Alcoholism refers to the persistent consumption of alcoholic beverages despite the negative consequences it brings.
Some definitions emphasise the presence of dependence and withdrawal symptoms.
Historical records indicate that problematic alcohol use has been recognised for centuries. According to the World Health Organization (WHO), worldwide, 2.6 million deaths were attributable to alcohol consumption in 2019, of which 2 million were among men and 0.6 million among women.
The term “alcoholism” was introduced in 1852; however, it, along with “alcoholic,” carries a stigma that may deter individuals from seeking help. Consequently, medical professionals often use terms like “alcohol use disorder” and “alcohol dependence” in clinical settings.
Alcohol can be habit-forming, and prolonged excessive consumption leads to numerous adverse health and social effects.
It can harm various organ systems, particularly the brain, heart, liver, pancreas, and immune system.
Chronic alcohol intake may cause sleep disturbances and serious cognitive problems, including dementia, brain injury, or Wernicke-Korsakoff syndrome.
Physical repercussions encompass irregular heartbeats, weakened immune responses, liver cirrhosis, heightened cancer risk, and intense withdrawal symptoms if cessation occurs abruptly. These health complications can shorten life expectancy by a decade. Consuming alcohol during pregnancy can negatively affect the child’s well-being, while driving under the influence raises the likelihood of traffic incidents. Additionally, alcoholism is linked to a rise in both violent and non-violent crimes.
The onset of alcoholism is influenced equally by genetic factors and environmental conditions. Many individuals may begin using alcohol as a means to cope with stress or anxiety, which can lead to problematic drinking. If a person has a parent or sibling struggling with an alcohol use disorder, their chances of developing a similar issue increase three to four times, although only a small percentage actually do. Environmental influences encompass social, cultural, and behavioral aspects. Additionally, heightened stress and anxiety, combined with the affordability and availability of alcohol, elevate the risk of developing alcoholism.
Individuals might keep consuming alcohol to alleviate or lessen withdrawal symptoms. Once someone ceases alcohol consumption, they could endure mild withdrawal symptoms for several months. From a medical standpoint, alcoholism is recognized as both a physical and psychological disorder.
Summary
Over consumption of alcohol can:
- cause harm to various organs in the body.
- cause cancer, liver cirrhosis and a weakened immune system.
- negetvly effect family, relationships, careers and studies.
- cause higher stress and anxiety levels
Treatment and recovery
Alcoholism treatment can take various approaches.
Due to potential medical issues that may arise during withdrawal, it is important to manage alcohol cessation carefully.
A widely used strategy involves administering benzodiazepines, like diazepam, either in a medical facility or at home. Additionally, medications such as acamprosate or disulfiram may be prescribed to reduce the likelihood of relapse.
Treatment can be complicated by co-occurring mental health conditions or other substance dependencies.
To support recovery, different forms of individual or group therapy and support networks are employed to help individuals avoid returning to alcohol use.
One of the notable organizations is Alcoholics Anonymous (AA), a fellowship focused on abstinence. A scientific review conducted in 2020 revealed that clinical approaches promoting greater involvement in AA, known as AA/twelve step facilitation (AA/TSF), led to higher rates of abstinence compared to other methods. Furthermore, most studies indicated that AA/TSF resulted in reduced healthcare expenses.
Summary
- Alcohol withdrawal can be dangerous and must be managed carefully with advice.
- The best way to detox is under the supervision of medical professionals in rehabilitation.
- Therapy during alcohol withdrawal is advised.
- Attending abstinence based groups like ‘The AA’ weekly is advised during alcohol cessation.
Medication for alcohol dependence
There are four medications sanctioned for treating alcoholism: acamprosate, two forms of naltrexone, and disulfiram.
Acamprosate
Acamprosate works by stabilising brain chemistry that has been disrupted by alcohol dependence, primarily by blocking the effects of glutamate, a neurotransmitter that becomes overly active following withdrawal. By decreasing excessive NMDA activity that arises during the early stages of alcohol withdrawal, acamprosate helps to minimize or avert neurotoxicity associated with withdrawal. Additionally, it lowers the likelihood of relapse in individuals with alcohol dependence. However, acamprosate is not advised for those suffering from severe, decompensated liver cirrhosis due to potential liver toxicity concerns.
