis:According to the DSM-IV criteria for...

"
  • alcohol abuse = repeated use despite recurrent adverse consequences.
  • alcohol dependence = alcohol abuse combined with tolerance, withdrawal
    Withdrawal
    Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...

    , and an uncontrollable drive to drink.

The term "alcoholism" was split into "alcohol abuse" and "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were moved from "abuse" to "dependence". It has been suggested that DSM-V merge alcohol abuse and alcohol dependence into a single new entry, named "alcohol-use disorder".
WHO's ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...

"alcohol harmful use" and "alcohol dependence syndrome" Definitions are similar to that of the DSM-IV. The World Health Organisation uses the term "alcohol dependence syndrome" rather than alcoholism. The concept of "harmful use" (as opposed to "abuse") was introduced in 1992's ICD-10 to minimize underreporting of damage in the absence of dependence. The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and ICD-9.


Despite the imprecision inherent in the term, there have been attempts to define how the word "alcoholism" should be interpreted when encountered. In 1992, it was defined by the NCADD
National Council on Alcoholism and Drug Dependence
The National Council on Alcoholism and Drug Dependence was founded in 1944 by the first female member of Alcoholics Anonymous , Marty Mann . It has a nationwide network of 95 affiliates around the United States...

 and ASAM
American Society of Addiction Medicine
The American Society of Addiction Medicine is a physician society with a focus on addiction and its treatment.- History :ASAM has its roots in research and clinical traditions that pre-date its founding in the early 1950s, when Ruth Fox, M.D. began regular meetings with other physicians interested...

 as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking." MeSH
Mesh
Mesh consists of semi-permeable barrier made of connected strands of metal, fiber, or other flexible/ductile material. Mesh is similar to web or net in that it has many attached or woven strands.-Types of mesh:...

 has had an entry for "alcoholism" since 1999, and references the 1992 definition.

AA describes alcoholism as an illness that involves a physical allergy (where "allergy" has a different meaning than that used in modern medicine.) and a mental obsession.The doctor and addiction specialist Dr. William D. Silkworth M.D. writes on behalf of AA that "Alcoholics suffer from a "(physical) craving beyond mental control".

A 1960 study by E. Morton Jellinek
E. Morton Jellinek
Elvin Morton "Bunky" Jellinek , E. Morton Jellinek, or most often, E. M. Jellinek, was a biostatistician, physiologist, and an alcoholism researcher. He was born in New York City and died at the desk of his study at Stanford University on 22 October 1963. He was fluent in nine languages and could...

 is considered the foundation of the modern disease theory of alcoholism
Disease Theory of Alcoholism
The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterized by altered brain structure and function. The existence of alcoholism as a disease is accepted by some within the medical and scientific communities, although critics...

. Jellinek's definition restricted the use of the word "alcoholism" to those showing a particular natural history
Natural history of disease
The natural history of disease refers to a description of the uninterrupted progression of a disease in an individual from the moment of exposure to causal agents until recovery or death. Knowledge of the natural history of disease ranks alongside causal understanding in importance for disease...

. The modern medical definition of alcoholism has been revised numerous times since then. The American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...

 currently uses the word alcoholism to refer to a particular chronic primary disease.

Long-term misuse




Alcoholism is characterised by an increased tolerance
Alcohol tolerance
Alcohol tolerance refers to the bodily responses to the functional effects of ethanol in alcoholic beverages. This includes direct tolerance, speed of recovery from insobriety and resistance to the development of alcoholism.-Consumption-induced tolerance:...

 of and physical dependence
Physical dependence
Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of withdrawal result from abrupt discontinuation or dosage reduction...

 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. The onset of depression is a common symptom.

Physical


Long-term alcohol abuse can cause a number of physical symptoms, including cirrhosis
Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules , leading to loss of liver function...

 of the liver, pancreatitis
Pancreatitis
Pancreatitis is inflammation of the pancreas. It occurs when pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine. It may be acute – beginning suddenly and lasting a few days, or chronic – occurring over many years...

, epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...

, polyneuropathy
Polyneuropathy
Polyneuropathy is a neurological disorder that occurs when many peripheral nerves throughout the body malfunction simultaneously. It may be acute and appear without warning, or chronic and develop gradually over a longer period of time. Many polyneuropathies have both motor and sensory...

, alcoholic dementia
Wernicke-Korsakoff syndrome
Wernicke–Korsakoff syndrome is a manifestation of thiamine deficiency, or beriberi. This is usually secondary to alcohol abuse...

, heart disease, nutritional deficiencies, and sexual dysfunction
Sexual dysfunction
Sexual dysfunction or sexual malfunction refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm....

, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...

, malabsorption
Malabsorption
Malabsorption is a state arising from abnormality in absorption of food nutrients across the gastrointestinal tract.Impairment can be of single or multiple nutrients depending on the abnormality...

, alcoholic liver disease
Alcoholic liver disease
Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis or cirrhosis. It is the major cause of liver disease in Western countries...

, and cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

. Damage to the central nervous system
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...

 and peripheral nervous system
Peripheral nervous system
The peripheral nervous system consists of the nerves and ganglia outside of the brain and spinal cord. The main function of the PNS is to connect the central nervous system to the limbs and organs. Unlike the CNS, the PNS is not protected by the bone of spine and skull, or by the blood–brain...

