alcoholism is the 3rd leading cause of death in the developed world; causes: automobile accidents, fetal alcohol syndrome, accidental injuries, denial of addiction, accidental or deliberate overdoses, withdrawal seizures, gastritis, ulcers, liver cirrhosis, pancreatitis, gastrointestinal cancers, heart disease, peripheral neuropathy
An individual diagnosed with alcohol use disorder needs to meet all of the following criteria:
A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
Alcohol is often taken in larger amounts or over a longer period than was intended.
There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
Craving, or a strong desire or urge to use alcohol.
Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
Recurrent alcohol use in situations in which it is physically hazardous.
Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
Tolerance, as defined by either of the following:
A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
A markedly diminished effect with continued use of the same amount of alcohol.
Withdrawal, as manifested by either of the following:
The characteristic withdrawal syndrome for alcohol:
Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use:
Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).
Increased hand tremor.
Nausea or vomiting.
Transient visual, tactile, or auditory hallucinations or illusions.
Generalized tonic-clonic seizures.
Alcohol (or closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
In early remission: After full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met for at least 3 months but for less than 12 months (with the exception that the criterion, "Craving, or a strong desire or urge to use alcohol," may be met).
In sustained remission: After full criteria for alcohol use disorder were previously met, none of the criteria for alcohol use disorder have been met at any time during a period of 12 months or longer (with the exception that the criterion, "Craving, or a strong desire or urge to use alcohol," may be met).
In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted.
The leading causes of death in USA in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (365 000 deaths; 15.2%), and alcohol consumption (85 000 deaths; 3.5%). Alcoholism is usually a chronic, episodic disorder associated with periods of sobriety punctuated by episodes of drinking. Therapy aims at preventing or shortening these relapses.
Only 3 medications have been proven successful in relapse prevention. Naltrexone blocks the pleasurable effect of alcohol, thus decreases the urge to drink. It can be given in daily oral form, or as a month-long injection. Acamprosate when taken daily decreases craving, anxiety and insomnia. Disulfiram, when taken with alcohol, causes a person to turn purple and vomit. Thus disulfiram can be taken to prevent drinking, or to prove that a person isn't drinking. Compliance is improved with daily supervision of pill swallowing. Antianxiety medication should only be used during medically supervised initial detoxification. Addiction counselling and regular attendance at Alcoholics Anonymous (self-help group) meetings significantly improves treatment outcome. Although residential rehabilitation programs are the most expensive of all treatments for alcohol use disorder; there are no randomized controlled clinical trials that have yet proven the superiority of residential treatment over non-residential, outpatient treatment.
Should Illicit Drugs Be Legalized?
Some people argue that illicit drugs should be legalized to decrease the crime associated with these drugs. Historically, tobacco and alcohol were once illegal drugs. Tobacco smoking is now the leading cause of death in America, and alcoholism is the third leading cause of death. Thus legalizing illicit drugs does not make them any less medically and socially harmful. In fact the opposite is true; legalizing illicit drugs increases their use and the harm they cause. The Government of Finland is passing legislation that will gradually ban all tobacco use by 2040.
Which Behavioral Dimensions Are Involved?
The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: wisdom, courage, helping others, self-control, and justice. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., irrationality, negative emotion, detachment, disinhibition, and antagonism). (Psychology named these same factors the "Big 5 dimensions of personality": "intellect", "neuroticism", "extraversion", "conscientiousness", and "agreeableness")
Alcohol use disorder is a condition characterized by the harmful consequences of repeated alcohol use, a pattern of compulsive alcohol use, and (sometimes) physiological dependence on alcohol (i.e., tolerance and/or symptoms of withdrawal). This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing.
Alcohol use is highly prevalent in most Western countries. However, in most Asian cultures, the overall prevalence of alcohol-related disorders is low. In Muslim countries, the Islamic religion strictly prohibits alcohol (hence the prevalence of alcohol-related disorders is very low). In the Western countries, this disorder is 5 times more prevalent in males than females. The lifetime risk of alcohol use disorder is approximately 15% in the general population. In any year, 5% of the general population will actively be suffering from alcohol use disorder.
