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[alcohol + -ism]
A chronic, frequently progressive, and sometimes fatal disease marked by impaired control over consumption of alcohol despite its adverse effects. Dependence on alcohol, tolerance of its effects, and remissions and relapses are common. Psychological features include preoccupation with consuming alcohol and denial of addiction even against evidence to the contrary.
Alcohol abuse is one of the major threats to health in the U.S., where it is estimated to affect between 2% and 9% of the population. Each year 10% of all deaths are related to alcohol. Chronic alcoholism and alcohol-related disorders can be physically, psychologically, and economically devastating to patients and their families.SEE: substance abuse; SEE: fetal alcohol syndrome; SEE TABLE: Levels of Alcohol Consumption: A Guide to Contemporary Usages

Psychological, physiological, genetic, familial, and cultural factors play parts in alcoholism. Family members of alcoholics and males are most likely to be predisposed to the disease. Underage drinkers are more likely to become alcohol-dependent than are those who do not use alcohol before 21, with youths who start drinking before 15 having the highest risk of alcohol addiction.

Pathological effects of alcoholism are found in almost any organ of the body but most commonly in the nervous system, bone marrow, liver, pancreas, stomach, and the other organs of the gastrointestinal tract. Symptoms arise both from organ-specific damage and from the psychological effects of the drug. Alcoholics are more likely than nonalcoholics to suffer falls, fractures, automotive accidents, job loss, and imprisonment. They also suffer from hypertension, gastritis, pancreatitis, hepatitis, cirrhosis, portal hypertension, memory disturbances, and oropharyngeal and pancreatic cancers at higher rates than the general population. In severe alcoholism, abstinence results in withdrawal symptoms and, occasionally, hallucinosis, delirium tremens, or withdrawal seizures. The life expectancy of alcoholics is shorter than that of nonalcoholics.

Alcoholism is diagnosed clinically. Although some alcoholics have many abnormal laboratory findings, none of these is definitively diagnostic. In severe hepatic disease, blood urea nitrogen is elevated, and serum glucose levels are decreased. Elevated liver function studies may indicate liver damage; and elevated serum amylase levels may indicate acute pancreatitis. Anemia, thrombocytopenia, leukopenia, increased prothrombin time, and increased partial thromboplastin time may be noted from hematologic studies.

Screening for alcoholism is best undertaken with questionnaires, like the Michigan Alcohol Screening Test (MAST) and the Alcohol Use Disorders Identification Test (AUDIT). CAGE, a widely used screening questionnaire, asks the questions: Do you feel the need to cut down on drinking? Are you annoyed by people who complain about your drinking? Do you feel guilty about your drinking? Do you need an eye-opener when you wake up? These tests are designed to determine when alcohol use has become physically, behaviorally, or emotionally problematic. Denial is a major concern, and patients may give false information in their health histories and deny physical problems associated with alcoholism. The usefulness of the assessment instrument depends upon the patient's honesty and trust in the clinicians. The assessor should be aware that indirect information obtained from the history and physical examination often reveals more than does direct questioning.

Abstinence from alcohol remains the cornerstone of treatment for alcoholism. Support groups for alcoholics, such as Alcoholics Anonymous (AA), have reported the highest rates of treatment success.
SEE: Alcoholics Anonymous

During acute intoxication or withdrawal, the patient is carefully monitored. Assessments should include mental status, temperature, heart rate, breath sounds, and blood pressure. Medications prescribed for symptom relief are administered, and desired and undesired effects are evaluated. Evaluation for signs of inadequate nutrition and dehydration is also necessary. Patients require orientation to reality because they may have hallucinations or may try to harm themselves or others. A calm environment with minimal noise and shadows reduces the incidence of delusions and hallucinations. Seizure precautions are instituted; mechanical restraint is avoided. Health care professionals should approach patients in a nonthreatening way and explain all procedures. Even if patients are verbally abusive, apathetic, or uninterested, care providers should listen attentively and reply with empathy. Patients are also monitored for signs of depression or impending suicide.

In long-term care of alcoholism, patients are assisted to accept their drinking problem and the need for abstinence. Patients should be confronted about alcohol-related behavior and urged to examine actions. Patients taking disulfiram (or who have taken it within the last 2 weeks) must be warned of the effects of alcohol ingestion, which may last from 30 minutes to 3 hr or longer. Even a small amount of alcohol will induce adverse reactions, e.g., nausea, vomiting, facial flushing, headache. The longer the patients drink alcohol, the greater their sensitivity; therefore, they must be warned to avoid medicinal or hygienic sources of alcohol, e.g., cough syrups, cold remedies, and mouthwashes.

The entire family is assisted to develop a long-term plan for follow-up and relapse prevention, including referral to organizations such as AA, Al-Anon, and Alateen. Family involvement in rehabilitation helps reduce family stressors and tensions. If the alcoholic patient has lost contact with family and friends and has a long history of unemployment, trouble with the law, or financial difficulties, social services or other appropriate agencies may assist with rehabilitation efforts. These may involve job training, sheltered workshops, and halfway houses.

Levels of Alcohol Consumption: A Guide to Contemporary Usages
Type of DrinkingDefinitionComment
Non-problematic drinking<1 standard drink daily (see definition of “standard drink” below)Some evidence suggests that this level of alcohol consumption is healthful
Moderate drinking≤2 drinks a day for males under age 65. ≤1 drink daily for women and people >65
At-risk drinkingMales: >4 drinks in any day or 14 drinks a week. Females: >3 drinks in a day or 7 drinks a weekAlso called “hazardous” drinking or “problematic alcohol use” by some agencies.
Binge drinking>5 drinks on any single occasionBinge drinking carries an increased risk of adverse consequences, including motor vehicle accidents, assaults or aggressive behaviors, and alterations in consciousness.
Harmful drinkingAny quantity of drinking that produces physical or psychological injury. Any drinking during pregnancy, for example.See “problem drinking” below.
Heavy drinkingMales: >2 drinks a day on average Females: >1 drink a day on averageNote that “heavy drinking” begins at the upper limit of “moderate drinking” and overlaps with “at-risk drinking.”
Problem drinkingDrinking that causes life problems for the drinker, e.g. health-related, legal, relationship, or occupational difficulties.“Problem drinking” is also called “alcohol abuse,” or “alcoholism” when it persists for >12 months.
Underage drinkingDrinking before reaching age 21Varies from one legal jurisdiction to another.
Driving while intoxicated (DWI)A legal term, defined by the states, for the crime defined as operating a motor vehicle while influenced by alcohol (or other drugs).Most states rely on both a standard that includes observable impairment in motor function, speech, and balance, and a blood alcohol level (adults) of 0.8. Also called ”DUI” (“driving under the influence”).

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