 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
Alcohol and breast cancer
Alcohol is a risk factor for breast cancer in women.A woman drinking an average of two units of alcohol per day has 8% higher of developing breast cancer than a woman who drinks an average of one unit of alcohol per day...

. 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
Anovulation
An anovulatory cycle is a menstrual cycle during which the ovaries do not release an oocyte. Therefore, ovulation does not take place. However, a woman who does not ovulate at each menstrual cycle is not necessarily going through menopause...

, decreased ovarian mass, problems or irregularity of the menstrual cycle
Menstrual cycle
The menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....

, and early menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...

. Alcoholic ketoacidosis
Ketoacidosis
Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and β-hydroxybutyrate....

 can occur in individuals who chronically abuse alcohol and have a recent history of binge drinking
Binge drinking
Binge drinking or heavy episodic drinking is the modern epithet for drinking alcoholic beverages with the primary intention of becoming intoxicated by heavy consumption of alcohol over a short period of time. It is a kind of purposeful drinking style that is popular in several countries worldwide,...

.

Even though, alcoholism can increase the risk of liver cancer,studies have shown that a moderate consumption of alcohol (1 serving/day for women and 2 servings/day for men)does not affect diabetes Type II greatly.

Psychiatric


Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are common; 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
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

 and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence. Psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...

, confusion
ConFusion
ConFusion is an annual science fiction convention organized by the Stilyagi Air Corps and its parent organization, the Ann Arbor Science Fiction Association. Commonly, it is held the third weekend of January. It is the oldest science fiction convention in Michigan, a regional, general SF con...

, and organic brain syndrome
Organic Brain Syndrome
Organic brain syndrome , also known as organic brain disease or organic brain disorder, is an older and nearly obsolete general term from psychiatry, referring to many physical disorders that cause impaired mental function. It usually does not include psychiatric disorders...

 may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

. Panic disorder
Panic disorder
Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...

 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
Post-traumatic stress disorder
Posttraumaticstress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity,...

 (PTSD), or borderline personality disorder
Borderline personality disorder
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...

. Men with alcohol-use disorders more often have a co-occurring diagnosis of narcissistic
Narcissistic personality disorder
Narcissistic personality disorder is a personality disorder in which the individual is described as being excessively preoccupied with issues of personal adequacy, power, prestige and vanity...

 or antisocial personality disorder
Antisocial personality disorder
Antisocial personality disorder is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition , as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood...

, bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

, 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. Alcohol abuse is associated with an increased risk of committing criminal offences, including child abuse
Child abuse
Child abuse is the physical, sexual, emotional mistreatment, or neglect of a child. In the United States, the Centers for Disease Control and Prevention and the Department of Children And Families define child maltreatment as any act or series of acts of commission or omission by a parent or...

, domestic violence
Domestic violence
Domestic violence, also known as domestic abuse, spousal abuse, battering, family violence, and intimate partner violence , is broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, or cohabitation...

, rape
Rape
Rape is a type of sexual assault usually involving sexual intercourse, which is initiated by one or more persons against another person without that person's consent. The act may be carried out by physical force, coercion, abuse of authority or with a person who is incapable of valid consent. The...

, burglary
Burglary
Burglary is a crime, the essence of which is illicit entry into a building for the purposes of committing an offense. Usually that offense will be theft, but most jurisdictions specify others which fall within the ambit of burglary...

 and assault
Assault
In law, assault is a crime causing a victim to fear violence. The term is often confused with battery, which involves physical contact. The specific meaning of assault varies between countries, but can refer to an act that causes another to apprehend immediate and personal violence, or in the more...

. Alcoholism is associated with loss of employment
Termination of employment
-Involuntary termination:Involuntary termination is the employee's departure at the hands of the employer. There are two basic types of involuntary termination, known often as being "fired" and "laid off." To be fired, as opposed to being laid off, is generally thought of to be the employee's...

, 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 or public disorder, or civil penalties for tort
Tort
A tort, in common law jurisdictions, is a wrong that involves a breach of a civil duty owed to someone else. It is differentiated from a crime, which involves a breach of a duty owed to society in general...

ious behavior, and may lead to a criminal sentence.

An alcoholic's behavior and mental impairment, while drunk, can profoundly affect those surrounding them and lead to isolation from family and friends. This isolation can lead to marital conflict
Relational disorder
According to Michael First, MD, of the DSM-5 working committee the locus of a relational disorder, in contrast to other DSM-IV disorders, "is on the relationship rather than on any one individual in the relationship."...

 and divorce
Divorce
Divorce is the final termination of a marital union, canceling the legal duties and responsibilities of marriage and dissolving the bonds of matrimony between the parties...

, or contribute to domestic violence
Domestic violence
Domestic violence, also known as domestic abuse, spousal abuse, battering, family violence, and intimate partner violence , is broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, or cohabitation...

. Alcoholism can also lead to child neglect
Child neglect
Child neglect is defined as:# "the failure of a person responsible for a child’s care and upbringing to safeguard the child’s emotional and physical health and general well-being"...