Alcohol use disorder has a variable course that is frequently characterized by periods of remission and relapse. The first episode of alcohol intoxication is likely to occur in the mid-teens, with the age at onset of alcohol use disorder peaking in the 20s to mid-30s. The large majority of those who develop alcohol use disorder do so by their late 30s.
Alcohol use disorder often has a familial pattern, and it is estimated that 40%-60% of the variance of risk is explained by genetic influences. The risk for alcohol use disorder is 3 to 4 times higher in close relatives of people with alcohol use disorder. Most studies have found a significantly higher risk for alcohol use disorder in the monozygotic twin than in the dizygotic twin of a person with alcohol use disorder. Adoption studies have revealed a 3- to 4-fold increase in risk for alcohol use disorder in the children of individuals with alcohol use disorder when these children were adopted away at birth and raised by adoptive parents who did not have this disorder.
School and job performance may suffer either from hangovers or from actual intoxication on the job or at school; child care or household responsibilities may be neglected; and alcohol-related absences may occur from school or job. The individual may use alcohol in physically hazardous circumstances (e.g., drunk driving or operating machinery while intoxicated). Legal difficulties may arise because of alcohol use (e.g., arrests for intoxicated behavior or for drunk driving). Individuals with this disorder may continue to abuse alcohol despite the knowledge that continued drinking poses significant social or interpersonal problems for them (e.g., violent arguments with spouse while intoxicated, child abuse). Alcohol intoxication causes significant intellectual impairment (and stupid behavior). Once a pattern of compulsive use develops, individuals with this disorder may devote substantial periods of time to obtaining and consuming alcoholic beverages. These individuals continue to use alcohol despite evidence of adverse psychological or physical consequences (e.g., depression, blackouts, liver disease, or other complications). Individuals with this disorder are at increased risk for accidents, violence, and suicide. It is estimated that 1 in 5 intensive care unit admissions in some urban hospitals is related to alcohol and that 40% of people in U.S.A. experience an alcohol-related accident at some time in their lives, with alcohol accounting for up to 55% of fatal driving events. More than one-half of all murderers and their victims are believed to have been intoxicated with alcohol at the time of the murder. Severe alcohol intoxication also contributes to disinhibition and feelings of sadness and irritability, which contribute to suicide attempts and completed suicides.
Only 5% of individuals with alcohol use disorder ever experience severe complications of withdrawal (e.g., delirium, grand mal seizures). However, repeated intake of high doses of alcohol can affect nearly every organ system, especially the gastrointestinal tract, cardiovascular system, and the central and peripheral nervous system. Gastrointestinal effects include gastritis, stomach or duodenal ulcers, and, in about 15% of those who use alcohol heavily, liver cirrhosis and pancreatitis. There is also an increased rate of cancer of the esophagus, stomach, and other parts of the gastrointestinal tract. One of the most common associated general medical conditions is low-grade hypertension. There is an elevated risk of heart disease. Peripheral neuropathy may be evidenced by muscular weakness, paresthesias, and decreased peripheral sensation. Most persistent central nervous system effects include cognitive deficits, severe memory impairment, and degenerative changes in the cerebellum (leading to poor balance and coordination). One devastating central nervous system effect is the relatively rare alcohol-induced persisting amnestic disorder (Wernicke-Korsakoff syndrome) in which there is a dramatic impairment in short-term memory. Men may develop erectile dysfunction and decreased testosterone levels. Repeated heavy drinking in women is associated with menstrual irregularities and, during pregnancy, with spontaneous abortion and fetal alcohol syndrome (leading to mentally retarded, hyperactive children). Alcohol use disorder can suppress immune mechanisms and predispose individuals to infections (e.g., pneumonia) and increase the risk for cancer.
Individuals with alcohol use disorder are at increased risk for major depressive disorder, other substance-related disorders (e.g., drug addiction), conduct disorder in adolescents, antisocial and emotionally unstable (borderline) personality disorders, schizophrenia, and bipolar disorder.
