Alcohol Abuse and Alcoholism
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The Relationship of Chronic Viral Hepatitis,
Alcoholism, and Cirrhosis to Liver Cancer
Medical Author: Jay W. Marks, MD
Medical Editor: Leslie J. Schoenfield, MD, PhD
Cancer can start within the liver (primary liver cancer or
hepatocellular cancer) or spread to the liver (metastatic liver cancer) from
other sites, such as the colon. Cancer that starts in the liver, which I
will refer to simply as liver cancer, is the fifth most common cancer in the
world. In the U.S., it is among the 10 most common cancers. This cancer is more
frequent among Native Americans, Asians, Pacific Islanders, and Hispanics than among
Caucasians.
Liver cancer is a bad cancer. It has frequently spread
beyond the liver by the time it is discovered, and only 5% of patients with
liver cancer that has begun to cause symptoms survive even five years without treatment.
The only hope for patients who are at risk for liver cancer is regular surveillance so
that the cancers can be found early. Early cancers can be treated by
surgical removal (resection), destruction of the individual tumors, or liver transplantation. Although
the current techniques for surveillance are not very good at detecting early
liver cancer, newer techniques are being tested and appear to be better.
The most common diseases associated with liver cancer
are chronic viral hepatitis, alcoholism, and cirrhosis (scarring of
the liver). Moreover, chronic viral hepatitis is common in alcoholism,
and both viral hepatitis and alcoholism cause cirrhosis which usually precedes the
development of cancer. Therefore, the contributions and interrelationships
of alcohol abuse, viral hepatitis, and cirrhosis in the development of liver
cancer are complex. Despite the complexity, it is important to try to understand
the contributions of each disease so that patients at highest risk for liver cancer
can be targeted for surveillance. Theoretically, they also might be targeted
with treatments that prevent the development of liver cancer, when such
treatments are developed.
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What is alcoholism?
Alcoholism, also known
as alcohol dependence, is a disease that includes the following four
symptoms:
- Craving—A strong need, or urge, to drink.
- Loss of control—Not being able to stop drinking once drinking has
begun.
- Physical dependence—Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping
drinking.
- Tolerance—The need to drink greater amounts of alcohol to get
"high."
For clinical and research purposes, formal diagnostic criteria for alcoholism
also have been developed. Such criteria are included in the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric
Association, as well as in the International Classification Diseases,
published by the World Health
Organization.
Is alcoholism a disease?
Yes, alcoholism is
a disease. The craving that an alcoholic feels for alcohol can be as strong as
the need for food or water. An alcoholic will continue to drink despite serious
family, health, or legal problems.
Like many other diseases, alcoholism is chronic, meaning that it lasts a
person's lifetime; it usually follows a predictable course; and it has symptoms.
The risk for developing alcoholism is influenced both by a person's genes and by
his or her lifestyle.
Is alcoholism inherited?
Research shows that the risk for
developing alcoholism does indeed run in families. The genes a person inherits
partially explain this pattern, but lifestyle is also a factor. Currently,
researchers are working to discover the actual genes that put people at risk for
alcoholism. Your friends, the amount of stress in your life, and how
readily available alcohol is also are factors that may increase your risk for
alcoholism.
But remember: Risk is not destiny. Just because alcoholism tends to run in
families doesn't mean that a child of an alcoholic parent will automatically
become an alcoholic too. Some people develop alcoholism even though no one in
their family has a drinking problem. By the same token, not all children of
alcoholic families get into trouble with alcohol. Knowing you are at risk is
important, though, because then you can take steps to protect yourself from
developing problems with alcohol.
Can alcoholism be cured?
No, alcoholism cannot be cured at this
time. Even if an alcoholic hasn't been drinking for a long time, he or she can
still suffer a relapse. Not drinking is the safest course for most people with alcoholism.
Can alcoholism be treated?
Yes, alcoholism can be treated.
Alcoholism treatment programs use both counseling and medications to help a
person stop drinking. Treatment has helped many people stop drinking and rebuild their lives.
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