, with subsequent lasting damage to the emotional development of the alcoholic's children. Collaborative Study on the Genetics of Alcoholism (COGA), notes that children of alcoholic parents, especially sons of alcoholic fathers, are four to nine times more likely to have problems with alcohol than children of non-alcoholic parents. For this reason, children of alcoholic parents can develop a host of emotional problems. For example, they can become frightful of their parents, because of their inconsistent mood behaviors. In addition, they can feel guilty over their inability to save their parents, and thus in turn, become depressed and develop poor self images.

Alcohol withdrawal



As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly managed. Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...

 depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence
Physical dependence
Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of withdrawal result from abrupt discontinuation or dosage reduction...

. When alcohol consumption is stopped too abruptly, the person's nervous system suffers from uncontrolled synapse
Synapse
In the nervous system, a synapse is a structure that permits a neuron to pass an electrical or chemical signal to another cell...

 firing. This can result in symptoms that include anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

, life threatening seizure
Seizure
An epileptic seizure, occasionally referred to as a fit, is defined as a transient symptom of "abnormal excessive or synchronous neuronal activity in the brain". The outward effect can be as dramatic as a wild thrashing movement or as mild as a brief loss of awareness...

s, delirium tremens
Delirium tremens
Delirium tremens is an acute episode of delirium that is usually caused by withdrawal from alcohol, first described in 1813...

, hallucinations, shakes and possible heart failure. Other neurotransmitter systems are also involved, especially dopamine
Dopamine
Dopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...

, NMDA
NMDA
N-Methyl-D-aspartic acid or N-Methyl-D-aspartate is an amino acid derivative which acts as a specific agonist at the NMDA receptor mimicking the action of glutamate, the neurotransmitter which normally acts at that receptor...

 and glutamate.

Acute withdrawal symptoms tend to subside after one to three weeks. Less severe symptoms (e.g. insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...

 and anxiety, anhedonia
Anhedonia
In psychology and psychiatry, anhedonia is defined as the inability to experience pleasure from activities usually found enjoyable, e.g. hobbies, exercise, social interaction or sexual activity....

) may continue as part of a post withdrawal syndrome gradually improving with abstinence for a year or more. Withdrawal symptoms begin to subside as the body and central nervous system restore alcohol tolerance and GABA functioning towards normal.

Causes


A complex mixture of genetic and environmental factors influences the risk of the development of alcoholism. Genes that influence the metabolism of alcohol also influence the risk of alcoholism, and may be indicated by a family history of alcoholism. One paper has found that alcohol use at an early age may influence the expression of genes
Gene expression
Gene expression is the process by which information from a gene is used in the synthesis of a functional gene product. These products are often proteins, but in non-protein coding genes such as ribosomal RNA , transfer RNA or small nuclear RNA genes, the product is a functional RNA...

 which increase the risk of alcohol dependence. Individuals who have a genetic disposition to alcoholism are also more likely to begin drinking at an earlier age than average. Also, a younger age of onset of drinking is associated with an increased risk of the development of alcoholism, and about 40 percent of alcoholics will drink excessively by their late adolescence. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view. A high testosterone concentration during pregnancy may be a risk factor for later development of alcohol dependence.
Severe childhood trauma
Psychological trauma
Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...

 is also associated with a general increase in the risk of drug dependency. Lack of peer and family support is associated with an increased risk of alcoholism developing. Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol abuse. Cortical degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.

Genetic variation


Genetic differences exist between different racial groups which affect the risk of developing alcohol dependence. For example, there are differences between African, East Asian and Indo-racial groups in how they metabolize alcohol. These genetic factors are believed to, in part, explain the differing rates of alcohol dependence among racial groups. The alcohol dehydrogenase
Alcohol dehydrogenase
Alcohol dehydrogenases are a group of dehydrogenase enzymes that occur in many organisms and facilitate the interconversion between alcohols and aldehydes or ketones with the reduction of nicotinamide adenine dinucleotide...

 allele ADH1 B*3 causes a more rapid metabolism of alcohol. The allele ADH1 B*3 is only found in those of African descent and certain Native American tribes. African Americans and Native Americans with this allele have a reduced risk of developing alcoholism. Native Americans
Indigenous peoples of the Americas
The indigenous peoples of the Americas are the pre-Columbian inhabitants of North and South America, their descendants and other ethnic groups who are identified with those peoples. Indigenous peoples are known in Canada as Aboriginal peoples, and in the United States as Native Americans...

 however, have a significantly higher rate of alcoholism than average; it is unclear why this is the case. Other risk factors such as cultural environmental effects e.g. trauma
Psychological trauma
Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...

 have been proposed to explain the higher rates of alcoholism among Native Americans compared to alcoholism levels in caucasians.

Pathophysiology


Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...

 depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence
Physical dependence
Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of withdrawal result from abrupt discontinuation or dosage reduction...

. The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs). This can be attributed to many reasons, the main being that women have less body water than men do. A given amount of alcohol, therefore becomes more highly concentrated in a woman's body. A given amount of alcohol causes greater intoxication for women due to different hormone release compared to men.

Social barriers


Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol abuse. This is more of a barrier for women than men. Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic. In contrast, reduced fear of stigma may lead men to admit that they are suffering from a medical condition, to display their drinking publicly, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is an alcoholic.

Screening


Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self-report
Self report study
A self-report study is a type of survey, questionnaire, or poll in which respondents read the question and select a response by themselves without researcher interference....

s in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.

