Composition 3
Alcohol Use Disorder
Authors: Rebecca J. Frey, PhD, Teresa Odle, BA, ELS, Tish Davidson, AM and Joan Schonbeck, RN
Editor: Brigham Narins
DEFINITION
The American Medical Association (AMA) defines alcoholism or alcohol (ethanol) dependence as “a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.” Alcohol use disorder is a medical diagnosis based on specific criteria. Alcohol use disorder is considered a mental health disorder.
(Press Association via AP Images)
DEMOGRAPHICS
The World Health Organization (WHO) estimates that about 2 billion people worldwide consume alcoholic beverages, and alcoholism is the most common addiction to a psychoactive substance. Alcohol addiction affects both sexes and all races and ethnicities. A 2015 study found that as many as 29.1% of Americans have alcohol use disorder at some point in their lives, and nearly 14% have had it in the previous 12 months. At least 16 million Americans have alcohol use disorder. About three times as many report having used alcohol recently, although not everyone who drinks has alcohol use disorder. In 2015, 9.8 million men older than age 18 and 5.3 million women were diagnosed in the United States. It is estimated that more than 620,000 adolescents also have alcohol use disorder. In the United States, alcohol is the most commonly used and abused drug among youth. Although drinking under the age of 21 is against the law, people ages 12–20 years drink nearly 20% of all alcohol consumed in the United States. Much of this alcohol is consumed in the form of binge drinking.
Men are more than twice as likely to be alcohol dependent than women, but studies of female alcoholics indicate that women are at higher risk than men for serious health problems related to alcoholism. Because women tend to metabolize alcohol more slowly and have a lower percentage of body water and a higher percentage of body fat than men, they develop higher blood alcohol levels at a given amount of alcohol per pound of body weight. Thus, even though women typically begin to drink heavily at a later age than men, they often become dependent more rapidly. This relatively speedy progression of alcoholism in women is called telescoping. Smokers who are alcohol dependent are also much more likely to develop serious or fatal health problems associated with alcoholism.
At the other end of the age distribution, alcoholism among the elderly appears to be under-recognized.Page 53 | Top of Article One-third of older persons with alcoholism develop the problem later in life, while the other two-thirds grow older with the medical and psychosocial consequences of early onset alcoholism. Confusion and other signs of intoxication in an elderly person are also often misinterpreted as side effects of medications. In addition, the effects of alcohol may be increased in elderly patients because of physiological changes associated with aging. The elderly are at higher risk than younger people for becoming dependent on alcohol because their bodies do not absorb it as efficiently; a 90-year-old who drinks the same amount of alcohol as a 20-year-old of the same sex will have a blood alcohol level 50% higher.
DESCRIPTION
Alcohol use disorder is characterized by compulsive drinking, inability to control how much one drinks, and feelings like stress , anxiety , or irritability when not drinking. Alcoholism is characterized by:
· A prolonged period of frequent, heavy alcohol use
· The inability to control drinking once it has begun
· Physical dependence manifested by withdrawal symptoms when the individual stops using alcohol
· Tolerance, or the need to use more and more alcohol to achieve the same effects
The effects of alcohol use disorder are far reaching. Alcohol affects every body system, causing a wide range of health problems. Problems include poor nutrition; memory disorders; difficulty with balance and walking; liver disease (including cirrhosis and hepatitis); high blood pressure; muscle weakness (including the heart); heart rhythm disturbances; anemia; clotting disorders; decreased immunity to infections; gastrointestinal inflammation and irritation; acute and chronic problems with the pancreas; low blood sugar; high cholesterol; interference with fertility; increased risk of cancer of the liver, esophagus, and breast; weakened bones; sleep disturbances; anxiety; and depression . About 20% of adults admitted to the hospital (for any reason) are alcohol dependent.
On a personal level, alcohol use can lead to difficulties in marital and other relationships, domestic violence , child abuse or neglect, difficulty finding or keeping a job, impaired school or work performance, homelessness, or legal problems such as driving while intoxicated (DUI).
