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alcohol dependence

Alternative Names 
alcoholism, alcohol addiction, alcohol abuse

Alcohol dependence is a chronic pattern of alcohol abuse. An alcoholic gets used to the effects of alcohol and requires more alcohol to get the desired effect. This is called tolerance. A person with alcohol dependence may experience an uncontrollable need for alcohol.

What is going on in the body? 
Alcohol is a depressant. At a blood alcohol level of 0.05%, thought, judgment and restraint are affected. At a level of 0.1%, motor skills become clumsy. When the blood alcohol level reaches 0.2%, the entire area of the brain that controls motor function is negatively affected. Alcohol also affects the parts of the brain that control emotions and behaviour. At 0.3%, the person is likely to be confused and stuporous. An individual at a blood alcohol level of 0.4% or higher may go into a coma. If blood alcohol levels exceed 0.5%, an individual might choke on vomit or stop breathing.

Prolonged alcohol use can actually alter the substance of the brain. People with alcoholism may have impaired memory, poor concentration, and inability to focus after a distraction.

What are the signs and symptoms of the condition? 
Signs and symptoms of alcohol dependency include:
  • alcohol withdrawal when drinking stops suddenly. Withdrawal symptoms include nervousness, shaking, irritability, and nausea.
  • increased tolerance to alcohol
  • alcohol consumed in larger amounts or over a longer period than was intended
  • unsuccessful attempts to stop drinking
  • considerable time devoted to activities associated with alcohol use or obtaining alcohol
  • neglected daily activities
  • disregard for consequences of negative behaviours
What are the causes and risks of the condition? 
No one knows for sure what causes alcohol abuse and dependence. Factors that increase a person's chance of becoming dependent on alcohol include: What can be done to prevent the condition? 
Teaching people, particularly those who are at risk for the disease, about alcoholism is important. This education needs to be started at a young age.

How is the condition diagnosed? 
There is no test to determine if an individual is an alcoholic. But the negative effects of alcohol on the body can be identified with laboratory tests. These laboratory tests will show damage to various organs or body systems.

What are the long-term effects of the condition? 
The long-term effects of alcohol dependency include:
  • pancreatitis, or inflammation of the pancreas
  • heart disease, including coronary artery disease
  • neuropathy, or damage to the nerves
  • bleeding oesophageal varices, or enlarged veins in the tube that connects the windpipe to the stomach
  • brain degeneration and alcoholic neuropathy
  • cirrhosis of the liver, a chronic disease that causes destruction of liver cells and loss of liver function
  • depression, insomnia, anxiety, and suicide
  • high blood pressure
  • increased incidence of many types of cancer, including breast cancer
  • nutritional deficiencies
  • Wernicke-Korsakoff's syndrome, a neuropsychiatric disorder caused by thiamine deficiency that results from poor nutrition in alcoholics
  • significant damage to occupational, social, and interpersonal areas, including sexual dysfunction
Children and teenagers who abuse alcohol are at increased risk for further drinking problems, depression, other substance abuse, and personality disorders as they get older. Adolescents who drink alcohol heavily can develop significant impairments in their ability to remember new information, and their schoolwork may suffer.

People who are heavy drinkers also tend to smoke and eat an unhealthy diet. This combination puts the person at higher risk for coronary artery disease, stroke, heart attack, diabetes, and other chronic diseases.

What are the risks to others? 
If a woman drinks alcohol during pregnancy, her foetus is at great risk for developing foetal alcohol syndrome. or FAS. Drinking reduces judgment, impulse control, and motor control. A person with alcohol dependency places himself or herself and others at risk for accident or emotional injury.

What are the treatments for the condition? 
Treatment begins with helping the person to recognise the problem. Alcohol dependency is associated with a tendency to deny the severity of the problem. There is a refusal to admit it to others. Once the person has recognised and admitted a problem, treatment begins with sobriety, or no alcohol intake.

Some individuals who are alcohol dependent will need to be medically detoxified. This is done in a healthcare setting. Potential complications are monitored during the detoxification process. Tranquilisers and sedatives are used 4 to 7 days to control the symptoms of alcohol withdrawal.

Alcohol recovery programs help people identify situations that trigger the desire to drink. These programs also help people develop coping skills and life management systems, so they can live without alcohol. Self-help groups such as Alcoholics Anonymous have been effective in helping thousands of alcoholics remain sober.

Occasionally medications, such as disulfram, that interfere with the metabolism or the effects of alcohol are used as a deterrent.

There are also certain medications available to assist in continuing abstinence such as sodium acamprosate and naltrexone, but their use is in combination with strict medical supervision.

What are the side effects of the treatments? 
Disulfram may cause drowsiness, depression, and erectile dysfunction.

What happens after treatment for the condition? 
Individuals who complete treatment for alcohol dependence often will continue some form of counselling or self-help group. A person in alcohol recovery will often voluntarily continue to attend self-help groups indefinitely.

How is the condition monitored? 
Alcohol dependence is monitored by doctors, counsellors, family, and friends. Any new or worsening symptoms should be reported to the doctor.

Author: Ann Reyes, Ph.D.
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 25/04/2005
Potential conflict of interest information for reviewers available on request

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