Alcoholism is a major and severe problem in the United States and Canada as well as in many countries around the globe. It not only negatively affects the lives of the alcoholics themselves but also has an extended and even lifelong effect on the lives of their family members. Alcoholism affects individuals in the workplace, where the alcoholic’s work performance is usually impaired, and in the general economy, where the overall work productivity is shortchanged when all alcoholics are considered.
Yet according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), some studies of primary care practices have shown that alcoholics receive an assessment by a medical professional and a referral to treatment only about 10 percent of the time. According to a study released by the Substance Abuse and Mental Health Services Administration in 2004, in considering the state averages of the percentages of people with alcohol dependence, the nationwide average statewide percentage for individuals ages 12 years and older for 2002 was 3.
percent of the population, with the highest nationwide percentage seen among young adults ages 18-25 years, or 7 percent. In considering alcohol dependence on a state-by-state basis, the highest percentage of alcohol dependence was in the District of Columbia (5. 20 percent) and the lowest rate in Pennsylvania: 2. 79 percent. Genetic IssuesThere is a family history of alcoholism among many alcoholics and this may be due at least in part to a genetic predisposition.
Studies of adoptees and their adoptive parents, with no genetic relationship to each other, have indicated that adopted adults (especially males) who have birth parents who are alcoholics have an increased risk for the development of alcoholism themselves. According to a 2002 article in Alcohol Research Health, studies of adopted individuals showed that males whose birth parents were alcoholics had a 1. 6 to 3. 6 times greater risk for alcoholism compared to adopted men with no birth family history of alcoholism.
The results were not clear-cut for adopted females. Some studies of adopted females showed an increased risk for alcoholism among women with a family history of alcoholism, and others did not. In another study of about 1,000 alcoholic subjects and their families, described in 2002 in Alcohol Research Health, the researchers found a genetic linkage in sibling pairs on the traits of alcoholism and depression, located on chromosome They also found possible evidence of a genetic link to alcohol dependence on chromosome
Psychiatric Problems and AlcoholismMany alcoholics also have psychiatric problems, such as depression, anxiety disorders, and other disorders; for example, alcoholics have nearly four times the risk of experiencing depression of nonalcoholics, nearly four times the risk of schizophrenia, and more than twice the risk for an anxiety disorder. Other studies have shown that 15-20 percent of alcoholic males and 10 percent of alcoholic females have Antisocial Personality Disorder.
In addition, eating disorders are often associated with alcoholism, particularly anorexia nervosa or bulimia nervosa, according to research discussed in 2002 in Alcohol Research Health. This does not mean that alcoholism causes these disorders, although it may trigger disorders in those with genetic predispositions toward them. It may also mean that individuals who have these disorders, particularly those who are untreated, are more likely to become alcoholics, perhaps in an attempt to self-medicate.
Researchers continue to argue over cause and effect when both alcoholism and psychiatric disorders are present in an individual, but the one point that they agree upon is that psychiatric disorders are more common among those who are alcoholics. Symptoms and Diagnostic PathThere are several classic symptoms of alcoholism, particularly when the individual is undergoing withdrawal and/or suffering from delirium tremens.
According to the NIAAA, alcoholism is characterized in individuals by the presence of three or more of the following indicators:- a tolerance to alcohol (more alcohol is needed to achieve intoxication than in the past)- withdrawal symptoms (when alcohol is not consumed, physical symptoms occur, such as nausea, sweating, and shakiness)- use of the substance in a larger quantity than was intended- the persistent desire to cut down or to control the use of alcohol- a significant amount of time spent on obtaining, using, or recovering from alcohol- drinking that occurs to prevent the symptoms of withdrawal- neglect of an individual’s normal social, occupational, or recreational tasks- continued use of alcohol despite the physical and psychological problems of the userIn addition to the NIAAA criteria, the following criteria may also be used for individuals to self-evaluate: the CAGE questionnaire. The individual is to ask himself or herself the following questions:- Have you ever felt the need to Cut down on your drinking? C)- Have you ever felt Annoyed by criticism of your drinking? (A)- Have you ever had Guilty feelings about your drinking? (G)- Have you ever taken a morning Eye opener? (E)If a person answers yes to one or more of the CAGE criteria, this suggests that he or she should be evaluated for alcoholism. If the person answers yes to two or more questions, it is likely the individual is an alcoholic. However, one major problem with the CAGE questions is that they do not distinguish between the past and current use of alcohol, and thus a recovering alcoholic could also respond positively to two or more questions. There are other means to evaluate whether alcohol abuse or dependence is a problem.
According to the NIAAA, physicians can assess patients for alcohol dependence by using the following guidelines provided in Helping Patients Who Drink Too Much: A Clinician’s Guide in 2005. Determine whether, in the past 12 months, your patient’s drinking has repeatedly caused or contributed to- role failure (interference with home, work, or school obligations- risk of bodily harm (drinking and driving, operating machinery, swimming)- run-ins with the law (arrests or other legal problems)- relationship trouble (family or friends)If yes to one or more than your patient has alcohol abuse. In either case, proceed to assess for dependence symptoms.
Determine whether, in the past 12 months, your patient has- shown tolerance (needed to drink a lot more to get the same effect)- shown signs of withdrawal (tremors, sweating, nausea, or insomnia when trying to quit or cut down)- not been able to stick to drinking limits (repeatedly gone over them)- not been able to cut down or stop (repeated failed attempts)- spent a lot of time drinking (or anticipating or recovering from drinking)- spent less time on other matters (activities that had been important or pleasurable)- kept drinking despite problems (recurrent physical or psychological problems)If yes to three or more than your patient has alcohol dependence. Treatment Options and OutlookSome individuals are treated for their alcoholism on an outpatient basis, while others receive treatment in a rehabilitative facility.
Of course many patients who have alcoholism are not treated at all, because they do not acknowledge that they have alcoholism, do not wish to receive treatment, or are not referred for treatment. According to information from the Treatment Episode Data Set (TEDS) on individuals receiving substance abuse treatment in the United States, 42 percent of patients admitted into treatment facilities had alcohol as their primary substance of abuse. Of those admitted for alcohol abuse, in about 75 percent of the cases, alcohol was the sole substance that was the individual’s problem. In 74 percent of the cases, the admitted patients were males. Treatment may include medications, such as Acamprosate (Campral), Naltrexone (Revia), or Disulfiram (Antabuse).
In addition, Benzodiazepines may be used to help alcoholics who are suffering from the symptoms of withdrawal. Behavioral therapy is also used effectively to treat alcoholism. Many patients benefit from self-help groups, such as Alcoholics Anonymous. Risk Factors and Preventive MeasuresAs discussed, many studies indicate that there are genetic predispositions to alcohol abuse and alcoholism; however, it is important to note that the children of alcoholics are not doomed to become alcoholics themselves. Some children of alcoholics choose never to drink, lest they risk developing the problem. Some others are able to drink in moderation without developing a problem with alcohol abuse or dependence. However, the best way to avoid alcoholism is to avoid alcohol altogether or to drink in moderation only.
Cite this National Institute on Alcohol Abuse and Alcoholism
National Institute on Alcohol Abuse and Alcoholism. (2016, Sep 17). Retrieved from https://graduateway.com/national-institute-on-alcohol-abuse-and-alcoholism/