ALCOHOL ABUSE AND DEPENDENCE

Alcohol

• It is a component of alcoholic drinks which is a central nervous system (brain and spinal cord)
depressant.
• The degree to which the central nervous system function is impaired depends on the
concentration of alcohol in the blood (BAC).
• When ingested, alcohol passes from the stomach into the small intestine, where it is rapidly
absorbed into the blood and distributed throughout the body.
• The liver is responsible for the elimination - through metabolism - of 95% of ingested alcohol
from the body. The remainder of the alcohol is eliminated through excretion of alcohol in breath,
urine, sweat, feces, milk and saliva.
• As a rule of thumb, a person will eliminate one average drink or 0.5 oz (15 ml) of alcohol per
hour.
• It's not how many drinks that you have, but how much alcohol that you consume.

Alcohol Content (in Percent) of Selected Beverages

Beverage Alcohol Content (%)

Beers 3.2 - 4.0
Malt Liquor 3.2 - 7.0
Sparkling wines 8.0 - 14.0
Brandies 40.0 - 43.0
Whiskies 40.0 - 75.0
Vodkas 40.0 - 50.0
Gin 40.0 - 48.5
Rum 40.0 - 95.0

Alcohol Content of Some Typical Drinks

Drink Alcohol Content

 Whiskey Sour/Highball 0.60 oz. (18 ml)
Table Wine - 5 oz. (148 ml) 0.55 oz. (16 ml)
Beer - 12 oz. (355 ml) 0.54 oz. (16 ml)
Reduced Alcohol Beer 0.28 oz. (8 ml)

• How much drinking is too much?

You are at risk of drinking too much and should talk to your doctor if you are:

 A woman who has more than 3 drinks at one time or more than 7 drinks a week. A
standard drink is 1 can of beer, 1 glass of wine, or 1 mixed drink.
 A man who has more than 4 drinks at one time or more than 14 drinks a week.

• The following is a generally accepted guide to the effects of alcohol.

Stages of alcohol intoxication

Blood Alcohol
Concentration
(BAC) Stage Clinical symptoms
(g/100 ml of
blood)
0.01 - 0.05 Subclinical Behavior nearly normal by ordinary observation
Mild euphoria, sociability, talkitiveness
Increased self-confidence; decreased inhibitions
0.03 - 0.12 Euphoria Diminution of attention, judgment and control
Beginning of sensory-motor impairment
Loss of efficiency in finer performance tests
Emotional instability; loss of critical judgment
Impairment of perception, memory and comprehension
Decreased sensitory response; increased reaction time
0.09 - 0.25 Excitement
Reduced visual acuity; peripheral vision and glare recovery
Sensory-motor incoordination; impaired balance
Drowsiness
0.18 - 0.30 Confusion Disorientation, mental confusion; dizziness
Exaggerated emotional states
Disturbances of vision and of perception of color, form, motion and
dimensions
 Increased pain threshold
Increased muscular incoordination; staggering gait; slurred speech
Apathy, lethargy
General inertia; approaching loss of motor functions
Markedly decreased response to stimuli
0.25 - 0.40 Stupor Marked muscular incoordination; inability to stand or walk
Vomiting; incontinence
Impaired consciousness; sleep or stupor
Complete unconsciousness
Depressed or abolished reflexes
Subnormal body temperature
0.35 - 0.50 Coma
Incontinence
Impairment of circulation and respiration
Possible death
0.45 + Death Death from respiratory arrest

Alcohol abuse and Alcohol dependence

Alcohol abuse means having unhealthy or dangerous drinking habits, such as drinking every day or
drinking too much at a time. Alcohol abuse can harm your relationships, cause you to miss work, and
lead to legal problems such as driving while drunk (intoxicated). When you abuse alcohol, you continue
to drink even though you know your drinking is causing problems.

Signs of alcohol abuse or dependence

• You have problems at work or school because of your drinking. These may include being late or
absent, being injured at work, and not doing your job or schoolwork as well as you can.
• You drink in dangerous situations, such as before or while driving a car.
• You have blackouts. This means that after a drinking episode you cannot remember what
happened while you were drinking.
• You have legal problems because of your drinking, such as being arrested for harming someone
or driving while drunk (intoxicated).
• You get hurt or you hurt someone else when you are drinking.
• You continue to drink despite health problems that are caused or made worse by alcohol use,
such as liver disease (cirrhosis).
 • Your friends or family members are worried about your drinking.

