User:Mercadora/Alcohol dependence

The effects of alcohol on the body.

For more information on Alcohol problems, see Alcohol abuse and Alcoholism

Alcohol Dependence

Alcohol Dependence, interchangeably referred to as 'alcohol abuse' or 'alcoholism,' is the psychological and physical compulsivity and reliability a person develops over time as they continue to drink alcohol excessively, resulting in serious damage to one's overall health and well-being.

Clinical studies demonstrated that alcohol dependent people are more sensitive to relapse-provoking cues and stimuli than nondependent people, and similar observations have been made in animal models of alcohol dependence, withdrawal, and relapse. Alcohol dependence is understood as a complex and dynamic process, and many neurobiological and environmental factors are believed to be an influenced motivation to drink.

History

The History of Alcohol

People around the world have used the process of fermentation on grains and fruits to produce alcohol. The earliest evidence that humans were brewing alcohol comes from residues in pottery jars found in northern China that date from 7000 to 6600 B.C.

Sumerians

Between 3,000 to 2,000 B.C., Sumerians in Mesopotamia produced beer; research have found over 20 different beer recipes recorded on clay tablets. The Sumerians drank beer with straws because bits of mash and grain remained in the unfiltered alcohol mixture. Sumerians used alcohol in sacrificial and religious settings as an offering to the gods.

Egypt

In ancient Egypt, beer was considered the drink of the gods, which typically consisted of barley, wheat, and yeast. Most Egyptians drank beer for its virtues and supposed nutritional benefits, in which they listed beer as a medicinal cure for several ailments. Alcohol was consumed for labor compensation of 3 beers per day. People also drank beer at festivals and celebrations, such as the Tekh Festival.

Greece

Alcohol played a crucial role in early Greek religious culture and was often used as an offering to the gods. Ancient Greece was on of the earliest known centers of wine production. Similar to the Egyptians, alcohol was used as a medicinal ailment to treat lethargy, diarrhea, childbirth pains, and keeping wounds clean and sterile. The Greeks often gathered around for symposium, which was a place for elite men to drink together, share conversation, tell stories and jokes, and have lively debates.

Rome

The Romans adopted wine production from the Greeks. Because of the play Bacchae, written by the Greek poet Euripides, the Roman Senate outlawed its production because it depicted how the god of Bacchus drank to excess and committed murder while intoxicated, as they believed that these followers could be a threat to public safety. However, the perspective of Roman culture changed after they overcame the anti-Bacchic purge. Wine became a standard ration for military personnel, as alcohol production became standardized, and the Romans created model vineyards and developed bulk wine.

China

China was the first country to distill spirits with yeast-fermented bases. Many Chinese sources cited the consumption of "natural alcohol," which referred to the natural fermentation process of fruits and flowers. Alcohol was considered sacred in Chinese cultures, moreover, people frequently drank among the events of important rituals and celebrations, such as family meals, weddings, and holidays. Additionally, the Chinese believed alcohol could heal and prevent illness, reduce degeneration from old age, and maintain overall health.

England

In England, the first excessive use of distilled spirits dates to 1525-1550. Around this time, England had mentioned drunkenness as a crime after Thomas Nash discussed the permeating negative effect of public intoxication among England's population.

In the year, 1643, Britain began the taxation of distilled spirits, which sparked the growth of the moonshine trade, and eventually infiltrated the development of gin industry around 1650 in Holland.

British soldiers fighting in the region of Holland, in 1700, which began to attract attention in both Scotland and Ireland for whiskey.

America

When the English first immigrated to America, they were unaccustomed to drinking water because it was contaminated and unsafe to consume. In the 1630s, colonists began brewing their own beer by using malted barley shipped from England.

By 1654, Massachusetts instilled laws against home brewing in the colonies, however, a law banning alcohol as payment resulted in an extreme labor strike. Colonial Americans had an Americans, by the end of the 17th century, began heavy consumptions of rum because the production of molasses was distilled in New England. By the 1790s, Americans consumed an average of 5.8 gallons of alcohol per person each year; by 1830, this figure peaked to 7.1 gallons (compared to 2.3 gallons today).

