Most Common Disorder of the Brain

Alcoholism

Overview

Alcohol problems vary in severity from mild to life threatening and affect the individual, the person's family, and society in numerous adverse ways. Despite all of the focus on drugs such as cocaine, alcohol remains the number one drug problem in the United States. According to community surveys, over 13% of adults in the United States will experience alcohol abuse or dependence (also referred to as alcoholism) at some point in their lives.

Withdrawal, for those physically dependent on alcohol, is much more dangerous than withdrawal from heroin or other narcotic drugs.

• Alcohol abuse refers to excessive or problematic use with one or more of the following:
  
  
  • Failure to fulfill major obligations at work, school, or home
    
    
  • Recurrent in situations where it is hazardous (such as driving a car or operating machinery)
    
    
  • Legal problems
    
    
  • Continued use of alcohol despite having social, family, or interpersonal problems caused by or worsened by drinking

• Alcohol dependence refers to a more serious disorder and involves excessive or maladaptive use leading to 3 or more of the following:
  
  
  • Tolerance changes (need for more to achieve desired effect, or achieving the effect with lesser amounts of alcohol)
    
    
  • Withdrawal symptoms following a reduction or cessation of drinking (such as sweating, rapid, tremors, insomnia, nausea, vomiting, hallucinations, agitation, anxiety, or seizures) or using alcohol to avoid withdrawal symptoms (for example, early morning drinking)
    
    
  • Drinking more alcohol or drinking over a longer period of time than intended (loss of control)
    
    
  • Inability to cut down or stop
    
    
  • Spending a great deal of time drinking or recovering from its effects
    
    
  • Giving up important social, occupational, or recreational activities
    
    
  • Continuing to drink despite knowing alcohol use has caused or worsened problems
  
  

  Alcoholism Causes

  The cause of alcoholism is not well established. There is growing evidence for genetic and biologic predispositions for this disease, but this research is controversial. Studies examining adopted children have shown that children of alcoholic biological parents have an increased risk of becoming alcoholics. Relatively recent research has implicated a gene (D2 dopamine receptor gene) that, when inherited in a specific form, might increase a person's chance of developing alcoholism. Twice as many men are alcoholics. And 10-23% of alcohol-consuming individuals are considered alcoholics.

  Usually, a variety of factors contribute to the development of a problem with alcohol. Social factors such as the influence of family, peers, and society, and the availability of alcohol, and psychological factors such as elevated levels of stress, inadequate coping mechanisms, and reinforcement of alcohol use from other drinkers can contribute to alcoholism. Also, the factors contributing to initial alcohol use may vary from those maintaining it, once the disease develops.

Alcoholism Symptoms

Alcoholism is a disease. It is often diagnosed more through behaviors and adverse effects on functioning than by specific medical symptoms. Only 2 of the diagnostic criteria are physiological (those are tolerance changes and withdrawal symptoms).

• Alcohol abuse and alcoholism are associated with a broad range of medical, psychiatric, social, legal, occupational, economic, and family problems. For example, parental alcoholism underlies many family problems such as divorce, spouse abuse, child abuse neglect, welfare dependence, and criminal behaviors, according to government sources.
  
  
  • The great majority of alcoholics go unrecognized by physicians and health care professionals. This is largely because of the alcoholic's ability to conceal the amount and frequency of drinking, denial of problems caused by or made worse by drinking, the gradual onset of the disease, and the body's ability to adapt to increasing alcohol amounts.
    
    
  • Family members often deny or minimize alcohol problems and unwittingly contribute to the continuation of alcoholism by well-meaning behaviors such as shielding the alcoholic from adverse consequences of drinking or taking over family or economic responsibilities. Often the drinking behavior is concealed from loved ones and health care providers.
    
    
  • Alcoholics, when confronted, will often deny excess consumption of alcohol. Alcoholism is a diverse disease and is often influenced by the alcoholic's personality as well as by other factors. Therefore, signs and symptoms often vary from person to person. There are, however, certain behaviors and signs that indicate someone may have a problem with alcohol. These behaviors and signs include insomnia, frequent falls, bruises of different ages, blackouts, chronic depression, anxiety, irritability, tardiness or absence at work or school, loss of employment, divorce or separation, financial difficulties, frequent intoxicated appearance or behavior, weight loss, or frequent automobile collisions.
    
    
  • Late signs and symptoms include medical conditions such as pancreatitis, gastritis, cirrhosis, neuropathy, anemia, cerebellar atrophy, alcoholic cardiomyopathy (heart diseases), Wernicke's encephalopathy (abnormal brain functioning), Korsakoff's dementia, central pontine myelinolysis (brain degeneration), seizures, confusion, malnutrition, hallucinations, peptic ulcers, and gastrointestinal bleeding.
  
  
• Compared with children in families without alcoholism, children of alcoholics are at increased risk for alcohol abuse, drug abuse, conduct problems, anxiety disorders, and mood disorders. Alcoholic individuals have a higher risk of psychiatric disorders and suicide. They often experience guilt, shame, and depression, especially when their alcohol use leads to significant losses (for example, job, relationships, status, economic security, or physical health). Many medical problems are caused by or made worse by alcoholism as well as by the alcoholic's poor adherence to medical treatment.

Symptoms of long term alcohol misuse

Alcoholism is characterised by an increased tolerance of and physical dependence on alcohol, affecting an individual's ability to control alcohol consumption safely. These characteristics are believed to play a role in impeding an alcoholic's ability to stop drinking. Alcoholism can have adverse effects on mental health, causing psychiatric disorders to develop and an increased risk of suicide.

Physical symptoms

Some of the possible long-term effects of ethanol an individual may develop. Additionally, in pregnant women, alcohol can cause fetal alcohol syndrome.

Long term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and cancer. Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption.

Women develop long-term complications of alcohol dependence more rapidly than do men. Additionally, women have a higher mortality rate from alcoholism than men. Examples of long term complications include brain, heart, and liver damage and an increased risk of breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause. Alcoholic ketoacidosis can occur in individuals who chronically abuse alcohol and have a recent history of binge drinking.

Psychiatric symptoms

Long term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are not uncommon; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia. Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time.

Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence. Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia. Panic disorder can develop or worsen as a direct result of long term alcohol misuse.

The co-occurrence of major depressive disorder and alcoholism is well documented. Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes). Additional use of other drugs may increase the risk of depression.

Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder. Women with alcoholism are more likely to have a history of physical or sexual assault, abuse and domestic violence than those in the general population, which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.