The CAGE questionnaire
CAGE questionnaire
The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used method of screening for alcoholism.The CAGE questionnaire, among other methods, has been extensively validated for use in identifying alcoholism...

, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.


The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol related problems; however, it has limitations in people with less severe alcohol related problems, white women and college students.


Other tests are sometimes used for the detection of alcohol dependence, such as the Alcohol Dependence Data Questionnaire, which is a more sensitive diagnostic test than the CAGE questionnaire
CAGE questionnaire
The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used method of screening for alcoholism.The CAGE questionnaire, among other methods, has been extensively validated for use in identifying alcoholism...

. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use. The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses, driving under the influence
Driving under the influence
Driving under the influence is the act of driving a motor vehicle with blood levels of alcohol in excess of a legal limit...

 being the most common. The Alcohol Use Disorders Identification Test
Alcohol Use Disorders Identification Test
The Alcohol Use Disorders Identification Test is a simple ten-question test developed by the World Health Organization to determine if a person's alcohol consumption may be harmful. The test was designed to be used internationally, and was validated in a study using patients from six countries...

 (AUDIT), a screening questionnaire developed by the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

, is unique in that it has been validated in six countries and is used internationally. Like the CAGE questionnaire
CAGE questionnaire
The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used method of screening for alcoholism.The CAGE questionnaire, among other methods, has been extensively validated for use in identifying alcoholism...

, it uses a simple set of questions – a high score earning a deeper investigation. The Paddington Alcohol Test
Paddington alcohol test
The Paddington Alcohol Test was first published in the Journal of Accident and Emergency Medicine in 1996. It was designed to identify alcohol-related problems amongst those attending Accident and Emergency departments...

 (PAT) was designed to screen for alcohol related problems amongst those attending Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.

Genetic predisposition testing


Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut suggest that alcoholism does not have a single cause—including genetic—but that genes do play an important role "by affecting processes in the body and brain that interact with
Gene-environment interaction
Gene–environment interaction is the phenotypic effect of interactions between genes and the environment....

 one another and with an individual's life experiences to produce protection or susceptibility". They also report that fewer than a dozen alcoholism-related genes have been identified, but that more likely await discovery.

At least one genetic test exists for an allele
Allele
An allele is one of two or more forms of a gene or a genetic locus . "Allel" is an abbreviation of allelomorph. Sometimes, different alleles can result in different observable phenotypic traits, such as different pigmentation...

 that is correlated to alcoholism and opiate addiction. Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymorphism. Those who possess the A1 allele (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin-releasing drugs like alcohol. Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is contradictory.

DSM diagnosis


The DSM-IV diagnosis of alcohol dependence represents one approach to the definition of alcoholism. In part this is to assist in the development of research protocols in which findings can be compared to one another. According to the DSM-IV, an alcohol dependence diagnosis is:

Urine and blood tests


There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content
Blood alcohol content
Blood alcohol content , also called blood alcohol concentration, blood ethanol concentration, or blood alcohol level is most commonly used as a metric of alcohol intoxication for legal or medical purposes....

 (BAC). These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few recognizable effects on the body, including:
  • Macrocytosis
    Macrocytosis
    Macrocytosis is the enlargement of red blood cells with near-constant hemoglobin concentration, and is defined by a mean corpuscular volume of greater than 100 femtolitres .- Causes :...

     (enlarged MCV
    Mean corpuscular volume
    The mean corpuscular volume, or "mean cell volume" , is a measure of the average red blood cell size that is reported as part of a standard complete blood count....

    )
  • Elevated GGT
    Gamma glutamyl transpeptidase
    Gamma-glutamyltransferase or gamma-glutamyl transpeptidase is an enzyme that transfers gamma-glutamyl functional groups...

  • Moderate elevation of AST
    Aspartate transaminase
    Aspartate transaminase , also called aspartate aminotransferase or serum glutamic oxaloacetic transaminase , is a pyridoxal phosphate -dependent transaminase enzyme . AST catalyzes the reversible transfer of an α-amino group between aspartate and glutamate and, as such, is an important enzyme in...

     and ALT
    Alanine transaminase
    Alanine transaminase or ALT is a transaminase enzyme . It is also called serum glutamic pyruvic transaminase or alanine aminotransferase ....

     and an AST: ALT ratio of 2:1
  • High carbohydrate deficient transferrin
    Carbohydrate deficient transferrin
    Carbohydrate-deficient transferrin is a laboratory test used to help detect heavy ethanol consumption.Carbohydrate-deficient transferrin is elevated in the blood of heavy alcoholism but raised levels can also be found in a number of medical conditions.Transferrin is a plasma protein that carries...

     (CDT)


However, none of these blood tests for biological markers is as sensitive as screening questionnaires.

Prevention


The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

, the European Union
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...

 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.

Management


Treatments are varied because there are multiple perspectives of alcoholism. Those who approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who approach the condition as one of social choice. Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support in order to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism typically supports an abstinence-based zero tolerance
Zero tolerance
Zero tolerance imposes automatic punishment for infractions of a stated rule, with the intention of eliminating undesirable conduct. Zero-tolerance policies forbid persons in positions of authority from exercising discretion or changing punishments to fit the circumstances subjectively; they are...

 approach; however, some prefer a harm-reduction approach.