19th and 20th Centuries

Prohibition 1920's.

On January 29, 1919, Congress ratified the 18th Amendment, which prohibited the manufacturing, transportation, and sale of alcohol in the United States. Later that year the National Prohibition Act, also called the Volstead Act, was passed to provide the government with the necessary support and funds to enforce Prohibition, and the 18th Amendment went into effect and Prohibition began in 1920.

Sheriff Captures 126 Gallons of Bootlegged Whiskey.

As the effects of the Prohibition were set in place during the 1920's, unintentionally, several consequences burdened the country's financial stability and safety. Under Prohibition law, entertainment and restaurant establishments began to fail without alcoholic merchandise, it severely affected tax revenues due to the loss of liquor sales, loopholes were found by pharmacists, bootleggers, and the acceptance of wine consumption for religious purposes, and crime rates began to rise caused by the illegal liquor trade.

The Prohibition helped establish powerful underground industries that exploited gangsters, for they sold illegal liquor for profit, commonly referred to as racketeering. Gangsters infiltrated legal businesses and used them to cover for illegal operations and speakeasies, and anyone who attempted to stop the gangsters were provided with a merciless death.

Most Americans had come to the conclusion that the Prohibition was ineffective, and it was repealed in 1933. Although, some states continued to maintain Prohibition in their own laws until well into the 1960s. Prohibition laws also presume in some religions. Prohibition ultimately failed to control alcohol over-consumption in the United States, and questions persist about how to control the threat of alcohol abuse that many continue to face. In fact, in 2015, nearly 27% of people over the age of 17 reported that they engaged in binge drinking in the past month, and 15.1 million adults over the age of 18 had an alcohol use disorder.

Signs and Symptoms

An Individual Living on the Streets and is Dependent on Alcohol.

There are various warning signs to help detect potential alcohol dependence. While many signs are recognizable, others may be more difficult to identify, some individuals will dedicate their efforts to attempt to hide their dependence for alcohol by drinking in private or isolating themselves from friends and family, making it challenging to intervene and help their loved ones recover. Symptoms more often than not, co-occur, which means there is no set limit of symptoms in individuals who struggle with alcohol dependence.

Common Signs and Symptoms of Alcohol Dependence:

1. Experiencing temporary blackouts or short-term memory loss.
2. Exhibiting signs of irritability and extreme mood swings.
3. Making excuses for drinking such as to relax, deal with stress or feel normal.
4. Choosing drinking over other responsibilities and obligations.
5. Becoming isolated and distant from friends and family members.
6. Drinking alone or in secrecy.
7. Feeling hungover when not drinking.
8. Changing appearance and group acquaintances you hang out with.

Health Risks and Types of Consumption

Types of Consumption

There are some people who should not consume alcohol, including:

• Those younger than 21 years of age.
• Those who are pregnant or planning to become pregnant.
• Those who are driving, planning to drive, or participate in activities that include cohesive skill, coordination, and alertness.
• Those who are taking prescription or over-the-counter medications that can react poorly with alcohol consumption.
• Those suffering from certain medical conditions.
• Recovering alcoholics or those who are dependent or likely to abuse alcohol.

Vehicle Accident.

Standard Drinking

In the United States, a standard drink contains 0.6 ounces (14.0 grams or 1.2 tablespoons) of pure alcohol. Generally, this amount of pure alcohol is found in:

• 12-ounces of beer (5% alcohol content).
• 8-ounces of malt liquor (7% alcohol content).
• 5-ounces of wine (12% alcohol content).
• 1.5 ounces of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).

Excessive Drinking

Excessive drinking, another name for binge drinking, heavy drinking, and any drinking by pregnant women or people younger than age 21.

• Binge drinking, which is the most common form of excessive drinking. Consumption is defined as:
  • 4 or more drinks consumed in a single occasion for women.
  • 5 or more drinks consumed in a single occasion for men.
• Heavy drinking consists of:
  • 8 or more drinks per week for women.
  • 15 or more drinks per week for men.