The risk of developing alcoholism has a definite genetic component. Studies have demonstrated that close relatives of people with alcoholism are more likely to become alcoholics themselves. This risk exists even for children adopted away from their biological families at birth and raised in a non-alcoholic adoptive family with no knowledge of their biological family's alcohol use. However, no specific gene for alcoholism has been found, and environmental factors (e.g., stress) and social factors (e.g., peer behavior, socializing patterns, and the availability of alcohol) are thought to play a role in whether a person becomes alcohol dependent. People who start drinking in their teens are at a much higher risk of developing alcohol dependency problems, compared to people who start drinking at age 21 or older.
Colored positron emission tomography scans of a heavy drinker's brain during withdrawal from alcohol; the top shows brain activity after 10 days (yellow areas), and the bottom shows brain activity after 30 days without alcohol.
(© Pascal Goetgheluck/SPL/Photo Researchers, Inc.)
CAUSES AND SYMPTOMS
Recently, some researchers have suggested that there are two distinct types of alcoholism. Alcoholism might develop in adulthood, often in the early twenties, most likely tied to the desire to relieve stress and anxiety. Some alcoholism develops earlier, usually during the teen years. Research is ongoing to determine a possible genetic (or inherited) cause of alcohol use disorder. It is apparent that some people inherit a risk for alcohol dependence, but not everyone born into a family with alcohol use problems will develop the disorder.
Causes
The cause of alcoholism is related to behavioral, biological, and genetic factors.
Behaviorally, alcohol consumption is related to internal or external feedback. Internal feedback is the internal state a person experiences during and after alcohol consumption. External feedback is made up of the cues that other people send the person when he or she drinks. Internal states pertaining to alcohol can include shame or hangover. Alcohol-related external cues can include reprimands,Page 54 | Top of Article criticism, or encouragement. People may drink to the point of dependence because of peer pressure, for acceptance in a peer group, or because drinking is related to specific moods (e.g., easygoing, relaxed, calm, sociable) that are related to the formation of intimate relationships.
Biologically, repeated use of alcohol can impair the brain levels of a “pleasure” neurotransmitter called dopamine . Neurotransmitters are chemicals in the brain that pass impulses from one nerve cell to the next. When a person is dependent on alcohol, the areas of his or her brain that produce dopamine become depleted, and the individual can no longer enjoy the pleasures of everyday life—his or her brain chemistry is rearranged to depend on alcohol for transient euphoria (state of happiness).
Genetic studies have suggested that the GABA -A receptor alpha 2 subunit gene (GABRA2) and alcohol dehydrogenase (ADH) genes increase the risk for alcohol dependence. The GABRA genes are related to a receptor for gamma-amino butyric acid (GABA), a chemical in the central nervous system that is believed to mediate some of the physiological effects of alcohol. ADH is a chemical involved in the oxidation of alcohol in the body. These genes related to alcohol use can be passed from parents to their children.
Past Month Binge and Heavy Alcohol Use among People Aged 12 or Older, by Age Group: Percentages, 2016
SOURCE: Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). 2017. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/ (accessed May 8, 2018).
NOTE: Since 2015, the threshold for determining binge alcohol use for males is consuming five or more drinks on an occasion and for females is consuming four or more drinks on an occasion.
The symptoms of alcoholism can be broken down into two major categories: symptoms of acute alcohol use, and symptoms of long-term alcohol use.
Immediate (acute) effects of alcohol use
Alcohol exerts a depressive effect on the brain. The blood-brain barrier does not prevent alcohol from entering the brain, so the brain alcohol level will quickly become equivalent to the blood alcohol level. In the brain, alcohol interacts with various neurotransmitters to alter nerve function. Alcohol's depressive effects result in difficulty walking, poor balance, slurring of speech, and generally poor coordination (accounting in part for the increased likelihood of injury). The affected person also may have impairment of peripheral vision. At higher alcohol levels, a person's breathing and heart rates may be slowed, and vomiting may occur (with a high risk of the vomit being breathed into the lungs, potentially resulting in aspiration pneumonia.) Still higher alcohol levels may result in coma and death.
