Content deleted Content added
That wasn't exactly an objective fact, and shouldn't be presented as such |
Typo fixing, minor formatting |
||
| (18 intermediate revisions by 14 users not shown) | |||
Line 9:
{{Infobox medical condition (new)
| name = Alcoholism
| synonyms = Alcohol addiction, alcohol dependence syndrome, alcohol use disorder (AUD)<ref name=MESH2020>{{cite web |title=Alcoholism MeSH Descriptor Data 2020 |url=https://meshb.nlm.nih.gov/record/ui?ui=D000437 |website=meshb.nlm.nih.gov |access-date=9 May 2020 |archive-date=23 June 2020 |archive-url=https://web.archive.org/web/20200623014248/https://meshb.nlm.nih.gov/record/ui?ui=D000437 |url-status=live }}</ref>
| image = A wife asking her drunkard husband to hand over a bottle Wellcome L0067935.jpg
| caption = A French temperance organisation poster depicting the [[alcoholism in family systems|effects of alcoholism in a family]], {{circa|1915}}: "Ah! When will we be rid of alcohol?"
Line 25:
| medication =
| prognosis =
| frequency = 380 million / 5.1% adults (2016)<ref name=WHO2018>{{cite book|title=Global status report on alcohol and health 2018|date=2018|publisher=World Health Organization|isbn=
| deaths = 3.3 million / 5.9%<ref name=NIH2015Stats/>
| alt =
}}
'''Alcoholism''' is the continued drinking of [[alcohol (drug)|alcohol]] despite it causing problems. Some definitions require evidence of dependence and withdrawal.<ref>{{cite book | vauthors = Littrell J |title=Understanding and Treating Alcoholism Volume I: An Empirically Based Clinician's Handbook for the Treatment of Alcoholism: Volume II: Biological, Psychological, and Social Aspects of Alcohol Consumption and Abuse|date=2014|publisher=Taylor and Francis|location=Hoboken|isbn=978-1-317-78314-5|page=55|url=https://books.google.com/books?id=2k57AgAAQBAJ&pg=PA55|quote=The World Health Organization defines alcoholism as any drinking which results in problems|url-status=live|archive-url=https://web.archive.org/web/20170720112756/https://books.google.com/books?id=2k57AgAAQBAJ&pg=PA55|archive-date=20 July 2017}}</ref> Problematic use of alcohol has been mentioned in the earliest historical records. The [[World Health Organization]] (WHO) estimated there were 283 million people with alcohol use disorders worldwide {{as of|2016|lc=y}}.<ref name=WHO2018/><ref name=un2020>{{cite web|url=https://population.un.org/wpp/DataQuery/|title=World Population Prospects – Population Division|publisher=United Nations|access-date=1 July 2024|archive-date=15 June 2020|archive-url=https://web.archive.org/web/20200615001511/https://population.un.org/wpp/DataQuery/|url-status=live}}</ref> The term ''alcoholism'' was first coined in 1852,<ref name="huss1852">{{cite book|title=Alcoholismus chronicus, eller Chronisk alkoholssjukdom|url={{google books |plainurl=y |id=wt6r2Zw8sCEC|page=5}}|publisher=Stockholm und Leipzig|access-date=19 February 2008|year=1852}}</ref> but ''alcoholism'' and ''alcoholic'' are sometimes considered [[Social stigma|stigmatizing]] and to discourage seeking treatment, so diagnostic terms such as '''alcohol use disorder''' or '''[[alcohol dependence]]''' are often used instead in a clinical context.<ref name=morrismoss2022>{{cite journal |last1=Morris |first1=J. |last2=Moss |first2=A. C. |last3=Albery |first3=I. P. |last4=Heather |first4=N. |date=1 January 2022 |title=The 'alcoholic other': Harmful drinkers resist problem recognition to manage identity threat |url=https://www.sciencedirect.com/science/article/abs/pii/S0306460321002781 |journal=Addictive Behaviors |volume=124 |pages=107093 |doi=10.1016/j.addbeh.2021.107093 |pmid=34500234 |access-date=1 July 2024 |archive-date=30 March 2024 |archive-url=https://web.archive.org/web/20240330234059/https://www.sciencedirect.com/science/article/abs/pii/S0306460321002781 |url-status=live }}</ref><ref name=ashfordbrown2018>{{cite journal |last1=Ashford |first1=Robert D. |last2=Brown |first2=Austin M. |last3=Curtis |first3=Brenda |date=1 August 2018 |title=Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias |journal=Drug and Alcohol Dependence |volume=189 |pages=131–138 |doi=10.1016/j.drugalcdep.2018.05.005|pmid=29913324 |pmc=6330014 }}</ref>
<!-- Summary of negative impacts-->
Alcohol is [[Addiction|addictive]], and heavy long-term alcohol use results in many negative health and social consequences. It can damage all the [[organ
<!-- Cause and diagnosis-->
Line 38:
<!-- Prevention and treatment -->