Associated Laboratory Findings
The most direct test available to measure alcohol consumption is blood alcohol concentration, which can also be used to judge tolerance to alcohol. An individual with a concentration of 100 mg of ethanol per deciliter of blood who does not show signs of intoxication can be presumed to have acquired tolerance to alcohol. At 200 mg/dL, most non-alcoholic individuals would demonstrate severe intoxication. An elevation (> 30 units) of gamma-glutamyltransferase (GGT) is a sensitive laboratory test for heavy drinking. At least 70% of individuals with a high GGT level are persistent heavy drinkers (i.e., consuming 8 or more drinks daily on a regular basis). Another sensitive test for heavy drinking is an elevation (> 20 units) in carbohydrate deficient transferrin (CDT). Both GGT and CDT levels return toward normal within days to weeks of stopping drinking, thus are useful tests to monitor abstinence. The combination of GGT and CDT may have even higher levels of sensitivity and specificity in diagnosing heavy drinking than either test used alone. Another useful laboratory test for heavy drinking is an elevated mean corpuscular volume (MCV). However, the MCV is a poor method of monitoring abstinence because it takes weeks to return to normal after the individual stops drinking. Liver function tests (e.g., alanine aminotransferase [ALT] and alkaline phosphatase) can reveal liver injury that is caused by heavy drinking. High fat content in the blood also contributes to the development of fatty liver.
Follow-up studies of the typical person with an alcohol use disorder show a higher than 65% 1-year abstinence rate following treatment. Even among less functional and homeless individuals with alcohol use disorder who complete a treatment program, as many as 60% are abstinent at 3 months, and 45% at 1 year. Some individuals (perhaps 20% or more) with alcohol use disorder achieve long-term sobriety even without treatment.
Top 20 Most Harmful Drugs In Britain In 2008
Professor David Nutt published in the Lancet the following rating of Britain's most dangerous drugs. They are listed in descending order from the most harmful.
Class A drug. Originally used as a painkiller and derived from the opium poppy. There were 897 deaths recorded from heroin and morphine use in 2008 in England and Wales, according to the Office of National Statistics (ONS). There were around 13,000 seizures, amounting to 1.6m tonnes of heroin.
Class A. Stimulant produced from the South American coca leaf. Accounted for 235 deaths -- a sharp rise on the previous year's fatalities. Nearly 25,000 seizures were made, amounting to 2.9 tonnes of the drug.
Class B. Synthetic sedatives used for anaesthetic purposes. Blamed for 13 deaths.
4. Street methadone
Class A. A synthetic opioid, commonly used as a substitute for treating heroin patients. Accounted for 378 deaths and there were more than 1,000 seizures of the drug.
Subject to increasing concern from the medical profession about its damage to health. According to the ONS, there were 8,724 alcohol deaths in the UK in 2007. Other sources claim the true figure is far higher.
Class C. A hallucinogenic dance drug for clubbers. There were 23 ketamine-related deaths in the UK between 1993 and 2006. Last year there were 1,266 seizures.
Class C. A hypnotic relaxant used to treat anxiety and insomnia. Includes drugs such as diazepam, temazepam and nitrazepam. Caused 230 deaths and 1.8m doses were confiscated in more than 4,000 seizure operations.
Class B. A psychostimulant that combats fatigue and suppresses hunger. Associated with 99 deaths, although this tally includes some ecstasy deaths. Nearly 8,000 seizures, adding up to almost three tonnes of confiscated amphetamines.
A stimulant that is highly addictive due to its nicotine content. More than 100,000 people a year die from smoking and tobacco-related diseases, including cancer, respiratory diseases and heart disease.
An opiate used for pain control, and sometimes as a substitute to wean addicts off heroin. Said to have caused 43 deaths in the UK between 1980 and 2002.
Class B. A psychoactive drug recently appearing in stronger forms such as "skunk". [Since this video was made; there is now conclusive proof that cannabis causes a 6.7 fold increase in the risk of developing schizophrenia.] Caused 19 deaths and there were 186,000 seizures, netting 65 tonnes of the drug and 640,000 cannabis plants.