Most people who drink excessively are not alcoholics or alcohol dependent.

Moderate Drinking

Otherwise known as, drinking in moderation, is the recommended drinking limit accompanied by the consumption at the legal age (21 or older).

• Adults of legal drinking age can choose not to drink, or drink in moderation by limiting intake to 2 drinks or less in a day for men or 1 drink or less in a day for women, on days when alcohol is consumed.

Causes of Alcohol Dependence

Biological

The brain reward system is a hormonal effect that increases the likelihood of an individual's feeling of pleasure, and is a longstanding belief to play a key role in addiction and substance abuse. Hereditarily speaking, alcohol abuse is among the most well studied substances likely because it is the only legal substance (except cannabis in some states.) An individual is at risk of developing a dependence on alcohol is predisposed, genetically. The majority of research on the brain reward system has focused on the mesocorticolimbic dopamine system, as it appears this area is the primary reward system of most substances that are abused. As research has evolved in the field of substance abuse, five additional neurotransmitters have also implicated in the reinforcing effect of addiction: dopamine, opioid peptides, GABA, serotonin, and endocannabinoids. More specifically, dopamine is less involved in opioid, alcohol, and cannabis.

Social

Families with a history of substance abuse are more lenient when it comes to engaging in drugs or alcohol than families that don't have a strong history of substance abuse. Susceptibility differs because people differ in their vulnerability to various genetic, environmental, and developmental factors. Results of twin, family, and adoption studies have shown that hereditary factors influence vulnerability to alcoholism. Additionally, pharmacogenomics of alcohol response is well established, and genetic variants for the principle enzymes of alcohol metabolism are thought to influence drinking behavior and protected against alcoholism. Children learn to mimic certain behaviors that of their parents or guardians. In other words, breaking the cycle of substance abuse in familial dynamics can be incredibly challenging because the substance problems can often be overlooked with enough exposure, to the point where these behaviors aren't even considered problematic.

Withdrawal

Withdrawals from alcohol dependence is a common side effect that occurs when a person with the dependency stops drinking abruptly or even cuts back on their drinking after a prolonged period of indulgence. Withdrawal from alcohol dependence can vary from mild, moderate to severe, depending on several factors such as: how long the person has been drinking, are they a binge drinker, do they relapse chronically, how much do they drink daily. All these factors can vary from one person to the next depending on psychological, environmental, and biological factors. Some common withdrawal side effects are as listed:

Mild

Alcohol withdrawals.

• Nausea
• Vomiting
• Rapid heartbeat
• Elevated blood pressure
• Fatigue
• Body aches / tremors
• Anxiety / Irritability / Depression
• Fuzzy brain
• Issues with sleeping

Severe

Hallucinations from Alcohol withdrawals.

• Vomiting
• Hypertensive crisis
• Seizures / Tremors
• Delusions / Hallucinations
• Dehydration
• Fever
• Chills / Shakes
• Extreme mood lability
• Mental Pandemonium
• Little to no appetite

The spectrum of alcohol withdrawal symptoms range from such minor symptoms as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens. Alcohol withdrawal syndrome can be very tricky to diagnose, due to other preliminary conditions that may exist from individual to individual.

Neurological Effects of Withdrawal

Alcohol Withdrawals on Adolescent Brain

The developmental transition from youth and adulthood requires a stressful thinking pattern from having physical and emotional dependence on family members or caretakers to being independent and learning to figure situations out alone. While experiencing adolescence, hormones throughout the brain and the body begin to change as the child begins growing into an adult, an essentially crucial stage when maturing. However, when adolescents cave-in to their curiosities with drugs and alcohol, brain development and hormones begin to have a negative effect during development. Prominent developmental transformations are seen in prefrontal cortex and limbic brain regions of adolescents across a variety of species, alterations that include an apparent shift in the balance between mesocortical and mesolimbic dopamine systems. Developmental changes in these stressor-sensitive regions, which are critical for attributing incentive salience to drugs and other stimuli, likely contribute to the unique characteristics of adolescence.

