ALCOHOLISM

Submitted by:

Richelle M. Santos

Submitted to:

Mrs. Baltazar
Alcoholism
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. 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. (The term alcohol dependence is
sometimes used as a synonym for alcoholism, sometimes in a narrower sense.)
Similarly in 1979 an expert World Health Organization committee disfavored the
use of "alcoholism" as a diagnostic entity, preferring the category of "alcohol
dependence syndrome". In the nineteenth and early twentieth centuries, alcohol
dependence was called dipsomania before the term "alcoholism" replaced it.

The biological mechanisms underpinning alcoholism are uncertain,

however, risk factors include social, stress, mental health, genetic predisposition,
age, ethnic group, and sex. 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. 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. Alcoholism
has profound social consequences for alcoholics and the people in their lives.

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. Questionnaire-based screening is a method of detecting harmful
drinking patterns, including alcoholism. Alcohol Detoxification is conducted to
withdraw the alcoholic person from drinking alcohol, usually with cross-tolerance
drugs, e.g. benzodiazepines to manage withdrawal symptoms. Post-medical
care, such as group therapy, or self-help groups, usually is required to maintain
alcoholic abstention. Often, alcoholics also are addicted to other drugs, most
often benzodiazepines, which might require additional medical treatment. 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. The World Health Organization estimates that there are 140 million
alcoholics worldwide.

PHILIPPINES (THE)

Recorded adult per capita consumption (age 15+)

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends
2003

Lifetime abstainers
 Data from the 2003 World
Health
Survey. Total sample size n
= 10
034; males n = 4639 and
females
n = 5395. Sample population
aged 18 years and above.

Estimates from key alcohol experts show that the proportion of adult males and
females who had been abstaining (last year before the survey) was 10% (males)
and 70% (females). Data is for after year 1995.

Heavy and hazardous drinkers

Data from the 2003 World Health

A Survey.
2001Total
survey of
sample size n = 10
034; males n = 4639 and females
n = 5395. Sample population
subjects aged between
aged 18 years and above.
Definition used: average
15consumption
and 74ofyears (total
40 g or more of
pure alcohol a day for men and 20
sample
g or more size n = 10
of pure alcohol a day
for women.
240) found that the rate
of regular drinking was
11.1% (total), 13% (males) and 5.9% (females). Regular drinking was defined as
drinking on four days or more per week.

According to the 2003 World Health Survey (total sample size n = 4951; males
n = 3430 and females n = 1521), the mean value (in grams) of pure alcohol
consumed per day among drinkers was 4.8 (total), 6.1 (males) and 2.0
(Females).
Heavy episodic drinkers
A 2001 survey (sub sample size of drinkers n = 3529; age group 15 to 74 years
old) found that among drinkers 4.8% were heavy drinkers. 6.6% of male drinkers
and 1.3% of female drinkers were heavy drinkers. Heavy drinking was defined as
having more than 12 drinks on an average drinking day.

Youth drinking (lifetime abstainers)

Youth drinking (current drinkers)

A 2001 survey (total sample size n = 1105; age group 15 to 19 years old) found
that 24.3% of the total population sampled were current drinkers. 42.4% of males
and 11.1% of females were reported to be currently drinking alcohol.
Youth survey interviewed a national sample of 5266 men and 5612 women aged
15 to 24 in 1994. Data for age group 15 to 19 years old show that the rate of
current drinkers among males was 47% and 12% among females.

According to a cross-sectional, three-stage stratified cluster sampling

representing 16 health regions of the country (total sample size n = 4198; aged
15–29 years old), the prevalence of alcohol use among Filipino youth is 39%;
males (66.5%) are twice more likely than females (33.5%) to drink alcohol. Seven
out of ten youth drinkers are light drinkers (70%), three out of ten are moderate
drinkers, and only 4% are heavy drinkers

Youth drinking (heavy episodic drinkers)

A 2001 survey (total sample size n = 1105; age group 15 to 19 years old) found
that 2.6% of the total population sampled were heavy drinkers. Heavy drinking
was defined as having more than 12 drinks on an average drinking day.

Traditional alcoholic beverages

Basi (sugar-cane wine) is made in the Philippines. It is made by fermenting

boiled, freshly extracted sugar-cane juice. A dried powdered starter is used to
start the fermentation. The mixture is left for up to three months to ferment and
up to one year to age. The final product is light brown in color and has a sweet
and sour flavor.
Unrecorded alcohol consumption

The unrecorded alcohol consumption in the Philippines is estimated to be 3.0

litres pure alcohol per capita for population older than 15 for the years after 1995
(estimated by a group of key alcohol experts).

Mortality rates from selected death causes where alcohol is one of the
underlying risk factors
The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or
indirect contributor.

Chronic mortality

Morbidity, health and social problems from alcohol use

There is little data available on the extent of alcoholism or alcohol abuse in

the Philippines. However, while there may be no official statistics available, the
consequences of alcoholism are very obvious in the community or inside homes.
There are many undocumented cases of alcoholic persons who collapsed in the
street because of drunkenness. Alcoholism is a growing concern in the culture
and social life of this country. In recent years, only a few alcohol-related cases
have been recorded by the Philippine General Hospital. This could be due to the
fact that alcoholism is not considered a medical problem by most Filipinos. Most
Filipinos with an alcohol problem do not submit to medical treatment even if their
condition is chronic. Alcohol rehabilitation centers have low admission rates
compared to similar institutions for illicit drug dependency. The Philippine
General Hospital alcohol support group centre offers treatment and counseling
for its indigent patients. For anonymity, patients from rich families go to private
rehabilitation centers. There are also some non-governmental organizations
which provide similar services and carry out advocacy work. However, more
effort is still needed in the Philippines in order to address the problems of alcohol
abuse.

Signs and Symptoms

Long term misuse

Alcoholism is characterized 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. Alcoholism
can have adverse effects on mental health, causing psychiatric disorders
to develop and an increased risk of suicide.

