Alcoholism: July 2010
Alcoholism is a chronic disease, progressive and often fatal; it is a primary disorder and not a symptom of other diseases or emotional problems. The chemistry of alcohol allows it to affect nearly every type of cell in the body, including those in the central nervous system. In the brain, alcohol interacts with centers responsible for pleasure and other desirable sensations. After prolonged exposure to alcohol, the brain adapts to the changes alcohol makes and becomes dependent on it. For people with alcoholism, drinking becomes the primary medium through which they can deal with people, work, and life. Alcohol dominates their thinking, emotions, and actions. The severity of this disease is influenced by factors such as genetics, psychology, culture, and response to physical pain. Alcoholism can develop insidiously; often there is no clear line between problem drinking and alcoholism [see Box, below]. The only early indications of alcoholism may be the unpleasant physical responses to withdrawal that occur during even brief periods of abstinence. Sometimes people experience long-term depression or anxiety, insomnia, chronic pain, or personal or work stress that lead to the use of alcohol for relief, but often no extraordinary events have occurred that account for the drinking problem.
Alcoholics have little or no control over the quantity they drink or the duration or frequency of their drinking. They are preoccupied with drinking, deny their own addiction, and continue to drink even though they are aware of the dangers. Over time, some people become tolerant to the effects of drinking and require more alcohol to become intoxicated, creating the illusion that they can "hold their liquor." They have blackouts after drinking and frequent hangovers that cause them to miss work and other normal activities. Alcoholics might drink alone and start early in the day. They periodically quit drinking or switch from hard liquor to beer or wine, but these periods rarely last. Severe alcoholics often have a history of accidents, marital and work instability, and alcohol-related health problems. Episodic violent and abusive incidents involving spouses and children and a history of unexplained or frequent accidents are often signs of drug or alcohol abuse
Labels: What Is Alcoholism
About 100,000 deaths a year can be wholly or partially attributed to drinking , and alcoholism reduces life expectancy by 10 to 12 years. Next to smoking, it is the most common preventable cause of death in America. Although studies indicate that adults who drink moderately (about one drink a day) have a lower mortality rate than their non-drinking peers, their risk for untimely death increases with heavier drinking. Any protection that occurs with moderate alcohol intake appears to be confined to adults over 60 who have risks for heart disease. The earlier a person begins drinking heavily, the greater their chance of developing serious illnesses later on. Alcoholism can kill in many different ways, and, in general, people who drink regularly have a higher rate of deaths from injury, violence, and some cancers.
Accidents, Suicide, and Murder.
Domestic Violence and Effects on Family.
Alcohol can affect the body in so many ways that researchers are having a hard time determining exactly what the consequences are of drinking. It is well known, however, that chronic consumption leads to many problems, some of them deadly. Heart Disease. Large doses of alcohol can trigger irregular heartbeats and raise blood pressure even in people with no history of heart disease. A major study found that those who consumed more than three alcoholic drinks a day had higher blood pressure than teetotalers. The more alcohol someone drank, the greater the increase in blood pressure. People who were binge drinkers had the highest blood pressures. One study found that binge drinkers (people who have nine or more drinks once or twice a week) had a risk for a cardiac emergency that was two and a half times that of nondrinkers. Chronic alcohol abuse can also damage the heart muscle, which leads to heart failure; women are particularly vulnerable to this disorder. Contrary to many previous reports, a recent study suggested that moderate to heaving drinking (more than two bottles of beer or two glasses of wine day) was a greater risk factor for coronary artery disease than smoking. As in other studies, light drinking (two to six drinks a week) was protective. More research is needed to confirm or refute this new study. In any case, moderate drinking does not appear to offer any heart benefits for people who are at low risk for heart disease to begin with.
Cancer. Alcohol may not cause cancer, but it probably does increase the carcinogenic effects of other substances, such as cigarette smoke. Daily drinking increases the risk for lung, esophageal, gastric, pancreatic, colorectal, urinary tract, liver, and brain cancers, lymphoma and leukemia. About 75% of cancers of the esophagus and 50% of cancers of the mouth, throat, and larynx are attributed to alcoholism. (Wine appears to pose less danger for these cancers than beer or hard liquor.) Smoking combined with drinking enhances risks for most of these cancers dramatically. When women consume as little as one drink a day, they may increase their chances of breast cancer by as much as 30%.
