Alcohol and related disorders Health Article

Definition

Alcoholism is defined as alcohol seeking and consumption behavior that is harmful. Long-term and uncontrollable harmful consumption can cause alcohol-related disorders that include: antisocial personality disorder, mood disorders (bipolar and major depression) and anxiety disorders.

Description

Alcoholism is the popular term for the disorder recognized by the American Psychiatric Association (APA) as alcohol dependence. The hallmarks of this disorder are addiction to alcohol, inability to stop drinking, and repeated interpersonal, school- or work-related problems that can be directly attributed to the use of alcohol. Alcoholism can have serious consequences, affecting an individual's health and personal life, as well as impacting society at large.

Alcohol dependence is a complex disorder that includes the social and interpersonal issues mentioned above, and also includes biological elements, as well. These elements are related to tolerance and withdrawal, cognitive (thinking) problems that include craving, and behavioral abnormalities including the impaired ability to stop drinking. Withdrawal is a term that refers to the symptoms that occur when a person dependent on a substance stops taking that substance for a period of time; withdrawal symptoms vary in type and severity depending on the substance, but alcohol withdrawal symptoms can include shaking, irritability, and nausea. Tolerance is a reduced response to the alcohol consumed and can be acute or chronic. Acute tolerance occurs during a single episode of drinking and is greater when blood alcohol concentration rises. Chronic tolerance occurs over the long term when there is greater resistance to the intoxicating effects of alcohol, and, as a result, the affected person has to drink more to achieve desired effect.

The APA also recognizes another alcohol use disorder called alcohol abuse. Alcohol abuse is similar to dependence in that the use of alcohol is impairing the affected person's ability to achieve goals and fulfill responsibilities, and his or her interpersonal relationships are affected by the alcohol abuse. However, unlike a person with dependence, a person diagnosed with alcohol abuse does not experience tolerance or, when not drinking, withdrawal symptoms. People who abuse alcohol can become dependent on the substance over time.

Alcohol-related disorders are groups of disorders that can result in persons who are long-term users of alcohol. These disorders can affect the person's metabolism, gastrointestinal tract, nervous system, bone marrow (the matter in bones that forms essential blood cells) and can cause endocrine (hormone) problems. Additionally, alcoholism can result in nutritional deficiencies. Some common alcohol-related medical disorders include vitamin deficiencies, alterations in sugar and fat levels in blood, hepatitis, fatty liver, cirrhosis, esophagitis (inflammation of the esophagus), gastritis (inflammation of the lining of the stomach), dementia, abnormal heart rates and rhythms, lowered platelets (cells important for forming a clot), leukopenia (decrease in the number of white blood cells that are important for body defenses and immunity), and testicular atrophy (shrinking of the testicles). People with anxiety, depression, or bipolar disorder may consume alcohol for temporary relief from their symptoms. Others, such as people with antisocial personality disorder, may use alcohol as part of a dual diagnosis of criminality and substance dependence.

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, criticism, or encouragement. People may drink to the point of dependence because of peer pressure, acceptance in a peer group, or because drinking is related to specific moods (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, his or her brain areas 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 isolated a gene that causes alcohol dependence and that is usually transmitted from affected fathers to sons. Other genetic studies have demonstrated that close relatives of an alcoholic are four times more likely to become alcoholics themselves. Furthermore, this risk holds true even for children who were adopted away from their biological families at birth and raised in a nonalcoholic adoptive family, with no knowledge of their biological family's difficulties with alcohol.