Naltrexone
Naltrexone acts as a competitive antagonist for opioid receptors, effectively inhibiting the effects of both endorphins and opioids. It can be administered as a daily oral tablet or via a monthly intramuscular injection. This medication helps to diminish alcohol cravings and promotes abstinence. When alcohol is consumed, it prompts the body to release endorphins, which subsequently trigger dopamine release and engage the brain’s reward systems; therefore, Naltrexone mitigates the pleasurable sensations associated with drinking alcohol. Research indicates that it lowers the likelihood of relapse among individuals with alcohol dependence and reduces excessive drinking. However, Naltrexone is contraindicated in patients with severe liver disease due to potential liver toxicity. Nalmefene is another medication that appears effective and functions similarly.
Disulfiram
Disulfiram blocks the removal of acetaldehyde by inhibiting the enzyme known as acetaldehyde dehydrogenase. Acetaldehyde is a substance formed in the body during ethanol metabolism and is responsible for various hangover symptoms associated with alcohol consumption. Its impact results in immediate discomfort upon alcohol intake, manifested through flushing, nausea, an elevated heart rate, and decreased blood pressure. Individuals with severe liver disease should avoid disulfiram due to the potential for serious liver toxicity.
Supplements for alcohol dependence
Alcohol addiction is a complex and challenging disease to overcome. Along with therapy and support, vitamins for recovering alcohol users can aid in reducing alcohol cravings and support the body’s, especially the livers, healing process.
- B-complex vitamins (especially Vitamin B3)
- Bacopa Monnieri
- Magnesium
- Tryptophan
- Choline
- L-Glutamine
- GABA
- Zinc
- Vitamin C
- 5-HTP
- Passion flower
- Valerian root
- L-Theanine
Signs and symptoms
The likelihood of developing alcohol dependence starts with minimal alcohol consumption and escalates with both the amount of alcohol ingested and the tendency to consume excessive quantities in a single sitting, often referred to as binge drinking.
This behavior represents the most prevalent form of alcoholism. Various definitions exist for binge drinking, with one such definition indicating that it occurs when a male consumes five or more alcoholic beverages in one sitting, or when a female has four or more drinks in a similar timeframe.
Summary
- Binge drinking for males is definied as a man having five plus alcoholic drinks per sitting.
- Binge drinking for females is definied as a woman having four plus alcohol drinks per sitting.
Long-term misuse
Prolonged abuse of alcohol can lead to various long-term consequences for individuals. For instance, pregnant women who consume alcohol risk the development of fetal alcohol syndrome in their unborn children.
Alcohol dependence is marked by a heightened tolerance, enabling individuals to drink larger amounts, alongside a physical reliance on alcohol that complicates their ability to moderate intake.
This dependency often results in intense cravings, making it challenging for those with alcohol use disorders to quit. Furthermore, alcoholism can negatively impact mental well-being, fostering psychiatric issues and elevating suicide risk.
Many heavy drinkers experience persistent feelings of depression as a common consequence of their excessive alcohol consumption.
Summary
- Pregnant woman who consume alcohol may risk their children being born with fetal alcohol syndrome.
- Alcohol dependence is defined as having a high tolerance for alcoholic beverages.
- Long-term use can result in cravings and psychological issues.
Red flags of abuse
Indicators of alcoholism include a rise in alcohol consumption and frequent drunkenness, an obsession with drinking that overshadows other pursuits, repeated vows to stop drinking that go unfulfilled, and memory lapses regarding actions or conversations while intoxicated (commonly referred to as “blackouts”).
Other signs encompass personality shifts linked to alcohol use, denial or rationalizations for drinking behavior, unwillingness to acknowledge excessive consumption, difficulties at work or school, neglect of personal grooming or hygiene, relationship and financial issues, and health complaints such as loss of appetite, respiratory illnesses, or heightened anxiety.
If you are worried about your alcohol use, you can check your drinking to see if it’s went from casual to excessive.
Summary
Someone who is dependent on alcohol may show the following signs:
- Intense desire to drink alcohol.
- Memory lapses and forgettfulness.
- Usually intoxicated.
- Rationalising or making excuses for their drinking.
- Neglecting relationships, studies, career, financial responsibilties or hygiene.
- Loss of apetite.
- General poor health.
- Jaundice (yellowing of the skin and eyes).