Blood alcohol concentration (BAC) produces the following symptoms of central nervous system (CNS) depression at specific levels:
· 50 mg/dL: feelings of calm or mild drowsiness
· 51–150 mg/dL: loss of physical coordination. The legal BAC for drivers in most states is 80 mg/dL.
· 151–200 mg/dL: loss of mental faculties
· 300–400 mg/dL: unconsciousness
· Over 400 mg/dL: may be fatal
Effects of long-term (chronic) alcoholism
Long-term use of alcohol affects virtually every organ system of the body:
· Nervous system. An estimated 30%–40% of all men in their teens and twenties have experienced alcoholic blackout from drinking a large quantity of alcohol. This results in the loss of memory of the time surrounding the episode of drinking. Alcohol also causes sleep disturbances, so sleep quality is diminished. Numbness and tingling (paresthesia) may occur in the arms and legs. Wernicke's syndrome and Korsakoff's syndrome, which can occur together or separately, are due to the low thiamine (a B vitamin) levels found in many people with an alcohol dependence. Wernicke's syndrome results in disordered eye movements, very poor balance, and difficulty walking. Korsakoff's syndrome affects memory and prevents new learning from taking place.
· Gastrointestinal system. Alcohol-associated conditions include acid reflux, stomach ulcers, esophageal varices (enlarged blood vessels in the esophagus prone to bursting and hemorrhaging), diarrhea, pancreatitis, malnutrition, cirrhosis, and hepatitis.Page 55 | Top of Article
· Blood. Alcohol may cause changes to all the types of blood cells. Red blood cells become abnormally large. White blood cells (important for fighting infections) decrease in number, resulting in a weakened immune system. This places alcohol-dependent individuals at increased risk for infections and may account in part for the increased risk of cancer faced by people with alcoholism. Platelets and blood clotting factors are affected, causing an increased risk of bleeding.
· Heart. Small amounts of alcohol cause a drop in blood pressure, but with increased consumption, alcohol raises blood pressure into a dangerous range (hypertension). High levels of fats circulating in the bloodstream increase the risk of heart disease. Heavy drinking results in an increase in heart size, weakening of the heart muscle, abnormal heart rhythms, a risk of blood clots forming within the chambers of the heart, and a greatly increased risk of stroke due to a blood clot entering the circulatory system and blocking a brain blood vessel.
· Reproductive system. Heavy drinking has a negative effect on fertility in both men and women. It decreases testicle and ovary size and interferes with both sperm and egg production.
People with chronic tolerance may appear to be sober (not intoxicated) even after consumption of alcohol quantities that could cause death in non-drinkers. People with alcohol dependence also develop alcohol withdrawal syndrome (a state of non-drinking). The nervous system adapts to chronic ethanol exposure by increasing the activity of nerve-cell mechanisms that counteract alcohol's depressant effects. When drinking is abruptly reduced, the affected person develops disordered perceptions, seizures, and tremor (often accompanied by irritability, nausea, and vomiting). Tremor of the hands, known colloquially as “morning shakes,” usually occurs in the morning due to overnight abstinence. The most serious manifestation of alcohol withdrawal syndrome is delirium tremens, which occurs in approximately 5% of people dependent on alcohol. Delirium tremens consists of agitation, disorientation, insomnia , hallucinations , delusions, intense sweating, fever, and increased heart rate (tachycardia). This state is a medical emergency because it can be fatal, and affected persons must be immediately hospitalized and treated with medications that control vital physiological functions.
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Risk factors for alcohol use disorder
· Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder.
· Age. People who begin drinking at an early age, and especially in a binge fashion, are at a higher risk of alcohol use disorder. Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s. However, it can begin at any age.
· Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be by genetic factors.
· Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances.
· Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it's OK to drink too much. For young people, the of parents, peers and other role models can impact risk.
SOURCE: “Alcohol use disorder.” Mayo Clinic. January 31, 2018. https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243 (accessed May 3, 2018).