Detoxification



Alcohol detoxification
Alcohol detoxification
Alcohol detoxification, or detox, for individuals with alcohol dependence, is the abrupt cessation of alcohol intake coupled with the substitution of alcohol with cross-tolerant drugs that have similar effects in order to prevent alcohol withdrawal...

 or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs, such as benzodiazepines, that have similar effects to prevent alcohol withdrawal
Alcohol withdrawal syndrome
-Protracted withdrawal:A protracted alcohol withdrawal syndrome occurs in many alcoholics where withdrawal symptoms continue beyond the acute withdrawal stage but usually at a subacute level of intensity and gradually decreasing with severity over time. This syndrome is also sometimes referred to...

. Individuals who are only at risk of mild to moderate withdrawal symptoms can be detoxified as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions are generally treated as inpatients. Detoxification does not actually treat alcoholism, and it is necessary to follow-up detoxification with an appropriate treatment program for alcohol dependence or abuse in order to reduce the risk of relapse.

Psychological


Various forms of group therapy
Group therapy
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group...

 or psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

 can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills. The mutual-help group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety. Alcoholics Anonymous
Alcoholics Anonymous
Alcoholics Anonymous is an international mutual aid movement which says its "primary purpose is to stay sober and help other alcoholics achieve sobriety." Now claiming more than 2 million members, AA was founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio...

 was one of the first organizations formed to provide mutual, nonprofessional counseling, and it is still the largest. Others include LifeRing Secular Recovery
LifeRing Secular Recovery
LifeRing Secular Recovery is a secular, non-profit organization providing peer-run addiction recovery groups for anyone with a desire to recover from alcohol and drug addiction or who are in a relationship with an addict or alcoholic. LifeRing split from Secular Organizations for Sobriety in 1997,...

, SMART Recovery
SMART Recovery
SMART Recovery is an international non-profit organization which provides assistance to individuals seeking abstinence from addictive behaviors. The approach used is secular and science-based using non-confrontational motivational, behavioral and cognitive methods...

, Women For Sobriety
Women For Sobriety
Women For Sobriety, Inc. , is a non-profit secular addiction recovery group for women with alcohol problems or alcohol dependence. WFS was created by sociologist Jean Kirkpatrick in 1976 as an alternative to twelve-step addiction recovery groups like Alcoholics Anonymous . As of 1998 there were...

, and Secular Organizations for Sobriety
Secular Organizations for Sobriety
Secular Organizations For Sobriety , also known as Save Our Selves, is a non-profit network of autonomous addiction recovery groups. The program stresses the need to place the highest priority on sobriety and uses mutual support to assist members in achieving this goal...

.
Rationing and moderation programs such as Moderation Management
Moderation Management
Moderation Management is a secular non-profit organization providing peer-run non-coercive support groups for anyone who would like to reduce their alcohol consumption...

 and DrinkWise do not mandate complete abstinence. While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 U.S. study by the National Institute on Alcohol Abuse and Alcoholism
National Institute on Alcohol Abuse and Alcoholism
The National Institute on Alcohol Abuse and Alcoholism , as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems...

 (NIAAA) showed that 17.7 percent of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. This group, however, showed fewer initial symptoms of dependency. A follow-up study, using the same subjects that were judged to be in remission in 2001–2002, examined the rates of return to problem drinking in 2004–2005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics. A long-term (60 year) follow-up of two groups of alcoholic men concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."

Medications


A variety of medications may be prescribed as part of treatment for alcoholism.
  • Disulfiram
    Disulfiram
    Disulfiram is a drug discovered in the 1920s and used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol. Trade names for disulfiram in different countries are Antabuse and Antabus manufactured by Odyssey Pharmaceuticals...

     (Antabuse) prevents the elimination of acetaldehyde
    Acetaldehyde
    Acetaldehyde is an organic chemical compound with the formula CH3CHO or MeCHO. It is one of the most important aldehydes, occurring widely in nature and being produced on a large scale industrially. Acetaldehyde occurs naturally in coffee, bread, and ripe fruit, and is produced by plants as part...

    , a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover
    Hangover
    A hangover describes the sum of unpleasant physiological effects following heavy consumption of alcoholic beverages. The most commonly reported characteristics of a hangover include headache, nausea, sensitivity to light and noise, lethargy, dysphoria, diarrhea and thirst, typically after the...

     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 nine-year study found that incorporation of supervised disulfiram and the related compound carbimide into a comprehensive treatment program resulted in an abstinence rate of over 50 percent.

  • Calcium carbimide (Temposil) works in the same way as Antabuse; it has an advantage in that the occasional adverse effects of disulfiram, hepatotoxicity
    Hepatotoxicity
    Hepatotoxicity implies chemical-driven liver damage.The liver plays a central role in transforming and clearing chemicals and is susceptible to the toxicity from these agents. Certain medicinal agents, when taken in overdoses and sometimes even when introduced within therapeutic ranges, may injure...

     and drowsiness, do not occur with calcium carbimide.