Alcohol dependence, also called alcoholism, means you are physically or mentally addicted to alcohol.
You have a strong need, or craving, to drink. You feel like you must drink just to get by.

Signs of alcohol dependence or addiction

• You cannot quit drinking or control how much you drink. You drink more often than you want
to, or you drink larger amounts than you want to.
• You need to drink more to get the same effect.
• You have withdrawal symptoms when you stop drinking. These include feeling sick to your
stomach, sweating, shakiness, and anxiety.
• You spend a lot of time drinking and recovering from drinking, or you have given up other
activities so you can drink.
• You have tried unsuccessfully to quit drinking or to cut back the amount you drink.
• You continue to drink even though it harms your relationships and causes you to develop
physical problems.

Other signs of possible trouble with alcohol include the following:

• You drink in the morning, are drunk often for long periods of time, or drink alone.
• You change what you drink, such as switching from beer to wine because you think that doing
this will help you drink less or keep you from getting drunk.
• You feel guilty after drinking.
• You make excuses for your drinking or do things to hide your drinking, such as buying alcohol at
different stores.
• You worry that you won't get enough alcohol for an evening or weekend.
• You have physical signs of alcohol dependence, such as weight loss, a sore or upset stomach
(gastritis), or redness of the nose and cheeks.
Risk Factors of developing Alcohol abuse or dependence

Non-modifiable risk factors (factors you can't change):

• Genes. People with alcohol problems often have a family history of alcohol abuse and
dependence.
• Gender. A man is 3 times more likely to develop problems with alcohol than a woman is.
• Early use. The younger you were when you first started drinking alcohol, the higher your risk is
for developing alcohol problems later as an adult.

Modifiable Risk factors (factors you can change):

• Mental health. If you have mental health problems, such as depression, bipolar disorder,
schizophrenia, or anxiety disorders, you are more likely to use alcohol. It's common to use
alcohol to ease the pain of these conditions.5
• Use of other substances. You are more likely to abuse alcohol if you abuse other things, such as
tobacco, illegal drugs, or prescription medicines.
• Environment. If you live in an area where alcohol is easy to get, people drink a lot, or heavy
drinking is accepted as part of life, you are more likely to drink.
• Friends. Your friends may influence you to drink by directly urging you to or by drinking when
you're around them.
• Problems with others. You may be more likely to drink when you are having problems in your
family or with friends.
• Not having purpose or satisfaction in your life. If you have no activities that give you a sense
of purpose, you may be more likely to drink. A satisfying job or schoolwork or volunteer
activities can give your life purpose and meaning.

***Just because you have risk factors for alcohol problems doesn't mean you'll have a drinking problem.
A person with many risk factors won't always develop alcoholism. And a person with no risk factors can
become dependent on alcohol.
Complications of Alcohol in our body

CARDIAC

 Dysrhythmias (disrupted heart rhythm)

 Hypertension (An association between heavy alcohol consumption and increased blood
pressure has been observed in more than 60 studies in diverse cultures and populations)
 Cardiomyopathy (Long-term heavy drinking can cause the heart to become enlarged and
lose some of its ability to contract, a condition known as alcoholic cardiomyopathy.
These symptoms include shortness of breath and an insufficient blood flow to the rest of
the body)

GASTROINTESTINAL
 Gastritis (inflammation of the stomach)
 Gastric/Duodenal ulcer (a sore in the inner lining of the stomach or upper small intestine
(duodenum). Ulcers develop when the intestine or stomach’s protective layer is broken down.)
 Pancreatitis (inflammation of the pancreas)
 Interference with absorption of Vitamin B12 (cyanocobalamine), B1 (thiamine) and B9 (folic acid)
 Wernicke-Korsakoff syndrome (is a combination of two conditions: Wernicke syndrome and
Korsakoff syndrome. Wernicke syndrome is caused by thiamine (vitamin B1) deficiency.
Symptoms such as blurred vision may go away if a person stops drinking and takes thiamine
supplements. Korsakoff syndrome is caused by changes in the brain that result from long-term
alcohol use. Symptoms include confusion and memory loss, especially of recent events, which
often lead the person to make up events (confabulation) to fill the memory gaps.)
 Alcoholic liver diseases (because 95% of the elimination of alcohol is through the liver,
excessive alcohol can cause damage to the liver cells. T h e re are three forms of ALD: fatty
liver, which is usually reversible with abstinence; alcoholic hepatitis, characterized by persistent
liver inflammation; and cirrhosis, characterized by progressive scarring of liver tissue.)

