ALCOHOL USE DISORDERS

Alcohol dependence was previously called as alcoholism. Alcohol dependence is more common in males, and has an onset in late second or early third decade. If the onset occurs late in life, especially after 40 years of age, an underlying mood disorder should be looked for.If the  alcoholic continues to drink, life span is shortened by an average of 10 years due to increased risk of death from heart disease, cancer, accidents, or suicide.

Causes

1.Psychological Factors

• Curiosity; need for novelty seeking
• General disobedience
• Early initiation of alcohol and tobacco
• Poor impulse control
• Low self-esteem (anomie)
• Concerns regarding personal autonomy
• Poor stress management skills
• Childhood trauma or loss
• Relief from fatigue and/or boredom
• Escape from reality
• Lack of interest in conventional goals
• Psychological distress

2.Social Factors

• Peer pressure (often more important than parental factors)
• Modelling (imitating behaviour of important others)
• Ease of availability of alcohol and drugs
• Intra familial conflicts
• Religious reasons
• Poor social/familial support
• Perceived distance within the family
• Permissive social attitudes
• Rapid urbanisation.

3.Biological Factors

• Genetic vulnerability (family history of substance use disorder; for example in type II alcoholism)
• Co-morbid psychiatric disorder or personality disorder
• Co-morbid medical disorders
• Reinforcing effects of drugs (explains continuation of drug use)
• Withdrawal effects and craving (explains continuation of drug use)
• Biochemical factors (for example, role of dopamine and norepinephrine in cocaine, ethanol and opioid dependence)

Symptoms

• Disorientation
• Confusion
• Recent memory disturbances
• Poor attention span and distractibility
• Being unable to limit the amount of alcohol you drink
• Wanting to cut down on how much you drink or making unsuccessful attempts to do so
• Spending a lot of time drinking, getting alcohol or recovering from alcohol use
• Feeling a strong craving or urge to drink alcohol
• Failing to fulfill major obligations at work, school or home due to repeated alcohol use
• Continuing to drink alcohol even though you know it’s causing physical, social or interpersonal problems
• Giving up or reducing social and work activities and hobbies
• Using alcohol in situations where it’s not safe, such as when driving or swimming
• Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount

Withdrawal Syndrome

The most common withdrawal syndrome is a hangover on the next morning. Mild tremors, nausea, vomiting, weakness, irritability, insomnia and anxiety.

Delirium tremens

Delirium tremens (DT) is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant abstinence from heavy alcohol drinking in about 5% of patients.

• Clouding of consciousness with disorientation in time and place.
• Poor attention span and distractibility.
• Visual (and also auditory) hallucinations and illusions, which are often vivid and very frightening. Tactile hallucinations of insects crawling over the body may occur.
• Marked autonomic disturbance with tachycardia, fever, hypertension, sweating and pupillary dilatation
• Psychomotor agitation and ataxia.
• Insomnia, with a reversal of sleep-wake pattern.
• Dehydration with electrolyte imbalance.

Alcoholic seizures (‘ rum fits’)

Generalised tonic clonic seizures occur in about 10% of alcohol dependence patients, usually 12-48 hours after a heavy bout of drinking.

Complications of Alcohol Dependence

Social Complications

• Accidents
• Marital disharmony
• Divorce
• Occupational problems, with loss of productive man-hours
• Increased incidence of drug dependence
• Criminality
• Financial difficulties.

 Gastrointestinal System

• Fatty liver, cirrhosis of liver, hepatitis, liver cell carcinoma, liver failure
• Gastritis, reflux oesophagitis, oesophageal varices peptic ulcer, carcinoma stomach and oesophagus
• Malabsorption syndrome, protein-losing enteropathy
• Pancreatitis: acute, chronic,

Miscellaneous

• Sexual dysfunction
• Diabetes mellitus
• Hypertension
• Myocardial infarction(heart attack)
• Storke
• Peripheral neuropathy
• Head injury and fractures
• Suicide
• Alcoholic dementia
• Alcoholic hypoglycaemia
• Anaemia,
• Thrombocytopenia
• Vitamin K factor deficiency
• Amenorrhoea
• Infertility
• Decreased testosterone
• Decreased immune function and proneness to infections

Treatment of Alcohol Dependence

Psychotherapy

The patient should be educated about the risks of continuing alcohol use, asked to resume personal responsibility for change and be given a choice of options for change. Motivational enhancement therapy with or without cognitive behaviour therapy and lifestyle modification is often useful.

Preventing alcohol misuse in children and teenagers

Take these steps to help prevent alcohol misuse in your children and teenagers:

• Communicate. Talk to your children about the risks of alcohol use and misuse.
• Listen. Be a good listener when your children talk about peer pressure, and be supportive of their efforts to resist it.
• Set a good example. Don’t misuse alcohol or addictive drugs. Children of parents who misuse alcohol are at greater risk of alcohol addiction.
• Strengthen the bond. Work on your relationship with your children. A strong, stable bond between you and your child will reduce your child’s risk of using or misusing alcohol.
• Avoid high-risk situations. Don’t go back to the neighborhood where you used to get your alcohol. And stay away from them.

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