  • Naltrexone
    Naltrexone
    Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. It is marketed in generic form as its hydrochloride salt, naltrexone hydrochloride, and marketed under the trade names Revia and Depade...

     is a competitive antagonist
    Competitive antagonist
    A competitive antagonist is a receptor antagonist that binds to a receptor but does not activate the receptor. The antagonist will compete with available agonist for receptor binding sites on the same receptor...

     for opioid receptors, effectively blocking the effects of endorphin
    Endorphin
    Endorphins are endogenous opioid peptides that function as neurotransmitters. They are produced by the pituitary gland and the hypothalamus in vertebrates during exercise, excitement, pain, consumption of spicy food, love and orgasm, and they resemble the opiates in their abilities to produce...

    s and opiate
    Opiate
    In medicine, the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy plant.-Overview:Opiates are so named because they are constituents or derivatives of constituents found in opium, which is processed from the latex sap of the opium poppy,...

    s. 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
    Sinclair Method
    The Sinclair Method is a treatment for alcoholism that involves the use of opiate antagonists such as naltrexone or nalmefene while continuing normal drinking habits in order to decrease the craving for alcohol over time. It relies upon a mechanism called pharmacological extinction, which works by...

    , which treats patients through a combination of Naltrexone and continued drinking.

  • Acamprosate
    Acamprosate
    Acamprosate, also known as N-acetyl homotaurine and by the brand name Campral, is a drug used for treating alcohol dependence.Acamprosate is thought to stabilize the chemical balance in the brain that would otherwise be disrupted by alcoholism, possibly by blocking glutamatergic...

     (Campral) 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. A 2010 review of medical studies demonstrated that acamprosate reduces the incidence of relapse amongst alcohol dependent persons.


A study of a large number (>27,000) of alcohol dependence-related insurance claims suggested that healthcare utilization, such as the number of inpatient detoxification days, alcoholism-related inpatient days, and alcoholism-related emergency department visits was significantly reduced in the patient population receiving alcoholism medications (naltrexone, naltrexone XR [an injectable sustained-release form of naltrexone], disulfiram [Antabuse], acomprosate) when compared to the patient population that did not take any medications.
  • Benzodiazepines, whilst useful in the management of acute alcohol withdrawal, if used long-term cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. This class of drugs is commonly prescribed to alcoholics for insomnia or anxiety management. Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for relapse into alcohol abuse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.

Dual addictions


Alcoholics may also require treatment for other psychotropic drug addictions. The most common dual addiction in alcohol dependence is benzodiazepine dependence
Benzodiazepine dependence
Benzodiazepine dependence or benzodiazepine addiction is a condition during which a person is dependent on benzodiazepine drugs. Dependence can be either a psychological dependence, physical dependence, or a combination of the two...

, with studies showing 10–20 percent of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepines. Benzodiazepines increase cravings for alcohol and the volume of alcohol consumed by problem drinkers. Benzodiazepine dependency requires careful reduction in dosage to avoid benzodiazepine withdrawal syndrome
Benzodiazepine withdrawal syndrome
Benzodiazepine withdrawal syndrome—often abbreviated to benzo withdrawal—is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug or during dosage reductions...

 and other health consequences.

Dependence on other sedative hypnotics such as zolpidem
Zolpidem
Zolpidem is a prescription medication used for the short-term treatment of insomnia, as well as some brain disorders. It is a short-acting nonbenzodiazepine hypnotic of the imidazopyridine class that potentiates gamma-aminobutyric acid , an inhibitory neurotransmitter, by binding to GABAA...

 and zopiclone
Zopiclone
Zopiclone is a non-benzodiazepine hypnotic agent used in the treatment of insomnia. In the United States, zopiclone is not commercially available, although its active stereoisomer, eszopiclone, is sold under the name Lunesta...

 as well as opiate
Opiate
In medicine, the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy plant.-Overview:Opiates are so named because they are constituents or derivatives of constituents found in opium, which is processed from the latex sap of the opium poppy,...

s and illegal drugs is common in alcoholics.

Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as barbiturate
Barbiturate
Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...

s, benzodiazepines and nonbenzodiazepine
Nonbenzodiazepine
The nonbenzodiazepines, also called benzodiazepine-like drugs, are a class of psychoactive drugs pharmacologically resembling the benzodiazepines, with similar benefits, side effects and risks, despite having dissimilar or entirely different chemical structures.-Classes:There are currently three...

s. Dependence upon and withdrawal from sedative hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...

 or seizure
Seizure
An epileptic seizure, occasionally referred to as a fit, is defined as a transient symptom of "abnormal excessive or synchronous neuronal activity in the brain". The outward effect can be as dramatic as a wild thrashing movement or as mild as a brief loss of awareness...

s if not managed properly.

Epidemiology


Substance use disorders are a major public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...

 problem facing many countries. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol." In the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, the number of 'dependent drinkers' was calculated as over 2.8 million in 2001. About 12% of American adults have had an alcohol dependence problem at some time in their life. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 estimates that about 140 million people throughout the world suffer from alcohol dependence. In the United States and Western Europe, 10 to 20 percent of men and 5 to 10 percent of women at some point in their lives will meet criteria for alcoholism.

Within the medical and scientific communities, there is broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."

Alcoholism has a higher prevalence among men, though in recent decades, the proportion of female alcoholics has increased. Current evidence indicates that in both men and women, alcoholism is 50–60 percent genetically determined, leaving 40–50 percent for environmental influences. Most alcoholics develop alcoholism during adolescence or young adulthood.