Physical

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 system and peripheral nervous system can occur
from sustained alcohol consumption.

Women develop long-term complications of alcohol dependence more

rapidly than do men. Additionally, women have a higher mortality rate from
alcoholism than men. Examples of long term complications include brain, heart,
and liver damage and an increased risk of breast cancer. Additionally, heavy
drinking over time has been found to have a negative effect on reproductive
functioning in women. This result in reproductive dysfunction such as an
ovulation, decreased ovarian mass, problems or irregularity of the menstrual
cycle, and early menopause. Alcoholic ketoacidosis can occur in individuals who
chronically abuse alcohol and have a recent history of binge drinking.

Psychiatric
 Long term misuse of alcohol can cause a wide range of mental health
problems. Severe cognitive problems are not uncommon; approximately 10
percent of all dementia cases are related to alcohol consumption, making it the
second leading cause of dementia. Excessive alcohol use causes damage to
brain function, and psychological health can be increasingly affected over time.

Psychiatric disorders are common in alcoholics, with as many as 25

percent suffering severe psychiatric disturbances. The most prevalent psychiatric
symptoms are anxiety and depression disorders. Psychiatric symptoms usually
initially worsen during alcohol withdrawal, but typically improve or disappear with
continued abstinence.
Psychosis, confusion, and organic brain syndrome may be caused by alcohol
misuse, which can lead to a misdiagnosis such as schizophrenia. Panic
disorder can develop or worsen as a direct result of long term alcohol misuse.

The co-occurrence of major depressive disorder and alcoholism is well

documented. Among those with comorbid occurrences, a distinction is commonly
made between depressive episodes that remit with alcohol abstinence
("substance-induced"), and depressive episodes that are primary and do not
remit with abstinence ("independent" episodes). Additional use of other drugs
may increase the risk of depression.

Psychiatric disorders differ depending on gender. Women who have

alcohol-use disorders often have a co-occurring psychiatric diagnosis such as
major depression, anxiety, panic disorder, bulimia, post-traumatic stress
disorder (PTSD), or borderline personality disorder. Men with alcohol-use
disorders more often have a co-occurring diagnosis of narcissistic or antisocial
personality disorder, bipolar disorder, schizophrenia, impulse disorders
or attention deficit/hyperactivity disorder. Women with alcoholism are more likely
to have a history of physical or sexual assault, abuse and domestic violence than
those in the general population, which can lead to higher instances of psychiatric
disorders and greater dependence on alcohol.

Social effects

The social problems arising from alcoholism are serious, caused by the
pathological changes in the brain and the intoxicating effects of alcohol. Alcohol
abuse is associated with an increased risk of committing criminal offences,
including child abuse, violence, rape, burglary and assault. Alcoholism is
associated with loss of employment,[64] which can lead to financial problems.
Drinking at inappropriate times and behavior caused by reduced judgment, can
lead to legal consequences, such as criminal charges for driving or public
disorder, or civil penalties for tortious behavior, and may lead to a criminal
sentence.

An alcoholic's behavior and mental impairment, while drunk, can

profoundly impact those surrounding them and lead to isolation from family and
friends. This isolation can lead to marital conflict and divorce, or contribute
to domestic violence. Alcoholism can also lead to child neglect, with subsequent
lasting damage to the emotional development of the alcoholic's children.

Alcohol withdrawal

As with similar substances with a sedative-hypnotic mechanism,

such as barbiturates and benzodiazepines, withdrawal from alcohol
dependence can be fatal if it is not properly managed. Alcohol's
primary effect is the increase in stimulation of the GABAA receptor,
promoting central nervous system depression. With repeated heavy
consumption of alcohol, these receptors are desensitized and
reduced in number, resulting in tolerance and physical dependence.
When alcohol consumption is stopped too abruptly, the person's
 nervous system suffers from uncontrolled synapse firing. This can
result in symptoms that include anxiety, life threatening seizures,
delirium tremens, hallucinations, shakes and possible heart failure.
Other neurotransmitter systems are also involved, especially
dopamine, NMDA and glutamate.

Acute withdrawal symptoms tend to subside after one to three

weeks. Less severe symptoms (e.g. insomnia and
anxiety, anhedonia) may continue as part of a post withdrawal
syndrome gradually improving with abstinence for a year or more.
Withdrawal symptoms begin to subside as the body and central
nervous system restore alcohol tolerance and GABA functioning
towards normal.

Causes
A complex mixture of genetic and environmental factors influences
the risk of the development of alcoholism. Genes which influence the
metabolism of alcohol also influence the risk of alcoholism, and may
be indicated by a family history of alcoholism. One paper has found
that alcohol use at an early age may influence the expression of
genes which increase the risk of alcohol dependence. Individuals
who have a genetic disposition to alcoholism are also more likely to
begin drinking at an earlier age than average. Also, a younger age of
onset of drinking is associated with an increased risk of the
development of alcoholism, and about 40 percent of alcoholics will
drink excessively by their late adolescence. It is not entirely clear
whether this association is causal, and some researchers have been
known to disagree with this view.
 Severe childhood trauma is also associated with an general increase
in the risk of drug dependency. Lack of peer and family support is
associated with a increased risk of alcoholism developing. Genetics
and adolescence are associated with an increased sensitivity to the
neurotoxic effects of chronic alcohol abuse. Cortical degeneration
due to the neurotoxic effects increases impulsive behavior, which
may contribute to the development, persistence and severity of
alcohol use disorders. There is evidence that with abstinence, there
is a reversal of at least some of the alcohol induced central nervous
system damage.

