Doctor's Notes on Alcoholism
Alcoholism is continued excessive consumption of alcohol-containing drinks. Signs and symptoms include cirrhosis, pancreatitis, gastritis, anemia, GI bleeding, ulcers, neuropathy, brain atrophy, cardiomyopathy, and abnormal brain functioning (confusion, hallucinations, encephalopathy, dementia). Also, behavior changes may be signs of the disease. For example, frequent falls, insomnia, depression, anxiety, irritability, aggression, missing school or work, divorce, financial problems and many others. The person frequently denies they have the disease and refuse medical help. The disease is involved with harming others: about 40% of fatal car crashes and violent crimes (homicide, rape, assault, spouse and/or child abuse) involve alcohol consumption. Alcoholism can lead to alcohol dependence (alcohol addiction), a potentially fatal disease.
The causes of alcoholism are not clear. However, researchers suggest there is evidence for genetic and biologic predispositions for it to develop. For example, if you have close relatives that have alcoholism, it makes it 4-7 times more likely that you will develop the disease. Other research suggests that if you inherit a gene (D2 receptor), you can increase your risk for the disease. However, there are many other factors, behavior and psychological, that may play a role. For example, peer pressure, social pressures and elevated stress levels. Twice as many males become alcohol dependent.
Alcoholism is a disease. It is often diagnosed more through behaviors and adverse effects on functioning than by specific medical symptoms. Only two of the diagnostic criteria are physiological (tolerance and withdrawal symptoms).
- Alcohol use disorder is associated with a broad range of medical, psychiatric, and social effects, as well as legal, occupational, economic, and family problems. For example, parental alcoholism underlies many family problems such as divorce, spouse abuse, child abuse, and neglect, as well as dependence on public assistance, and criminal behaviors, according to government sources.
- The great majority of individuals with alcoholism go unrecognized by physicians and health-care professionals. This is largely because the person with alcohol use disorder is able to conceal the amount and frequency of drinking, deny problems caused by or made worse by drinking, there is gradual onset of the disease and effects on the body, and the body has the ability to adapt to increasing alcohol amounts up to a point.
- Family members often deny or minimize alcohol problems and unwittingly contribute to the continuation of alcoholism by well-meaning behaviors such as shielding (enabling) the person with alcohol dependence from adverse consequences of drinking or taking over family or economic responsibilities. Often the drinking behavior is concealed from loved ones and health-care professionals.
- Individuals with alcohol use disorder, when confronted, will often deny excess consumption of alcohol. Alcoholism is a diverse disease and is often influenced by the alcoholism sufferer's personality as well as by other factors. Signs of a drinking problem and symptoms often vary from person to person. There are certain behaviors and signs that indicate someone may have a problem with alcohol, including insomnia, frequent falls, bruises of different ages, blackouts, chronic depression, anxiety, irritability, tardiness or absence at work or school, loss of employment, divorce or separation, financial difficulties, frequent intoxicated appearance or behavior, weight loss, or frequent automobile collisions.
- Symptoms of intoxication include slurred speech, reduced inhibitions and judgment, lack of muscle control, problems with coordination, confusion, or problems with memory or concentration. Continued drinking causes a rise in the blood alcohol content (BAC) and high BAC can lead to breathing problems, coma, and even death.
- Signs of a drinking problem and symptoms often vary from person to person. There are certain behaviors and signs that indicate someone may have a problem with alcohol, including insomnia, frequent falls, bruises of different ages, blackouts, chronic depression, anxiety, irritability, aggression or lack of restraint, tardiness or absence at work or school, loss of employment, divorce or separation, financial difficulties, frequent intoxicated appearance or behavior, self-destructive behavior, weight loss, or frequent automobile collisions.
- Signs and symptoms of chronic alcohol abuse include medical conditions such as pancreatitis, gastritis, (liver) cirrhosis, neuropathy, anemia, cerebellar (brain) atrophy, alcoholic cardiomyopathy (heart disease), Wernicke's encephalopathy (abnormal brain functioning), Korsakoff's dementia, central pontine myelinolysis (brain degeneration), seizures, confusion, malnutrition, hallucinations, peptic (stomach) ulcers, and gastrointestinal bleeding.
- Compared with children in families without alcoholism, children of alcohol-dependent individuals are at increased risk for alcohol abuse, substance abuse, conduct problems, violent behavior, anxiety disorders, compulsive behavior, and mood disorders. Alcoholic individuals have a higher risk of psychiatric disorders and suicide. They often experience guilt, shame, loneliness, fear, and depression, especially when their alcohol use leads to significant losses (for example, job, relationships, status, economic security, or physical health). Many medical problems are caused by or made worse by alcoholism as well as by the alcoholic's poor adherence to medical treatment.
The cause of alcoholism is not well-established. There is growing evidence for genetic and biologic predispositions for this disease. First-degree relatives of individuals with alcohol use disorder are four to seven times more likely to develop alcoholism than the general population. Research has implicated a gene (D2 dopamine receptor gene) that, when inherited in a specific form, might increase a person's chance of developing alcoholism.
Usually, a variety of factors contribute to the development of a problem with alcohol. Social factors such as the influence of family, peers, and society, and the availability of alcohol, and psychological factors such as elevated levels of stress, inadequate coping mechanisms, and reinforcement of alcohol use from other drinkers can contribute to alcoholism. Also, the factors contributing to initial alcohol use may vary from those maintaining it, once the disease develops.
While it may not be causative, twice as many men are alcohol dependent. One study showed one-third of men age 18-24 met the criteria for alcohol dependence, and those who start drinking before age 15 are four times more likely to develop alcohol dependence. Men are more likely to engage in binge drinking or heavy drinking. They are also more likely to be involved in behaviors that harm themselves or others such as alcohol-related violence, using other drugs such as marijuana and cocaine, having sex with six or more partners, and earning mostly Ds and Fs in school grades.
Alcohol consumption can cause numerous diseases. Many people know that heavy drinking can lead to cirrhosis of the liver and is a leading cause of automobile accidents. But did you know chronic drinking could also lead to cancer and heart attack? Read on to find out consequences of heavy drinking.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.