ALCOHOLISM
First of all, what is Alcoholism?. Alcoholism is the compulsive consumption of alcohol. Some believe it to be a biological disease. The etiology and nature of alcoholism are both currently being debated within the medical and scientific communities and the very definition of alcoholism is a part of that debate. Alcoholism is often a controversial subject and the disease hypothesis represents a focus of the debate.
TERMINOLOGY
There are many terms, such as use, misuse, heavy use, addiction, abuse and dependence, all of which have different and sometimes non-standard meanings. 'Use' refers to simple use of a substance.
An individual who drinks a beer once a day uses alcohol. Misuse and 'heavy use' do not have standard definitions in the field. It has been determined that the human system can tolerate up to 14 two-ounce "doses" of alcohol per week before they begin to show signs of long-term cellular damage.
Addiction refers to any single or group of conditions which cause a user of a substance to continue using a substance in spite of any negative effects that that use may cause. Negative effects are highly varied, but include those that are psychological, physical, social or monetary.
Alcohol addiction has been identified as having many components.
Psychological addiction involves those things which convince a person that they gain benefit from the use of the substance. For instance, if they feel that they are more socially adept while drunk or that it allows them to better handle stress, then they might feel that any problems caused were worth the benefits.
Physical addiction (a.k.a., dependence) involves the physical adaptation of a person's biological systems to the continued presence of alcohol in their system. The person's systems become more comfortable when they have the "normal" level of alcohol, and higher doses are required to maintain an equivalent effect. A decrease in the level of alcohol causes reverse imbalances resulting in withdrawal symptoms, which for alcohol can be deadly.
Neurochemical addiction involves the hijacking of existing learning mechanisms in order to convince the system that an addictive behavior is good for it, despite all evidence to the contrary. Endorphin is the body's way of telling the mind that a behavior is good for it. We release endorphin into the blood stream during sex, exercise and consumption of some foods for instance, and this is responsible for "runner's high" and "afterglow". This is more than just a good feeling, it is teaching our brain that these are the behaviors that it should repeat. It has been demonstrated in various clinical tests that mammals with more active endorphin systems are more prone to alcohol addiction. This is because alcohol triggers the release of endorphins into our system, and we learn that alcohol drinking is a behavior that we should repeat. This effect is also visible in the use of opiates, and in various risk-taking behaviors such as skydiving and gambling.
DIAGNOSIS
Although there is no specific diagnosis for alcoholism, there have been many efforts at diagnostic approaches to alcohol dependence, abuse and complications associated with chronic alcohol consumption.
In a 1992 JAMA article, the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published this definition for alcoholism: "Alcoholism is a primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic."
The DSM IV diagnosis of alcohol dependence represents another approach to the definition of alcoholism, one more closely based on specifics than the 1992 JAMA article. In part this is to assist in the development of research protocols in which findings can be compared with one another, but the DSM definition is the one in general use from a diagnostic standpoint. That definition 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.
Note that many sedative agents are cross-tolerant with alcohol (meaning that these agents can be taken instead of alcohol to relieve withdrawal symptoms or to maintain the level of sedation provided by alcohol). A more general diagnosis than alcohol dependence is that of sedative dependence. Whether an individual uses alcohol or another sedative, if they meet the criteria above, the process is likely the same.
TREATMENTS
Medications
The classical use of medications for alcholism is to encourage abstinence. Antabuse (also known as disulfiram), for instance, prevents the elimination of chemicals which cause severe discomfort when alcohol is ingested, effectively preventing the alcoholic from drinking in significant amounts while they take the medicine. Heavy drinking while on antabuse can result in severe illness and death. Naltrexone has also been used because it helps curb cravings for alcohol while the person is on it. Both of these, however, have been demonstrated to cause a rebound effect when the user stops taking them. These do allow a person to overcome psychological addictions to alcohol, but they do not treat the neurochemical addiction.
In more recent studies it has been demonstrated that the use of naltrexone while the alcoholic continues to drink can result in extinction of the neurochemical addiction. This technique is used to good effect in Finland, Florida, and Pennsylvania, but it has failed to penetrate much of the world because of the long-standing bias against any treatment that doesn't involve detoxification and abstinence.
Rationing
Rationing or other attempts to control use are increasingly ineffective as pathological attachment to the drug develops. Use may continue despite serious adverse health, personal, legal, work-related, and financial consequences. Comorbidity, genetic, and psychosocial factors contribute to the risk of developing this disease." The lifetime prevalence of this condition was estimated in the mid-1990s at approximately 15% (DSM-IV-TR).
Detoxification
Treatments for alcohol dependence include detoxification programs run by medical institutions. These may involve stays for a number of weeks in specialized hospital wards, where drugs may be used to avoid withdrawal symptoms, which in severe cases may lead to death. To that point, even a simple "de-tox" can involve seizures, if not properly monitored.
Therapy
After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues leading to alcohol dependence, and also to provide the recovering addict with relapse prevention skills. Aversion therapies may be supported by drugs like Disulfiram, which causes a strong and prompt sensitivity reaction whenever alcohol is consumed. Naltrexone or Acamprosate may improve compliance with abstinence planning by treating the physical aspects of cravings to drink. The standard pharmocopoeia of antidepressants, anxiolytics, and other psychotropic drugs treat underlying mood disorders, neuroses, and psychoses associated with alcoholic symptoms.
In the mid-1930s, the mutual-help group-counselling approach to treatment began and has become very popular. Alcoholics Anonymous is the best-known example of this movement. Other groups include LifeRing Secular Recovery and SMART Recovery.
Prevention
Some programs attempt to help problem drinkers before they become dependents. These programs focus on harm-reduction and reducing alcohol intake as opposed to cold-turkey approaches. One such program is called Moderation Management.
Nutritional therapy
Another treatment program is based on nutritional therapy. Many alcohol dependents have insulin resistance syndrome, a metabolic disorder where the body's difficulty in processing sugars causes an unsteady supply to the blood stream. While the disorder can be treated by a hypoglycemic diet, this can affect behaviour and emotions, side-effects often seen among alcohol dependents in treatment. The metabolic aspects of such dependence are often overlooked, resulting in poor treatment outcomes.
Return to normal drinking
Although it has long been argued that alcoholic dependents cannot learn to drink in moderation, research by the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicates that about 18% of such individuals in the US whose dependence began more than one year earlier are now drinking in moderation. In contrast, roughly 78% of those who undergo naltrexone use-reduction therapy are capable of normal drinking habits, although this does involve the use of naltrexone an hour before any drinking occurs in order to maintain this.
SOURCES :
- http://www.wikipedia.pl]Wikipedia[/url]
- Alcohol Dependance
- [url=http://www.alcoholics-anonymous.org/?Media=PlayFlash