Alcoholism

Alcoholism is when someone keeps drinking alcohol even though it causes problems in their life. This can mean they feel they need to drink to feel okay, or they can't stop even when they want to. It has been known since ancient times, and today, many people around the world struggle with it.

Drinking a lot over a long time can hurt many parts of the body, especially the brain, heart, and liver. It can cause trouble sleeping, memory problems, and increase the chance of getting serious illnesses like dementia or cancer. It can also make the heart beat irregularly and weaken the immune system. Stopping suddenly can be very dangerous.

Alcoholism can shorten a person's life by about 10 years. Drinking while pregnant can harm the baby, and drinking while driving can lead to accidents. It is linked to many types of crime as well. Both family history and environment play roles in whether someone develops alcoholism. Having a close family member with the condition makes it more likely, but not everyone will develop it. Stress, anxiety, and easy access to alcohol also increase the risk.

Treating alcoholism often needs careful medical help because stopping alcohol can be very unsafe without support. Some medicines can help, and counseling or support groups like Alcoholics Anonymous are often used to help people stay sober. These groups have been shown to help many people stay healthy and avoid drinking.

Signs and symptoms

Drinking alcohol too much can cause big problems. When someone drinks more than they should, especially all at once, it is called binge drinking. This is a common way people struggle with alcohol.

When someone drinks too much over time, their body can get used to it. This means they need more alcohol to feel the same way, and it becomes hard to stop drinking. This can make them feel very eager to drink and can hurt their mind and body. It can also lead to feeling very sad.

There are many signs that show someone might be struggling with drinking too much. They might drink more than they plan to, forget things they did while drinking, or keep promising to stop but can’t. They might also have trouble at work or school, feel worse about themselves, or have problems with family and friends.

Drinking too much can also cause problems right away. It can make someone feel very happy and confident at first, but as they drink more, they might feel sleepy, have trouble balancing, or even pass out. Very high levels of alcohol in the blood can be very dangerous and even cause death.

Over time, drinking too much can hurt many parts of the body, like the liver, heart, and brain. It can also cause problems with memory, mood, and the way a person thinks. It can lead to serious health issues and even shorten a person’s life. Women often experience these problems faster than men.

People who struggle with alcohol might also have other mental health issues, like feeling very worried or sad. These can make it even harder to stop drinking. Alcohol can also cause problems in relationships and at work, leading to more stress and loneliness.

Causes

A mix of genetic and environmental factors affects the chances of someone developing alcoholism. Genes play a role in how the body processes alcohol, and having a family history of alcoholism can increase risk. Starting to drink at a young age can also raise the chances of depending on alcohol later in life.

Severe experiences in childhood can also make someone more likely to struggle with alcohol. Not having good support from family or friends can increase this risk. The way genes work during teenage years can make the brain more sensitive to the harmful effects of drinking too much alcohol for a long time.

Diagnosis

Because there is disagreement on the definition of the word alcoholism, it is not a recognized diagnosis, and the use of the term alcoholism is discouraged due to its heavily stigmatized connotations. It is classified as alcohol use disorder in the DSM-5 or alcohol dependence in the ICD-11. In 1979, the World Health Organization discouraged the use of alcoholism due to its inexact meaning, preferring alcohol dependence syndrome.

Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker. The Dietary Guidelines for Americans, issued by the United States Department of Agriculture (USDA) in 2005, defines "moderate use" as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a two-hour period. According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits. Despite this risk, a 2014 report in the National Survey on Drug Use and Health found that only 10% of either "heavy drinkers" or "binge drinkers" defined according to the above criteria also met the criteria for alcohol dependence, while only 1.3% of non-binge drinkers met the criteria.

The term alcoholism is commonly used amongst laypeople, but the word is poorly defined. In 1992, it was defined by the National Council on Alcoholism and Drug Dependence (NCADD) and ASAM as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking." MeSH has had an entry for alcoholism since 1999, and references the 1992 definition.