Treatment of alcoholism may take several forms.<ref name="Blondell-2005"/> Due to medical problems that can occur during withdrawal, [[alcohol detoxification|alcohol cessation]] should be controlled carefully.<ref name="Blondell-2005"/> One common method involves the use of [[benzodiazepine]] medications, such as [[diazepam]].<ref name="Blondell-2005"/> These can be taken while admitted to a health care institution or individually.<ref name="Blondell-2005">{{cite journal | vauthors = Blondell RD | title = Ambulatory detoxification of patients with alcohol dependence | journal = American Family Physician | volume = 71 | issue = 3 | pages = 495–502 | date = February 2005 | pmid = 15712624 }}</ref> The medications [[acamprosate]] or [[disulfiram]] may also be used to help prevent further drinking.<ref name=Test2014>{{cite journal | vauthors = Testino G, Leone S, Borro P | title = Treatment of alcohol dependence: recent progress and reduction of consumption | journal = Minerva Medica | volume = 105 | issue = 6 | pages = 447–66 | date = December 2014 | pmid = 25392958 }}</ref> Mental illness or other [[addiction]]s may complicate treatment.<ref>{{cite journal | vauthors = DeVido JJ, Weiss RD | title = Treatment of the depressed alcoholic patient | journal = Current Psychiatry Reports | volume = 14 | issue = 6 | pages = 610–8 | date = December 2012 | pmid = 22907336 | pmc = 3712746 | doi = 10.1007/s11920-012-0314-7 }}</ref> Various individual or group therapy or [[support group]]s are used to attempt to keep a person from returning to alcoholism.<ref name="Morgan-Lopez-2006">{{cite journal | vauthors = Morgan-Lopez AA, Fals-Stewart W | title = Analytic complexities associated with group therapy in substance abuse treatment research: problems, recommendations, and future directions | journal = Experimental and Clinical Psychopharmacology | volume = 14 | issue = 2 | pages = 265–73 | date = May 2006 | pmid = 16756430 | pmc = 4631029 | doi = 10.1037/1064-1297.14.2.265 }}</ref><ref>{{cite journal | vauthors = Albanese AP | title = Management of alcohol abuse | journal = Clinics in Liver Disease | volume = 16 | issue = 4 | pages = 737–62 | date = November 2012 | pmid = 23101980 | doi = 10.1016/j.cld.2012.08.006 }}</ref> Among them is the abstinence based [[Mutual aid (organization theory)|mutual aid]] fellowship [[Alcoholics Anonymous]] (AA). A 2020 scientific review found that clinical interventions encouraging increased participation in AA (AA/twelve step facilitation (AA/TSF))—resulted in higher abstinence rates over other clinical interventions, and most studies in the review found that AA/TSF led to lower health costs.{{efn|"Twelve-Step Facilitation (TSF) interventions include extended counseling, adopting some of the techniques and principles of AA, as well as brief interventions designed to link individuals to community AA groups."<ref>{{cite journal |doi=10.1002/14651858.CD012880.pub2 |pmid=32159228 |title=Alcoholics Anonymous and other 12-step programs for alcohol use disorder |year=2020 |last1=Kelly |first1=John F. |last2=Humphreys |first2=Keith |last3=Ferri |first3=Marica |journal=Cochrane Database of Systematic Reviews |volume=3 |issue=CD012880 |page=15 |pmc=7065341}}</ref>}}<ref name="Cochrane2020">{{cite journal |last1=Kelly |first1=John F. |last2=Humphreys |first2=Keith |last3=Ferri |first3=Marica |year=2020 |title=Alcoholics Anonymous and other 12-step programs for alcohol use disorder |journal=Cochrane Database of Systematic Reviews |volume=3 |issue=3 |pages=CD012880 |doi=10.1002/14651858.CD012880.pub2 |pmc=7065341 |pmid=32159228}}</ref><ref name="Cochrane2020distilled">{{cite journal |last1=Kelly |first1=John F. |last2=Abry |first2=Alexandra |last3=Ferri |first3=Marica |last4=Humphreys |first4=Keith |year=2020 |title=Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers |journal=Alcohol and Alcoholism |volume=55 |issue=6 |pages=641–651 |doi=10.1093/alcalc/agaa050 |pmc=8060988 |pmid=32628263}}</ref><ref>{{cite web |year=2020 |title=Alcoholics Anonymous most effective path to alcohol abstinence |url=https://med.stanford.edu/news/all-news/2020/03/alcoholics-anonymous-most-effective-path-to-alcohol-abstinence.html |access-date=1 July 2024 |archive-date=20 February 2022 |archive-url=https://web.archive.org/web/20220220224453/https://med.stanford.edu/news/all-news/2020/03/alcoholics-anonymous-most-effective-path-to-alcohol-abstinence.html |url-status=live }}</ref>
Many terms, some [[Pejorative|slurs]] and some [[slang|informal]], have been used to refer to people affected by alcoholism such as ''tippler'', ''drunkard'', ''[[dipsomaniac]]'' and ''souse''.<ref>{{cite book|title=Chambers English Thesaurus|publisher=Allied Publishers|isbn=978-81-86062-04-3|page=175|url=https://books.google.com/books?id=IamKT5uk5lMC&pg=PA175}}</ref>
Line 44:
==Signs and symptoms==
The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of [[Binge drinking|drinking larger amounts on an occasion]], to the point of intoxication, which is sometimes called ''binge drinking''. Binge drinking is the most common pattern of alcoholism. It has different definitions and one of this defines it
===Long-term misuse===
Line 62:
{{See also|Long-term effects of alcohol consumption}}
