ALCOHOLISM

Alcoholism, also known as alcohol dependence, is a disabling addictive disorder. It

is characterized by compulsive and uncontrolled consumption of alcohol despite its
negative effects on the drinker's health, relationships, and social standing. Like other
drug addictions, alcoholism is medically defined as a treatable disease. The term
"alcoholism" is a widely used term first coined in 1849 by Magnus Huss, but in
medicine the term was replaced by "alcohol abuse" and "alcohol dependence" in the
1980s DSM III. Similarly in 1979 an expert World Health Organisation committee
disfavoured the use of "alcoholism" as a diagnostic entity, preferring the category of
"alcohol dependence syndrome". In the 19th and early 20th centuries, alcohol
dependence was called dipsomania before the term "alcoholism" replaced it.

The biological mechanisms underpinning alcoholism are uncertain, however, risk

factors include social environment, stress, mental health, genetic predisposition, age,
ethnic group, and sex. Long-term alcohol abuse produces physiological changes in the
brain such as tolerance and physical dependence. Such brain chemistry changes
maintain the alcoholic's compulsive inability to stop drinking and result in alcohol
withdrawal syndrome upon discontinuation of alcohol consumption.[10] Alcohol
damages almost every organ in the body, including the brain; because of the
cumulative toxic effects of chronic alcohol abuse, the alcoholic risks suffering a range
of medical and psychiatric disorders. Alcoholism has profound social consequences
for alcoholics and the people of their lives.

Alcoholism is the cyclic presence of tolerance, withdrawal, and excessive alcohol use;
the drinker's inability to control such compulsive drinking, despite awareness of its
harm to his or her health, indicates that the person might be an alcoholic.
Questionnaire-based screening is a method of detecting harmful drinking patterns,
including alcoholism. Alcohol detoxification is conducted to withdraw the alcoholic
person from drinking alcohol, usually with cross-tolerance drugs, e.g. benzodiazepines
to manage withdrawal symptoms. Post-medical care, such as group therapy, or self-
help groups, usually is required to maintain alcoholic abstention. Often, alcoholics
also are addicted to other drugs, most often benzodiazepines, which might require
additional medical treatment. The alcoholic woman is more sensitive to alcohol's
deleterious physical, cerebral, and mental effects, and increased social stigma, in
relation to a man, for being an alcoholic. The World Health Organisation estimates
that there are 140 million alcoholics worldwide
 Alcohol problems vary in severity from mild to life threatening and affect the
individual, the person's family, and society in numerous adverse ways. Despite all of
the focus on drugs such as cocaine, alcohol remains the number one drug problem in
the United States. According to community surveys, over 13% of adults in the United
States will experience alcohol abuse or dependence (also referred to as alcoholism) at
some point in their lives.

Withdrawal, for those physically dependent on alcohol, is much more dangerous than
withdrawal from heroin or other narcotic drugs.

← Alcohol abuse refers to excessive or problematic use with one or more of

the following:

o Failure to fulfill major obligations at work, school, or home

o Recurrent use in situations where it is hazardous (such as driving a car or

operating machinery)

o Legal problems

o Continued use of alcohol despite having social, family, or interpersonal problems

caused by or worsened by drinking

← Alcohol dependence refers to a more serious disorder and involves

excessive or maladaptive use leading to 3 or more of the following:

o Tolerance changes (need for more to achieve desired effect, or achieving the
effect with lesser amounts of alcohol)

o Withdrawal symptoms following a reduction or cessation of drinking (such as

sweating, rapid pulse, tremors, insomnia, nausea, vomiting, hallucinations,
agitation, anxiety, or seizures) or using alcohol to avoid withdrawal symptoms
(for example, early morning drinking)
o Drinking more alcohol or drinking over a longer period of time than intended
(loss of control)

o Inability to cut down or stop

o Spending a great deal of time drinking or recovering from its effects

o Giving up important social, occupational, or recreational activities

o Continuing to drink despite knowing alcohol use has caused or

worsened problems
 CAUSES OF ALCOHOL

The cause of alcoholism is not well established. There is growing evidence for genetic
and biologic predispositions for this disease, but this research is controversial. Studies
examining adopted children have shown that children of alcoholic biological parents
have an increased risk of becoming alcoholics. Relatively recent research has
implicated a gene (D2 dopamine receptor gene) that, when inherited in a specific
form, might increase a person's chance of developing alcoholism. Twice as many men
are alcoholics. And 10-23% of alcohol-consuming individuals are considered
alcoholics.