Liver Disorders. The liver is particularly endangered by alcoholism. About 10% to 35% of heavy drinkers develop alcoholic hepatitis, and 10% to 20% develop cirrhosis. In the liver, alcohol converts to an even more toxic substance, acetaldehyde, which can cause substantial damage. Not eating when drinking and consuming a variety of alcoholic beverages are also factors that increase the risk for liver damage. People with alcoholism are also at higher risk for hepatitis B and C, potentially chronic liver diseases than can lead to cirrhosis and liver cancer. People with alcoholism should be immunized against hepatitis B; they may need a higher-than-normal dose of the vaccine for it to be effective. [See also Well-Connected, Report #59, Hepatitis.]
Gastrointestinal Problems. Alcohol can cause diarrhea and hemorrhoids. Alcohol can also contribute to serious infections of the pancreas and to ulcers in people taking the painkillers known as nonsteroidal anti-inflammatory drugs (such as aspirin or ibuprofen).
Pneumonia and Other Infections. Alcohol suppresses the immune system, so people with alcoholism are prone to infections. In particularly, acute alcoholism is strongly associated with very serious pneumonia. One study on laboratory animals suggests that alcohol specifically damages the bacteria-fighting capability of lung cells.
Mental and Neurologic Disorders. Alcohol has widespread effects on the brain. One study that scanned the brains of inebriated subjects suggested that while alcohol stimulates those parts of the brain related to reward and induces euphoria, it does not appear to impair cognitive performance (the ability to think and reason). Habitual use of alcohol, however, eventually produces depression and confusion. In chronic cases, gray matter is destroyed, possibly leading to psychosis and mental disturbances. Alcohol can also cause milder neurologic problems, including insomnia and headache (especially after drinking red wine). Except in severe cases, neurologic damage is not permanent and abstinence nearly always leads to recovery of normal mental function. Alcohol may increase the risk for hemorrhagic stroke (caused by bleeding in the brain), although it may protect against stroke caused by narrowed arteries.
Skin, Muscle, and Bone Disorders. Severe alcoholism is associated with osteoporosis, wasting away of muscles with swelling and pain, skin sores, and itching. In addition, alcohol-dependent women seem to face an increased risk for damage to muscles, including muscles of the heart, from the toxic effects of alcohol.
Hormonal Effects. Alcoholism increases levels of the female hormone estrogen and reduces levels of the male hormone testosterone, factors that contribute to impotence in men.
Smoking. Alcoholics who smoke face compound their health problems. More alcoholics die from tobacco-related illnesses, such as heart disease or cancer, than from chronic liver disease, cirrhosis, or other conditions more directly tied to excessive drinking.
Diabetes. Alcohol can cause hypoglycemia, a drop in blood sugar, which is especially dangerous for people with diabetes who are taking insulin. Intoxicated diabetics may not be able to recognize symptoms of hypoglycemia, a particularly hazardous condition.
Malnutrition and Wernicke-Korsakoff Syndrome. A pint of whiskey provides about half the daily calories needed by an adult, but it has no nutritional value. In addition to replacing food, alcohol may also interfere with absorption of proteins, vitamins, and other nutrients. Of particular concern in alcoholism is a severe deficiency in the B-vitamin thiamin, which can cause a serious condition called Wernicke-Korsakoff syndrome. Symptoms of this syndrome include severe loss of balance, confusion, and memory loss. Eventually, it can result in permanent brain damage and death. Another serious nutritional problem among alcoholics is deficiency of the B vitamin folic acid, which can cause severe anemia.
Acute Respiratory Distress Syndrome. One study indicated that intensive care patients with a history of alcohol abuse have a significantly higher risk for developing acute respiratory distress syndrome (ARDS) during hospitalization. ARDS is a form of lung failure that can be fatal. It is can by caused by many of the medical conditions common in chronic alcoholism, including severe infection, trauma, blood transfusions, pneumonia, and other serious lung conditions.
Drug Interactions. The effects of many medications are strengthened by alcohol, while others are inhibited. Of particular importance is its reinforcing effect on antianxiety drugs, sedatives, antidepressants, and antipsychotic medications. Alcohol also interacts with many drugs used by diabetics. It interferes with drugs that prevent seizures or blood clotting. It increases the risk for gastrointestinal bleeding in people taking aspirin or other nonsteroidal inflammatory drugs including ibuprofen and naproxen. In other words, taking almost any medication should preclude drinking alcohol.
Pregnancy and Infant Development.
Complications in Older People.