Having more than one drink a day for women or two drinks for men increases the risk of heart disease, [[high blood pressure]], [[atrial fibrillation]], and [[stroke]].<ref name="Kee2014">{{cite journal|vauthors=O'Keefe JH, Bhatti SK, Bajwa A, DiNicolantonio JJ, Lavie CJ|date=March 2014|title=Alcohol and cardiovascular health: the dose makes the poison…or the remedy|journal=Mayo Clinic Proceedings|volume=89|issue=3|pages=382–93|doi=10.1016/j.mayocp.2013.11.005|pmid=24582196|doi-access=free}}</ref> Risk is greater with [[binge drinking]], which may also result in violence or accidents. About 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol each year.<ref name="NIH2015Stats" /> Alcoholism reduces a person's life expectancy by around ten years<ref name="Schu2014" /> and alcohol use is the third leading cause of early death in the United States.<ref name=Kee2014 /> Long-term alcohol misuse can cause a number of physical symptoms, including [[cirrhosis]] of the liver, [[pancreatitis]], [[epilepsy]], [[polyneuropathy]], [[Wernicke-Korsakoff syndrome|alcoholic dementia]], heart disease, nutritional deficiencies, [[Duodenal ulcer|peptic ulcers]]<ref>{{cite book |last=American Medical Association |title=Complete Medical Encyclopedia |url=
Women develop long-term complications of alcohol dependence more rapidly than do men, women also have a higher mortality rate from alcoholism than men.<ref name="Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all 1998 861–870"/> Examples of long-term complications include brain, heart, and liver damage<ref name="Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al. 2003 253–268" /> and an [[alcohol and breast cancer|increased risk of breast cancer]]. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as [[anovulation]], decreased ovarian mass, problems or irregularity of the [[menstrual cycle]], and early [[menopause]].<ref name="Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all 1998 861–870" /> Alcoholic [[ketoacidosis]] can occur in individuals who chronically misuse alcohol and have a recent history of [[binge drinking]].<ref name="Mihai-">{{cite journal | vauthors = Mihai B, Lăcătuşu C, Graur M | title = [Alcoholic ketoacidosis] | journal = Revista Medico-Chirurgicala a Societatii de Medici Si Naturalisti Din Iasi | volume = 112 | issue = 2 | pages = 321–6 | date = April–June 2008 | pmid = 19294998 }}</ref><ref name="Sibaï-2005">{{cite journal | vauthors = Sibaï K, Eggimann P | title = [Alcoholic ketoacidosis: not rare cause of metabolic acidosis] | journal = Revue Médicale Suisse | volume = 1 | issue = 32 | pages = 2106, 2108–10, 2112–5 | date = September 2005 | doi = 10.53738/REVMED.2005.1.32.2106 | pmid = 16238232 }}</ref> The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher [[blood alcohol concentration]]s (BACs), since women generally have a lower weight and higher percentage of body fat and therefore a lower volume of distribution for alcohol than men.<ref name="pmid23101976">{{cite journal | vauthors = Cederbaum AI | title = Alcohol metabolism | journal = Clinics in Liver Disease | volume = 16 | issue = 4 | pages = 667–85 | date = November 2012 | pmid = 23101976 | pmc = 3484320 | doi = 10.1016/j.cld.2012.08.002 }}</ref>
====Psychiatric====
Long-term misuse of alcohol can cause a wide range of [[mental health]] problems. Severe [[cognitive]] problems are common; approximately 10% of all dementia cases are related to alcohol consumption, making it the second leading cause of [[dementia]].<ref name="aamaibnc">{{cite web |url=http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php |title=Alcoholism-associated molecular adaptations in brain neurocognitive circuits | vauthors = Bakalkin G |date=8 July 2008 |website=Eurekalert.org |access-date=11 January 2012 |url-status=live |archive-url=https://web.archive.org/web/20111130152434/http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php |archive-date=30 November 2011 }}</ref> Excessive alcohol use causes [[Brain damage|damage to brain function]], and psychological health can be increasingly affected over time.<ref>{{cite journal | vauthors = Oscar-Berman M, Marinkovic K | title = Alcoholism and the brain: an overview | journal = Alcohol Research & Health | volume = 27 | issue = 2 | pages = 125–33 | year = 2003 | pmid = 15303622 | pmc = 6668884 }}</ref> [[Social skills]] are significantly impaired in people with alcoholism due to the neurotoxic effects of alcohol on the brain, especially the [[prefrontal cortex]] area of the brain. The social skills that are impaired by alcohol use disorder include impairments in perceiving facial emotions, [[Prosody (linguistics)|prosody]], perception problems, and [[theory of mind]] deficits; the ability to understand humor is also impaired in people who misuse alcohol.<ref name="pmid18412750">{{cite journal | vauthors = Uekermann J, Daum I | title = Social cognition in alcoholism: a link to prefrontal cortex dysfunction? | journal = Addiction | volume = 103 | issue = 5 | pages = 726–35 | date = May 2008 | pmid = 18412750 | doi = 10.1111/j.1360-0443.2008.02157.x }}</ref> Psychiatric disorders are common in people with alcohol use disorders, with as many as 25% also having severe psychiatric disturbances. The most prevalent psychiatric symptoms are [[anxiety disorder|anxiety]] and [[Major depressive disorder|depression]] disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.<ref>{{cite journal | vauthors = Wetterling T, Junghanns K | title = Psychopathology of alcoholics during withdrawal and early abstinence | journal = European Psychiatry | volume = 15 | issue = 8 | pages = 483–8 | date = December 2000 | pmid = 11175926 | doi = 10.1016/S0924-9338(00)00519-8 | s2cid = 24094651 }}</ref> [[Psychosis]], [[confusion]], and [[organic brain syndrome]] may be caused by alcohol misuse, which can lead to a misdiagnosis such as [[schizophrenia]].