When Alcohol Becomes a Problem
By Ronald Pies
Alcohol-use disorders (AUDs) are probably the most common mental disorders in the United States: Nearly one person in seven suffers from an AUD at some time in his or her life. The prevalence of AUDs among men is about three-to-five times greater than among women. Nevertheless, alcohol can have serious consequences in women, since they are more sensitive to alcohol's damaging effects on the liver, heart and brain. Women also end up with higher blood levels of alcohol than men given the same amount consumed -- probably due to sex differences in how alcohol is broken down and distributed in body tissues.
The Scourge of AlcoholAlcohol abuse and dependence does incalculable harm in the United States, accounting for about 5 percent of all deaths. The main health hazard associated with AUDs is cirrhosis of the liver, which was the ninth-leading cause of death in the U.S. in 1988. AUDs are also associated with driving accidents, violence and suicide. Very often, AUDs are accompanied by another psychiatric disorder such as a depression, anxiety or personality disorder. In some cases, AUDs can arise from attempts to "self-medicate" one of these other disorders with alcohol -- but in many cases the AUD is the primary, underlying disorder. Nevertheless, when an individual has both an AUD and a major mood or anxiety disorder, both problems must be addressed in treatment.
What causes "alcoholism" -- the common but poorly defined term usually applied to AUDs? This has been a source of controversy for decades, even among health-care professionals. The emerging consensus is that AUDs result from a complex interaction between biological and psychosocial factors. While the precise role of heredity in AUDs is not known, some types of AUDs appear to run in families, and are at least partly related to genetic factors. While blaming someone for having an AUD may be unjustified, holding the person responsible for getting help is critical. After all, diabetes is a biological disorder, but diabetics are still held accountable for taking their insulin.
Recognizing and Dealing with AUDs
How do you know when you or a loved one has developed a serious drinking problem? The actual amount of alcohol he or she drinks is not a good basis for answering this. Neither is the person's insistence that, "I can stop drinking anytime I want to." Most chronic alcoholics have stopped drinking for extended periods at one time or another, but that does not mean that they can control the problem without help: Almost always, the abstinent alcoholic will relapse unless he or she remains in some form of substance-abuse treatment. You should suspect an AUD when the person in question
The treatment of AUDs requires a thorough medical and psychological assessment. Concurrent physical disorders, vitamin deficiencies and potential psychiatric problems must be addressed. In some cases, a mood stabilizer or antidepressant may be part of the overall treatment plan. The medication naltrexone (ReVia) may help reduce the urge to drink and enhance abstinence in some patients but should be used in concert with psychotherapy or a twelve-step program, such as Alcoholics Anonymous.
A few studies support the use of disulfiram (Antabuse), a medication that induces nausea and other unpleasant reactions if the individual drinks. For families who must deal with a loved one's AUD, Al-Anon and similar support groups for families can be helpful. The key to success is helping the individual accept the need for help and insisting that he or she gets it.
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