Labels: How Serious Is Alcoholism
Even when people with alcoholism experience withdrawal symptoms, they nearly always deny the problem, leaving it up to coworkers, friends, or relatives to recognize the symptoms and take the first steps toward treatment. Family members cannot always rely on a physician to make an initial diagnosis. Although 15% to 30% of people who are hospitalized suffer from alcoholism or alcohol dependence, physicians often fail to screen for the problem. In addition, doctors themselves often cannot recognize the symptoms. In one study, alcohol problems were detected by the physician in less than half of patients who had them. It is particularly difficult to diagnose alcoholism in the elderly, where symptoms of confusion, memory loss, or falling may be attributed to the aging process alone. Heavy drinkers may be more likely to complain to their doctors about so-called somatization symptoms, which are vague ailments such as joint pain, intestinal problems, or general weakness, that have no identifiable physical cause. Such complaints should signal the physician to follow-up with screening tests for alcoholism. Alcoholism is particularly less likely to be recognized in elderly women. In fact, only 1% of older women who need treatment for alcoholism are diagnosed accurately and treated appropriately. Instead, they are often diagnosed with depression and may even be prescribed anti-anxiety drugs or antidepressants that can have dangerous interactions with alcohol. Even when physicians identify an alcohol problem, however, they are frequently reluctant to confront the patient with a diagnosis that might lead to treatment for addiction.
Screening for Alcoholism.
A physician who suspects alcohol abuse should ask the patient questions about current and past drinking habits to distinguish moderate from heavy drinking. If alcohol abuse or dependency is indicated, the physician will usually perform a screening test. Many are available for diagnosing alcoholism, usually either standardized questionnaires that the patient can take on their own or that are conducted by the physician. Because people with alcoholism often deny their problem or otherwise attempt to hide it, the tests are designed to elicit answers related to problems associated with drinking rather than the amount of liquor consumed or other specific drinking habits. The quickest test takes only one minute; it is called the CAGE test, an acronym for the following questions: (C) attempts to Cut down on drinking; (A) Annoyance with criticisms about drinking; (G) Guilt about drinking; and (E) use of alcohol as an Eye-opener in the morning. This test and another called the Self-Administered Alcoholism Screening Test (SAAST), however, appear to be most useful in detecting alcoholism in white middle-aged males. They are not very accurate for identifying alcohol abuse in older people, white women, and African- and Mexican-Americans. A more effective test for such individuals may be the Alcohol Use Disorders Identification Test (AUDIT), which asks three questions about amount and frequency of drinking, three questions about alcohol dependence, and four questions about problems related to alcohol consumption. Other short screening tests are the Michigan Alcoholism Screening Test (MAST) and The Alcohol Dependence Scale (ADS) .
Laboratory and Other Tests.
Getting the Patient to Seek Treatment.
Once a diagnosis of alcoholism is made, the next major step is getting the patient to seek treatment. One study reported that the main reasons alcoholics do not seek treatment are lack of confidence in successful therapies, denial of their own alcoholism, and the social stigma attached to the condition and its treatment. Studies have found that even a brief intervention (e.g., several fifteen-minute counseling sessions with a physician and a follow-up by a nurse) can be very effective in reducing drinking in heavy drinkers who are not yet dependent. However, the best approaches are group meetings between people with alcoholism and their friends and family members who have been affected by the alcoholic behavior. Using this interventional approach, each person affected offers a compassionate but direct and honest report describing specifically how he or she has been specifically hurt by their loved one's or friend's alcoholism. Children may even be involved in this process, depending on their level of maturity and ability to handle the situation. The family and friends should express their affection for the patient and their intentions for supporting the patient through recovery, but they must strongly and consistently demand that the patient seek treatment. Employers can be particularly effective. Their approach should also be compassionate but strong, threatening the employee with loss of employment if he or she does not seek help. Some large companies provide access to inexpensive or free treatment programs for their workers. The alcoholic patient and everyone involved should fully understand that alcoholism is a disease and that the responses to this diseaseneed, craving, fear of withdrawalare not character flaws but symptoms, just as pain or discomfort are symptoms of other illnesses. They should also realize that treatment is difficult and sometimes painful, just as treatments for other life-threatening diseases, such as cancer, are, but that it is the only hope for a cure.
Labels: How Is Alcoholism Diagnosed
Treatment for Mild to Moderate Withdrawal Symptoms.
Treatment for Delirium Tremens, Seizures, and Other Severe Symptoms.
People with symptoms of delirium tremens must be treated immediately. Untreated delirium tremens has a fatality rate that can be as high as 20%. They are usually first given intravenous anti-anxiety medications and their physical condition is stabilized. It is extremely important that fluids be administered. Restraints may be necessary to prevent injury to themselves or others. Seizures are usually self-limited and treated only with a benzodiazepine. Intravenous phenytoin (Dilantin) along with a benzodiazepine may be used in patients who have a history of seizures, who have epilepsy, or whose seizures cannot be controlled. Because phenytoin may lower blood pressure, the patient's heart should be monitored during treatment. For hallucinations or extremely aggressive behavior, antipsychotic drugs, particularly haloperidol (Haldol), may be administered. Lidocaine (Xylocaine) may be given to people with disturbed heart rhythms.