Genetic variation

Genetic differences exist between different racial groups which

affect the risk of developing alcohol dependence. For example, there are
differences between African, East Asian and Indo-racial groups in how they
metabolize alcohol. These genetic factors are believed to, in part, explain
the differing rates of alcohol dependence among racial groups. The alcohol
dehydrogenase allele ADH1 B*3 causes a more rapid metabolism of
alcohol. The allele ADH1 B*3 is only found in those of African descent and
certain Native American tribes. African and Native Americans with this
allele have a reduced risk of developing alcoholism. Native
Americans however, have a significantly higher rate of alcoholism than
average; it is unclear why this is the case. Other risk factors such as
cultural environmental effects e.g. trauma have been proposed to explain
the higher rates of alcoholism among Native Americans compared to
alcoholism levels in Caucasians.

Pathophysiology
 Alcohol's primary effect is the increase in stimulation of
the GABAA receptor, promoting central nervous system depression.
With repeated heavy consumption of alcohol, these receptors are
desensitized and reduced in number, resulting
in tolerance and physical dependence. The amount of alcohol that
can be biologically processed and its effects differ between sexes.
Equal dosages of alcohol consumed by men and women generally
result in women having higher blood alcohol concentrations (BACs).
This can be attributed to many reasons, the main being that women
have less body water than men. A given amount of alcohol therefore
becomes more highly concentrated in a woman's body. A given
amount of alcohol causes greater intoxication for women due to
different hormone release compared to men.

Diagnosis
Social barriers

Attitudes and social stereotypes can create barriers to the detection

and treatment of alcohol abuse. This is more of a barrier for women
than men. Fear of stigmatization may lead women to deny that they
are suffering from 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 is an alcoholic.
In contrast, reduced fear of stigma may lead men to admit that they
are suffering from a medical condition, to publicly display their
drinking, 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 an alcoholic.

Screening
 Several tools may be used to detect a loss of control of alcohol use.
These tools are mostly self reports in questionnaire form. Another
common theme is a score or tally that sums up the general severity
of alcohol use.

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. The Alcohol Use
Disorders Identification Test (AUDIT), a screening questionnaire developed by
the World Health Organization, is unique in that it has been validated in six
countries and is used internationally. Like the CAGE questionnaire, it uses a
simple set of questions – a high score earning a deeper investigation.
The Paddington Alcohol Test (PAT) was designed to screen for alcohol related
problems amongst those attendingAccident and Emergency departments. It
concords well with the AUDIT questionnaire but is administered in a fifth of the
time.

Urine and blood tests

There are reliable tests for the actual use of alcohol, one common
test being that of blood alcohol content (BAC). These tests do not
differentiate alcoholics from non-alcoholics; however, long-term heavy
drinking does have a few recognizable effects on the body, including:

 Macrocytosis (enlarged MCV)

 Elevated GGT
 Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1
 High carbohydrate deficient transferrin (CDT)

However, none of these blood tests for biological markers is as sensitive as

screening questionnaires.

Prevention

The World Health Organization, the European Union and other regional
bodies, national governments and parliaments have formed alcohol policies in
order to reduce the harm of alcoholism. Targeting adolescents and young adults
is regarded as an important step to reduce the harm of alcohol abuse. Increasing
the age at which licit drugs of abuse such as alcohol can be purchased, the
banning or restricting advertising of alcohol has been recommended as additional
ways of reducing the harm of alcohol dependence and abuse. Credible, evidence
based educational campaigns in the mass media about the consequences of
alcohol abuse have been recommended. Guidelines for parents to prevent
alcohol abuse amongst adolescents and for helping young people with mental
health problems have also been suggested.

Management

Treatments are varied because there are multiple perspectives of

alcoholism. Those who approach alcoholism as a medical condition or disease
recommend differing treatments than, for instance, those who approach the
condition as one of social choice. Most treatments focus on helping people
discontinue their alcohol intake, followed up with life training and/or social
support in order to help them resist a return to alcohol use. Since alcoholism
involves multiple factors which encourage a person to continue drinking, they
must all be addressed in order to successfully prevent a relapse. An example of
this kind of treatment is detoxification followed by a combination of supportive
therapy, attendance at self-help groups, and ongoing development of coping
mechanisms. The treatment community for alcoholism typically supports an
abstinence-based zero tolerance approach; however, there are some who
promote a harm-reduction approach as well.

Detoxification

Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of

alcohol drinking coupled with the substitution of drugs, such
asbenzodiazepines, that have similar effects to prevent alcohol
withdrawal. Individuals who are only at risk of mild to moderate
withdrawal symptoms can be detoxified as outpatients. Individuals at
risk of a severe withdrawal syndrome as well as those who have
significant or acute comorbid conditions are generally treated as
inpatients. Detoxification does not actually treat alcoholism, and it is
 necessary to follow-up detoxification with an appropriate treatment
program for alcohol dependence or abuse in order to reduce the risk
of relapse.

Group therapy and psychotherapy

Various forms of group therapy or psychotherapy can be used to

deal with underlying psychological issues that are related to alcohol
addiction, as well as provide relapse prevention skills. The mutual-
help group-counseling approach is one of the most common ways of
helping alcoholics maintain sobriety. Alcoholics Anonymous was
one of the first organizations formed to provide mutual,
nonprofessional counseling, and it is still the largest. Others include
Life Ring Secular Recovery, SMART Recovery, and Women for
Sobriety.

Rationing and moderation

Rationing and moderation programs such as Moderation

Management and DrinkWise do not mandate complete abstinence.
While most alcoholics are unable to limit their drinking in this way,
some return to moderate drinking. A 2002 U.S. study by the National
Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7
percent of individuals diagnosed as alcohol dependent more than
one year prior returned to low-risk drinking. This group, however,
showed fewer initial symptoms of dependency. A follow-up study,
using the same subjects that were judged to be in remission in 2001–
2002, examined the rates of return to problem drinking in 2004–2005.
The study found abstinence from alcohol was the most stable form
of remission for recovering alcoholics. A long-term (60 year) follow-
up of two groups of alcoholic men concluded that "return to
 controlled drinking rarely persisted for much more than a decade
without relapse or evolution into abstinence."