Usually, a variety of factors contribute to the development of a problem with alcohol.

Social factors such as the influence of family, peers, and society, and the availability
of alcohol, and psychological factors such as elevated levels of stress, inadequate
coping mechanisms, and reinforcement of alcohol use from other drinkers can
contribute to alcoholism. Also, the factors contributing to initial alcohol use may vary
from those maintaining it, once the disease develops.

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 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 and native Americans with this
allele have a reduced risk of developing alcoholism. 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 have been
proposed to explain the higher rates of alcoholism among Native Americans compared
to alcoholism levels in caucasians.
 SIGNS & SYMPTOMS
Symptoms of long term alcohol misuse

Alcoholism is characterised by an increased tolerance of and physical dependence 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.

Physical symptoms

Some of the possible long-term effects of ethanol an individual may develop.

Additionally, in pregnant women, alcohol can cause fetal alcohol syndrome.
Long term alcohol abuse can cause a number of physical symptoms, including
cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart
disease, nutritional deficiencies, and sexual dysfunction, and can eventually be fatal.
Other physical effects include an increased risk of developing cardiovascular disease,
malabsorption, alcoholic liver disease, and cancer. Damage to the central nervous
system and peripheral nervous system 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. [20]
Examples of long term complications include brain, heart, and liver damage [21] and an
increased risk of breast cancer. 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, decreased ovarian mass, problems or
irregularity of the menstrual cycle, and early menopause.[20] Alcoholic ketoacidosis
can occur in individuals who chronically abuse alcohol and have a recent history of
binge drinking.

Psychiatric symptoms

Long term misuse of alcohol can cause a wide range of mental health problems.
Severe cognitive problems are not uncommon; 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
and depression disorders. Psychiatric symptoms usually initially worsen during
alcohol withdrawal, but typically improve or disappear with continued abstinence.
Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse,
which can lead to a misdiagnosis such as schizophrenia. Panic disorder 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 (PTSD), or borderline
personality disorder. Men with alcohol-use disorders more often have a co-occurring
diagnosis of narcissistic or antisocial personality disorder, bipolar disorder,
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, domestic violence, rape, burglary and assault. Alcoholism is associated with
loss of employment, 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 drivingor public disorder, or civil penalties for tortious
behavior, and may lead to a criminal sentence.
An alcoholic's behavior and mental impairment, while drunk, can profoundly impact
those surrounding them and lead to isolation from family and friends. This isolation
can lead to marital conflict and divorce, or contribute to domestic violence.
Alcoholism can also lead to child neglect, with subsequent lasting damage to the
emotional development of the alcoholic's children

SYMPTOMS

 Alcohol intoxication
 Unconsciousness

 Accidents

 Accidental death

 Accidental drowning

 Liver disease

 Cirrhosis of the liver

 Pancreatitis

 Peripheral neuropathy

 Congestive heart failure

 Impotence

 Menstrual disorders

 Dementia

 Fetal Alcohol Syndrome (FAS) - in children born to alcoholic mothers.