Prognosis


A 2002 study by the National Institute on Alcohol Abuse and Alcoholism
National Institute on Alcohol Abuse and Alcoholism
The National Institute on Alcohol Abuse and Alcoholism , as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems...

 surveyed a group of 4,422 adults meeting the criteria for alcohol dependence
Alcohol dependence
Alcohol dependence, as described in the DSM-IV, is a psychiatric diagnosis describing an entity in which an individual uses alcohol despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship.-Definition and diagnosis:According to the DSM-IV criteria for...

 and found that after one year, some met the authors' criteria for low-risk drinking, even though only 25.5 percent of the group received any treatment, with the breakdown as follows: 25 percent were found to be still dependent, 27.3 percent were in partial remission (some symptoms persist), 11.8 percent asymptomatic drinkers (consumption increases chances of relapse) and 35.9 percent were fully recovered — made up of 17.7 percent low-risk drinkers plus 18.2 percent abstainers.

In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence." Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage."

The most common cause of death in alcoholics is from cardiovascular complications. There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also very common in adolescent alcohol abusers, with 25 percent of suicides in adolescents being related to alcohol abuse. Approximately 18 percent of alcoholics commit suicide, and research has found that over 50 percent of all suicides are associated with alcohol or drug dependence. The figure is higher for adolescents, with alcohol or drug misuse playing a role in up to 70 percent of suicides.

History



Historically the name dipsomania
Dipsomania
Dipsomania is a historical term describing a medical condition involving an uncontrollable craving for alcohol. It was used in the 19th century to describe a variety of alcohol-related problems, most of which are most commonly conceptualized today as alcoholism, but it is occasionally still used to...

 was coined by German physician Dr. C. W. Hufeland in 1819 before it was superseded by alcoholism. The term "alcoholism" was first used in 1849 by the Swedish physician Magnus Huss to describe the systematic adverse effects of alcohol.

Alcohol has a long history of use and misuse throughout recorded history. Biblical, Egyptian and Babylonian sources record the history of abuse and dependence on alcohol. In some ancient cultures alcohol was worshiped and in others its abuse was condemned. Excessive alcohol misuse and drunkenness were recognised as causing social problems even thousands of years ago. However, the defining of habitual drunkenness as it was then known as and its adverse consequences were not well established medically until the 18th century. In 1647 a Greek monk named Agapios was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis and internal bleeding. In 1920 the effects of alcohol abuse and chronic drunkenness led to the failed prohibition
Prohibition
Prohibition of alcohol, often referred to simply as prohibition, is the practice of prohibiting the manufacture, transportation, import, export, sale, and consumption of alcohol and alcoholic beverages. The term can also apply to the periods in the histories of the countries during which the...

 of alcohol being considered and eventually enforced briefly in America. In 2005 the cost of alcohol dependence and abuse was estimated to cost the USA economy approximately 220 billion dollars per year, more than cancer and obesity.

Society and culture



The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs. Alcohol use is a major contributing factor for head injuries
Head injury
Head injury refers to trauma of the head. This may or may not include injury to the brain. However, the terms traumatic brain injury and head injury are often used interchangeably in medical literature....

, motor vehicle accidents, violence, and assaults. Beyond money, there are also significant social costs to both the alcoholic and their family and friends. For instance, alcohol consumption by a pregnant woman can lead to fetal alcohol syndrome
Fetal alcohol syndrome
Fetal alcohol syndrome is a pattern of mental and physical defects that can develop in a fetus in association with high levels of alcohol consumption during pregnancy. Current research also implicates other lifestyle choices made by the prospective mother...

, an incurable and damaging condition.

Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six percent of a country's GDP. One Australian estimate pegged alcohol's social costs at 24% of all drug abuse costs; a similar Canadian study concluded alcohol's share was 41%. One study quantified the cost to the UK of all forms of alcohol misuse in 2001 as £18.5–20 billion. All economic costs in the United States in 2006 have been estimated at $223.5 billion.

Stereotype
Stereotype
A stereotype is a popular belief about specific social groups or types of individuals. The concepts of "stereotype" and "prejudice" are often confused with many other different meanings...

s of alcoholics are often found in fiction
Fiction
Fiction is the form of any narrative or informative work that deals, in part or in whole, with information or events that are not factual, but rather, imaginary—that is, invented by the author. Although fiction describes a major branch of literary work, it may also refer to theatrical,...

 and popular culture
Popular culture
Popular culture is the totality of ideas, perspectives, attitudes, memes, images and other phenomena that are deemed preferred per an informal consensus within the mainstream of a given culture, especially Western culture of the early to mid 20th century and the emerging global mainstream of the...

. The 'town drunk
Town drunk
The town drunk is a stock character, almost always male, who is drunk more often than sober.The town drunk typically dwells in a small enough town that he is the only conspicuous alcoholic...

' is a stock character
Stock character
A Stock character is a fictional character based on a common literary or social stereotype. Stock characters rely heavily on cultural types or names for their personality, manner of speech, and other characteristics. In their most general form, stock characters are related to literary archetypes,...

 in Western popular culture. Stereotypes of drunkenness may be based on racism
Racism
Racism is the belief that inherent different traits in human racial groups justify discrimination. In the modern English language, the term "racism" is used predominantly as a pejorative epithet. It is applied especially to the practice or advocacy of racial discrimination of a pernicious nature...

 or xenophobia
Xenophobia
Xenophobia is defined as "an unreasonable fear of foreigners or strangers or of that which is foreign or strange". It comes from the Greek words ξένος , meaning "stranger," "foreigner" and φόβος , meaning "fear."...