<ref>{{cite journal | vauthors = Schuckit MA | title = Alcoholism and other psychiatric disorders | journal = Hospital & Community Psychiatry | volume = 34 | issue = 11 | pages = 1022–7 | date = November 1983 | pmid = 6642446 | doi = 10.1176/ps.34.11.1022 }}</ref> [[Panic disorder]] can develop or worsen as a direct result of long-term alcohol misuse.<ref>{{cite journal | vauthors = Cowley DS | title = Alcohol abuse, substance abuse, and panic disorder | journal = The American Journal of Medicine | volume = 92 | issue = 1A | pages = 41S–48S | date = January 1992 | pmid = 1346485 | doi = 10.1016/0002-9343(92)90136-Y }}</ref><ref>{{cite journal | vauthors = Cosci F, Schruers KR, Abrams K, Griez EJ | title = Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship | journal = The Journal of Clinical Psychiatry | volume = 68 | issue = 6 | pages = 874–80 | date = June 2007 | pmid = 17592911 | doi = 10.4088/JCP.v68n0608 }}</ref>
The co-occurrence of [[major depressive disorder]] and alcoholism is well documented.<ref>{{cite journal | vauthors = Grant BF, Harford TC | title = Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey | journal = Drug and Alcohol Dependence | volume = 39 | issue = 3 | pages = 197–206 | date = October 1995 | pmid = 8556968 | doi = 10.1016/0376-8716(95)01160-4 | url = https://zenodo.org/record/1258497 | access-date = 1 July 2024 | archive-date = 28 November 2020 | archive-url = https://web.archive.org/web/20201128214542/https://zenodo.org/record/1258497 | url-status = live }}</ref><ref>{{cite journal | vauthors = Kandel DB, Huang FY, Davies M | title = Comorbidity between patterns of substance use dependence and psychiatric syndromes | journal = Drug and Alcohol Dependence | volume = 64 | issue = 2 | pages = 233–41 | date = October 2001 | pmid = 11543993 | doi = 10.1016/S0376-8716(01)00126-0 | author-link1 = Denise Kandel }}</ref><ref>{{cite book | vauthors = Cornelius JR, Bukstein O, Salloum I, Clark D | title = Recent Developments in Alcoholism | chapter = Alcohol and psychiatric comorbidity | series = Recent Dev Alcohol | volume = 16 | pages = [https://archive.org/details/recentdevelopment00gala/page/361 361–74] | year = 2003 | pmid = 12638646 | doi = 10.1007/0-306-47939-7_24 | chapter-url = https://archive.org/details/recentdevelopment00gala/page/361 | isbn = 978-0-306-47258-9 | issn = 0738-422X | publisher = Kluwer Academic/Plenum Publishers }}</ref> Among those with [[comorbid]] occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes).<ref>{{cite journal | vauthors = Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock VM, Smith TL | title = Comparison of induced and independent major depressive disorders in 2,945 alcoholics | journal = The American Journal of Psychiatry | volume = 154 | issue = 7 | pages = 948–57 | date = July 1997 | pmid = 9210745 | doi = 10.1176/ajp.154.7.948 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Schuckit MA, Tipp JE, Bucholz KK, Nurnberger JI, Hesselbrock VM, Crowe RR, Kramer J | title = The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls | journal = Addiction | volume = 92 | issue = 10 | pages = 1289–304 | date = October 1997 | pmid = 9489046 | doi = 10.1111/j.1360-0443.1997.tb02848.x | s2cid = 14958283 }}</ref><ref>{{cite journal | vauthors = Schuckit MA, Smith TL, Danko GP, Pierson J, Trim R, Nurnberger JI, Kramer J, Kuperman S, Bierut LJ, Hesselbrock V | title = A comparison of factors associated with substance-induced versus independent depressions | journal = Journal of Studies on Alcohol and Drugs | volume = 68 | issue = 6 | pages = 805–12 | date = November 2007 | pmid = 17960298 | doi = 10.15288/jsad.2007.68.805 | s2cid = 17528609 }}</ref> Additional use of other drugs may increase the risk of depression.<ref>{{cite journal | vauthors = Schuckit M | title = Alcoholic patients with secondary depression | journal = The American Journal of Psychiatry | volume = 140 | issue = 6 | pages = 711–4 | date = June 1983 | pmid = 6846629 | doi = 10.1176/ajp.140.6.711 }}</ref> Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as [[major depression]], [[anxiety]], [[panic disorder]], [[bulimia]], [[post-traumatic stress disorder]] (PTSD), or [[borderline personality disorder]]. Men with alcohol-use disorders more often have a co-occurring diagnosis of [[narcissistic personality disorder|narcissistic]] or [[antisocial personality disorder]], [[bipolar disorder]], [[schizophrenia]], [[impulse disorder]]s or [[attention deficit/hyperactivity disorder]] (ADHD).<ref name="Karrol_2002">{{cite journal| vauthors = Karrol BR |s2cid=73186615 |title=Women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of Social Work |volume=2 |issue=3 |pages=337–56 |year=2002 |doi=10.1177/146801730200200305 }}</ref> Women with alcohol use disorder are more likely to experience physical or [[sexual assault]], abuse, and [[domestic violence]] than women in the general population,<ref name="Karrol_2002" /> which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.