 Social problems

o Loss of employment

o Divorce

o Loss of friends

o Homelessness

o Blackouts - loss of memory of events

o Loss of recent memory

 Deterioration in personal relationships

 Deterioration in family relationships

 Deterioration in social relationships

 Deterioration in work performance

 Deterioration in school performance

 Nutritional deficiencies

 Increased risk of alcohol-related accident

 Increased risk of cardiovascular disease

 Increased risk of liver disease

 Increased risk of cancer

 Increased risk of psychiatric disorders

 Increased risk of depression

 Increased risk of personality disorders

 Increased risk of schizophrenia

 Increased risk of pancreatitis

 Increased risk of epilepsy

 Increased risk of polyneuropathy

 Alcoholic dementia

 Sexual dysfunction

 Increased risk of death from a variety of causes

 Increased risk of cognitive problems

 Serious negative health effects on fetus

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
GABA receptor, promoting central nervous system depression. With repeated heavy
consumption of alcohol, these receptors are desensitized and reduced in number,
resulting in tolerance and physical dependence. When alcohol consumption is stopped
too abruptly, the person's nervous system suffers from uncontrolled synapse firing.
This can result in symptoms that include anxiety, life threatening seizures, delirium
tremens, hallucinations, shakes and possible heart failure. Other neurotransmitter
systems are also involved, especially dopamine and NMDA. Acute withdrawal
symptoms tend to subside after one to three weeks. Less severe symptoms (e.g.
insomnia and anxiety, anhedonia) 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
 Pathophysiology

Alcohol's primary effect is the increase in stimulation of the GABAA receptor,

promoting central nervous system depression. With repeated heavy consumption of
alcohol, these receptors are desensitized and reduced in number, resulting in tolerance
and physical dependence. 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. 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.
 Diagnosis

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 publicly display their drinking, 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 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

he 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. 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 being the most common. The Alcohol Use Disorders Identification Test
(AUDIT), a screening questionnaire developed by the World Health Organization, is
unique in that it has been validated in six countries and is used internationally. Like
the CAGE questionnaire, it uses a simple set of questions – a high score earning a
deeper investigation. The Paddington Alcohol Test (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 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 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:

... 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.
Urine and blood tests

There are reliable tests for the actual use of alcohol, one common test being that of
blood alcohol content (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 (enlarged MCV)

 Elevated GGT
 Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1

 High carbohydrate deficient transferrin (CDT)

However, none of these blood tests for biological markers are as sensitive as screening
questionnaires
 Prevention

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. 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 suggeste

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 approach; however, there are
some who promote a harm-reduction approach as well.

DETOXIFICATION
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 in order to reduce the
risk of relapse.

Group therapy and psychotherapy

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.Alcoholics Anonymous was
one of the first organizations formed to provide mutual, nonprofessional counseling,
and it is still the largest. Others include LifeRing Secular Recovery, SMART
Recovery, and Women For Sobriety.

Rationing And Moderation

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. A 2002 U.S. study by the
National Institute on Alcohol Abuse and Alcoholism (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.

Medications currently in use

 Antabuse (disulfiram) prevents the elimination of acetaldehyde, a chemical the

body produces when breaking down ethanol. Acetaldehyde itself is the cause
of many hangover 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 9-year study found
that incorporation of supervised disulfiram and the related compound
carbamide into a comprehensive treatment program resulted in an abstinence
rate of over 50 percent.
 Temposil (calcium carbimide) works in the same way as Antabuse; it has an
advantage in that the occasional adverse effects of disulfiram, hepatotoxicity
and drowsiness, do not occur with calcium carbimide.[105][106]

 Naltrexone is a competitive antagonist for opioid receptors, effectively

blocking the effects of endorphins and opiates. 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, which treats patients
through a combination of Naltrexone and continued drinking.

 Campral (acamprosate) 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.[109]

Experimental medications

 Topamax (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 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.

Medications which may worsen outcome

 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 are
 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. Patients
often mistakenly think that they are sober despite continuing to take
benzodiazepines. 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 a benzodiazepine dependence,
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 and other health consequences.

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. 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 managed properly
 Epidemiology

Substance use disorders are a major public health problem facing many countries.
"The most common substance of abuse/dependence in patients presenting for
treatment is alcohol." In the United Kingdom, 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 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 surveyed a
group of 4,422 adults meeting the criteria for alcohol dependence 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.

Alcoholism Affects 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, 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, 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.

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 depiction of the Irish 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.

History
Alcohol has a long history of use and misuse throughout recorded human history.
Biblical, Egyptian and Babylonian sources record history of abuse and dependence on
alcohol. In some ancient cultures alcohol was worshiped and others its abuse was
condemned. Excessive alcohol misuse and drunkenness were recognised as causing
problems thousand 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 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 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.
 ALCOHOLISM AS A DISEASE

One of the difficulties in recognizing alcoholism as a disease is it just plain doesn't

seem like one. It doesn't look, sound, smell and it certainly doesn't act like a disease.
To make matters worse, generally it denies it exists and resists treatment.