In addition to physical symptoms, most persons with alcoholism have a history of psychiatric, occupational, financial, legal, or interpersonal problems. Alcohol misuse is the single most important predictor of violence between domestic partners as well as intergenerational violence within families. Since the early 1990s, most states have passed stricter laws against alcohol-impaired driving. These laws include such provisions as license suspension for the first arrest for driving while impaired (driving under the influence or DUI) and lowering the legal blood alcohol limit to 0.08 g/dL for adults, plus zero tolerance for drivers under age 21. Penalties for repeated DUI citations include prison sentences, house arrest with electronic monitoring, automobile confiscation, and putting a special ignition interlock on the offender's car. Deaths caused by a drunk driver may be punishable with prison time.
Alcohol use during pregnancy
A large body of evidence indicates that maternal alcohol consumption during pregnancy contributes adversely to a fetus's development. Abnormalities in infants and children associated with maternal alcohol consumption may include prenatal and postnatal physical retardation, neurological deficits (e.g., impaired attention control), intellectual disability, behavioral problems (e. g., impulsivity), skull or brain malformations, and facial malformations (e.g., a thin upper lip and elongated and flattened midface). These abnormalities, influenced by maternal alcohol consumption during pregnancy, are referred to as fetal alcohol effects (FAEs), or fetal alcohol syndrome (FAS) if a sufficient number of effects are apparent in the child.
FAS is the leading cause of intellectual disability in the United States. One to two of every 1,000 infants born in the United States are afflicted with FAS. Research studies that have followed infants with FAS and FAEsPage 56 | Top of Article across time have found that many of these children continue to have cognitive difficulties (e.g., lower IQ scores, more learning problems, and poorer short-term memory functioning) and behavioral problems (e.g., high impulsivity and high activity level) into childhood and adolescence.
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KEY TERMS
Acamprosate—
Also called Campral, an anti-craving medication used since 1989 in Europe and since 2004 in the United States to reduce the craving for alcohol.
Alcohol Use Disorders Inventory Test (AUDIT)—
A test for alcohol use developed by the World Health Organization (WHO). Its ten questions address three specific areas of drinking over a 12-month period: the amount and frequency of drinking, dependence upon alcohol, and problems that have been encountered due to drinking alcohol.
Behavioral therapy—
Form of psychotherapy used to treat depression, anxiety disorders, phobias, and other forms of psychopathology.
Binge drinking—
Consumption of five or more alcoholic drinks in a single, short period.
Blood-brain barrier—
A network of blood vessels characterized by closely spaced cells that prevents many potentially toxic substances from penetrating the blood vessel walls to enter the brain. Alcohol is able to cross this barrier.
CAGE—
A four-question assessment for the presence of alcoholism in both adults and children.
The phase of treatment during which a patient stops drinking and is monitored and cared for while he or she experiences withdrawal from alcohol.
Disulfiram—
A medication that has been used since the late 1940s as part of a treatment plan for alcohol abuse. Disulfiram, which is sold under the trade name Antabuse, produces changes in the body's metabolism of alcohol that cause headaches, vomiting, and other unpleasant symptoms if the patient drinks even small amounts of alcohol.
Ethanol—
The chemical name for beverage alcohol. It is also sometimes called ethyl alcohol or grain alcohol to distinguish it from isopropyl or rubbing alcohol.
A medication originally developed to treat addiction to heroin or morphine that is also used to treat alcoholism. It works by reducing the craving for alcohol rather than by producing vomiting or other unpleasant reactions.
Neurotransmitter—
One of a group of chemicals secreted by a nerve cell (neuron) to carry a chemical message to another nerve cell, often as a way of transmitting a nerve impulse. Examples of neurotransmitters include acetylcholine , dopamine, serotonin , and norepinephrine .
Relapse—
A return to a disease state, after recovery appeared to be occurring. In alcoholism, relapse refers to a patient beginning to drink alcohol again after a period of avoiding alcohol.
Tolerance—
A phenomenon during which a drinker becomes physically accustomed to a particular quantity of alcohol and requires ever-increasing quantities in order to obtain the same effects.
Withdrawal—
Those signs and symptoms experienced by a person who has become physically dependent on a drug, experienced upon decreasing the drug's dosage or discontinuing its use.
DIAGNOSIS
The diagnosis of alcoholism is based on specific criteria found through patient history, a thorough physical examination, laboratory findings, and the results of psychodiagnostic assessment.