Drugs Used for Mild to Moderate Withdrawal Symptoms.
Benzodiazepines. Benzodiazepines are anti-anxiety drugs that inhibit nerve-cell excitability in the brain. They relieve withdrawal symptoms and make it easier for patients to remain in treatment. The drugs may be administered intravenously or orally, depending on the severity of symptoms. For most adults with alcoholism, the longer-acting drugs, such as diazepam (Valium) or chlordiazepoxide (Librium), are usually prescribed. To prevent seizures, the physician may give the patient an initial, or loading, dose of the long-acting drug diazepam with additional doses given every one to two hours thereafter over the period of withdrawal. This regimen can cause very heavy sedation. People with serious medical problems, particularly respiratory disorders, may be given repeated doses of shorter-acting benzodiazepines, such as lorazepam (Ativan) and oxazepam (Serax); these drugs can be withdrawn immediately at any sign of trouble. Some physicians question the use of any anti-anxiety medication for mild withdrawal symptoms. Others believe that repeated withdrawal episodes, even mild forms, that are inadequately treated may result in increasingly severe episodes with seizures and possible brain damage. Benzodiazepines are usually not prescribed for more than two weeks or administered for more than three nights per week. Tolerance to these drugs may develop after as little as four weeks of daily use. Physical dependence may develop after just three months of normal dosage. People who discontinue benzodiazepines after taking them for long periods may experience rebound symptomssleep disturbance and anxietywhich can develop within hours or days after stopping the medication. Some patients experience withdrawal symptoms from the drugs, including stomach distress, sweating, and insomnia, that can last from one to three weeks. Common side effects are day-time drowsiness and a hung-over feeling. Respiratory problems may be exacerbated. Benzodiazepines are potentially dangerous when used in combination with alcohol. They should not be used by pregnant women or nursing mothers unless absolutely necessary.
Other Drugs for Mild to Moderate Withdrawal. Beta blockers, such as propranolol (Inderal) and atenolol (Tenormin), may sometimes be used in combination with a benzodiazepine. This class of drugs is effective in slowing heart rate and reducing tremor. Other drugs being tested are clonidine (Catapres) and carbamazepine (Tegretol). When used by themselves, they do not, however, appear to be effective in reducing seizures or delirium. Chlormethiazole, a derivative of vitamin B1, is presently used in Europe and is showing promise in reducing agitation and seizures.
Labels: What Is the Treatment for Alcohol Withdrawal
Between 80% and 90% of people treated for alcoholism relapseeven after years of abstinence. Patients and their caregivers should understand that relapses of alcoholism are analogous to recurrent flare-ups of chronic physical diseases. One study found that three factors placed a person at high risk for relapse: frustration and anger, social pressure, and internal temptation. Treatment of relapses, however, does not always require starting from scratch with detoxification or hospitalization; often, abstinence can begin the next day. Self-forgiveness and persistence are behaviors essential for permanent recovery.
One of the most difficult problems facing a person with alcoholism is being around people who are able to drink socially without danger of addiction. A sense of isolation, a loss of enjoyment, and the ex-drinker's belief that pitynot respectis guiding a friend's attitude can lead to loneliness, low self-esteem, and a strong desire to drink. Close friends and even intimate partners may have difficulty in changing their responses to this newly sober person and, even worse, may encourage a return to drinking. To preserve marriages to alcoholics, spouses often build their own self-images on surviving or handling their mates' difficult behavior and then discover that they are threatened by abstinence. Friends may not easily accept the sober, perhaps more subdued, comrade. In such cases, separation from these "enablers" may be necessary for survival. It is no wonder that, when faced with such losses, even if they are temporary, a person returns to drinking. The best course in these cases is to encourage close friends and family members to seek help as well. Fortunately, groups such as Al-Anon exist for this purpose.
Social and Cultural Pressures.
The media portrays the pleasures of drinking in advertising and programming. The medical benefits of light to moderate drinking are frequently publicized, giving ex-drinkers the spurious excuse of returning to alcohol for their health. These messages must be categorically ignored and acknowledged for what they arean industry's attempt to profit from potential great harm to individuals.