Alcoholism has been recognized for many years by professional medical

organizations as a primary, chronic, progressive and sometimes fatal disease. The
National Council on Alcoholism and Drug Dependence offers a detailed and complete
definition of alcoholism

Mental obsession? Did you ever wake up in the morning with a song playing over and
over in your head? It might have been a commercial jingle you heard on television, or
a song from the radio, but it kept playing ... and playing and playing.

Mental Obsession

Remember what that was like? No matter what you did, that silly tune kept on
playing. You could try to whistle or sing another song or turn on the radio and listen
to another tune, but the one in your head just kept on playing. Think about it. There
was something going on in your mind that you didn't put there and, no matter how
hard you tried, couldn't get out!
That is an example of a simple mental obsession -- a thought process over which you
have no control. Such is the nature of the disease of alcoholism. When the drinking
"song" starts playing in the mind of an alcoholic, he is powerless. He didn't put the
song there and the only way to get it to stop is to take another drink.

The problem is the alcoholic's mental obsession with alcohol is much more subtle than
a song playing in his mind. In fact, he may not even know it's there. All he knows is
he suddenly has an urge to take a drink -- a physical compulsion to drink.

Much of our knowledge of alcoholism has been gathered from studies conducted with
a predominance of male subjects. Recent studies involving more female subjects
reveal that drinking differs between men and women. Studies in the general
population indicate that fewer women than men drink. It is estimated that of the 15.1
million alcohol-abusing or alcohol-dependent individuals in the United States,
approximately 4.6 million (nearly one-third) are women

On the whole, women who drink consume less alcohol and have fewer alcohol-related
problems and dependence symptoms than men (2,3), yet among the heaviest drinkers,
women equal or surpass men in the number of problems that result from their drinking

Drinking behavior differs with the age, life role, and marital status of women. In
general, a woman's drinking resembles that of her husband, siblings, or close friends.
Whereas younger women (aged 18-34) report higher rates of drinking-related
problems than do older women, the incidence of alcohol dependence is greater among
middle-aged women (aged 35-49)

Contrary to popular belief, women who have multiple roles (e.g., married women who
work outside the home) may have lower rates of alcohol problems than women who
do not have multiple roles. In fact, role deprivation (e.g., loss of role as wife, mother,
or worker) may increase a woman's risk for abusing alcohol

Women who have never married or who are divorced or separated are more likely to
drink heavily and experience alcohol-related problems than women who are married
or widowed. Unmarried women living with a partner are more likely still to engage in
heavy drinking and to develop drinking problems.

Environmental Factors

Heath and colleagues studied drinking behavior among a select sample of female
twins to identify possible environmental factors that may modulate drinking behavior.
They reported that, among women, marital status appears to modify the effects of
genetic factors that influence drinking habits. Marriage or a marriage-like relationship
lessens the effect of an inherited liability for drinking.

Several researchers have explored whether drinking patterns and alcohol-related

problems vary among women of different racial or ethnic groups. Black women (46
percent) are more likely to abstain from alcohol than white women (34 percent)
Further, although it is commonly assumed that a larger proportion of black women
drink heavily,researchers have disproved this assumption:

Equal proportions of black and white women drink heavily (3,9). Black women report
fewer alcohol-related personal and social problems than white women, yet a greater
proportion of black women experience alcohol-related health problems

Data from self-report surveys suggest that Hispanic women are infrequent drinkers or
abstainers (12,13), but this may change as they enter new social and work arenas.
Gilbert found that reports of abstention are greater among Hispanic women who have
immigrated to the United States; reports of moderate or heavy drinking are greater
among younger, American-born Hispanic women.
 GREATER PHYSIOLOGICAL
IMPAIRMENT
The interval between onset of drinking-related problems and entry into treatment
appears to be shorter for women than for men. Moreover, studies of women alcoholics
in treatment suggest that they often experience greater physiological impairment
earlier in their drinking careers, despite having consumed less alcohol than men.
These findings suggest that the development of consequences associated with heavy
drinking may be accelerated or "telescoped" in women.