The Diagnostic and Statistical Manual of Mental Disorders , 5th edition, text revision (DSM-5), has merged former distinctions of alcohol abuse and alcohol dependence into the single category of alcohol use disorder. The manual this lists ways to classify the disorder as mild, moderate, or severe.
The DSM-5 requires at least two of the following eleven criteria to be present during the same 12 months for a diagnosis of alcohol use disorder, with severity based on how many of the criteria exist:
· Times when the individual drank more alcohol or drank for longer than intended
· Trying to stop or reduce drinking more than once in the 12 months but could not
· Spending unusual amount of time drinking or experiencing aftereffects or sickness from drinking
· Strongly craving alcoholPage 57 | Top of Article
· Drinking or being sick after drinking has often interfered with daily job or family tasks, or caused problems at work, school, or at home
· Continuing drinking even though it is affecting relationships with family and friends
· Quitting or cutting back on important or pleasurable activities to drink
· Getting into situations that put the person at risk for being physically hurt (such as driving, swimming, risky sexual activities) more than once
· Continuing drinking despite alcohol causing a sense of anxiety or depression, a memory blackout, or other health problem
· Experiencing the need to drink more than usual to get the same desired effect, or noting less effect from the same number of drinks
· Experiencing withdrawal symptoms such as trouble sleeping, shakiness, irritability, depression, anxiety, nausea, sweating, and others when alcohol effects wear off
Some factors have complicated diagnosis of alcoholism in the United States, including: 1) the increasing tendency to combine alcohol with use of other drugs , and 2) the rising rates of alcohol use and dependence among children under 12 years of age.
Examination
A physician who suspects that a patient is abusing or dependent upon alcohol should perform a complete physical examination with appropriate laboratory tests, paying particular attention to liver function and the nervous system. Physical findings that suggest alcoholism include head injuries after age 18, broken bones after age eighteen, evidence of blackouts, frequent accidents or falls, puffy eyelids, flushed face, alcohol odor on the breath, shaky hands, slurred speech or tongue tremor, rapid involuntary eye movements (nystagmus), enlargement of the liver (hepatomegaly), hypertension, insomnia, and impotence (in males). Severe memory loss may point to advanced alcoholic damage to the central nervous system.
Tests
Several laboratory tests can be used to support a diagnosis of alcohol use disorder and evaluate the presence of medical problems related to drinking. These tests include:
· Complete blood cell count (CBC). This test indicates the presence of anemia, which is common in alcoholics.
· Liver function tests. Tests for serum glutamine oxaloacetic transaminase (SGOT) and alkaline phosphatase can indicate alcohol-related injury to the liver. A high level (30 units) of gamma-glutamyltransferase (GGT) is a useful marker because it is found in 70% of heavy drinkers.
· Blood alcohol levels.
· Carbohydrate deficient transferrin (CDT) tests. This test should not be used as a screener, but it is useful in monitoring alcohol consumption in heavy drinkers (those who consume at least 60 grams of alcohol per day). When CDT is present, it indicates regular daily consumption of alcohol.
The results of these tests might not be accurate if the patient is using or is dependent on other substances.
Behavioral screening
Since some of the physical signs and symptoms of alcoholism can be produced by other drugs or disorders, screening tests can also help to determine the existence of a drinking problem. The Alcohol Use Disorder Identification Test, or AUDIT, highlights some of the physical symptoms of alcohol abuse that doctors look for during a physical examination of the patient. The Substance Abuse Subtle Screening Inventory (SASSI) can be given in either group or individual settings in a paper-and-pencil or computerized format. The SASSI is available in an adolescent as well as an adult version from the SASSI Institute. Selection of an appropriate screen is important.
TREATMENT
Traditional
Treatment of alcoholism often is a combination of medicines and behavioral therapies. The combination of both approaches works best for most people. Some people are treated as inpatients, and others have outpatient therapy, depending on the individual's alcohol history and physical condition. The person with alcohol use disorder often resists the idea that he or she has an alcohol problem and needs to stop drinking. Treatment cannot be forced on adults unless imposed by a court of law. However, if the person is a danger to himself or herself or to others, immediate hospitalization may be possible without the individual's consent.