, as in the depiction of the Irish
Irish people
The Irish people are an ethnic group who originate in Ireland, an island in northwestern Europe. Ireland has been populated for around 9,000 years , with the Irish people's earliest ancestors recorded having legends of being descended from groups such as the Nemedians, Fomorians, Fir Bolg, Tuatha...

 as heavy drinkers. Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.

Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. In Asian countries that have a high gross domestic product, there is heightened drinking compared to other Asian countries, but it is nowhere near as high as it is in other countries like the United States. It also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption.

In a study done on Korean immigrants in Canada, they reported alcohol was even an integral part of their meal, and is the only time solo drinking should occur. They also believe alcohol is necessary at any social event as it helps conversations start.

Caucasians have a much lower abstinence rate (11.8%) and much higher tolerance to symptoms (3.4±2.45 drinks) of alcohol than Chinese (33.4% and 2.2±1.78 drinks respectively). Also, the more acculturation there is between cultures, the more influenced the culture is to adopt Caucasians drinking practices.

Peyote, a psychoactive agent, has even shown promise in treating alcoholism. This is interesting because alcohol replaced peyote as Native American’s psychoactive agent of choice in rituals when peyote was outlawed.

Research

  • Topiramate
    Topiramate
    Topiramate is an anticonvulsant drug. It was originally produced by Ortho-McNeil Neurologics and Noramco, Inc., both divisions of the Johnson & Johnson Corporation. This medication was discovered in 1979 by Bruce E. Maryanoff and Joseph F. Gardocki during their research work at McNeil...

    , a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiveness of topiramate concluded that the results of published trials are promising, however as of 2008, data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence. A 2010 review found that topiramate may be superior to existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings.

See also

  • Addictive personality
    Addictive personality
    An addictive personality refers to a particular set of personality traits that make an individual predisposed to addictions. People who are substance dependent are characterized by: a physical or psychological dependency that negatively impacts the quality of life...

  • Alcoholism in family systems
    Alcoholism in family systems
    Alcoholism in family systems refers to the conditions in families that enable alcoholism, and the effects of alcoholic behavior by one or more family members on the rest of the family. Mental health professionals are increasingly considering alcoholism and addiction as diseases that flourish in and...

  • Alcohol-related traffic crashes
  • Drug addiction
  • High-functioning alcoholic
    High-functioning alcoholic
    A High-functioning alcoholic is a form of alcoholism where the alcoholic is able to maintain their outside life such as jobs, academics, relationships etc. all while drinking alcoholically. Many HFAs are not viewed by society as alcoholics because they do not fit the common alcoholic stereotype...

  • List of countries by alcohol consumption

Questionnaires
  • Alcohol Use Disorders Identification Test
    Alcohol Use Disorders Identification Test
    The Alcohol Use Disorders Identification Test is a simple ten-question test developed by the World Health Organization to determine if a person's alcohol consumption may be harmful. The test was designed to be used internationally, and was validated in a study using patients from six countries...

  • CAGE questionnaire
    CAGE questionnaire
    The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used method of screening for alcoholism.The CAGE questionnaire, among other methods, has been extensively validated for use in identifying alcoholism...

  • CRAFFT Screening Test
    CRAFFT Screening Test
    CRAFFT Screening Test is a short, self-administered behavioural health screening tool developed to screen adolescents for high risk alcohol and other drug use disorders simultaneously. It is considered an effective screening tool intended to assess whether further assessment is warranted...

  • Paddington Alcohol Test
    Paddington alcohol test
    The Paddington Alcohol Test was first published in the Journal of Accident and Emergency Medicine in 1996. It was designed to identify alcohol-related problems amongst those attending Accident and Emergency departments...

  • Severity of Alcohol Dependence Questionnaire
    Severity of Alcohol Dependence Questionnaire
    The Severity of Alcohol Dependence Questionnaire is a 20 item clinical screening tool designed to measure the presence and level of alcohol dependence.It is divided into 5 sections:* Physical withdrawal symptoms* Affective withdrawal symptoms...


Further reading



  • National Institute on Alcohol Abuse and Alcoholism. "Etiology and Natural History of Alcoholism".
  • The Online Resource for Addiction Recovery, Addiction Treatment & Addiction help. "Addiction Recovery".
  • Pence, Gregory, "Kant on Whether Alcoholism is a Disease," Ch. 2, The Elements of Bioethics, McGraw-Hill Books, 2007 ISBN 0-07-313277-2.
  • Thompson, Warren, MD, FACP. "Alcoholism." Emedicine.com, June 6, 2007. Retrieved 2007-09-02.


External links


  • DMOZ Alcohol abuse links and support groups at the Open Directory Project
    Open Directory Project
    The Open Directory Project , also known as Dmoz , is a multilingual open content directory of World Wide Web links. It is owned by Netscape but it is constructed and maintained by a community of volunteer editors.ODP uses a hierarchical ontology scheme for organizing site listings...