Alcohol has played an influential role in many countries throughout the world. The earliest forms of alcohol were found in China around 7000 to 6600 BC. This was discovered from residue in pottery jars. In the 1630’s English colonists began brewing their own beer by using malted barley shipped from England. By 1654, Massachusetts reaffirmed laws against home brewing and this resulted in an extreme labor strike. The founding fathers had an affinity for alcohol and colonial Americans started to drink throughout the days. They started to prefer cider, beer and then eventually rum. By the 1790’s Americans began to consume alcohol heavily.
Alcoholism, or Alcohol Use Disorder (AUD), is a chronic, relapsing disease that is defined as one person’s inability to control the amount on alcohol they consume. There are four ranges of drinking when you are defining alcoholism; they range from moderate to heavy drinking. Moderate drinking is defined as one drink a day for women and two drinks a day for men. High risk drinking for women is eight drinks or more weekly, and for men is 15 drinks or more weekly. Binge Drinking is considered four drinks under two hours for women and five drinks under two hours for men. Finally, heavy drinking is where both men and women binge drink for five or more days of the week.
Blood alcohol concentration levels are measurements of alcohol intoxication that is used for medical and legal purposes. The legal limit for anyone over 21 is a .08%. A .02 BAC can result in the decline in visual functions, decline in the ability to perform two tasks at once. A .05 BAC causes reduced coordination, reduced ability to track moving objects, and difficulty steering. A .08 BAC can lead to short term memory loss, reduced speed control, and reduced information processing capabilities. A .10 BAC results in the reduced ability to maintain lane position and braking appropriately. Finally, a .15 BAC can have substantial impairment in vehicle control, attention to driving tasks, and in necessary visual and auditory information processing.
A “drink” is considered 12 ounces of beer, five ounces of wine and 1.5 ounces of hard liquor. Women tend to have a lower recommendation than men not just because of their size compared to men, but women produce less of the enzyme alcohol dehydrogenase, also know as ADH, which breaks down alcohol. Women also obtain more body fat than men, which retains more alcohol.
Consuming an overabundant amount of alcohol over long periods of time can drastically affect someone’s health. According to a new study, Adults who drink 7-14 drinks a week could expect a six-month shorter life expectancy, adults who consume 14-25 drinks per week could expect a one-two year shorter life expectancy and if an adult consumes more than 25 drinks per week, they can expect a four-five year shorter life expectancy.
While there are negative effects of alcohol, there are also positive effects. Having a drink while hanging out with friend or family can help relieve stress and help promote a sense of well-being. Alcohol is considered a “social lubricant”. Drinking may encourage social interaction. Studies show that moderate drinking can lower the risks of: heart attack, most common types of stroke, deaths due to cardiovascular disease, diabetes and gallstones. While these may be positive effects, they are only considered correlations, which does not necessarily mean they can prevent it.
The negative effects of alcohol outweigh the positive effects of alcohol. Liver Cirrhosis and liver failure are a major negative effect of alcohol. Liver Cirrhosis is a complication of liver disease. This causes the loss of liver cells and irreversible scarring of the liver. Liver Cirrhosis can cause weakness, loss of appetite, easy bruising, jaundice and fatigue. The complications of cirrhosis can include swelling of the abdomen, hip, thigh, leg and ankles. Diagnosis of liver cirrhosis can be diagnosed by history, physical exanimation or a liver biopsy. Higher risk of blood pressure, heart failure and dementia as well as certain cancers such as: breast, liver, digestive tract cancer. People who consume high levels of alcohol over a long period of time can be at a higher risk for depression, anxiety and addiction. This can affect one’s ability to establish and maintain social relationships and employment. The negative affects not only affect the alcoholic themselves, but also their family, friends and coworkers as well.
Alcohol is a legal drug but carries a significant risk of addiction. This is the reason most people with alcohol use disorder refuse to believe they have an addiction. There are three common types of symptoms: physical, psychological and behavior. Physical symptoms can be the most prominent in some cases. A tipoff that someone’s behavior has progressed to alcohol use disorder is their diet. They often neglect their nutritional health. They also may show signs malnutrition, hair loss or thinning, dark circles, and a gaunt appearance. These symptoms can be signs of Thiamine Deficiency (B1). The brain needs this for proper functioning.
Psychological effects are almost immediately recognizable. Individuals may repeat themselves and show poor judgement. They can also have slowed reaction times, blackouts, impaired judgement, slurred speech and memory impairment. These symptoms can lead to permanent and debilitating health conditions.
According to the National Council on Alcoholism and Drug Dependence explains that behavioral symptoms can also usually be apparent. A person with an alcohol addiction can become increasingly secretive about their activities because they do not want to hear about peoples concerns or advice to stop. They may drink in secret, either in private or out in public away from concerned family members and friends. These people may become more prone to accidents and show signs of injury and try to cover them up. Keeping a ready supply near by in fear of running out of alcohol is another behavioral symptom that people with Alcoholic Use Disorder may have. The use of alcohol may lead to diminished level of care for hygiene. They may start to stop shaving, showering or no longer washing/changing clothes.