In professional and research contexts, the term alcoholism is not currently favored, but rather alcohol abuse, alcohol dependence, or alcohol use disorder are used.

In the United States, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most common diagnostic guide for mental disorders, whereas most countries use the International Classification of Diseases (ICD) for administrative and diagnostic purposes. The two manuals use similar but not identical nomenclature to classify alcohol problems.

Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol use disorder. This is more of a barrier for women than men, as the fear of stigmatization may lead women to deny that they have a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know has alcohol use disorder. In contrast, reduced fear of stigma may lead men to admit that they are having a medical condition, to display their drinking publicly, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is someone with an alcohol use disorder.

While screening for alcohol misuse is recommended among those over the age of 18, the screening interval is not well established. Some national organizations recommend screening adolescents 12 years and older. Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self-reports in questionnaire form.

The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.

Two "yes" responses indicate that the respondent should be investigated further.

The questionnaire asks the following questions:

1. Have you ever felt you needed to cut down on your drinking?
2. Have people annoyed you by criticizing your drinking?
3. Have you ever felt guilty about drinking?
4. Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?

The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems; however, it has limitations in people with less severe alcohol-related problems, white women and college students.

Other tests are sometimes used for the detection of alcohol dependence, such as the Alcohol Dependence Data Questionnaire, which is a more sensitive diagnostic test than the CAGE questionnaire. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use. The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses, driving under the influence being the most common.

Alcohol use is generally measured by self-reporting, but in clinical settings biomarkers are recommended. Various biological markers are used to assess chronic or recent use of alcohol, one common test being that of blood alcohol content (BAC). Monitoring levels of gamma-glutamyl transpeptidase (GGT) is sometimes used to assess continued alcohol intake. But levels of GGT are elevated in only half of men with alcohol use disorder, and it is less commonly elevated in women and younger people. GGT levels remain persistently elevated for many weeks with continued drinking, with a half life of 2–3 weeks, making the GGT level a useful assessment of continued and chronic alcohol use. However, elevated levels of GGT may also be seen in non-alcohol related liver diseases, diabetes, obesity or overweight, heart failure, hyperthyroidism and some medications. Phosphatidylethanol (PEth) is a biomarker that is present in the red blood cells for several weeks after drinking, with its levels grossly corresponding to amount of alcohol consumed, and a detection limit as long as 5 weeks, making it a useful test to assess continued alcohol use. Phosphatidylethanol is considered to have a high specificity, which means that a negative test result is very likely to mean the subject is not alcohol dependent. Studies have consistently measured PEth specificity of 100%.

Ethyl glucuronide may be measured to assess recent alcohol intake, with levels being detected in urine up to 48 hours after alcohol intake. However, it is a poor measure of the amount of alcohol consumed. Measurement of ethanol levels in the blood, urine and breath are also used to assess recent alcohol intake, often in the emergency setting.

Prevention

Further information: Alcohol education

The World Health Organization, the European Union, and other groups have created rules to help lower the harm caused by drinking too much alcohol. Some ways to help include making alcohol harder to buy for younger people, such as raising the age you need to be to purchase it, and limiting ads for alcohol. Another way is to make alcohol more expensive, because when prices go up, people often buy and drink less.

Good information shared through TV, radio, and other media can also help people understand why drinking too much can be bad. Parents can also learn tips to help their children avoid drinking too much. Since some people drink to feel better when they are worried or stressed, reducing stress can also help prevent problems with alcohol.

Management

Treatments for alcoholism differ because there are many ways to think about it. Some see it as a medical issue, while others think it is a choice. Most treatments aim to help people stop drinking, followed by support to avoid starting again. Because many factors encourage drinking, all must be addressed to prevent returning to alcohol.

One common method is to stop drinking completely and then join support groups or learn new ways to cope. Some prefer ways to reduce harm rather than stop entirely. Medical help may include special medicines or therapy to manage withdrawal symptoms and support staying alcohol-free.

Research

Topiramate has been found helpful for people who want to stop drinking or drink less. It works by changing how the brain processes certain messages.