Medications

A variety of medications may be prescribed as part of treatment for

alcoholism.

Medications currently in use

Antabuse (disulfiram) prevents the elimination of acetaldehyde, a chemical

the body produces when breaking down ethanol. Acetaldehyde itself
is the cause of many hangover symptoms from alcohol use. The
overall effect is severe discomfort when alcohol is ingested: an
extremely fast-acting and long-lasting uncomfortable hangover. This
discourages an alcoholic from drinking in significant amounts while
they take the medicine. A recent nine-year study found that
incorporation of supervised disulfiram and the related
compound carbamide into a comprehensive treatment program
resulted in an abstinence rate of over 50 percent.

Temposil (calcium carbimide) works in the same way as Antabuse; it has

an advantage in that the occasional adverse effects of
disulfiram, hepatotoxicity and drowsiness, do not occur with calcium
carbimide.

Naltrexone is a competitive antagonist for opioid receptors, effectively

blocking the effects of endorphins and opiates. Naltrexone is used to
decrease cravings for alcohol and encourage abstinence. Alcohol
causes the body to release endorphins, which in turn release
dopamine and activate the reward pathways; hence when naltrexone
is in the body there is a reduction in the pleasurable effects from
consuming alcohol. Naltrexone is also used in an alcoholism
 treatment method called the Sinclair Method, which treats patients
through a combination of Naltrexone and continued drinking.

Campral (acamprosate) stabilizes the brain chemistry that is altered due to

alcohol dependence via antagonising the actions of glutamate, a
neurotransmitter which is hyperactive in the post-withdrawal phase.
A 2010 review of medical studies demonstrated that acamprosate
reduces the incidence of relapse amongst alcohol dependent
persons.

A study of a large number (>27,000) of alcohol dependence-related

insurance claims suggested that healthcare utilization, such as the number
of inpatient detoxification days, alcoholism-related inpatient days, and
alcoholism-related emergency department visits was significantly reduced
in the patient population receiving alcoholism medications (naltrexone,
naltrexone XR [an injectible sustained-release form of naltrexone],
disulfiram [Antabuse], acomprosate) when compared to the patient
population that did not take any medications.

Experimental medications

Topamax (topiramate), a derivative of the naturally occurring sugar

monosaccharide D-fructose, has been found effective in helping
alcoholics quit or cut back on the amount they drink. Evidence
suggests that topiramate antagonizes excitatory glutamate
receptors, inhibits dopamine release, and enhances inhibitory
gamma-aminobutyric acid function. A 2008 review of the
effectiveness of topiramate concluded that the results of published
 trials are promising, however as of 2008, data was insufficient to
support using topiramate in conjunction with brief weekly
compliance counseling as a first-line agent for alcohol dependence.
A 2010 review found that topiramate may be superior to existing
alcohol pharmacotherapeutic options. Topiramate effectively
reduces craving and alcohol withdrawal severity as well as
improving quality-of-life-ratings.

Medications which may worsen outcome

Benzodiazepines, whilst useful in the management of acute alcohol

withdrawal, if used long-term cause a worse outcome in alcoholism.
Alcoholics on chronic benzodiazepines have a lower rate of
achieving abstinence from alcohol than those not taking
benzodiazepines. This class of drugs is commonly prescribed to
alcoholics for insomnia or anxiety management. Initiating
prescriptions of benzodiazepines or sedative-hypnotics in
individuals in recovery has a high rate of relapse with one author
reporting more than a quarter of people relapsed after being
prescribed sedative-hypnotics. Those who are long-term users of
benzodiazepines should not be withdrawn rapidly, as severe anxiety
and panic may develop, which are known risk factors for relapse into
alcohol abuse. Taper regimes of 6–12 months have been found to be
the most successful, with reduced intensity of withdrawal.

Dual addictions

Alcoholics may also require treatment for other psychotropic drug

addictions. The most common dual addiction in alcohol dependence is
abenzodiazepine dependence, with studies showing 10–20 percent of alcohol-
dependent individuals had problems of dependence and/or misuse problems of
benzodiazepines. Benzodiazepines increase cravings for alcohol and the volume
of alcohol consumed by problem drinkers. Benzodiazepine dependency requires
careful reduction in dosage to avoid benzodiazepine withdrawal syndrome and
other health consequences.

Dependence on other sedative hypnotics such as zolpidem and zopiclone

as well as opiates and illegal drugs is common in alcoholics. Alcohol itself is a
sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such
as barbiturates, benzodiazepines and nonbenzodiazepines. Dependence upon
and withdrawal from sedative hypnotics can be medically severe and, as with
alcohol withdrawal, there is a risk of psychosis or seizures if not managed
properly.

Epidemiology

Substance use disorders are a major public health problem facing many
countries. "The most common substance of abuse/dependence in patients
presenting for treatment is alcohol." In the United Kingdom, the number of
'dependent drinkers' was calculated as over 2.8 million in 2001.[119] About 12% of
American adults have had an alcohol dependence problem at some time in their
life. The World Health Organization estimates that about 140 million people
throughout the world suffer from alcohol dependence. In the United States and
Western Europe 10 to 20 percent of men and 5 to 10 percent of women at some
point in their lives will meet criteria for alcoholism.

Within the medical and scientific communities, there is broad consensus

regarding alcoholism as a disease state. For example, the American Medical
Association considers alcohol a drug and states that "drug addiction is a chronic,
relapsing brain disease characterized by compulsive drug seeking and use
despite often devastating consequences. It results from a complex interplay of
biological vulnerability, environmental exposure, and developmental factors (e.g.,
stage of brain maturity)."

Alcoholism has a higher prevalence among men, though in recent

decades, the proportion of female alcoholics has increased. Current evidence
indicates that in both men and women, alcoholism is 50–60 percent genetically
determined, leaving 40–50 percent for environmental influences. Most alcoholics
develop alcoholism during adolescence or young adulthood.