The first step in the treatment of alcoholism, called detoxification, involves helping the person stop drinking and ridding his or her body of the harmful (toxic) effects of alcohol. Because the person's brain and body have become accustomed to alcohol, he or she will most likely develop withdrawal symptoms and need to be supported through them. Withdrawal will be different for differentPage 58 | Top of Article individuals, depending on the severity of the alcoholism as measured by the quantity of alcohol ingested daily and the length of time the patient has been alcohol dependent.
Withdrawal symptoms can range from mild to life-threatening. Mild withdrawal symptoms include nausea, achiness, diarrhea, difficulty sleeping, sweatiness, anxiety, and trembling. This phase usually lasts no more than three to five days. More severe effects of withdrawal can include hallucinations in which a patient sees, hears, or feels something that is not actually present; seizures; an unbearable craving for more alcohol; confusion; fever; fast heart rate (tachycardia); high blood pressure (hypertension); and delirium (a fluctuating level of consciousness). Patients at the highest risk for the most severe symptoms of withdrawal are those with other medical problems, including malnutrition, liver disease, or Wernicke's syndrome. Severe withdrawal symptoms usually begin about three days after the individual's last drink and may last a variable number of days.
People going through mild withdrawal are monitored to make sure that more severe symptoms do not develop. Medications usually are unnecessary. Treatment of a patient suffering more severe effects of withdrawal may require sedative medications to relieve the discomfort of withdrawal and to avoid the potentially life-threatening complications of high blood pressure, fast heart rate, and seizures. Benzodiazepine drugs may be helpful in those patients experiencing hallucinations. If the patient vomits for an extended period, fluids may need to be given through a vein (intravenously, IV). Thiamine (a vitamin) is often included in the fluids, because thiamine levels are often very low in alcohol-dependent patients, and thiamine deficiency is responsible for the Wernicke-Korsakoff syndrome.
After the individual is no longer drinking and has passed through withdrawal, the next steps involve helping the individual avoid relapsing (the return to drinking). This phase of treatment is referred to as rehabilitation. It can continue for a lifetime. Many programs incorporate the family into rehabilitation therapy, because the family has likely been severely affected by the patient's drinking. Some therapists believe that family members, in an effort to deal with their loved one's drinking problem, develop patterns of behavior that unintentionally support or enable the patient's drinking. This situation is referred to as co-dependence. These patterns should be addressed in order to help successfully treat a person's alcoholism.
Sessions led by peers, in which recovering alcoholics meet regularly and provide support for each other's recoveries, are considered among the best methods of preventing a return to drinking. The best-known group following this model is Alcoholics Anonymous (AA), which uses a twelve-step program and a buddy (sponsor) system to help people avoid drinking. The AA steps involve recognizing the destructive power that alcohol has held over the individual's life, looking to a higher power for help in overcoming the problem, reflecting on the ways in which the use of alcohol has hurt others and, if possible, making amends to those people. According to the American Psychological Association (APA), anyone, regardless of his or her religious beliefs or lack of religious beliefs, can benefit from participation in twelve-step programs such as AA. The number of visits to twelve-step self-help groups exceeds the number of visits to all mental health professionals combined.
Psychotherapy may also help affected persons to anticipate, understand, recognize, and prevent relapse. Along with support groups, behavioral therapy approaches typically include cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET). CBT focuses on teaching alcoholics recognition and coping skills for craving states and high-risk situations that precipitate or trigger relapsing behaviors. MET can motivate patients to use their personal resources to initiate changes in behavior.
Drugs
Most drugs used to treat alcoholism fall into one of two groups: those that restrain the desire to drink by producing painful physical symptoms if the patient does drink, and those that appear to reduce the craving for alcohol directly. Several medications in the second category were originally developed to treat addiction to opioid substances (e.g., heroin and morphine). Drugs alone will not prevent relapse. They are most effective when used in conjunction with a self-help program and/or psychotherapy aimed at changing behavior.