Mental Health

If family history is associated with clinical features that are thought to index seriousness of disorder, this could inform clinicians predicting patients' prognosis and researchers selecting cases for genetic studies. Although tests of associations between family history and clinical features are numerous for depression, such tests are relatively lacking for other disorders.

Associations between family history of a disorder and clinical features of that disorder in probands showed consistent direction of effects across depression, anxiety disorder, alcohol dependence, and drug dependence. For these disorder types, family history is useful for determining patients' clinical prognosis and for selecting cases for genetic studies.

Clinical Diagnosis

DSM-V Criteria: Alcohol Use Disorder

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 of time than 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 where it is physically dangerous.
• 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.
• Withdrawal.

Severity:

• Mild: 2-3 symptoms.
• Moderate: 4-5 symptoms.
• Severe: 6 or more symptoms.

Epidemiology

When evaluated by drinking pattern, the prevalence of alcohol dependence was 10.2% (95% CI, 9.8%–10.6%) among excessive drinkers, 10.5% (95% CI, 10.1%–11.0%) among binge drinkers, and 1.3% (95% CI, 1.2%–1.5%) among non-binge drinkers.

Treatment

Al-Anon Sign.

The ultimate goal when it comes to treating Alcohol dependence or as the DSM-5 now calls it Alcohol use disorder, is to help with establishing abstinence from drinking. There are several other benefits that come along with treatment. For some it is reconnecting with themselves and obtaining self-esteem and confidence, a healthier lifestyle (physically and mentally), creating new relationships with other like minded people as well as rekindling or mending old relationships if possible. The treatment process consists typically of two parts short term and long term. First there is the path to abstinence and/or recovery. There are several reasons why someone with alcohol use disorder or alcohol dependency would seek treatment. This can either be a personal reason or because of law enforcement. There is a series of different levels of treatment processes depending on the severity subtype. Some would or could benefit from medication treatment with psychosocial treatment, while others could just benefit from psychosocial treatment. Listed below are different some different types of treatments that are used with treating alcohol dependency/alcohol use disorder depending on several factors that vary from person to person.

Types of treatments:

• Withdrawals (No medication aid needed)
• withdrawals (depending on severity of symptoms, could be accompanied with supervision by medical personal and medication)
• psychosocial treatment (Counseling, CBT, psychoeducation, Assertive Community Treatment)
• Alcoholics Anonymous
• Inpatient or Outpatient programs
• Social services (case management)
• Al-Anon

See Also

• Alcoholic Drink
• Alcohol Intoxication
• Alcoholism in family systems
• High-functioning alcoholic

References

Crews, Fulton T, Vetreno, Ryan P, Broadwater, Margaret A, & Robinson, Donita L. (2016). Adolescent Alcohol Exposure Persistently Impacts Adult Neurobiology and Behavior. Pharmacological Reviews, 68(4), 1074–1109. https://doi.org/10.1124/pr.115.012138

Montag, Annika C. (2016). Fetal alcohol-spectrum disorders: identifying at-risk mothers. International Journal of Women's Health, 8, 311–323. https://doi.org/10.2147/IJWH.S85403

Korean Association for the Study of the Liver, & The Korean Association for the Study of the Liver. (2013). KASL clinical practice guidelines: management of alcoholic liver disease. Clinical and Molecular Hepatology, 19(3), 216–254. https://doi.org/10.3350/cmh.2013.19.3.216

Pompili, Maurizio, Serafini, Gianluca, Innamorati, Marco, Dominici, Giovanni, Ferracuti, Stefano, Kotzalidis, Giorgio D, Serra, Giulia, Girardi, Paolo, Janiri, Luigi, Tatarelli, Roberto, Sher, Leo, & Lester, David. (2010). Suicidal behavior and alcohol abuse. International Journal of Environmental Research and Public Health, 7(4), 1392–1431. https://doi.org/10.3390/ijerph7041392