Alcoholism From Wikipedia, the free encyclopedia Jump to: navigation, search Alcoholism Classification and external resources "King Alcohol and his Prime Minister" circa 1820 ICD-10 F 10. .2 ICD-9 303 MedlinePlus alcoholism MeSH D000437 Alcoholism is a disabling addictive disorder. It is characterized by compulsive and uncontrolled consumption of alcohol despite its negative effects on the drinker's health, relationships, and social standing. Like other drug addictions, alcoholism is medically defined as a treatable disease.[1] The term alcoholism is widely used, and was first coined in 1849 by Magnus Huss, but in medicine the term was replaced by the concepts of "alcohol abuse" and "alcohol dependence" in the 1980s DSM III.[2] (The term alcohol dependence is sometimes used as a synonym for alcoholism,[3][4] sometimes in a narrower sense.) Similarly in 1979 an expert World Health Organisation committee disfavoured the use of "alcoholism" as a diagnostic entity, preferring the category of "alcohol dependence syndrome".[5] In the nineteenth and early twentieth centuries, alcohol dependence was called dipsomania before the term "alcoholism" replaced it.[6] The biological mechanisms underpinning alcoholism are uncertain, however, risk factors include social environment, stress,[7] mental health, genetic predisposition, age, ethnic group, and sex.[8][9] Long-term alcohol abuse produces physiological changes in the brain such as tolerance and physical dependence. Such brain chemistry changes maintain the alcoholic's compulsive inability to stop drinking and result in alcohol withdrawal syndrome upon discontinuation of alcohol consumption.[10] Alcohol damages almost every organ in the body, including the brain; because of the cumulative toxic effects of chronic alcohol abuse, the alcoholic risks suffering a range of medical and psychiatric disorders.[11] Alcoholism has profound social consequences for alcoholics and the people of their lives.[12][13] Alcoholism is the cyclic presence of tolerance, withdrawal, and excessive alcohol use; the drinker's inability to control such compulsive drinking, despite awareness of its harm to his or her health, indicates that the person might be an alcoholic.[14] Questionnaire-based screening is a method of detecting harmful drinking patterns, including alcoholism.[15] Alcohol detoxification is conducted to withdraw the alcoholic person from drinking alcohol, usually with cross-tolerance drugs, e.g. benzodiazepines to manage withdrawal symptoms.[16] Post-medical care, such as group therapy, or self-help groups, usually is required to maintain alcoholic abstention.[17][18] Often, alcoholics also are addicted to other drugs, most often benzodiazepines, which might require additional medical treatment.[19] The alcoholic woman is more sensitive to alcohol's deleterious physical, cerebral, and mental effects, and increased social stigma, in relation to a man, for being an alcoholic.[20][21] The World Health Organisation estimates that there are 140 million alcoholics worldwide.[22][23] Moderate use is defined by The Dietary Guidelines for Americans as no more than two alcoholic beverages per day for men and no more than one alcoholic beverage per day for women.[24] The term "alcoholism" is commonly used, but poorly defined. The WHO calls alcoholism "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO Expert Committee. The Big Book (from Alcoholics Anonymous) states that once a person is an alcoholic, they are always an alcoholic, but does not define what is meant by the term "alcoholic" in this context. In 1960, Bill W., co-founder of AA, said: We have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always called it an illness, or a malady -- a far safer term for us to use.[25] In professional and research contexts, the term "alcoholism" sometimes encompasses both alcohol abuse and alcohol dependence.[26] and sometimes is considered equivalent to alcohol dependence. In psychology and psychiatry, the DSM is the most common global standard, while in medicine, the standard is ICD. The terms they recommend are similar but not identical: Organization Preferred term(s) Definition • alcohol abuse = repeated use despite recurrent adverse consequences.[27] • alcohol dependence = alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to "alcohol abuse" drink.[27] APA's DSM- and "alcohol IV The term "alcoholism" was split into "alcohol abuse" and dependence" "alcohol dependence" in 1980's DSM-III, and in 1987's DSM- III-R behavioral symptoms were moved from "abuse" to "dependence".[2] It has been suggested that DSM-V merge alcohol abuse and alcohol dependence into a single new entry, [28] named "alcohol-use disorder".[29] Definitions are similar to that of the DSM-IV. The World Health Organisation uses the term alcohol dependence "alcohol harmful syndrome rather than alcoholism.[5] The concept of "harmful WHO's ICD- use" and "alcohol use" (as opposed to "abuse") was introduced in 1992's ICD-10 10 dependence to minimize underreporting of damage in the absence of syndrome" dependence.[2] The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and ICD-9.[30] Despite the imprecision inherent in the term, there have been attempts to define how the word "alcoholism" should be interpreted when encountered. In 1992, it was defined by the 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."[31] MeSH has had an entry for "alcoholism" since 1999, and references the 1992 definition.[32] Contents [hide] • 1 Etymology • 2 Signs and symptoms ○ 2.1 Symptoms of long term alcohol misuse 2.1.1 Physical symptoms 2.1.2 Psychiatric symptoms 2.1.3 Social effects ○ 2.2 Alcohol withdrawal • 3 Causes ○ 3.1 Genetic variation • 4 Pathophysiology • 5 Diagnosis ○ 5.1 Social barriers ○ 5.2 Screening ○ 5.3 Genetic predisposition testing ○ 5.4 DSM diagnosis ○ 5.5 Urine and blood tests • 6 Prevention • 7 Management ○ 7.1 Detoxification ○ 7.2 Group therapy and psychotherapy ○ 7.3 Rationing and moderation ○ 7.4 Medications ○ 7.5 Dual addictions • 8 Epidemiology • 9 Prognosis • 10 History • 11 Society and culture • 12 See also • 13 References • 14 Further reading • 15 External links [edit] Etymology 1904 advertisement describing alcoholism as a disease. Historically the name dipsomania was coined by German physician Dr. C. W. Hufeland in 1819 before it was superseded by alcoholism.[33][34] The term "alcoholism" was first used in 1849 by the Swedish physician Magnus Huss to describe the systematic adverse effects of alcohol.[35] AA describes alcoholism as an illness that involves a physical allergy[36]:p.28 and a mental obsession.[36]:p.23[37] Note that the definition of "allergy" used in this context is not the same as used in modern medicine.[38] The doctor and addiction specialist Dr. William D. Silkworth M.D. writes on behalf of AA that "Alcoholics suffer from a "(physical) craving beyond mental control".[36]:XXVI A 1960 study by E. Morton Jellinek is considered the foundation of the modern disease theory of alcoholism.[39] Jellinek's definition restricted the use of the word "alcoholism" to those showing a particular natural history. The modern medical definition of alcoholism has been revised numerous times since then. The American Medical Association currently uses the word alcoholism to refer to a particular chronic primary disease.[40] A minority opinion within the field, notably advocated by Herbert Fingarette and Stanton Peele, argue against the existence of alcoholism as a disease. Critics of the disease model tend to use the term "heavy drinking" when discussing the negative effects of alcohol consumption. [edit] Signs and symptoms [edit] Symptoms of long term alcohol misuse Main article: Long-term effects of alcohol 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.[10] Alcoholism can have adverse effects on mental health, causing psychiatric disorders to develop and an increased risk of suicide.[41][42] [edit] 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.[43][44] Women develop long-term complications of alcohol dependence more rapidly than do men. Additionally, women have a higher mortality rate from alcoholism than men.[20] Examples