- Shaking or experiencing tremors.
DNA damage
DNA damage caused by alcohol consumption, if not adequately repaired, is thought to play a significant role in the neurotoxic effects associated with alcohol. The brain can metabolize ethanol into acetaldehyde, and the neurotoxic impact of ethanol seems linked to DNA damage from acetaldehyde, such as DNA adducts and crosslinks. Furthermore, alcohol metabolism generates potentially harmful reactive oxygen species, which have been shown to lead to oxidative damage to DNA.
Withdrawal
Like other substances that have sedative-hypnotic properties, including barbiturates and benzodiazepines, alcohol withdrawal can be life-threatening if not adequately addressed. Alcohol primarily enhances the stimulation of the GABAA receptor, leading to depression of the central nervous system. With frequent heavy drinking, these receptors become less sensitive and decrease in quantity, which leads to the development of tolerance and physical dependence.
Abruptly halting alcohol intake can lead to erratic synaptic activity in the nervous system. This may trigger symptoms such as severe anxiety, dangerous seizures, delirium tremens, visual or auditory hallucinations, tremors, and even heart failure. Various neurotransmitter systems, particularly dopamine, NMDA, and glutamate, play a significant role in this process.
Intense withdrawal symptoms, including delirium tremens and seizures, are uncommon after one week of stopping alcohol consumption. The acute withdrawal phase typically spans from one to three weeks. During the 3 to 6 weeks following cessation, individuals often experience anxiety, depression, fatigue, and sleep issues. Comparable post-acute withdrawal symptoms have also been noted in animal studies related to alcohol dependence and withdrawal.
Summary
- Alcohol withdrawal can be life-threatening
- The nervous system is being depressed by alcohol
- Abruptly stopping alcohol intake can cause the nervous system to experience too much activity.
Withrdrawal can cause:
- severe anxiety
- seizures
- delirium tremens
- visual or auditory hallucinations
- tremors
- heart failure
- death
Always seek advise from your doctor when stopping alcohol intake after a period of dependence.
Kindling effect
A kindling effect also occurs in people with alcohol use disorders whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol.
Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes.
The kindling phenomenon causes lasting alterations in the neural circuits of the brain, as well as affecting gene expression. Additionally, it exacerbates the psychological symptoms associated with alcohol withdrawal.
Healthcare professionals can utilise various assessment tools and questionnaires to evaluate withdrawal symptoms effectively. One such tool, the CIWA-Ar, quantifies the symptoms of alcohol withdrawal to inform treatment decisions. This approach facilitates a streamlined interview process while maintaining clinical relevance, accuracy, and dependability, which is crucial for ensuring the safety and proper management of patients at risk during withdrawal, who may face life-threatening conditions.
Summary
- Individuals who have quit alcohol previously and have relapsed again or multiple times, may suffer more severe withdrawal symptoms than someone who has quit for the first time.
Causes of alcohol dependence
A multifaceted interplay of genetic and environmental elements affects the likelihood of developing alcoholism.
Genetic factors impacting alcohol metabolism are linked to alcoholism risk, along with a familial history of the condition.
Strong evidence suggests that early alcohol consumption can affect gene expression associated with a heightened risk of alcohol dependence.
These genetic and epigenetic findings align with extensive longitudinal studies indicating that an earlier age of first drinking correlates with a higher incidence of lifelong alcohol dependence.
Childhood trauma
Significant childhood trauma is linked to a heightened likelihood of developing substance dependence.
Insufficient support from friends and family correlates with a greater chance of alcoholism emerging. Additionally, genetic factors and the teenage years can heighten vulnerability to the harmful effects of prolonged alcohol abuse. The brain’s deterioration caused by these neurotoxic effects can lead to increased impulsivity, which may play a role in the onset, continuation, and intensity of alcohol use disorders.
Research indicates that refraining from alcohol can lead to a reduction of certain types of damage caused to the central nervous system. Additionally, cannabis consumption has been linked to subsequent alcohol-related issues. Moreover, alcohol use has been correlated with a higher likelihood of later using tobacco and illicit substances like cannabis.
Summary
- Childhood trauma is linked to alcohol misuse.
- Genetic factors can make people vulnerable to addiction.
- Drinking at a young age can leave adults susceptible to continuing alcohol abuse.