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Alcohol dependence

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See also: Alcoholism
Alcohol dependence
SpecialtyPsychiatry Edit this on Wikidata
Addiction and dependence glossary[1][2][3]
  • addiction – a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences
  • addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain reward systems
  • dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)
  • drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose
  • drug withdrawal – symptoms that occur upon cessation of repeated drug use
  • physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens)
  • psychological dependence – dependence socially seen as being extremely mild compared to physical dependence (e.g., with enough willpower it could be overcome)
  • reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them
  • rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach
  • sensitization – an amplified response to a stimulus resulting from repeated exposure to it
  • substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress
  • tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

Alcohol dependence is a substance-related disorder in which an individual is physically or psychologically dependent upon drinking alcohol. In certain diagnostic models (e.g., the DSM-5), the term has a broader definition that also includes other alcohol use-related disorders as well.

Definition and diagnosis

According to the DSM-IV criteria for alcohol dependence, at least three out of seven of the following criteria must be manifest during a 12-month period:

  • Tolerance
  • Withdrawal symptoms or clinically defined alcohol withdrawal syndrome
  • Use in larger amounts or for longer periods than intended
  • Persistent desire or unsuccessful efforts to cut down on alcohol use
  • Time is spent obtaining alcohol or recovering from effects
  • Social, occupational and recreational pursuits are given up or reduced because of alcohol use
  • Use is continued despite knowledge of alcohol-related harm (physical or psychological)[4]

History and epidemiology

About 12% of American adults have had an alcohol dependence problem at some time in their life.[5] In the UK the NHS estimates that around 9% of men and 4% of UK women show signs of alcohol dependence.[6] The term 'alcohol dependence' has replaced 'alcoholism' as a term in order that individuals do not internalize the idea of cure and disease, but can approach alcohol as a chemical they may depend upon to cope with outside pressures.

The contemporary definition of alcohol dependence is still based upon early research. There has been considerable scientific effort over the past several decades to identify and understand the core features of alcohol dependence.[7] This work began in 1976, when the British psychiatrist Griffith Edwards and his American colleague Milton M. Gross [8] collaborated to produce a formulation of what had previously been understood as ‘alcoholism’ – the alcohol dependence syndrome.

The alcohol dependence syndrome was seen as a cluster of seven elements that concur. It was argued that not all elements may be present in every case, but the picture is sufficiently regular and coherent to permit clinical recognition. The syndrome was also considered to exist in degrees of severity rather than as a categorical absolute. Thus, the proper question is not ‘whether a person is dependent on alcohol’, but ‘how far along the path of dependence has a person progressed’.

"The Drunkard’s Progress", 1846

Screening tools

The Alcohol Use Disorders Identification Test (AUDIT) is considered the most accurate alcohol screening tool for identifying potential alcohol misuse, including dependence.[9] It was developed by the World Health Organisation, designed initially for use in primary healthcare settings with supporting guidance.[10] Its use has replaced older screening tools such as CAGE but there are many shorter alcohol screening tools,[11] mostly derived from the AUDIT. The Severity of Alcohol Dependence Questionnaire (SAD-Q) is a more specific twenty item inventory for assessing the presence and severity of alcohol dependence.

Because only 3 of the 7 DSM-IV criteria for alcohol dependence are required, not all patients meet the same criteria and therefore not all have the same symptoms and problems related to drinking. Not everyone with alcohol dependence, therefore, experiences physiological dependence. Alcohol dependence is differentiated from alcohol abuse by the presence of symptoms such as tolerance and withdrawal. Both alcohol dependence and alcohol abuse are sometimes referred to by the less specific term alcoholism. However, many definitions of alcoholism exist, and only some are compatible with alcohol abuse. There are two major differences between alcohol dependence and alcoholism as generally accepted by the medical community.

  1. Alcohol dependence refers to an entity in which only alcohol is the involved addictive agent. Alcoholism refers to an entity in which alcohol or any cross-tolerant addictive agent is involved.
  2. In alcohol dependence, reduction of alcohol, as defined within DSM-IV, can be attained by learning to control the use of alcohol. That is, a client can be offered a social learning approach that helps them to 'cope' with external pressures by re-learning their pattern of drinking alcohol. In alcoholism, patients are generally not presumed to be 'in remission' unless they are abstinent from alcohol.