====Social effects====
{{See also|Drug-related crime}}
Serious social problems arise from alcohol use disorder; these dilemmas are caused by the pathological changes in the brain and the intoxicating effects of alcohol.<ref name="aamaibnc"/><ref name="Jessica Kingsley Publishers"/> Alcohol misuse is associated with an increased risk of committing criminal offences, including [[child abuse]], [[domestic violence]], [[rape]], [[burglary]] and [[assault]].<ref name="drug_use_a_reference_handbook">{{cite book | last1 = Isralowitz | first1 = Richard | title = Drug use: a reference handbook | url =
===Alcohol withdrawal===
Line 81:
[[File:A maniacal man is visited in prison by his children, all rui Wellcome V0019408.jpg|thumb|[[The Bottle (etchings)|"The bottle has done its work"]]. Reproduction of an etching by G. Cruikshank, 1847.]]
As with similar substances with a [[sedative]]-hypnotic mechanism, such as [[barbiturates]] and [[benzodiazepines]], withdrawal from alcohol dependence can be fatal if it is not properly managed.<ref name="Jessica Kingsley Publishers"/><ref>{{cite book |last1=Galanter |first1=Marc |last2=Kleber |first2=Herbert D. |title=The American Psychiatric Publishing Textbook of Substance Abuse Treatment |url=
Severe acute withdrawal symptoms such as [[delirium tremens]] and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation, anxiety, depression, fatigue, and sleep disturbance are common.<ref name="pmid20148778">{{cite journal | vauthors = Heilig M, Egli M, Crabbe JC, Becker HC | title = Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked? | journal = Addiction Biology | volume = 15 | issue = 2 | pages = 169–84 | date = April 2010 | pmid = 20148778 | pmc = 3268458 | doi = 10.1111/j.1369-1600.2009.00194.x }}</ref> Similar post-acute withdrawal symptoms have also been observed in animal models of alcohol dependence and withdrawal.<ref>{{cite book | last1 = Johnson | first1 = Bankole A. | title = Addiction medicine: science and practice | url = {{google books |plainurl=y |id=zvbr4Zn9S9MC|page=342}} | year = 2011 | publisher = Springer | location = New York | isbn = 978-1-4419-0337-2 | pages = 301–03 | url-status = live | archive-url = https://web.archive.org/web/20151201092622/https://books.google.com/books?id=zvbr4Zn9S9MC&pg=PA342 | archive-date = 1 December 2015
A [[Kindling (sedative-hypnotic withdrawal)|kindling effect]] also occurs in people with alcohol use disorders whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to [[gene expression]].<ref name="Breese-2011">{{cite journal | vauthors = Breese GR, Sinha R, Heilig M | title = Chronic alcohol neuroadaptation and stress contribute to susceptibility for alcohol craving and relapse | journal = Pharmacology & Therapeutics | volume = 129 | issue = 2 | pages = 149–71 | date = February 2011 | pmid = 20951730 | pmc = 3026093 | doi = 10.1016/j.pharmthera.2010.09.007 }}</ref> Kindling also results in the intensification of psychological symptoms of alcohol withdrawal.<ref name="pmid20148778" /> There are decision tools and questionnaires that help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.<ref>{{cite journal | vauthors = Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM | title = Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) | journal = British Journal of Addiction | volume = 84 | issue = 11 | pages = 1353–7 | date = November 1989 | pmid = 2597811 | doi = 10.1111/j.1360-0443.1989.tb00737.x | url = http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/CIWA-ARBJA.pdf | access-date = 25 October 2017 | citeseerx = 10.1.1.489.341
==Causes==
[[File:Mental health as a risk factor for alcohol dependency or abuse, OWID.svg|thumb|upright=2|Mental health as a risk factor for alcohol dependence or abuse]]
[[File:William Hogarth - Gin Lane.jpg|thumb|[[William Hogarth|William Hogarth's]] ''[[Gin Lane]]'', 1751]]
A complex combination of genetic and environmental factors influences the risk of the development of alcoholism.<ref name="Enoch-2006">{{cite journal | vauthors = Enoch MA | title = Genetic and environmental influences on the development of alcoholism: resilience vs. risk | journal = Annals of the New York Academy of Sciences | volume = 1094 | issue = 1 | pages = 193–201 | date = December 2006 | pmid = 17347351 | doi = 10.1196/annals.1376.019 | url = https://zenodo.org/record/1235882 | bibcode = 2006NYASA1094..193E | s2cid = 248697 | access-date = 1 July 2024 | archive-date = 25 July 2020 | archive-url = https://web.archive.org/web/20200725015737/https://zenodo.org/record/1235882 | url-status = live }}</ref> Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism.<ref name="Edenberg 2281–2297">{{cite journal | vauthors = Edenberg HJ, McClintick JN | title = Alcohol Dehydrogenases, Aldehyde Dehydrogenases, and Alcohol Use Disorders: A Critical Review | journal = Alcoholism: Clinical and Experimental Research | volume = 42 | issue = 12 | pages = 2281–2297 | date = December 2018 | pmid = 30320893 | pmc = 6286250 | doi = 10.1111/acer.13904 }}</ref> There is compelling evidence that alcohol use at an early age may influence the [[gene expression|expression of genes]] which increase the risk of alcohol dependence. These [[Molecular and epigenetic mechanisms of alcoholism|genetic and epigenetic results]] are regarded as consistent with large longitudinal population studies finding that the younger the age of drinking onset, the greater the prevalence of lifetime alcohol dependence.<ref>{{cite journal | vauthors = Agrawal A, Sartor CE, Lynskey MT, Grant JD, Pergadia ML, Grucza R, Bucholz KK, Nelson EC, Madden PA, Martin NG, Heath AC | title = Evidence for an interaction between age at first drink and genetic influences on DSM-IV alcohol dependence symptoms | journal = Alcoholism: Clinical and Experimental Research | volume = 33 | issue = 12 | pages = 2047–56 | date = December 2009 | pmid = 19764935 | pmc = 2883563 | doi = 10.1111/j.1530-0277.2009.01044.x }}</ref><ref name="pmid27677720">{{cite journal|vauthors=Crews FT, Vetreno RP, Broadwater MA, Robinson DL| title=Adolescent Alcohol Exposure Persistently Impacts Adult Neurobiology and Behavior. | journal=Pharmacol Rev | year= 2016 | volume= 68 | issue= 4 | pages= 1074–1109 | pmid=27677720 | doi=10.1124/pr.115.012138 | pmc=5050442 }}</ref>
[[Psychological trauma|Severe childhood trauma]] is also associated with a general increase in the risk of drug dependency.<ref name="Enoch-2006"/> Lack of peer and family support is associated with an increased risk of alcoholism developing.<ref name="Enoch-2006"/> Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol misuse. [[Cerebral cortex|Cortical]] degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.<ref name="Crews-2009">{{cite journal | vauthors = Crews FT, Boettiger CA | title = Impulsivity, frontal lobes and risk for addiction | journal = Pharmacology, Biochemistry, and Behavior | volume = 93 | issue = 3 | pages = 237–47 | date = September 2009 | pmid = 19410598 | pmc = 2730661 | doi = 10.1016/j.pbb.2009.04.018 }}</ref> The use of cannabis was associated with later problems with alcohol use.<ref name="PMID26875671">{{cite journal | vauthors = Weinberger AH, Platt J, Goodwin RD | title = Is cannabis use associated with an increased risk of onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States | journal = Drug and Alcohol Dependence | volume = 161 | pages = 363–7 | date = April 2016 | pmid = 26875671 | pmc = 5028105 | doi = 10.1016/j.drugalcdep.2016.01.014 }}</ref> Alcohol use was associated with an increased probability of later use of tobacco and illegal drugs such as cannabis.<ref name="PMID22712674">{{cite journal | vauthors = Kirby T, Barry AE | title = Alcohol as a gateway drug: a study of US 12th graders | journal = The Journal of School Health | volume = 82 | issue = 8 | pages = 371–9 | date = August 2012 | pmid = 22712674 | doi = 10.1111/j.1746-1561.2012.00712.x | url = http://www.mamacultiva.org/wp-content/uploads/2015/pdf/A8%20-%20Alcohol%20as%20a%20Gateway%20Drug%20A%20Study%20of%20US%2012th%20Graders.pdf | url-status = live | archive-url = https://web.archive.org/web/20160604012851/http://www.mamacultiva.org/wp-content/uploads/2015/pdf/A8%20-%20Alcohol%20as%20a%20Gateway%20Drug%20A%20Study%20of%20US%2012th%20Graders.pdf | archive-date = 4 June 2016 }}</ref>
===Availability===
Alcohol is the most available, widely consumed, and widely misused [[recreational drug]]. [[Beer]] alone is the world's most widely consumed<ref>{{cite web|title=Volume of World Beer Production|website=European Beer Guide|url=http://www.europeanbeerguide.net/eustats.htm#production|access-date=17 October 2006| archive-url= https://web.archive.org/web/20061028165040/http://www.europeanbeerguide.net/eustats.htm| archive-date= 28 October 2006 | url-status= live}}</ref> [[alcoholic beverage]]; it is the third-most popular drink overall, after [[Drinking water|water]] and [[tea]].<ref name="Nelson 2005">{{cite book|url=
===Gender difference===
Line 127:
===Definition===
[[File:Emil Mayer 024.jpg|thumb|A man drinking from a bottle of liquor while sitting on a boardwalk, {{circa|1905}}–1914. Picture by Austrian photographer [[Emil Mayer]].]]