Depending on the individual and severity of alcohol use disorder, patients might have medications that make them more sensitive to alcohol, help eliminate cravings for alcohol, or manage symptoms of alcoholism and withdrawal. Drugs approved for treating alcohol use disorder include disulfiram to make alcohol unpleasant, naltrexone to reduce cravings, and acamprosate to reduce cravings right after quitting drinking. The American Psychiatric Association in 2018 recommended naltrexone or acamprosate for patients with moderate to severe disorder. The group also suggested disulfiram to help people achieve abstinence and offer of topiramate or gabapentin to patients with moderate to server disorder who cannot take other recommended medications.
Other medications are available to treat the symptoms of alcohol withdrawal, such as shakiness, nausea, and sweating, that occur after someone with alcohol dependence stops drinking.
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Clinical trial information is constantly updated by the National Institutes of Health, and the most recent information on alcohol use disorder trials can be found at clinicaltrials.gov.
Alternative
Alternative treatments may be a helpful addition to care for the recovering alcoholic once the medical danger of withdrawal has passed. Stress is a drinking trigger for many people. Alternative therapies can help the recovering alcoholic eliminate or manage stress. These therapies include massage, meditation, hypnotherapy, yoga, and acupuncture.
Malnutrition caused by long-term alcohol use may be addressed by nutrition-oriented practitioners with careful attention to a healthy diet and the use of nutritional supplements such as vitamins A, B complex, and C, as well as certain fatty acids, amino acids , zinc, magnesium, and selenium.
Herbal treatments include milk thistle (Silybum marianum), which is thought to protect the liver against damage. Other herbs are thought to be helpful for the patient suffering through withdrawal. These include lavender (Lavandula officinalis), skullcap (Scutellaria lateriflora), chamomile (Matricaria recutita), peppermint (Mentha piperita), yarrow (Achillea millefolium), and valerian (Valeriana officinalis).
PROGNOSIS
The prognosis for recovery from alcoholism varies widely. The usual course of alcohol use disorder varies. The most common pattern is one of periodic attempts at abstinence alternating with relapses into uncontrolled drinking. On the other hand, it is thought that as many as 20% of persons diagnosed with milder alcohol use disorder achieve long-term sobriety even without medical treatment.
It is difficult to compare the outcomes of the various treatment approaches to alcoholism, in part because their definitions of success vary. Some researchers count only total abstinence from alcohol as a successful outcome, while others regard curtailed drinking and better social adjustment as indicators of success. The role of genetic factors in the prognosis is still disputed. Available evidence suggests that such factors as the presence of a spouse, partner, or close friend in the individual's life can outweigh genetic vulnerability to the disorder.
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QUESTIONS TO ASK YOUR DOCTOR
· Can alcoholism be treated without medications?
· How can I best understand the factors that led to my alcoholism?
· Will I recover?
· Are lifestyle changes required?
· Are there associated conditions that also require treatment?
Recovery from alcohol use disorder is a lifelong process. The potential for relapse remains present and must be acknowledged and respected. Many individuals stop drinking and then relapse multiple times before attaining extended periods of sobriety. Statistics suggest that, among middle-class alcohol-dependent individuals in stable financial and family situations who have undergone treatment, 60% or more successfully stop drinking for at least one year.
PREVENTION
Prevention must begin at a young age, since the first instance of intoxication usually occurs during the teenage years. It is particularly important that teenagers who are at high risk for alcohol use disorder—those with a family history of alcoholism, early or frequent use of alcohol, a tendency to drink to drunkenness, alcohol use that interferes with school work, a poor family environment, or a history of domestic violence—receive education about alcohol and its long-term effects. How this is best achieved, without alienating these young people and thus losing their attention, is the subject of continuing debate and study.
Source Citation (MLA 8th Edition)
Frey, Rebecca J., PhD, et al. "Alcohol Use Disorder." The Gale Encyclopedia of Mental Health, edited by Brigham Narins, 4th ed., vol. 1, Gale, 2019, pp. 52-60. Gale Ebooks, https://link.gale.com/apps/doc/CX2491200024/GVRL?u=txshracd2500&sid=GVRL&xid=3dfb3d32. Accessed 17 Oct. 2019.