Prognosis

A 2002 study by the National Institute on Alcohol Abuse and

Alcoholism surveyed a group of 4,422 adults meeting the criteria for alcohol
dependence and found that after one year, some met the authors' criteria for low-
risk drinking, even though only 25.5 percent of the group received any treatment,
with the breakdown as follows: 25 percent were found to be still dependent, 27.3
percent were in partial remission (some symptoms persist), 11.8 percent
asymptomatic drinkers (consumption increases chances of relapse) and 35.9
percent were fully recovered — made up of 17.7 percent low-risk drinkers plus
18.2 percent abstainers.

In contrast, however, the results of a long term (60 year) follow-up of two
groups of alcoholic men by George Vaillant at Harvard Medical School indicated
that "return to controlled drinking rarely persisted for much more than a decade
without relapse or evolution into abstinence." Vaillant also noted that "return-to-
controlled drinking, as reported in short-term studies, is often a mirage."
 The most common cause of death in alcoholics is from cardiovascular
complications. There is a high rate of suicide in chronic alcoholics, which
increases the longer a person drinks. This is believed to be due to alcohol
causing physiological distortion of brain chemistry, as well as social isolation.
Suicide is also very common in adolescent alcohol abusers, with 25 percent of
suicides in adolescents being related to alcohol abuse. Approximately 18 percent
of alcoholics commit suicide, and research has found that over 50 percent of all
suicides are associated with alcohol or drug dependence. The figure is higher for
adolescents, with alcohol or drug misuse playing a role in up to 70 percent of
suicides.

History

Alcohol has a long history of use and misuse throughout recorded history.
Biblical, Egyptian and Babylonian sources record history of abuse and
dependence on alcohol. In some ancient cultures alcohol was worshiped and in
others its abuse was condemned. Excessive alcohol misuse and drunkenness
were recognised as causing problems thousands of years ago. However, the
defining of habitual drunkenness as it was then known as and its adverse
consequences were not well established medically until the 18th century. In 1647
a Greek monk named Agapios was the first to document that chronic alcohol
misuse was associated with toxicity to the nervous system and body which
resulted in a range of medical disorders such as seizures, paralysis and internal
bleeding. In 1920 the effects of alcohol abuse and chronic drunkenness led to the
failed prohibition of alcohol being considered and eventually enforced briefly in
America. In 2005 the cost of alcohol dependence and abuse was estimated to
cost the USA economy approximately 220 billion dollars per year, more than
cancer and obesity.

Society and Culture

 The various health problems associated with long-term alcohol
consumption are generally perceived as detrimental to society, for example,
money due to lost labor-hours, medical costs, and secondary treatment costs.
Alcohol use is a major contributing factor for head injuries, motor vehicle
accidents, violence, and assaults. Beyond money, there are also significant
social costs to both the alcoholic and their family and friends. For instance,
alcohol consumption by a pregnant woman can lead to fetal alcohol syndrome,
an incurable and damaging condition.

Estimates of the economic costs of alcohol abuse, collected by the World

Health Organization, vary from one to six percent of a country's GDP. One
Australian estimate pegged alcohol's social costs at 24% of all drug abuse costs;
a similar Canadian study concluded alcohol's share was 41%.

Stereotypes of alcoholics are often found in fiction and popular culture. The 'town
drunk' is a stock character in Western popular culture. Stereotypes of
drunkenness may be based on racism orxenophobia, as in the depiction of
the Irish as heavy drinkers. Studies by social psychologists Stivers and Greeley
attempt to document the perceived prevalence of high alcohol consumption
amongst the Irish in America.

Alcoholic Lung Disease

Alcoholic lung disease is disease of the lungs caused by excessive

alcohol consumption. Chronic alcohol ingestion impairs multiple critical cellular
functions in the lung. These cellular impairments lead to increased susceptibility
to serious complications from lung disease. Recent research cites alcoholic lung
 disease as comparable to liver disease in alcohol related mortality.
Alcoholics have a higher risk of developing acute respiratory distress
syndrome (ARDS) and experience higher rates of mortality from ARDS when
compared to non-alcoholics.

The mechanisms of alcoholic lung disease are:

 Metabolism of alcohol reduces glutathione anti-oxidant levels in the lungs.

 Oxidation damage to the cells impairs the ability of the lungs to remove
fluid.
 Oxidative damage to cells reduces immune response.
 Oxidative damage to cells results in a reduced ability to recover from
injury.

These chemical changes compound the negative mechanical and

microbiological effects of alcoholism on the respiratory system. These include:
impaired gag reflex and cilia function and greater likelihood of colonies
of pneumococcal bacteria in the upper respiratory system.

Alcoholism in Family Systems

Alcoholism in family systems refers to the conditions in families that

enable alcoholism, and the effects of alcoholic behavior by one or more family
members on the rest of the family. Mental health professionals are increasingly
considering alcoholism and addiction as diseases that flourish in and are enabled
by family systems. Family members react to the alcoholic with particular
behavioral patterns. They may enable the addiction to continue by shielding the
addict from the negative consequences of his actions. Such behaviors are
referred to as codependence. In this way, the alcoholic is said to suffer from
the disease of addiction, whereas the family members suffer from the disease of
codependence.

Alcoholism is one of the leading causes of a dysfunctional family. As of

2001, there were an estimated 26.8 million children of alcoholics (COAs) in the
United States, with as many as 11 million of them under than age of 18. Children
of addicts have an increased suicide rate and on average have total health care
costs 32 percent greater than children of nonalcoholic families.

Adults from alcoholic families experience higher levels of state and

trait anxiety and lower levels of differentiation of self than adults raised in non-
alcoholic families. Additionally adult children of alcoholics have lower self-
esteem, excessive feelings of responsibility, difficulties reaching out, higher
incidence of depression, and increased likelihood of becoming alcoholics.

