Alcoholism

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Original Editors - Stephanie Gloyeske from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Alcoholism is a serious disease where people have an overpowering desire for the physical and mental effects of drinking alcoholic beverages.¹ The formal term for this type of abuse is alcohol dependence. It the most severe type of alcohol problem.

Prevalence

• Alcoholism is the most common drug abuse problem in the US, affecting more than 15 million Americans, including the adolescent and aging populations. (patho book 76)
• Affects 1 in every 12 adults in the US (NIAAA)
• Men are typically more dependent that women (NIAAA)
• Problems are highest among young adults 18-29 and lowest among adults 65+ (NIAAA)
• The earlier one starts drinking (ie 14 or younger) the more likely they will develop alcohol related problems (NIAAA)

Characteristics/Clinical Presentation

• Continued drinking even after drinking has caused problems such as missing work, driving drunk, getting into trouble with the law, or avoid responsibilities.
• Three out of the following seven symptoms experienced during a one year period is considered alcoholism: (alcoholism.about.com)
     o Neglect of activities – important activities are given up because of alcohol
     o Excessive use – large amounts of alcohol is consumed over a period of time
     o Impaired control – cannot quite on own
     o Persistence of use – consumption is continued despite knowing it is a problem
     o Large amounts of time spent in alcohol related activities
     o Withdrawal – experience nausea, vomiting, sweating, shakiness, and anxiety with alcohol is stopped
     o Tolerance – increasing amount in order to feel effects
• Mayo Clinic symptoms
     o Drinking alone or in secret
     o “Blacking out”
     o Keeping alcohol in unlikely places
     o Feeling a need/compulsion to drink
     o Becoming intoxicated intentionally
• Affects the CNS (depressant) leading to: (medline)
     o Activity
     o Anxiety
     o Inhibitions
     o tension
• Symptoms include (medline):
     o Abdominal pain
     o Confusion
     o Episodes of violence with drinking
     o Hostility when confronted about drinking
     o Making excuses to drink
     o Need for daily/regular alcohol use to function
     o Neglecting to eat
     o Not caring for physical appearance
     o Numbness & tingling
     o Shaking in the morning

Associated Co-morbidities

• Anxiety
  
• Depression

Medications

• Disulfram (Antabuse)
     o Alcohol-sensitizing drug that will not cure alcoholism or remove the craving, but will cause severe physical reactions flushing, vomiting, nausea) if alcohol is consumed
• Naltrexone (ReVia)
     o Blocks the narcotic high and reduces the urge to drink
• Acamprosate (Campral)
     o Anti-craving medication to help abstain from alcohol

Diagnostic Tests/Lab Tests/Lab Values

• To be diagnosed with alcoholism one must meet the criterion which has been spelled out in the Diagnostic and Statistical Manual of Mental Disorders. (mayo clinic)
• The criteria include:
     o Pattern of abuse leading to significant impairment, as indicated by 3 or more of the following at any time during one 12-month period:
           An increase amount of alcohol to feel “intoxicated”
           Withdrawal symptoms (tremors, insomnia, nausea & vomiting, anxiety)
           Drinking over a longer period of time than you intended
           Unsuccessful attempts to quite drinking
           Spending a significant amount of time obtaining, using, and recovering from using
           Giving up important social, occupational, or recreational activities
           Continued use of alcohol despite knowing it’s causing problems
• It is often difficult to screen for alcohol abuse because some signs & symptoms (falling, memory loss) may be associated with aging or people may complain about digestive problems, pain or weakness but never reveal alcohol abuse.
• Denial is a hallmark sign

Causes

• Alcoholism is a gradual process.
• Alters the balance of chemicals in the brain such as GABA, glutamate, and dopamine. Excessive alcohol use may increase of decrease the amount of these chemicals causing cravings.
• Others factors:
     o Genetics
     o Emotional state – high levels of stress, anxiety, or emotional pain
     o Psychological factors – depression, low self-esteem, being around drinking
     o Social or cultural factors

Systemic Involvement

• Alcohol affects the central nervous system (medline)
• Liver – breaks down alcohol so it can be eliminated. If more alcohol is consumed than can be processed, the imbalance injures the liver by interfering with the normal breakdown of proteins, fats, and carbohydrates (liver foundation)
     o Three types of liver disease
           Fatty liver – build up of fat cells
           Alcoholic hepatitis – inflammation of the liver
           Alcoholic cirrhosis – most serious; replacement of normal liver cells with scar tissue
• Kidney – thickening of the glomerulus caused by cell proliferation; enlarged and altered cells in tubules;
• Heart – heavy consumption, over time, can lead to high blood pressure, alcoholic cardiomyopathy (enlarged and weakened heart), congestive heart failure, and stroke. (women’s heart) Drinking puts more fat into circulations raising the triglyceride levels.
• Pancreas -
• Respiratory

Medical Management (current best evidence)

• Alcoholics enter treatment reluctantly because they deny they have a problem.
• Types of treatment depend on level of dependence – may include evaluation, a brief intervention, an outpatient program or counseling, or an inpatient facility.
• Residential treatment programs include
     o Detoxification & withdrawal – detox (4-7 days), may experience delirium tremens or other withdrawal seizures
     o Medical assessment & treatment – high blood pressure, elevated blood sugar, and liver and heart disease are common medical problems
     o Psychological support & psychiatric treatment – counseling regarding the psychological aspects of alcoholism, family/couples therapy
     o Emphasis on acceptance & abstinence – need to accept the addiction for successful recovery
     o Drug treatments – see under medications section
     o Continuing support – help abstain from drinking, manage relapses, and cope with necessary lifestyle changes

Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

• Acupuncture (mayo)

Differential Diagnosis

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Case Reports

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Resources

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Recent Related Research (from Pubmed)

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References

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