The following elements are the template for which the degree of dependence is judged:

  1. Narrowing of the drinking repertoire.
  2. Increased salience of the need for alcohol over competing needs and responsibilities.
  3. An acquired tolerance to alcohol.
  4. Withdrawal symptoms.
  5. Relief or avoidance of withdrawal symptoms by further drinking.
  6. Subjective awareness of compulsion to drink.
  7. Reinstatement after abstinence.[12]

Treatment

Treatments for alcohol dependence can be separated into two groups, those directed towards severely alcohol-dependent people, and those focused for those at risk of becoming dependent on alcohol. Treatment for alcohol dependence often involves utilizing relapse prevention, support groups, psychotherapy,[13] and setting short-term goals. The Twelve-Step Program is also a popular process used by those wishing to recover from alcohol dependence.[14]

There is insufficient evidence to support the use of anticonvulsants to treat those with alcohol dependence.[15]

Lifestyle

Follow the recommendations. It is especially important to:

  • Identify stressors
  • Eliminate or reduce sources of stress
  • Identify negative coping patterns and replace them with positive patterns
  • Perform a relaxation/breathing exercise for a minimum of five minutes twice per day
  • Manage time effectively
  • Enhance your relationships through better communication
  • Get regular exercise

See also

Questionnaires

Notes

  1. ^ Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 15: Reinforcement and Addictive Disorders". In Sydor A, Brown RY (eds.). Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. pp. 364–375. ISBN 9780071481274.
  2. ^ Nestler EJ (December 2013). "Cellular basis of memory for addiction". Dialogues in Clinical Neuroscience. 15 (4): 431–443. PMC 3898681. PMID 24459410. Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type [nucleus accumbens] neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... Another ΔFosB target is cFos: as ΔFosB accumulates with repeated drug exposure it represses c-Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug-treated state.41. ... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.
  3. ^ Volkow ND, Koob GF, McLellan AT (January 2016). "Neurobiologic Advances from the Brain Disease Model of Addiction". New England Journal of Medicine. 374 (4): 363–371. doi:10.1056/NEJMra1511480. PMC 6135257. PMID 26816013. Substance-use disorder: A diagnostic term in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) referring to recurrent use of alcohol or other drugs that causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Depending on the level of severity, this disorder is classified as mild, moderate, or severe.
    Addiction: A term used to indicate the most severe, chronic stage of substance-use disorder, in which there is a substantial loss of self-control, as indicated by compulsive drug taking despite the desire to stop taking the drug. In the DSM-5, the term addiction is synonymous with the classification of severe substance-use disorder.
  4. ^ http://www.alcoholcostcalculator.org/business/about/dsm.html Reference for the whole section.
  5. ^ Hasin D; et al. (2007). "Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States". Archives of General Psychiatry. 64 (7): 830–42. doi:10.1001/archpsyc.64.7.830. PMID 17606817. {{cite journal}}: Explicit use of et al. in: |author= (help)
  6. ^ DrinkAware UK Website http://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/mental-health/alcohol-dependence
  7. ^ Irving B. Weiner; Thomas A. Widiger; George Stricker (2003). Handbook of Psychology: Clinical psychology. John Wiley and Sons. pp. 201–. ISBN 978-0-471-39263-7. Retrieved 16 April 2010.
  8. ^ Edwards G. & Gross MM, Alcohol dependence: provisional description of a clinical syndrome, BMJ 1976; i: 1O58-106
  9. ^ "AUDIT - Alcohol Use Disorders Identification Test". Alcohol Learning Centre. 28 June 2010. Retrieved 3 June 2012.
  10. ^ Supporting guidance
  11. ^ Alcohol screening tools
  12. ^ Clark, David, Background Briefing, Alcohol Dependence, Drink and Drug News, 7 February 2005, p. 11
  13. ^ "Alcohol Dependence and Treatment". ICAP Blue Book. International Center for Alcohol Policies. Retrieved 2 June 2012.
  14. ^ "What is Alcohol Addiction: What Causes Alcohol Addiction?". MedicalBug. 6 January 2012. Retrieved 2 June 2012.
  15. ^ Pani, Pier Paolo; Trogu, Emanuela; Pacini, Matteo; Maremmani, Icro; Pani, Pier Paolo (2014). "Anticonvulsants for alcohol dependence". doi:10.1002/14651858.CD008544.pub2. {{cite journal}}: Cite journal requires |journal= (help)
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