Labels: Why Do People with Alcoholism Relapse
Alcoholism: July 2010
Alcoholism is a chronic disease, progressive and often fatal; it is a primary disorder and not a symptom of other diseases or emotional problems. The chemistry of alcohol allows it to affect nearly every type of cell in the body, including those in the central nervous system. In the brain, alcohol interacts with centers responsible for pleasure and other desirable sensations. After prolonged exposure to alcohol, the brain adapts to the changes alcohol makes and becomes dependent on it. For people with alcoholism, drinking becomes the primary medium through which they can deal with people, work, and life. Alcohol dominates their thinking, emotions, and actions. The severity of this disease is influenced by factors such as genetics, psychology, culture, and response to physical pain. Alcoholism can develop insidiously; often there is no clear line between problem drinking and alcoholism [see Box, below]. The only early indications of alcoholism may be the unpleasant physical responses to withdrawal that occur during even brief periods of abstinence. Sometimes people experience long-term depression or anxiety, insomnia, chronic pain, or personal or work stress that lead to the use of alcohol for relief, but often no extraordinary events have occurred that account for the drinking problem.
Alcoholics have little or no control over the quantity they drink or the duration or frequency of their drinking. They are preoccupied with drinking, deny their own addiction, and continue to drink even though they are aware of the dangers. Over time, some people become tolerant to the effects of drinking and require more alcohol to become intoxicated, creating the illusion that they can "hold their liquor." They have blackouts after drinking and frequent hangovers that cause them to miss work and other normal activities. Alcoholics might drink alone and start early in the day. They periodically quit drinking or switch from hard liquor to beer or wine, but these periods rarely last. Severe alcoholics often have a history of accidents, marital and work instability, and alcohol-related health problems. Episodic violent and abusive incidents involving spouses and children and a history of unexplained or frequent accidents are often signs of drug or alcohol abuse
Labels: What Is Alcoholism
About 100,000 deaths a year can be wholly or partially attributed to drinking , and alcoholism reduces life expectancy by 10 to 12 years. Next to smoking, it is the most common preventable cause of death in America. Although studies indicate that adults who drink moderately (about one drink a day) have a lower mortality rate than their non-drinking peers, their risk for untimely death increases with heavier drinking. Any protection that occurs with moderate alcohol intake appears to be confined to adults over 60 who have risks for heart disease. The earlier a person begins drinking heavily, the greater their chance of developing serious illnesses later on. Alcoholism can kill in many different ways, and, in general, people who drink regularly have a higher rate of deaths from injury, violence, and some cancers.
Accidents, Suicide, and Murder.
Domestic Violence and Effects on Family.
Alcohol can affect the body in so many ways that researchers are having a hard time determining exactly what the consequences are of drinking. It is well known, however, that chronic consumption leads to many problems, some of them deadly. Heart Disease. Large doses of alcohol can trigger irregular heartbeats and raise blood pressure even in people with no history of heart disease. A major study found that those who consumed more than three alcoholic drinks a day had higher blood pressure than teetotalers. The more alcohol someone drank, the greater the increase in blood pressure. People who were binge drinkers had the highest blood pressures. One study found that binge drinkers (people who have nine or more drinks once or twice a week) had a risk for a cardiac emergency that was two and a half times that of nondrinkers. Chronic alcohol abuse can also damage the heart muscle, which leads to heart failure; women are particularly vulnerable to this disorder. Contrary to many previous reports, a recent study suggested that moderate to heaving drinking (more than two bottles of beer or two glasses of wine day) was a greater risk factor for coronary artery disease than smoking. As in other studies, light drinking (two to six drinks a week) was protective. More research is needed to confirm or refute this new study. In any case, moderate drinking does not appear to offer any heart benefits for people who are at low risk for heart disease to begin with.
Cancer. Alcohol may not cause cancer, but it probably does increase the carcinogenic effects of other substances, such as cigarette smoke. Daily drinking increases the risk for lung, esophageal, gastric, pancreatic, colorectal, urinary tract, liver, and brain cancers, lymphoma and leukemia. About 75% of cancers of the esophagus and 50% of cancers of the mouth, throat, and larynx are attributed to alcoholism. (Wine appears to pose less danger for these cancers than beer or hard liquor.) Smoking combined with drinking enhances risks for most of these cancers dramatically. When women consume as little as one drink a day, they may increase their chances of breast cancer by as much as 30%.