Fumes inhaled to produce a sense of intoxication. Usually abused by teenagers. Derived from commonly available products such as glue and aerosol sprays. Causes around 50 deaths a year.
Class A. Originally designed for laboratory research. Releases serotonin in the body. Only four deaths reported in the UK between 1997 and 2004.
Class A. Hallucinogenic drug originally synthesised by a German chemist in 1938. Very few deaths recorded.
Class B drug. Brand name of Ritalin. A psychostimulant sometimes used in the treatment of attention deficit disorders.
16. Anabolic steroids
Class C. Used to develop muscles, notably in competitive sports. Also alleged to induce aggression. Have been blamed for causing deaths among bodybuilders. More than 800 seizures.
Class C drug. A clear liquid dance drug said to induce euphoria, also described as a date rape drug. Can trigger comas and suppress breathing. Caused 20 deaths and 47 seizures were recorded.
Class A. Psychoactive dance drug. Caused 44 deaths, with around 5,000 seizures made.
19. Alykl nitrites
Known as "poppers". Inhaled for their role as a muscle relaxant and supposed sexual stimulant. Reduce blood pressure, which can cause fainting and in some cases death.
A psychoactive plant, the leaves of which are chewed in east Africa and Yemen. Also known as qat. Produces mild psychological dependence. Its derivatives, cathinone and cathine, are Class C drugs in the UK.
Do women differ from men on Alcoholics Anonymous participation and abstinence? A multi-wave analysis of treatment seekers. (2012) Women and men attended AA at similar rates and similarly practiced specific AA behaviors, and they were alike on most factors associated with AA participation and abstention across time including abstinence goal, drink volume, negative consequences, prior treatment, and encouragement to reduce drinking. Relative to men, women with higher drug severity were less likely to participate in AA. Although higher AA participation was a predictor of abstinence for both genders, men were less likely to be abstinent across time. Men were also more likely to reduce their AA participation across time.
Predictors of membership in Alcoholics Anonymous in a sample of Successfully remitted alcoholics. (2011) This study identifies factors associated with Alcoholics Anonymous (AA) membership in a sample of 81 persons who have achieved at least one year of total abstinence from alcohol and other drugs. Forty-four were AA members, 37 were not. Having more positive views of God and more negative consequences of drinking were significantly associated with AA membership. This information can be used by clinicians to identify clients for whom AA might be a good fit, and can help others overcome obstacles to AA or explore alternative forms of abstinence support.
Meta-analysis of pharmacological therapy with acamprosate, naltrexone, and disulfiram--a systematic review. (2011) The meta-analysis is based on 16 randomized controlled trials of acamprosate, 18 of naltrexone and 7 of disulfiram. Acamprosate and naltrexone were 52% (RR = 1.52; 95% confidence interval (CI): 1.35-1,72) and 27% (RR = 1.27; 95% CI: 1,06-1,52) better than placebo when it came to supporting continuous abstinence. Acamprosate increased the total number of abstinence days by 14% (MD = 14.02; 95% CI: 9.57-18.47). Disulfiram appeared to be effective only when the intake was supervised. Based on the amount of scientific evidence, acamprosate and naltrexone therapy should be increased in clinical practice in the treatment of alcoholism.
Mindfulness based interventions for addictive disorders: a review. (2011) Results of six clinical trials evaluating four different programs were found. Five studies were controlled and four were randomized. Drop-out rates were relatively high (from 28 to 55%). In five cases out of six, the program significantly reduced substance use. In four comparative trials out of five, interventions based on mindfulness proved more effective than control conditions.
A literature review of cost-benefit analyses for the treatment of Alcohol use disorder. (2011) In the psychotherapy studies, major benefits are typically seen within the first six months of treatment. The benefit-cost ratio ranged from 1.89 to 39.0. Treatment with acamprosate was found to accrue a net benefit of 21,301 BEF (528 €) per patient over a 24-month period in Belgium and lifetime benefit for each patient in Spain was estimated to be Pta. 3,914,680 (23,528 €). To date, only a few studies exist that have examined the cost-benefit of psychotherapy or pharmacotherapy treatment of AD. Most of the available treatment options for AD appear to produce marked economic benefits.