Alcoholism does not have uniform effects on all families. The levels of
dysfunction and resiliency of the non-alcoholic adults are important factors in
effects on children in the family. Children of untreated alcoholics score lower on
measures of family cohesion, intellectual-cultural orientation, active-recreational
orientation, and independence. They have higher levels of conflict within the
family, and many experience other family members as distant and non-
communicative. The cumulative effect of the family dysfunction may affect the
children in families with untreated alcoholics' ability to grow in developmentally
healthy ways.

List of Countries by Alcohol Consumption

 This is a list of countries by alcohol consumption measured in litres of
pure ethyl alcohol consumed per capita in a given year, according to the most
recent data from the World Health Organization. The methodology used by the
WHO counted use by persons 15 years of age or older.

Alcohol consumption among adults (age 15+) in litres per capita

Alcohol consumption among adults (age 15+) in litres per capita[1]

country recorded unrecorded total beer wine spirits other

Moldova 8.22 10.00 18.22 4.57 4.67 4.42 0.00
Czech Republic 14.97 1.48 16.45 8.51 2.33 3.59 0.39
Hungary 12.27 4.00 16.27 4.42 4.94 3.02 0.14
Russia 11.03 4.73 15.76 3.65 0.10 6.88 0.34
Ukraine 8.10 7.50 15.60 2.69 0.58 5.21 0.02
Estonia 13.77 1.80 15.57 5.53 1.09 9.19 0.43
Andorra 14.08 1.40 15.48 3.93 5.69 3.14 0.00
Romania 11.30 4.00 15.30 4.07 2.33 4.14 0.00
Slovenia 12.19 3.00 15.19 4.10 5.10 1.33 0.00
Belarus 11.22 3.91 15.13 1.84 0.80 4.08 2.67
Croatia 12.61 2.50 15.11 4.66 5.80 1.91 0.14
Lithuania 12.03 3.00 15.03 5.60 1.80 4.50 0.60
South Korea 11.80 3.00 14.80 2.14 0.06 9.57 0.04
Portugal 12.45 2.10 14.55 3.75 6.65 1.27 0.51
Ireland 13.39 1.00 14.41 7.04 2.75 2.51 1.09
France 13.30 0.36 13.66 2.31 8.14 2.62 0.17
United Kingdom 11.67 1.70 13.37 4.93 3.53 2.41 0.67
Denmark 11.37 2.00 13.37 5.06 4.43 1.78 0.00
Slovakia 10.33 3.00 13.33 3.90 1.70 5.40 0.00
Netherlands 9.55 3.70 13.25 5.27 1.23 2.97 0.00
Austria 12.60 0.64 13.24 6.70 4.10 1.60 0.40
Luxembourg 12.01 1.00 13.01 1.59 8.16 2.00 0.00
Germany 11.81 1.00 12.81 6.22 3.15 2.30 0.00
Finland 9.72 2.80 12.52 4.59 2.24 2.82 0.31
Latvia 9.50 3.00 12.50 3.61 1.10 6.24 0.10
Bulgaria 11.24 1.20 12.44 3.53 2.44 4.88 0.10
Nigeria 9.78 2.50 12.28 0.54 0.01 0.02 9.17
Uganda 10.93 1.00 11.93 0.51 0.00 0.18 14.52
Saint Lucia 11.35 0.50 11.85 3.49 0.71 8.21 0.31
Spain 10.22 1.40 11.62 4.52 3.59 1.31 0.61
Armenia 10.05 1.30 11.35 1.05 0.39 0.65 9.36
Serbia 9.97 1.12 11.09 4.40 2.21 3.42 0.04
Switzerland 10.56 0.50 11.06 3.10 5.10 1.80 0.10
Kazakhstan 6.06 4.90 10.96 1.69 0.30 4.19 0.01
Belgium 9.77 1.00 10.77 5.49 3.55 0.62 0.03
Greece 8.95 1.80 10.75 2.20 4.51 2.38 0.13
Italy 8.33 2.35 10.68 1.73 6.38 0.42 0.00
Azerbaijan 7.30 3.30 10.60 7.00 0.03 0.97 0.00
Seychelles 9.59 1.00 10.59 7.15 3.15 1.59 0.00
Grenada 9.85 0.50 10.35 3.16 0.42 7.15 0.04
Sweden 6.70 3.60 10.30 2.60 2.90 1.10 0.00
Palau 9.10 1.00 10.10 8.68 0.52 2.10 0.00
Poland 9.55 3.70 13.25 4.72 3.26 1.56 0.00
Australia 9.89 0.13 10.02 4.56 3.12 1.16 1.02
Argentina 8.00 2.00 10.00 2.49 4.62 0.52 0.20
 Niue 8.85 1.00 9.85 4.63 0.11 2.95 0.00
Rwanda 6.80 3.00 9.80 0.54 0.00 0.01 6.44
Canada 7.77 2.00 9.77 4.10 1.50 2.10 0.00
Sierra Leone 6.72 3.00 9.72 0.46 0.01 0.02 6.06
Bosnia and
9.63 0.00 9.63 2.22 0.34 7.08 0.00
Herzegovina
New Zealand 9.12 0.50 9.62 4.09 3.04 1.37 0.81
Namibia 5.87 3.75 9.62 4.35 0.48 1.30 0.35
Guyana 7.50 2.00 9.50 1.14 0.31 5.70 0.01
Burundi 6.47 3.00 9.47 1.16 0.01 0.00 5.07
South Africa 6.96 2.50 9.46 3.93 1.17 1.15 0.75
United States 8.44 1.00 9.44 4.47 1.36 2.65 0.00
Saint Kitts and Nevis 8.93 0.50 9.43 3.98 0.18 6.00 0.10
Ecuador 4.01 5.37 9.38 2.30 0.07 1.69 0.00
Gabon 7.32 2.00 9.32 5.38 0.80 1.69 0.00
Cyprus 8.26 1.00 9.26 3.25 2.97 2.95 0.12
Brazil 6.16 3.00 9.16 3.36 0.33 2.49 0.03
Bahamas 8.16 0.60 8.76 3.99 1.55 5.27 0.23
São Tomé and
5.82 2.92 8.74 1.12 3.40 0.83 0.00
Príncipe
Chile 6.55 2.00 8.55 2.03 2.59 2.16 0.04
Macedonia 5.61 2.90 8.51 2.11 1.62 2.08 0.00
Mexico 5.02 3.40 8.42 3.96 0.02 1.09 0.03
Venezuela 6.83 1.40 8.23 5.19 0.07 1.65 0.00
Uruguay 6.14 2.00 8.14 1.33 3.95 1.21 0.06
Japan 7.83 0.20 8.03 1.72 0.29 3.37 2.61
Botswana 4.96 3.00 7.96 2.56 0.04 0.00 1.88
Paraguay 6.38 1.50 7.88 3.48 0.97 1.77 0.19
Dominica 7.34 0.50 7.84 0.50 0.80 6.69 0.07
Norway 6.21 1.60 7.81 2.98 2.00 1.28 0.11
Cameroon 4.97 2.60 7.57 2.05 0.05 0.00 2.60
Antigua and Barbuda 6.76 0.46 7.22 2.67 1.70 5.04 0.09
Thailand 6.37 0.71 7.08 1.75 0.02 4.69 0.00
