Young People and Alcohol: Impact, Policy, Prevention, Treatment
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The kindling effect leads to persistent functional changes in brain neural circuits as well as to gene expression. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.
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A complex mixture of genetic and environmental factors influences the risk of the development of alcoholism. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view. Severe childhood trauma is also associated with a general increase in the risk of drug dependency.
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. Alcohol is the most available, widely consumed, and widely abused recreational drug. Beer alone is the world's most widely consumed  alcoholic beverage ; it is the third-most popular drink overall, after water and tea.
Males had higher rates than females for all measures of drinking in the past month: any alcohol use Genetic differences that exist between different racial groups 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 partially explain the differing rates of alcohol dependence among racial groups. African Americans and Native Americans with this allele have a reduced risk of developing alcoholism. Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker.
According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as one ounce bottle of beer, one 5-ounce glass of wine, or 1. An inference drawn from this study is that evidence-based policy strategies and clinical preventive services may effectively reduce binge drinking without requiring addiction treatment in most cases.
The term alcoholism is commonly used amongst laypeople, but the word is poorly defined. The WHO calls alcoholism "a term of long-standing use and variable meaning", and use of the term was disfavored by a WHO expert committee. The Big Book from Alcoholics Anonymous 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 , Bill W. 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 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. He looks at this in four phases. The first two are considered "normal" drinking and the last two are viewed as "typical" alcoholic drinking.
They describe the process in three stages:. The terms they recommend are similar but not identical. 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: "maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae.
In , it was defined by the National Council on Alcoholism and Drug Dependence NCADD and ASAM 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.
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AA describes alcoholism as an illness that involves a physical allergy  : 28 where "allergy" has a different meaning than that used in modern medicine. William D. Silkworth M. Morton Jellinek is considered the foundation of the modern disease theory of alcoholism. The modern medical definition of alcoholism has been revised numerous times since then.
The American Medical Association uses the word alcoholism to refer to a particular chronic primary disease. 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.
This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is an alcoholic. Screening is recommended among those over the age of These tools are mostly self-reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.
The CAGE questionnaire , named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office. 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. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.
Like the CAGE questionnaire, it uses a simple set of questions — a high score earning a deeper investigation. There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content BAC. With regard to alcoholism, BAC is useful to judge alcohol tolerance , which in turn is a sign of alcoholism. However, none of these blood tests for biological markers is as sensitive as screening questionnaires.
The World Health Organization , the European Union and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. 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. Treatments are varied because there are multiple perspectives of alcoholism. Those who approach alcoholism as a medical condition or disease recommend differing treatments from, for instance, those who approach the condition as one of social choice.
Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed 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 approach; however, some prefer a harm-reduction approach. Alcohol detoxification 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. 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 to reduce the risk of relapse. Various forms of group therapy or psychotherapy 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. Rationing and moderation programs such as Moderation Management and DrinkWise do not mandate complete abstinence.
While most alcoholics are unable to limit their drinking in this way, some return to moderate 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 —, examined the rates of return to problem drinking in — The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics.
In the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram. Evidence does not support the use of selective serotonin reuptake inhibitors SSRIs , tricyclic antidepressants TCAs , antipsychotics , or gabapentin. Alcoholics may also require treatment for other psychotropic drug addictions and drug dependences. These drugs are, like alcohol, depressants. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as illegal drugs.
Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers. Dependence on other sedative-hypnotics such as zolpidem and zopiclone as well as opiates and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as barbiturates , benzodiazepines and nonbenzodiazepines.
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Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of psychosis or seizures if not properly managed. The World Health Organization estimates that as of there are million people with alcoholism worldwide 4. Within the medical and scientific communities, there is a 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. Under the DSM 's new definition of alcoholics, that means about 37 percent of college students may meet the criteria. Alcoholism often reduces a person's life expectancy by around ten years. Approximately 3—15 percent of alcoholics commit suicide,  and research has found that over 50 percent of all suicides are associated with alcohol or drug dependence.
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. Historically the name " dipsomania " was coined by German physician C. Hufeland in before it was superseded by "alcoholism".
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 recognized 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 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 the effects of alcohol abuse and chronic drunkenness boosted membership of the temperance movement and led to the prohibition of alcohol in the United States , a nationwide constitutional ban on the production, importation, transportation, and sale of alcoholic beverages that remained in place until ; this policy resulted in the decline of death rates from cirrhosis and alcoholism.
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 due to injuries due to drunkenness and organ damage from long-term use, and secondary treatment costs, such as the costs of rehabilitation facilities and detoxification centers. Alcohol use is a major contributing factor for head injuries , motor vehicle accidents due to drunk driving , domestic violence , and assaults. Beyond the financial costs that alcohol consumption imposes, there are also significant social costs to both the alcoholic and their family and friends.
Stereotypes of alcoholics are often found in fiction and popular culture. The " town drunk " is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia , as in the fictional depiction of the Irish as heavy drinkers. 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 is also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption.
They also believe alcohol is necessary at any social event as it helps conversations start. Caucasians have a much lower abstinence rate Also, the more acculturation there is between cultures, the more influenced the culture is to adopt Caucasians drinking practices. Topiramate , 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 review of the effectiveness of topiramate concluded that the results of published trials are promising, however, as of , data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings. Ondansetron , a 5HT3 antagonist, appears to have promise as a treatment. According to a retrospective analysis of six studies from the s and s LSD-assisted psychotherapy has potential as a treatment for alcoholism.
From Wikipedia, the free encyclopedia. Broad term for problems with alcohol. For alcoholic beverages, see alcoholic drink. For the song by Starsailor, see Alcoholic song. Play media. Main article: Short-term effects of alcohol. See also: Long-term effects of alcohol consumption. See also: Drug-related crime. Main article: Alcohol withdrawal syndrome. See also: Kindling sedative-hypnotic withdrawal. See also: Addiction medicine. Further information: Alcohol education. Main article: Alcohol detoxification.
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Competing interests: Amy Pennay declares no competing interests. In the past 3 years, Dan Lubman has received speaking honoraria from Astra Zeneca, Janssen-Cilag and Servier, and has provided consultancy support to Lundbeck. Matthew Frei has received financial support from Reckitt Benckiser for conference presentations. Provenance and peer review: Commissioned; externally peer reviewed. To open click on the link, your computer or device will try and open the file using compatible software.
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