Brief interventions for heavy alcohol users admitted to general hospital wards. (2011) Objective: To determine whether brief interventions reduce alcohol consumption and improve outcomes for heavy alcohol users admitted to general hospital inpatient units. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD -69.43 (95% CI -128.14 to -10.72) and nine months follow up, MD -182.88 (95% CI -360.00 to -5.76) but this is not maintained at one year. In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening, asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behaviour.
How cognitive assessment through clinical neurophysiology may help optimize chronic alcoholism treatment. (2011) Although psychosocial treatments (e.g. individual or group therapy) have historically been the mainstay of alcoholism treatment, a successful approach for alcohol dependence consists in associating pharmacologic medications with therapy, as 40-70% of patients following only psychosocial therapy typically resume alcohol use within a year of post-detoxification treatment. Nowadays, two main pharmacological options, naltrexone and acomprosate, both approved by the US Food and Drug Administration, are available and seemingly improve on the results yielded by standard techniques employed in the management of alcoholism. However, insufficient data exist to confirm the superiority of one drug over the other.
The efficacy of disulfiram for the treatment of alcohol use disorder. (2011) Supervised treatment with disulfiram has some effect on short-term abstinence and days until relapse as well as number of drinking days when compared with placebo, none, or other treatments for patients with alcohol dependency or abuse. Long-term effect on abstinence has not been evaluated yet. However, there is a need for more homogeneous and high-quality studies in the future regarding the efficacy of disulfiram.
Medical treatment of alcohol dependence: a systematic review. (2011) The evidence base for oral naltrexone (6% more days abstinent than placebo in the largest study) and topiramate (prescribed off-label) (e.g., 26.2% more days abstinent than placebo in a recent study) is positive but modest. Acamprosate shows modest efficacy with recently abstinent patients, with European studies showing better results than U.S. ones. The evidence-base for disulfiram is equivocal. Depot naltrexone shows efficacy (25% greater reduction in rate of heavy drinking vs. placebo, in one of the largest studies) in a limited number of studies. Some studies suggest that patients do better with extensive psychosocial treatments added to medications while others show that brief support can be equally effective.
Following problem drinkers over eleven years: understanding changes in alcohol consumption. (2010) Results suggest that problem and dependent drinkers continue to drink at an elevated level over the course of years. Gatekeepers, family members, and policymakers should encourage and facilitate contact with social service agencies and with AA for problem drinkers. Suggestions from others to do something about one's drinking and seeking specialty care occur more often in those with more severe problems and do not appear to be linked to less drinking over time.
Negative affect, relapse, and Alcoholics Anonymous (AA): does AA work by reducing anger? (2010) Findings revealed substantially elevated levels of anger in those attending AA compared with the general population (98th percentile) that decreased over 15-month follow-up but remained high (89th percentile). AA attendance was associated with better drinking outcomes, and higher levels of anger were associated with heavier drinking. However, AA attendance was unrelated to changes in anger.
Opioid antagonists for alcohol dependence. (2010) Naltrexone reduced the risk of heavy drinking to 83% of the risk in the placebo group RR 0.83 (95% CI 0.76 to 0.90) and decreased drinking days by about 4%, MD -3.89 (95% CI -5.75 to -2.04). Naltrexone appears to be an effective and safe strategy in alcoholism treatment; even though the sizes of treatment effects might appear moderate in their magnitudes.
Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. (2009) Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also effective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm.
Epidemiology of alcoholics anonymous participation. (2008) Fully one-half of those completing AA's most recent membership survey reported that they had been abstinent for more than 5 years. Disengagement from AA does not appear to necessarily translate to loss of abstinence among those with initial high levels of AA exposure, but long-term abstinence is more likely among those with continued engagement.