Liver Disorders. The liver is particularly endangered by alcoholism. About 10% to 35% of heavy drinkers develop alcoholic hepatitis, and 10% to 20% develop cirrhosis. In the liver, alcohol converts to an even more toxic substance, acetaldehyde, which can cause substantial damage. Not eating when drinking and consuming a variety of alcoholic beverages are also factors that increase the risk for liver damage. People with alcoholism are also at higher risk for hepatitis B and C, potentially chronic liver diseases than can lead to cirrhosis and liver cancer. People with alcoholism should be immunized against hepatitis B; they may need a higher-than-normal dose of the vaccine for it to be effective. [See also Well-Connected, Report #59, Hepatitis.]
Gastrointestinal Problems. Alcohol can cause diarrhea and hemorrhoids. Alcohol can also contribute to serious infections of the pancreas and to ulcers in people taking the painkillers known as nonsteroidal anti-inflammatory drugs (such as aspirin or ibuprofen).
Pneumonia and Other Infections. Alcohol suppresses the immune system, so people with alcoholism are prone to infections. In particularly, acute alcoholism is strongly associated with very serious pneumonia. One study on laboratory animals suggests that alcohol specifically damages the bacteria-fighting capability of lung cells.
Mental and Neurologic Disorders. Alcohol has widespread effects on the brain. One study that scanned the brains of inebriated subjects suggested that while alcohol stimulates those parts of the brain related to reward and induces euphoria, it does not appear to impair cognitive performance (the ability to think and reason). Habitual use of alcohol, however, eventually produces depression and confusion. In chronic cases, gray matter is destroyed, possibly leading to psychosis and mental disturbances. Alcohol can also cause milder neurologic problems, including insomnia and headache (especially after drinking red wine). Except in severe cases, neurologic damage is not permanent and abstinence nearly always leads to recovery of normal mental function. Alcohol may increase the risk for hemorrhagic stroke (caused by bleeding in the brain), although it may protect against stroke caused by narrowed arteries.
Skin, Muscle, and Bone Disorders. Severe alcoholism is associated with osteoporosis, wasting away of muscles with swelling and pain, skin sores, and itching. In addition, alcohol-dependent women seem to face an increased risk for damage to muscles, including muscles of the heart, from the toxic effects of alcohol.
Hormonal Effects. Alcoholism increases levels of the female hormone estrogen and reduces levels of the male hormone testosterone, factors that contribute to impotence in men.
Smoking. Alcoholics who smoke face compound their health problems. More alcoholics die from tobacco-related illnesses, such as heart disease or cancer, than from chronic liver disease, cirrhosis, or other conditions more directly tied to excessive drinking.
Diabetes. Alcohol can cause hypoglycemia, a drop in blood sugar, which is especially dangerous for people with diabetes who are taking insulin. Intoxicated diabetics may not be able to recognize symptoms of hypoglycemia, a particularly hazardous condition.
Malnutrition and Wernicke-Korsakoff Syndrome. A pint of whiskey provides about half the daily calories needed by an adult, but it has no nutritional value. In addition to replacing food, alcohol may also interfere with absorption of proteins, vitamins, and other nutrients. Of particular concern in alcoholism is a severe deficiency in the B-vitamin thiamin, which can cause a serious condition called Wernicke-Korsakoff syndrome. Symptoms of this syndrome include severe loss of balance, confusion, and memory loss. Eventually, it can result in permanent brain damage and death. Another serious nutritional problem among alcoholics is deficiency of the B vitamin folic acid, which can cause severe anemia.
Acute Respiratory Distress Syndrome. One study indicated that intensive care patients with a history of alcohol abuse have a significantly higher risk for developing acute respiratory distress syndrome (ARDS) during hospitalization. ARDS is a form of lung failure that can be fatal. It is can by caused by many of the medical conditions common in chronic alcoholism, including severe infection, trauma, blood transfusions, pneumonia, and other serious lung conditions.
Drug Interactions. The effects of many medications are strengthened by alcohol, while others are inhibited. Of particular importance is its reinforcing effect on antianxiety drugs, sedatives, antidepressants, and antipsychotic medications. Alcohol also interacts with many drugs used by diabetics. It interferes with drugs that prevent seizures or blood clotting. It increases the risk for gastrointestinal bleeding in people taking aspirin or other nonsteroidal inflammatory drugs including ibuprofen and naproxen. In other words, taking almost any medication should preclude drinking alcohol.
Pregnancy and Infant Development.
Complications in Older People.