Additional symptoms of AUD can also be apparent. These symptoms can include legal troubles, assault, dui, domestic abuse, showing up to work or family function intoxicated, overreacting to any perceived criticism, stealing and lying about it and finally engaging in risky activities such as drunk driving.
As with all addictions, diagnosing someone with AUD can be difficult. The diagnosis depends on the person drinking being willing to answer questions about their daily habits and health truthfully. Before a healthcare provider sees the issue, friends and family usually start to see the issue first. In order to assess the issue, doctors will likely try a variety of tests. They may ask several questions about drinking habits and may ask for permission to speak to friends and family. They will likely perform a physical exam, and conduct lab tests and imaging. They might also request that the person receives and complete psychological evaluation.
According to the DSM-5, in order for someone to be diagnosed with a disorder due to a substance, they must meet 2 of the 11 following criteria: consuming more alcohol than originally planned, constant worry about stopping or failed efforts to control use, spending a large amount of time drinking, drinking results in failure to maintain major role obligations, alcohol cravings, continued use in a dangerous situation, continued use despite the negative effects on relationships, repeated use despite health problems, giving up or reducing activities, building up a tolerance, and experiencing withdrawal symptoms.
Different types of treatment depend on the severity of each case. Most people can benefit from some form of therapy. Treatments can include medicine and behavioral therapies. For many, the use of both types of treatment give the best results. People with alcohol use disorder can find it helpful to go to support classes such as alcoholics anonymous, while others may need more intensive treatment.
Disulfiram, Naltrexone, and Acamprosate and all FDA approved medicines to help treat AUD. Disulfiram causes unpleasant symptoms such as nausea and skin flushing when a person consumes alcohol. Naltrexone is a synthetic opioid antagonist used in its hydrochloride form to help treat addiction to alcohol. An antagonist binds to the receptors in the brain and block them. Naltrexone interrupts the pathways to the brain that release endorphins when alcohol is consumed, making the patient feel less pleasure when drinking alcohol. While this medicine helps with blocking the receptors, Acamprosate makes it easier to maintain alcohol abstinence. This drug is administered after someone has completed detox to help prevent further urges to drink. Unlike other drugs, Acamprosate is non-habit forming and will not result in prescription drug abuse.
When it comes to finding help with an alcohol use disorder, there are many health professionals to choose from. A primary care provider, psychiatrist, psychologist, social worker, and alcohol counselors are all people who can treat alcoholics. A primary care provider (M.D., D.O.) can prescribe medications, give brief behavioral treatment and can refer someone to a specialist. A psychiatrist (also (M.D., D.O.) can prescribe medicines and perform behavioral therapies. A psychologist (Ph.D., Psy.D., M.A.) are only allowed to perform behavioral therapies. Social workers (M.S.W., L.C.S.W.) and alcohol counselors (the degrees vary by state) are also only allowed to use behavioral treatment.
All behavioral treatment shares certain features. They focus on building the skills needed to stop or reduce drinking, they help build a strong support system, they help set reachable goals and help with coping and avoiding triggers that might cause relapse. There are four main types of behavioral treatment: cognitive-behavioral therapy, motivational enhancement therapy, marital and family counseling, and brief interventions.
Cognitive-behavioral therapy is one-on-one with a therapist that helps focus on identifying the feelings and situations, these feelings and situations are called “cues”, that lead to heavy drinking. The goal this form of therapy hopes to achieve is to change the thought processes that lead to excessive drinking and developing skills necessary to cope with everyday situations. Motivational enhancement therapy is conducted over a short period of time to build and strengthen the will to change drinking behavior.
This therapy focuses on identifying the pros and cons of seeking treatment and forming a plan to make changes. This includes building the confidence and skills needed to stick to a plan. Marital and family counseling incorporates spouses and other family members during the treatment process. This therapy plays an important role in repairing and improving family relationships. Strong family support through family therapy increases the changes maintaining abstinence. Finally, brief interventions are short, one-on-one or small group counseling that is limited. The counselor provides information about the individuals’ drinking habits and potential risks. After the client receives personalized feedback, the counselor will work with them to set goals and provide ideas to help make a change.
When it comes to selective treatment, all the options can be overwhelming for each person and family. When finally choosing treatment, ask these questions. What kind of treatment does the program offer? Is treatment tailored to each client? What is expected of me? Is treatment success measured? How does the program handle relapse? Asking these questions may help decide on what treatment is best.
Growing up with divorced parents and primarily living with my mother, I was never a victim of alcoholism compared to the defenseless children that may be victims of this disease to this day. An estimated 26.8 million children are exposed to alcoholism within their families and 11 million are under the age of 18. Children of alcoholics are at a much higher risk for cognitive, behavioral and emotional problems. Living in a home with an alcoholic is full of chaos. These families tend to be driving by a lack of flexibility and the children often feel confused. When children are presented with this feeling during this situation, it can cause them to shut down and detach from their loved ones. According to Psychology Today, the mental health trauma can be almost as severe as what a soldier goes through during combat.