HEMATOPOIETIC (Blood)
  Anemia (Folic Acid Deficiency Anemia; Pernicious or Vitamin B12 deficiency anemia)
 Thrombocytopenia (decreased platelet in the blood)

MUSCULOSKELETAL
 Osteoporosis (Decreased bone density with risk of fracture)

IMMUNE
 Depressed immune system which may lead to increased susceptibility to infections

RESPIRATORY
 Altered respirations
 Pneumonia or Tuberculosis (due to depressed immune system)

ENDOCRINE

 Testicular atrophy (decrease ikn size of the testicles)

 Gynecomastia (enlargement of breasts in males)
 Irregular menses
 Hypoglycemia (decreased blood sugar)
 Alcoholic ketoacidosis (because of hypoglycemia or decreased blood sugar, cells in the body are
unable to get the sugar (glucose) they need for energy. When the cells do not receive sugar, the
body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids
which are the by-product of fat metabolism, are produced and enter the bloodstream, causing the
chemical imbalance (metabolic acidosis) called alcoholic ketoacidosis.)

Treatment

Three general steps are involved in treatment once the disorder has been diagnosed:

• Intervention
 • Detoxification
• Rehabilitation

INTERVENTION

Many people with alcohol problems don't recognize when their drinking gets out of hand. In the past,
treatment providers believed that alcoholics should be confronted about their drinking problems, but
now research has shown that compassion and empathy are more effective.

The ideal approach is to help people realize the negative impact alcohol abuse is having on their life, and
on the lives of those around them. They can aim for a personal goal of leading a more fulfilling and
sober life.

Studies find that more people enter treatment if their family members or employers are honest with them
about their concerns, and try to help them see that drinking is preventing them from reaching their goals.

DETOXIFICATION

Withdrawal from alcohol is done in a controlled, supervised setting in which medications relieve
symptoms. Detoxification usually takes 4 to 7 days.

Examination for other medical problems is necessary. For example, liver and blood clotting problems
are common.

Eating a balanced diet with vitamin supplements is important. Complications can occur with alcohol
withdrawal, such as delirium tremens (DT's), which could be fatal. Depression or other mood disorders
should be evaluated and treated. Often, alcohol abuse develops from efforts to self-treat an illness.

REHABILITATION

After detoxification, alcohol recovery or rehabilitation programs can help people stay off alcohol. These
programs usually offer counseling, psychological support, nursing, and medical care. Therapy involves
education about alcoholism and its effects.
Many of the staff members at rehabilitation centers are recovering alcoholics who serve as role models.
Programs can be inpatient, where patients live in the facility during the treatment. Or they can be
outpatient, where patients attend the program while they live at home.

Long-term treatment with counseling or support groups is often necessary. The effectiveness of
medication and counseling varies.

Treatment programs usually include counseling, such as:

• Individual and group therapy, where you talk about your recovery with a counselor or with other
people who are trying to quit. You can get support from others who have struggled with alcohol.
• Cognitive-behavioral therapy (CBT), where you learn to change thoughts and actions that make
you more likely to use alcohol. A counselor teaches you ways to deal with cravings and avoid
going back to alcohol.
• Motivational interviewing (MI), where you resolve mixed feelings about quitting and getting
treatment. A counselor helps you find personal motivation to change.
• Motivational enhancement therapy (MET), which uses motivational interviewing to help you
find motivation to quit. It usually lasts for two to four sessions.
• Brief intervention therapy, which provides feedback, advice, and goal-setting.
• Couples and family therapy, which can help you become and stay sober and keep good
relationships within your family.

A treatment program may include medicines that can help keep you sober during recovery. You cannot
take these medications if you are pregnant or have certain medical conditions. These include:

• Disulfiram (Antabuse), which makes you sick to your stomach when you drink.
• Naltrexone (ReVia, Vivitrol), which interferes with the pleasure you get from drinking. ReVia is
a pill you take every day. Vivitrol is a once-a-month injection used to treat alcohol dependence.
• Acamprosate (Campral), which may reduce your craving for alcohol.
 • Topiramate (Topamax), which is a medicine used to treat seizures. One recent study shows that it
might also help treat alcohol problems.6 Experts are studying how this medicine, and medicines
like it, might help with recovery from alcohol abuse and addiction.

Most programs provide education about alcohol abuse and dependence. Understanding alcohol problems
can help you and your family knows how to overcome them. Some programs also offer job or career
training.