Burkina Faso 4.48 2.50 6.98 0.41 0.09 0.42 3.77
Barbados 6.41 0.50 6.91 2.90 0.73 3.78 0.17
 Peru 2.90 4.00 6.90 2.16 0.32 0.61 0.00
Panama 5.85 1.00 6.85 3.71 0.22 1.91 0.01
Tanzania 4.75 2.00 6.75 0.57 0.02 0.15 4.51
Laos 5.73 1.00 6.73 1.42 0.03 4.35 0.00
Albania 4.58 2.10 6.68 1.61 0.94 2.30 0.02
Haiti 5.99 0.62 6.61 0.01 0.01 5.20 0.00
Côte d'Ivoire 4.48 2.00 6.48 0.61 0.33 0.05 3.55
Dominican Republic 5.76 0.65 6.41 2.69 0.14 2.92 0.01
Georgia 3.90 2.50 6.40 0.76 0.83 2.56 0.02
Philippines 4.38 2.00 6.38 1.29 0.02 2.91 0.00
Iceland 5.91 0.40 6.31 3.67 1.95 1.33 0.10
Trinidad and Tobago 5.78 0.50 6.28 3.10 0.11 2.78 0.04
Colombia 4.17 2.00 6.17 2.71 0.08 1.44 0.02
Suriname 5.19 0.90 6.09 2.00 0.13 3.26 0.05
Equatorial Guinea 5.31 0.77 6.08 0.45 4.18 0.00 0.00
Belize 5.07 1.00 6.07 3.89 0.13 1.78 0.01
China 4.21 1.70 5.91 1.50 0.15 2.51 0.23
Puerto Rico 5.47 0.28 5.75 3.68 0.34 1.35 0.05
Swaziland 5.70 0.00 5.70 1.64 0.21 0.15 3.05
Costa Rica 4.15 1.40 5.55 2.29 0.18 1.71 0.02
Lesotho 1.90 3.65 5.55 1.24 0.00 0.01 0.69
Cuba 4.41 1.10 5.51 1.48 0.05 2.94 0.01
Federated States of
4.50 1.00 5.50 1.43 1.31 0.60 0.00
Micronesia
Saint Vincent and the
4.94 0.50 5.44 2.55 0.12 3.16 0.05
Grenadines
Angola 3.80 1.60 5.40 1.81 1.37 1.12 0.41
Nicaragua 3.77 1.60 5.37 1.13 0.03 2.55 0.00
Bolivia 2.62 2.50 5.12 2.17 0.06 0.61 0.00
Kyrgyzstan 3.19 1.90 5.09 0.45 0.10 2.26 0.01
Zimbabwe 4.08 1.00 5.08 0.96 0.19 0.06 2.61
Liberia 3.47 1.59 5.06 0.30 0.01 3.16 0.01
Jamaica 3.50 1.50 5.00 1.49 0.11 1.80 0.10
Cape Verde 2.06 2.90 4.96 0.36 1.99 0.14 0.00
Nauru 2.33 2.50 4.83 2.24 0.08 0.00 0.00
 Samoa 3.80 1.00 4.80 3.31 0.08 0.24 0.00
Cambodia 1.77 3.00 4.77 0.74 0.02 1.21 0.00
Turkmenistan 2.33 2.30 4.63 0.21 0.90 1.22 0.00
Honduras 3.08 1.40 4.48 1.29 0.04 1.87 0.00
Chad 0.38 4.00 4.38 0.23 0.01 0.02 0.15
Malta 3.85 0.42 4.27 1.79 1.45 1.86 0.15
Republic of the Congo 2.04 2.23 4.20 1.76 0.00 0.11 0.12
Kenya 1.64 2.50 4.14 0.84 0.02 0.51 0.55
Guatemala 2.43 1.60 4.03 1.12 3.92 1.20 0.05
Ethiopia 0.52 3.50 4.02 0.19 0.01 0.13 0.25
Zambia 2.35 1.50 3.85 0.42 0.01 0.27 1.62
Tonga 3.28 0.50 3.78 0.89 2.29 0.64 0.18
Vietnam 1.07 2.70 3.77 1.13 0.01 0.02 0.00
Mauritius 2.72 1.00 3.72 1.92 0.32 0.39 0.00
Kiribati 1.71 2.00 3.71 1.56 0.02 0.02 0.00
Cook Islands 3.20 0.50 3.70 0.54 1.39 3.45 0.00
Guinea-Bissau 2.58 1.10 3.68 0.24 0.66 0.53 1.75
Bahrain 3.56 0.10 3.66 1.91 0.52 1.24 0.00
El Salvador 2.61 1.00 3.61 0.88 0.04 1.57 0.00
Uzbekistan 1.64 1.90 3.54 0.28 0.19 1.30 0.00
Papua New Guinea 1.49 2.00 3.49 0.57 0.02 0.90 0.00
Gambia 2.40 0.99 3.39 0.19 0.06 0.04 2.07
Tajikistan 0.39 3.00 3.39 0.08 0.02 0.29 0.00
Central African
1.65 1.70 3.35 0.21 0.02 0.03 1.37
Republic
Democratic Republic 1.97 1.26 3.30 0.32 0.01 0.02 1.67
of the Congo
Malawi 1.24 2.00 3.24 0.39 0.11 0.67 0.21
Ghana 1.47 1.50 2.97 0.40 0.07 0.03 0.97
Israel 2.39 0.50 2.89 0.97 0.18 1.30 0.04
Djibouti 1.37 1.50 2.87 0.78 0.07 0.46 0.00
India 0.55 2.04 2.59 0.06 0.02 0.50 0.00
Mozambique 1.56 1.00 2.56 0.00 0.00 0.27 1.08
Tuvalu 1.94 0.50 2.44 0.71 0.02 0.58 0.00
Fiji 1.43 1.00 2.43 1.46 0.02 0.58 0.00
Iraq 0.20 2.21 2.41 0.07 0.00 0.13 0.00
Sudan 1.56 0.82 2.38 0.52 0.09 0.79 0.05
Lebanon 1.73 0.50 2.23 0.36 0.56 0.78 0.01
Benin 1.15 1.00 2.15 0.49 0.14 0.15 0.30
Brunei 1.76 0.25 2.01 1.67 0.02 0.05 0.00
Togo 0.99 1.00 1.99 0.43 0.32 0.06 0.22
Turkey 1.37 0.50 1.87 0.24 0.08 1.35 0.00
Mongolia 1.24 0.50 1.74 0.14 0.00 0.22 0.74
Solomon Islands 1.16 0.50 1.66 0.66 0.03 0.40 0.00
Singapore 0.55 1.00 1.55 1.45 0.25 0.40 0.00
Eritrea 0.94 0.60 1.54 0.56 0.00 0.25 0.00
Morocco 0.46 1.00 1.46 0.23 0.17 0.06 0.00
Syria 1.13 0.30 1.43 0.04 0.32 0.69 0.00
Madagascar 0.78 0.55 1.33 0.34 0.11 0.32 0.00
Tunisia 1.09 0.20 1.29 0.67 0.34 0.04 0.00
Qatar 0.85 0.40 1.25 0.04 0.11 0.73 0.01
Mali 0.54 0.50 1.04 0.07 0.00 0.01 0.46
Iran 0.02 1.00 1.02 0.02 0.00 0.00 0.00
Algeria 0.66 0.30 0.96 0.09 0.07 0.00 0.50
Oman 0.64 0.30 0.94 0.27 0.00 0.39 0.00
Vanuatu 0.43 0.50 0.93 0.46 0.19 0.19 0.00
Timor-Leste 0.36 0.50 0.86 0.30 0.01 0.00 0.00
Malaysia 0.50 0.32 0.82 0.38 0.02 0.08 0.00
Sri Lanka 0.35 0.44 0.79 0.02 0.00 0.33 0.00
Comoros 0.26 0.50 0.76 0.17 0.02 0.03 0.00
Jordan 0.41 0.30 0.71 0.04 0.01 0.34 0.01
Senegal 0.30 0.30 0.60 0.15 0.12 0.01 0.00
Indonesia 0.06 0.50 0.59 0.06 0.00 0.00 0.00
Myanmar 0.11 0.46 0.57 0.10 0.00 0.01 0.01
Bhutan 0.22 0.33 0.55 0.21 0.00 0.00 0.00
United Arab Emirates 0.34 0.20 0.54 0.30 0.01 0.00 0.02
Afghanistan 0.00 0.50 0.50 0.00 0.00 0.00 0.00
Nepal 0.20 0.20 0.40 0.14 0.00 0.07 0.00
Egypt 0.27 0.10 0.37 0.10 0.02 0.06 0.00
 Guinea 0.26 0.10 0.36 0.14 0.02 0.06 0.00