Because there is disagreement on the definition of the word alcoholism, it is not a recognized diagnosis, and the use of the term alcoholism is discouraged due to its heavily [[Social stigma|stigmatized]] connotations.<ref name=morrismoss2022 /><ref name="ashfordbrown2018" /> It is classified as alcohol use disorder<ref name="NIH2013" /> in the [[DSM-5]]<ref name="DSM5" /> or [[alcohol dependence]] in the [[ICD-11]].<ref>{{cite web|date=September 2020|title=6C40.2 Alcohol dependence|url=https://icd.who.int/browse11/l-m/en#/https%3a%2f%2frp.liu233w.com%3a443%2fhttp%2fid.who.int%2ficd%2fentity%2f1580466198|access-date=6 December 2020|website=ICD-11 for Mortality and Morbidity Statistics|archive-date=1 August 2018|archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/https%3a%2f%2frp.liu233w.com%3a443%2fhttp%2fid.who.int%2ficd%2fentity%2f1580466198|url-status=live}}</ref> In 1979, the World Health Organization discouraged the use of ''alcoholism'' due to its inexact meaning, preferring ''alcohol dependence syndrome''.<ref name="ladtpwho">{{cite web |url=https://www.who.int/substance_abuse/terminology/who_lexicon/en/ |title=Lexicon of alcohol and drug terms published by the World Health Organization |author=WHO |publisher=World Health Organization |archive-url=https://web.archive.org/web/20130205230313/http://www.who.int/substance_abuse/terminology/who_lexicon/en/ |archive-date=5 February 2013 }}</ref>
Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker.<ref name="the_american_heritage_dictionary_of_the_english_language_a12">{{cite book| author= American Heritage Dictionaries | title = The American Heritage dictionary of the English language | url = {{google books |plainurl=y |id=uPCFIQAACAAJ}} | year=2006 |publisher = Houghton Mifflin | location = Boston | edition = 4 |quote = To use wrongly or improperly; misuse: abuse alcohol | isbn = 978-0-618-70172-8 }}</ref> ''The Dietary Guidelines for Americans'', issued by the [[United States Department of Agriculture]] (USDA) in 2005, defines "moderate use" as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women.<ref>{{cite web |url=http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm |title=Dietary Guidelines for Americans 2005 |year=2005 |publisher=health.gov |archive-url=https://web.archive.org/web/20070701174135/http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm |archive-date=1 July 2007 |access-date=28 November 2009 }} Dietary Guidelines</ref> The [[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) defines [[binge drinking]] as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a two-hour period. According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 [[standard drink]]s per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.<ref>{{cite journal |date=April 2006 |title=Young Adult Drinking |url=http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm |url-status=live |journal=Alcohol Alert |archive-url=https://web.archive.org/web/20130213205702/http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm |archive-date=13 February 2013 |access-date=18 February 2013 |number=68}}</ref> Despite this risk, a 2014 report in the National Survey on Drug Use and Health found that only 10% of either "heavy drinkers" or "binge drinkers" defined according to the above criteria also met the criteria for alcohol dependence, while only 1.3% of non-binge drinkers met the criteria. An inference drawn from this study is that evidence-based policy strategies and clinical preventive services may effectively reduce binge drinking without requiring addiction treatment in most cases.<ref name="Esser2014">{{cite journal | vauthors = Esser MB, Hedden SL, Kanny D, Brewer RD, Gfroerer JC, Naimi TS | title = Prevalence of alcohol dependence among US adult drinkers, 2009–2011 | journal = Preventing Chronic Disease | volume = 11 | pages = E206 | date = November 2014 | pmid = 25412029 | pmc = 4241371 | doi = 10.5888/pcd11.140329 }}</ref>
Line 168:
| Episode of harmful use of alcohol, Harmful pattern of use of alcohol, or Alcohol dependence
|
* ''Episode of harmful use of alcohol'' – "A single episode of use of alcohol that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."<ref>{{cite web
* ''Harmful pattern of use of alcohol'' – "A pattern of alcohol use that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."<ref>{{cite web
* ''Alcohol dependence'' – "Alcohol dependence is a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. The characteristic feature is a strong internal drive to use alcohol. ... The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 1 month."<ref>{{cite web
|-
|}
Line 191:
# Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?<ref>{{cite journal | vauthors = Ewing JA | title = Detecting alcoholism. The CAGE questionnaire | journal = JAMA | volume = 252 | issue = 14 | pages = 1905–7 | date = October 1984 | pmid = 6471323 | doi = 10.1001/jama.1984.03350140051025 }}</ref><ref>{{cite web|url=http://www.whoguidemhpcuk.org/downloads/primary_care/11-1_CAGE_questionnaire.pdf |title=CAGE questionnaire – screen for alcohol misuse |archive-url=https://web.archive.org/web/20110728175054/http://www.whoguidemhpcuk.org/downloads/primary_care/11-1_CAGE_questionnaire.pdf |archive-date=28 July 2011 }}</ref>}}
