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ALCOHOLISM was declared

a disease by the
World Health Organisation
and
American Psychiatric Association
in the year 1956

ICD 10 (INTERNATIONAL
CLASSIFICATION OF DISEASES)
Alcohol dependence syndrome
World Health Organisation has defined alcoholism as
A state, psychic and usually also physical,
resulting from taking alcohol
Characterised by a compulsion to take alcohol
on a continuous or periodic basis to experience
its psychic effects or to avoid the discomfort
Tolerance may or may not be present

DSM IV
(Diagnostic and Statistical Manual)
Substance Dependence is
A maladaptive pattern of substance use, leading to
clinically significant impairment or distress, as
manifested by at least three of the following
Tolerance
Increased tolerance
Diminished effect with the same amount of substance

DSM IV

(contd..)

Withdrawal
The characteristic withdrawal syndrome for
the substance
The
same substance is taken to avoid
symptoms

withdrawal

OTHER SYMPTOMS

Larger amount / longer period


Persistent desire / unsuccessful attempts to cut down
Spending a lot of time in drug related activities
Important activities given up
Substance use is continued despite recurrent
physical and psychological problems

WHO IS AN ALCOHOLIC?
When a person's drinking interferes with one or all
areas of his life
Occupation
Family
Finance
Inter-personal relationship
Physical and mental health

and in spite of this he continues to drink, then he


is an alcoholic

An alcoholic continues to drink because of


Physical dependence
Psychological dependence

The disease of alcoholism is

Primary
Progressive
Treatable

SYMPTOMS OF ALCOHOLISM
Early phase
Increased tolerance
Black out
Preoccupation with drinking
Avoiding discussion about drinking

Middle phase

Loss of control

Giving excuses for drinking

Grandi ose and aggres s ive behaviour

Abstaining f rom alcohol f or a set period of time

Uns ucce ssfu l attem pts to con trol b y ch angin g


the drink ing pat tern

Chronic phase
Binge drinking
Experiences withdrawal symptoms
Ethical breakdown
Physical and psychological deterioration

Alcoholism is a treatable disease


An alcoholic can be treated at any stage
Treatment becomes easier if help is sought in
the early phase

TOTAL ABSTINENCE
IS THE ONLY SOLUTION

IN A DISEASE WE LOOK FOR


Aetiological agent

That which causes the disease


Epidemiology
How the agent comes in contact with the patient

Pathogenesis
What happens when the
contact is made

Lesion
The focus of damage and its consequences

Structural
Biochemical
Physiological
Behavioural

Syndrome
A collection of symptoms

ALCOHOLISM
Aetiological agent

Ethyl alcohol
Epidemiology
Complex process / clearly seen
Pathogenesis
Numerous effects in the body
Lesion
Clear cut in the liver
Syndrome
Well defined and stereotyped reaction

An alcoholic is a sick person


A person with a DISEASE

THREE STAGES OF ADDICTION


Stage I
Experimental and social use
Frequency of use
Occasional / usually on weekends
Source of drugs / alcohol
Friends / peers at parties

REASONS
Curiosity / risk taking and seeking thrill
For pleasurable feelings / relief from boredom

Peer pressure / to be sociable


To obtain social acceptance
To appear grown up / to defy
parental limits

EFFECTS
Experiences euphoria and returns to normal
state after using
Small amount may cause intoxication
Feelings sought - fun, excitement, thrill,
belonging and control

BEHAVIOURAL INDICATORS
Little noticeable change
Experiences moderate hangovers
Occasional evidence of use such as beer can
or marijuana joint

Stage II - Abuse
Frequency of use
Regular / several times per week
Some times during the day
Prefers to use alone
Source of drug / alcohol
Friends
Buys for himself
May borrow / steal / peddle drugs to
maintain supply

REASONS
To manipulate emotions experience
pleasure, cope with stress and
uncomfortable feelings and to overcome
feelings of inadequacy
To stay high or at least to maintain normal
feelings

EFFECTS
May experience discomfort in the absence of drugs

Intoxication becomes regular


Feelings sought - pleasure, relief from negative
emotions and stress reduction
May feel guilty, ashamed and afraid
Has suicidal ideation / may attempt suicide
Tries to control use but fails

BEHAVIOURAL INDICATORS
Decline in work performance

Mood swings
Changes in personality
Lying and stealing
Change in friendships

..

BEHAVIOURAL INDICATORS (contd..)

Decrease in extra

curricular activities
Begins adopting drug

culture (clothing, hairstyle)

..

BEHAVIOURAL INDICATORS (contd..)


Conflict with family members
Becomes more rebellious
Interest focused on procuring

and using
drugs / alcohol

Stage III
Dependency / addiction
Frequency of use
Daily use / continuous
Source of drugs / alcohol
Uses any means to get alcohol / drugs
May engage in criminal activities to get
money for drugs

REASONS
Has no control over his behaviour
To avoid pain and depression
To escape from realities of daily living

EFFECTS
Normal state is pain and discomfort

Unlikely to experience euphoria


Experiences suicidal thoughts / may attempt suicide

..

EFFECTS

(contd..)

Experiences
Guilt, shame and remorse
Repeated blackouts
Changing emotions such as

depression, irritation and apathy

BEHAVIOURAL INDICATORS
Physical deterioration including weight loss,
health problems
Memory loss, flash back, paranoia, volatile
mood swings and other psychiatric problems
Likely to dropout or get expelled from college or
lose jobs
..

BEHAVIOURAL INDICATORS
Away from home most of the time
Possible overdoses
Not concerned about being caught
Focuses only on procuring and using drugs