Niger 0.09 0.25 0.34 0.05 0.01 0.03 0.00

Saudi Arabia 0.05 0.20 0.25 0.00 0.00 0.05 0.00
Bangladesh 0.00 0.20 0.20 0.00 0.00 0.00 0.00
Kuwait 0.00 0.17 0.17 0.00 0.00 0.00 0.00
Libya 0.01 0.10 0.11 0.00 0.00 0.00 0.00
Mauritania 0.01 0.10 0.11 0.00 0.00 0.01 0.00
Somalia 0.00 0.10 0.10 0.00 0.00 0.00 0.00
Pakistan 0.01 0.05 0.06 0.00 0.00 0.00 0.01
Yemen 0.00 0.02 0.02 0.00 0.00 0.01 0.00

The headings in this table are explained as follows. All columns refer to
2005 only, except Recorded and Total. Recorded refers to an average of
recorded consumption for 2003-2005. Unrecorded consumption was calculated
using empirical investigations and expert judgments. Total is the sum of the first
two columns. The last four columns are a breakdown of the (2005) recorded
alcohol consumption by type. Beer refers to malt beer, wine refers to grape wine,
spirits refers to all distilled beverages, and other refers to all other alchoholic
beverages. Values were corrected for tourism only in countries where the
number of tourists per year was at least equivalent to the number of inhabitants.