Labels: How Serious Is Alcoholism
Even when people with alcoholism experience withdrawal symptoms, they nearly always deny the problem, leaving it up to coworkers, friends, or relatives to recognize the symptoms and take the first steps toward treatment. Family members cannot always rely on a physician to make an initial diagnosis. Although 15% to 30% of people who are hospitalized suffer from alcoholism or alcohol dependence, physicians often fail to screen for the problem. In addition, doctors themselves often 
cannot recognize the symptoms. In one study, alcohol problems were detected by the physician in less than half of patients who had them. It is particularly difficult to diagnose alcoholism in the elderly, where symptoms of confusion, memory loss, or falling may be attributed to the aging process alone. Heavy drinkers may be more likely to complain to their doctors about so-called somatization symptoms, which are vague ailments such as joint pain, intestinal problems, or general weakness, that have no identifiable physical cause. Such complaints should signal the physician to follow-up with screening tests for alcoholism. Alcoholism is particularly less likely to be recognized in elderly women. In fact, only 1% of older women who need treatment for alcoholism are diagnosed accurately and treated appropriately. Instead, they are often diagnosed with depression and may even be prescribed anti-anxiety drugs or antidepressants that can have dangerous interactions with alcohol. Even when physicians identify an alcohol problem, however, they are frequently reluctant to confront the patient with a diagnosis that might lead to treatment for addiction.
Screening for Alcoholism.
A physician who suspects alcohol abuse should ask the patient questions about current and past drinking habits to distinguish moderate from heavy drinking. If alcohol abuse or dependency is indicated, the physician will usually perform a screening test. Many are available for diagnosing alcoholism, usually either standardized questionnaires that the patient can take on their own or that are conducted by the physician. Because people with alcoholism often deny their problem or otherwise attempt to hide it, the tests are designed to elicit answers related to problems associated with drinking rather than the amount of liquor consumed or other specific drinking habits. The quickest test takes only one minute; it is called the CAGE test, an acronym for the following questions: (C) attempts to Cut down on drinking; (A) Annoyance with criticisms about drinking; (G) Guilt about drinking; and (E) use of alcohol as an Eye-opener in the morning. This test and another called the Self-Administered Alcoholism Screening Test (SAAST), however, appear to be most useful in detecting alcoholism in white middle-aged males. They are not very accurate for identifying alcohol abuse in older people, white women, and African- and Mexican-Americans. A more effective test for such individuals may be the Alcohol Use Disorders Identification Test (AUDIT), which asks three questions about amount and frequency of drinking, three questions about alcohol dependence, and four questions about problems related to alcohol consumption. Other short screening tests are the Michigan Alcoholism Screening Test (MAST) and The Alcohol Dependence Scale (ADS) .
Laboratory and Other Tests.
Getting the Patient to Seek Treatment.
Once a diagnosis of alcoholism is made, the next major step is getting the patient to seek treatment. One study reported that the main reasons alcoholics do not seek treatment are lack of confidence in successful therapies, denial of their own alcoholism, and the social stigma attached to the condition and its treatment. Studies have found that even a brief intervention (e.g., several fifteen-minute counseling sessions with a physician and a follow-up by a nurse) can be very effective in reducing drinking in heavy drinkers who are not yet dependent. However, the best approaches are group meetings between people with alcoholism and their friends and family members who have been affected by the alcoholic behavior. Using this interventional approach, each person affected offers a compassionate but direct and honest report describing specifically how he or she has been specifically hurt by their loved one's or friend's alcoholism. Children may even be involved in this process, depending on their level of maturity and ability to handle the situation. The family and friends should express their affection for the patient and their intentions for supporting the patient through recovery, but they must strongly and consistently demand that the patient seek treatment. Employers can be particularly effective. Their approach should also be compassionate but strong, threatening the employee with loss of employment if he or she does not seek help. Some large companies provide access to inexpensive or free treatment programs for their workers. The alcoholic patient and everyone involved should fully understand that alcoholism is a disease and that the responses to this diseaseneed, craving, fear of withdrawalare not character flaws but symptoms, just as pain or discomfort are symptoms of other illnesses. They should also realize that treatment is difficult and sometimes painful, just as treatments for other life-threatening diseases, such as cancer, are, but that it is the only hope for a cure.
Labels: How Is Alcoholism Diagnosed
Treatment for Mild to Moderate Withdrawal Symptoms.
Treatment for Delirium Tremens, Seizures, and Other Severe Symptoms.
