Alcoholism

Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing. It is medically considered a disease, specifically an addictive illness, and in psychiatry several other terms are used, specifically "alcohol abuse" and "alcohol dependence," which have slightly different definitions.[1] In 1979 an expert World Health Organization committee discouraged the use of "alcoholism" in medicine, preferring the category of "alcohol dependence syndrome".[2] In the 19th and early 20th centuries, alcohol dependence in general was called dipsomania, but that term now has a much more specific meaning.[3] People suffering from alcoholism are often called "alcoholics". Many other terms, some of them insulting or informal, have been used throughout history. The World Health Organization estimates that there are 140 million people with alcoholism worldwide.[4][5] The American Medical Association supports a dual classification of alcoholism to include both physical and mental components.[6] The biological mechanisms that cause alcoholism are not well understood. Social environment, stress,[7] mental health, family history, age, ethnic group, and gender all influence the risk for the condition.[8][9] Significant alcohol intake produces changes in the brain's structure and chemistry, though some alterations occur with minimal use of alcohol over a short term period, such as tolerance and physical dependence. These changes maintain the person with alcoholism's compulsive inability to stop drinking and result in alcohol withdrawal syndrome if the person stops.[10] Alcohol misuse has the potential to damage almost every organ in the body, including the brain. The cumulative toxic effects of chronic alcohol abuse can cause both medical and psychiatric problems.[11] Identifying alcoholism is difficult for the individual afflicted because of the social stigma associated with the disease that causes people with alcoholism to avoid diagnosis and treatment for fear of shame or social consequences. The evaluation responses to a group of standardized questioning is a common method for diagnosing alcoholism. These can be used to identify harmful drinking patterns, including alcoholism.[12] In general, problem drinking is considered alcoholism when the person continues to drink despite experiencing social or health problems caused by drinking.[13] Treatment of alcoholism takes several steps. Because of the medical problems that can be caused by withdrawal, alcohol detoxification is carefully controlled and may involve medications such as benzodiazepines such as diazepam (Valium).[14] People with alcoholism also sometimes have other addictions, including addictions to benzodiazepines, which may complicate this step.[15] After detoxification, other support such as group therapy or self-help groups are used to help the person remain sober.[16][17] Thombs (1999) states according to behavioural sciences alcoholism is described as a maladaptive behaviour. He explains this must not be confused with misbehaviour. Behavioural scientists explain that addicts have a behaviour pattern that may lead to destructive consequences for themselves, their families and society. This does not label addicts as bad or irresponsible.[18] Compared with men, women are more sensitive to alcohol's harmful physical, cerebral, and mental effects.

Causes
A complex mixture of genetic and environmental factors influences the risk of the development of alcoholism.[59] Genes that influence the metabolism of alcohol also influence the risk of alcoholism, and may be indicated by a family history of alcoholism.[60] One paper has found that alcohol use at an early age may influence the expression of genes which increase the risk of alcohol dependence.[61] Individuals who have a genetic disposition to alcoholism are also more likely to begin drinking at an earlier age than average.[62] Also, a younger age of onset of drinking is associated with an increased risk of the development of alcoholism,[62] and about 40 percent of alcoholics will drink excessively by their late adolescence. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view.[63] A high testosterone concentration during pregnancy may be a risk factor for later development of alcohol dependence.[64] Severe childhood trauma is also associated with a general increase in the risk of drug dependency.[59] Lack of peer and family support is associated with an increased risk of alcoholism developing.[59] Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol abuse. Cortical degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.[65]
Alcohol availability

Alcohol is the most available and widely abused substance; Beer alone is the world's most widely consumed[66] alcoholic beverage; it is the third-most popular drink overall, after water and tea.[67] It is thought by some to be the oldest fermented beverage.[68][69][70][71]
Gender difference

Based on combined data from SAMHSA's 2004-2005 National Surveys on Drug Use & Health, the rate of past year alcohol dependence or abuse among persons aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or abuse in the past year. Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or abuse in the past year (10.5% vs. 5.1%).[72]
Genetic variation See also: Human genetic variation

Genetic differences exist between different racial groups which affect the risk of developing alcohol dependence. For example, there are differences between African, East Asian and Indo-racial groups in how they metabolize alcohol. These genetic factors are believed to, in part, explain the differing rates of alcohol dependence among racial groups.[73][74] The alcohol dehydrogenase allele ADH1 B*3 causes a more rapid metabolism of alcohol. The allele

ADH1 B*3 is only found in those of African descent and certain Native American tribes. African Americans and Native Americans with this allele have a reduced risk of developing alcoholism.[75] Native Americans however, have a significantly higher rate of alcoholism than average; it is unclear why this is the case.[76] Other risk factors such as cultural environmental effects e.g. trauma have been proposed to explain the higher rates of alcoholism among Native Americans compared to alcoholism levels in caucasians.[
The Effects of Alcoholism