In addition to these many psych osocial and epidemiological differences, the sexes
also experience different physiological effects of alcohol. Women become intoxicated
after drinking smaller quantities of alcohol than are needed to produce intoxication in
men. Three possible mechanisms may explain this response.

First, women have lower total body water content than men of comparable size. After
alcohol is consumed, it diffuses uniformly into all body water, both inside and outside
cells. Because of their smaller quantity of body water, women achieve higher
concentrations of alcohol in their blood than men after drinking equivalent amounts of
alcohol. More simply, blood alcohol concentration in women may be likened to the
result of dropping the same quantity of alcohol into a smaller pail of water.

Second, diminished activity of alcohol dehydrogenase (the primary enzyme involved

in the metabolism of alcohol) in the stomach also may contribute to the gender-related
differences in blood alcohol concentrations and a woman's heightened vulnerability to
the physiological consequences of drinking. Julkunen and colleagues demonstrated in
rats that a substantial amount of alcohol is metabolized by gastric alcohol
dehydrogenase in the stomach before it enters the systemic circulation.
 Chronic Alcohol Abuse

This "first-pass metabolism" of alcohol decreases the availability of alcohol to the

system. Frezza and colleagues reported that, because of diminished activity of
gastric alcohol dehydrogenase, first-pass metabolism was decreased in women
compared with men and was virtually nonexistent in alcoholic women.

Third, fluctuations in gonadal hormone levels during the menstrual cycle may affect
the rate of alcohol metabolism, making a woman more susceptible to elevated blood
alcohol concentrations at different points in the cycle. Research findings to date,
however, have been inconsistent (22,23,24).

Chronic alcohol abuse exacts a greater physical toll on women than on men. Female
alcoholics have death rates 50 to 100 percent higher than those of male alcoholics.
Further, a greater percentage of female alcoholics die from suicides, alcohol-related
accidents, circulatory disorders, and cirrhosis of the liver.

Increasing evidence suggests that the detrimental effects of alcohol on the liver are
more severe for women than for men. Women develop alcoholic liver disease,
particularly alcoholic cirrhosis and hepatitis, after a comparatively shorter period of
heavy drinking and at a lower level of daily drinking than men. Proportionately more
alcoholic women die from cirrhosis than do alcoholic men.

Heightened Vulnerability

The exact mechanisms that underlie women's heightened vulnerability to alcohol-

induced liver damage are unclear. Differences in body weight and fluid content
between men and women may be contributing factors In addition, Johnson and
Williams suggested that the combined effect of estrogens and alcohol may augment
liver damage. Finally, alcoholic women may be more susceptible to liver damage
because of the diminished activity of gastric alcohol dehydrogenase in first-pass
metabolism

Drinking also may be associated with an increased risk for breast cancer. After
reviewing epidemiological data on alcohol consumption and the incidence of breast
cancer, Longnecker and colleagues reported that risk increases when a woman
consumes 1 ounce or more of absolute alcohol daily. Increased risk appears to be
related directly to the effects of alcohol

Moreover, risk for breast cancer and lower levels of alcohol consumption are weakly
associated. Data from other studies, however, do not concur with these findings,
suggesting that more research is needed to explore the relationship between drinking
and breast cancer.

Menstrual disorders (e.g., painful menstruation, heavy flow, premenstrual discomfort,

and irregular or absent cycles) have been associated with chronic heavy drinking.
These disorders can have adverse effects on fertility Further, continued drinking may
lead to early menopause.
 BARRIERS TO TREATMENT

Animal studies have provided data that replicate the findings of studies in humans to
determine the effects of chronic alcohol consumption on female reproductive function.
Studies in rodents and monkeys demonstrated that prolonged alcohol exposure
disrupts estrus regularity and increases the incidence of ovulatory failure.