People with symptoms of delirium tremens must be treated immediately. Untreated delirium tremens has a fatality rate that can be as high as 20%. They are usually first given intravenous anti-anxiety medications and their physical condition is stabilized. It is extremely important that fluids be administered. Restraints may be necessary to prevent injury to themselves or others. Seizures are usually self-limited and treated only with a benzodiazepine. Intravenous phenytoin (Dilantin) along with a benzodiazepine may be used in patients who have a history of seizures, who have epilepsy, or whose seizures cannot be controlled. Because phenytoin may lower blood pressure, the patient's heart should be monitored during treatment. For hallucinations or extremely aggressive behavior, antipsychotic drugs, particularly haloperidol (Haldol), may be administered. Lidocaine (Xylocaine) may be given to people with disturbed heart rhythms.
Drugs Used for Mild to Moderate Withdrawal Symptoms.
Benzodiazepines. Benzodiazepines are anti-anxiety drugs that inhibit nerve-cell excitability in the brain. They relieve withdrawal symptoms and make it easier for patients to remain in treatment. The drugs may be administered intravenously or orally, depending on the severity of symptoms. For most adults with alcoholism, the longer-acting drugs, such as diazepam (Valium) or chlordiazepoxide (Librium), are usually prescribed. To prevent seizures, the physician may give the patient an initial, or loading, dose of the long-acting drug diazepam with additional doses given every one to two hours thereafter over the period of withdrawal. This regimen can cause very heavy sedation. People with serious medical problems, particularly respiratory disorders, may be given repeated doses of shorter-acting benzodiazepines, such as lorazepam (Ativan) and oxazepam (Serax); these drugs can be withdrawn immediately at any sign of trouble. Some physicians question the use of any anti-anxiety medication for mild withdrawal symptoms. Others believe that repeated withdrawal episodes, even mild forms, that are inadequately treated may result in increasingly severe episodes with seizures and possible brain damage. Benzodiazepines are usually not prescribed for more than two weeks or administered for more than three nights per week. Tolerance to these drugs may develop after as little as four weeks of daily use. Physical dependence may develop after just three months of normal dosage. People who discontinue benzodiazepines after taking them for long periods may experience rebound symptomssleep disturbance and anxietywhich can develop within hours or days after stopping the medication. Some patients experience withdrawal symptoms from the drugs, including stomach distress, sweating, and insomnia, that can last from one to three weeks. Common side effects are day-time drowsiness and a hung-over feeling. Respiratory problems may be exacerbated. Benzodiazepines are potentially dangerous when used in combination with alcohol. They should not be used by pregnant women or nursing mothers unless absolutely necessary.
Other Drugs for Mild to Moderate Withdrawal. Beta blockers, such as propranolol (Inderal) and atenolol (Tenormin), may sometimes be used in combination with a benzodiazepine. This class of drugs is effective in slowing heart rate and reducing tremor. Other drugs being tested are clonidine (Catapres) and carbamazepine (Tegretol). When used by themselves, they do not, however, appear to be effective in reducing seizures or delirium. Chlormethiazole, a derivative of vitamin B1, is presently used in Europe and is showing promise in reducing agitation and seizures.
Labels: What Is the Treatment for Alcohol Withdrawal
Between 80% and 90% of people treated for alcoholism relapseeven after years of abstinence. Patients and their caregivers should understand that relapses of alcoholism are analogous to recurrent flare-ups of chronic physical diseases. One study found that three factors placed a person at high risk for relapse: frustration and anger, social pressure, and internal temptation. Treatment of relapses, however, does not always require starting from scratch with detoxification or hospitalization; often, abstinence can begin the next day. Self-forgiveness and persistence are behaviors essential for permanent recovery.
One of the most difficult problems facing a person with alcoholism is being around people who are able to drink socially without danger of addiction. A sense of isolation, a loss of enjoyment, and the ex-drinker's belief that pitynot respectis guiding a friend's attitude can lead to loneliness, low self-esteem, and a strong desire to drink. Close friends and even intimate partners may have difficulty in changing their responses to this newly sober person and, even worse, may encourage a return to drinking. To preserve marriages to alcoholics, spouses often build their own self-images on surviving or handling their mates' difficult behavior and then discover that they are threatened by abstinence. Friends may not easily accept the sober, perhaps more subdued, comrade. In such cases, separation from these "enablers" may be necessary for survival. It is no wonder that, when faced with such losses, even if they are temporary, a person returns to drinking. The best course in these cases is to encourage close friends and family members to seek help as well. Fortunately, groups such as Al-Anon exist for this purpose.
Social and Cultural Pressures.
The media portrays the pleasures of drinking in advertising and programming. The medical benefits of light to moderate drinking are frequently publicized, giving ex-drinkers the spurious excuse of returning to alcohol for their health. These messages must be categorically ignored and acknowledged for what they arean industry's attempt to profit from potential great harm to individuals.
Labels: Why Do People with Alcoholism Relapse