The long-term effects of alcohol (ethanol) consumption range from cardioprotective health benefits for low to moderate alcohol consumption in industrialized societies with higher rates of cardiovascular disease[2][3] to severe detrimental effects in cases of chronic alcohol abuse.[4] High levels of alcohol consumption are associated with an increased risk of alcoholism, malnutrition, chronic pancreatitis, alcoholic liver disease, and cancer. In addition damage to the central nervous system and peripheral nervous system can occur from chronic alcohol abuse.[5][6] Long-term use of alcohol in excessive quantities is capable of damaging nearly every organ and system in the body.[7] The developing adolescent brain is particularly vulnerable to the toxic effects of alcohol.[8] In addition, the developing fetal brain is also vulnerable, and fetal alcohol syndrome (FAS) may result if pregnant mothers consume alcohol. The inverse relation in Western cultures between alcohol consumption and cardiovascular disease has been known for over 100 years.[9] There has been reluctance by many physicians, however, to promote alcohol consumption given the many concerns associated with chronic alcohol abuse. Some even suggest that alcohol should be regarded as a recreational drug, and prefer exercise and good nutrition to combat cardiovascular disease.[10][11] Others have argued that the benefits of moderate alcohol consumption may be outweighed by other increased risks, including those of injuries, violence, fetal damage, liver disease, and certain forms of cancer.[12] The adverse effects of long-term excessive use of alcohol are close to those seen with other sedative-hypnotics (apart from organ toxicity which is much more problematic with alcohol). Withdrawal effects and dependence are also almost identical.[13] Alcohol at moderate levels has some positive and negative effects on health. The negative effects include increased risk of liver diseases, oropharyngeal cancer, esophageal cancer and pancreatitis. Conversely moderate intake of alcohol may have some beneficial effects on gastritis and cholelithiasis.[14] Chronic alcohol misuse and abuse has serious effects on physical and mental health. Chronic excess alcohol intake, or alcohol dependence, can lead to a wide range of neuropsychiatric or neurological impairment, cardiovascular disease, liver disease, and malignant neoplasms. The psychiatric disorders which are associated with alcoholism include major depression, dysthymia, mania, hypomania, panic disorder, phobias, generalized anxiety disorder, personality disorders, schizophrenia, suicide, neurologic deficits (e.g. impairments of working memory, emotions, executive functions, visuospatial abilities and gait and balance) and brain damage. Alcohol dependence is associated with hypertension, coronary heart disease, and ischemic stroke, cancer of the respiratory system, and also cancers of the digestive system, liver, breast and ovaries. Heavy drinking is associated with liver disease, such as cirrhosis.[15] Excessive alcohol consumption can have a negative impact on aging.[16]

Recent studies have focused on understanding the mechanisms by which moderate alcohol consumption confers cardiovascular benefit.[17] One study has suggested a beneficial effect of alcohol on patients with hypertension
BLACKOUTS AND MEMORY LAPSES
Alcohol can produce detectable impairments in memory after only a few drinks and, as the amount of alcohol increases, so does the degree of impairment. Large quantities of alcohol, especially when consumed quickly and on an empty stomach, can produce a blackout, or an interval of time for which the intoxicated person cannot recall key details of events, or even entire events. Blackouts are much more common among social drinkers than previously assumed and should be viewed as a potential consequence of acute intoxication regardless of age or whether the drinker is clinically dependent on alcohol (2). White and colleagues (3) surveyed 772 college undergraduates about their experiences with blackouts and asked, Have you ever awoken after a night of drinking not able to remember things that you did or places that you went? Of the students who had ever consumed alcohol, 51 percent reported blacking out at some point in their lives, and 40 percent reported experiencing a blackout in the year before the survey. Of those who reported drinking in the 2 weeks before the survey, 9.4 percent said they blacked out during that time. The students reported learning later that they had participated in a wide range of potentially dangerous events they could not remember, including vandalism, unprotected sex, and driving.

LIVER DISEASE
Most people realize that heavy, longterm drinking can damage the liver, the organ chiefly responsible for breaking down alcohol into harmless byproducts and clearing it from the body. But people may not be aware that prolonged liver dysfunction, such as liver cirrhosis resulting from excessive alcohol consumption, can harm the brain, leading to a serious and potentially fatal brain disorder known as hepatic encephalopathy (20). Hepatic encephalopathy can cause changes in sleep patterns, mood, and personality; psychiatric conditions such as anxiety and depression; severe cognitive effects such as shortened attention span; and problems with coordination such as a flapping or shaking of the hands (called asterixis). In the most serious cases, patients may slip into a coma (i.e., hepatic coma), which can be fatal. New imaging techniques have enabled researchers to study specific brain regions in patients with alcoholic liver disease, giving them a better understanding of how hepatic encephalopathy develops. These studies have confirmed that at least two toxic substances, ammonia and manganese, have a role in the development of hepatic encephalopathy. Alcohol damaged liver cells allow excess amounts of these harmful byproducts to enter the brain, thus harming brain cells.

Treatment
Physicians typically use the following strategies to prevent or treat the development of hepatic encephalopathy. Treatment that lowers blood ammonia concentrations, such as administering L ornithine L aspartate. Techniques such as liverassist devices, or artificial livers, that clear the patients blood of harmful toxins. In initial studies, patients using these devices showed lower amounts of ammonia circulating in their blood, and their encephalopathy became less severe (21). Liver transplantation, an approach that is widely used in alcoholic cirrhotic patients with severe (i.e., endstage) chronic liver failure. In general, implantation of a new liver results in significant improvements in cognitive function in these patients (22) and lowers their levels of ammonia and manganese (23).