Researchers have begun to examine whether women and men require distinct
treatment approaches. It has been suggested that women alcoholics may encounter
different conditions that facilitate or discourage their entry into treatment.
Women represent 25.4 percent of alcoholism clients in traditional treatment centers in
the United States. Although it appears that they comprise a small proportion of the
treatment population (25 percent women compared with 75 percent men), the
proportion of female alcoholics to male alcoholics in treatment is similar to the
proportion of all female alcoholics to male alcoholics (30 percent women to 70
percentmen).
In addition, women drinkers pursue avenues other than traditional alcoholism
programs, such as psychiatric services or personal physicians, for treatment
 Treatment Outcomes

Women alcoholics may encounter motivators and barriers to seeking treatment that
differ from those encountered by men. Women are more likely to seek treatment
because of family problems, and they often are encouraged by parents or children to
pursue therapy. Men usually are encouraged to pursue therapy by their wives.

Fewer women than men reach treatment through the criminal justice system or
through employee assistance programs Lack of child care is one of the most
frequently reported barriers to treatment for alcoholic women.

Sokolow and colleagues attempted to compare treatment outcome between men and
women and reported that, among those who completed treatment, abstinence was
slightly higher among women than among men. Women had a higher abstinence rate
if treated in a medically oriented alcoholism facility, whereas the abstinence rate was
higher for men treated in a peer group-oriented facility.

Treatment outcome was better for women treated in a facility with a smaller
proportion of female clients and better for men in a facility with a larger proportion of
female clients. This study provided preliminary data on gender-specific treatment
outcome; however, the trials were not controlled. Although the question of whether
women should have separate treatment opportunities is an important one, the
supporting evidence still has not been found.
 Alcohol and Women

The extent of women's participation in alcoholism treatment appears to equal roughly

the prevalence of alcohol-related problems among women. Even so, some women
may face barriers that limit access to treatment. Limited financial resources may be
one barrier. For example, many women do not have access to the employer-paid
alcoholism treatment provided by larger industries, where men tend to predominate in
the work force. Child-care concerns and the fear that an identified alcohol problem
will cause the loss of dependent children also may create barriers to treatment. With
regard to treatment, many questions remain to be answered by research, including
whether specialized treatment in a women-only program is more effective than
treatment in a mixed-gender setting.

Previous concerns about a lack of women as research subjects in alcohol studies are
beginning to be addressed. However, there have been recent charges that alcohol
research on women is discriminatory (48,49). Research on fetal alcohol and drug
effects and the fear of discriminatory actions, such as imprisoning pregnant women
solely because of their addiction, is central to this controversy. The issue of fetal
effects and how to prevent and treat them will not go away simply because
discriminatory policies have been suggested. The challenge for alcohol research will
be how both sexes can benefit from the fruits of science.
 Alcoholism statistics
These Alcoholism Statistics are Really Scary………………………..

The statistics of Alcoholism gives evidence of the fact that driving after drinking
cause approximately 10% property damages, near about 23% non fatal injuries and
48% injuries causing death. The percentage of females involved in drunk driving and
causing accidents are also increasing nowadays. Men's have alcohol related problems
more than that of women. Nearly 3.9 million women and 9.8 million men are
alcoholics.

The highest rate of drunken driving is associated with young people aged between 21
to 24 years. An average of one in every 30 minutes alcohol related traffic accident is
happening. At least 3 out of 10 are involved in alcohol related traffic accidents at
some stage in their life time. One third of alcohol deaths are suicides or accidents like
car crashes, drowning, falling etc. In some cases, alcohol causes cancer and heart
diseases and thereby leads to death. The study shows that alcohol related deaths are
more in youths.

The family statistics shows that nearly 76 million people have been addicted to
alcoholism in families. Nearly 6.6million children have at least one alcoholic parent.
Nearly half of the Americans reported that they have some close relatives with drug
abuse problems. Young people particularly teens have more alcohol problems.
 Home Remedies for Alcoholism

Tip 1:
First and foremost the person should be willing to give up alcohol. Sadly, but very
true that the only way to do it is, to make a clean break. 

Tip 2:
Apples- eating as many Apples as possible at regular intervals, reduces the craving for
alcohol. They also help to clear the toxins from the system. 

Tip 3:
Grapes-This fruit contains a pure form of alcohol. A person wanting to give up this
habit should have a meal of grapes every 4-5 hours, for a month at least.

Tip 4:
The juice of Bitter gourd leaves is very good for clearing intoxication. 3 tspns of juice
mixed in a glass of buttermilk is very good as it helps to heal the damaged liver also