Baclofen, a GABA_B receptor medicine, is being studied to help with drinking problems, but more research is needed to know if it is safe and effective.

Some medicines and substances might be used along with alcohol treatment. For example, benzodiazepine dependence is common among people who struggle with alcohol. These medicines can increase the desire to drink and the amount consumed. Careful steps are needed when reducing these medicines to avoid health issues.

People with alcohol problems might also use other substances like opiates or illegal drugs, which can make their situation more complex.

Epidemiology

The World Health Organization estimates that in 2016, about 380 million people around the world struggled with drinking too much alcohol. This affects about 5.1% of people over 15 years old, especially more men and younger adults. It is least common in Africa but most common in Eastern Europe.

In the United States in 2015, about 17 million adults and around 700,000 teenagers between 12 and 17 years old were affected by drinking too much. Many people in the United States and Western Europe have dealt with drinking problems at some point in their lives. Scientists agree that drinking too much can be a health issue, influenced by both genes and environment, often starting in teenage years or early adulthood.

Prognosis

Alcoholism can shorten a person's life by about ten years. The biggest health risks come from problems with the heart. Many people struggle with strong feelings that can lead to difficult decisions.

Some people with alcohol dependence can return to drinking in a safer way after a year, though many need support to stay healthy. Studies show that keeping to safer drinking habits is challenging over many years.

History

Alcohol has been used and sometimes misused for a very long time. Ancient writings from places like Egypt and Babylon talk about problems with drinking too much. Some cultures even worshipped alcohol, while others warned against drinking too much.

A long time ago, people began to notice that drinking too much alcohol could hurt the body. In the 1700s, a doctor named Benjamin Rush said that alcohol could cause health problems. Later, doctors started looking at both the alcohol and the person drinking to understand these problems better. The word alcoholism was first used in 1852 by a doctor named Magnus Huss to describe the bad effects of alcohol on the body.

In the early 1900s, many people joined groups that wanted to stop alcohol use, which led some countries to ban alcohol for a time. These bans helped reduce some health problems related to alcohol. Today, the cost of alcohol misuse is very high, affecting health and the economy.

Evolution

Alcoholism is a complex issue that has deep roots in human history. One way scientists study it is by looking at how humans evolved. Early humans often ate fruits that had naturally fermented, which contained a type of alcohol called ethanol. This ethanol gave them extra energy and nutrients, giving those who could find and eat these fruits an advantage. Over time, some people may have developed a natural preference for these fermenting fruits, which could explain why some individuals today are more likely to struggle with alcoholism.

As humans evolved, they lived in areas where fruits fermented quickly. This led to adaptations that made them prefer ethanol. Even small amounts of ethanol might have offered health benefits, similar to how small amounts of stress can be helpful. However, in today’s world, alcohol is easy to find and consume in large amounts, which can lead to problems. Just as easy access to sugary and fatty foods can lead to obesity, easy access to alcohol can lead to alcoholism.

Society and culture

Long-term drinking of alcohol can cause many problems for society. It can lead to lost work hours, medical costs from injuries, and expenses for treatment centers. Alcohol use often contributes to head injuries, car accidents, violence, and other serious issues.

The economic costs of alcohol misuse can be very high, taking up a large part of a country's money used for goods and services. In some places, these costs are a big part of all the money spent on drug misuse. For example, in the United Kingdom, the cost was estimated to be a large amount of money in 2001, and in the United States, it was even higher in 2006.

The idea of "hitting rock bottom" means reaching a very low point in life because of alcohol misuse. This might involve losing a job, harming relationships, or facing health problems. Some groups and researchers talk about this idea when helping people change their behavior.

Stereotypes about alcohol use appear in stories and popular culture. For example, the "town drunk" is a common character. These stereotypes can sometimes be based on unfair views about different groups of people. Studies show that alcohol use varies in different countries and cultures.

Some natural substances, like peyote, have been studied for their possible help in treating alcohol misuse.