:The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems; however, it has limitations in people with less severe alcohol-related problems, white women and college students.<ref>{{cite journal | vauthors = Dhalla S, Kopec JA | title = The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies | journal = Clinical and Investigative Medicine | volume = 30 | issue = 1 | pages = 33–41 | year = 2007 | pmid = 17716538 | doi = 10.25011/cim.v30i1.447
Other tests are sometimes used for the detection of alcohol dependence, such as the [[Alcohol Dependence Data Questionnaire]], which is a more sensitive diagnostic test than the [[CAGE questionnaire]]. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.<ref>{{cite web |url=http://www.emcdda.europa.eu/html.cfm/index3556EN.html |title=Alcohol Dependence Data Questionnaire (SADD) | vauthors = Raistrick D, Dunbar G, Davidson R |year=1983 |publisher=European Monitoring Centre for Drugs and Drug Addiction |url-status=live |archive-url=https://web.archive.org/web/20160721101929/http://www.emcdda.europa.eu/html.cfm/index3556EN.html |archive-date=21 July 2016 }}</ref> The [[Michigan Alcohol Screening Test]] (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,<ref>{{cite web |url=http://www.ncadd-sfv.org/symptoms/mast_test.html |title=Michigan Alcohol Screening Test |publisher=The National Council on Alcoholism and Drug Dependence |archive-url=https://web.archive.org/web/20060906123532/http://www.ncadd-sfv.org/symptoms/mast_test.html |archive-date=6 September 2006 }}</ref> [[driving under the influence]] being the most common. The [[Alcohol Use Disorders Identification Test]] (AUDIT), a screening questionnaire developed by the [[World Health Organization]], is unique in that it has been validated in six countries and is used internationally. Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper investigation.<ref>{{cite web |url=http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf |title=The Alcohol Use Disorders Identification Test; Guidelines for Use in Primary Care |first1=Thomas F. |last1=Babor |first2=John C. |last2=Higgins-Biddle |first3=John B. |last3=Saunders |first4=Maristela G. |last4=Monteiro |year=2001 |publisher=World Health Organization |archive-url=https://web.archive.org/web/20060502132711/http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf |archive-date=2 May 2006 }}</ref> The [[Paddington Alcohol Test]] (PAT) was designed to screen for alcohol-related problems amongst those attending [[Accident and Emergency department]]s. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.<ref>{{cite journal | vauthors = Smith SG, Touquet R, Wright S, Das Gupta N | title = Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT) | journal = Journal of Accident & Emergency Medicine | volume = 13 | issue = 5 | pages = 308–12 | date = September 1996 | pmid = 8894853 | pmc = 1342761 | doi = 10.1136/emj.13.5.308 }}</ref>
===Urine and blood tests===
There are reliable tests for the actual use of alcohol, one common test being that of [[blood alcohol content]] (BAC).<ref>{{cite journal | vauthors = Jones AW | s2cid = 11117640 | title = Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship | journal = Toxicological Reviews | volume = 25 | issue = 1 | pages = 15–35 | year = 2006 | pmid = 16856767 | doi = 10.2165/00139709-200625010-00002 }}</ref> These tests do not differentiate people with alcohol use disorders from people without; however, long-term heavy drinking does have a few recognizable effects on the body, including:
* [[Macrocytosis]] (enlarged [[Mean corpuscular volume|MCV]])
* Elevated [[Gamma glutamyl transpeptidase|GGT]]
Line 208:
==Prevention==
{{further|Alcohol education}}
The [[World Health Organization]], the [[European Union]] and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism.<ref name="alchwho2010">{{cite web |url=https://www.who.int/topics/alcohol_drinking/en/ |title=Alcohol |
Increasing the age at which alcohol can be purchased, and banning or restricting alcohol beverage advertising are common methods to reduce alcohol use among adolescents and young adults in particular. Another common method of alcoholism prevention is taxation of alcohol products – increasing price of alcohol by 10% is linked with reduction of consumption of up to 10%.<ref name=Elder2009>{{cite journal | vauthors = Elder R, Lawrence B, Ferguson A, Naimi T, Brewer R, Chattopadhyay S, Toomey T, Fielding J | title = The Effectiveness of Tax Policy Interventions for Reducing Excessive Alcohol Consumption and Related Harms | journal = American Journal of Preventive Medicine | volume = 38 | issue = 2 |year = 2010 | pages = 217–229 | issn = 0749-3797 | doi = 10.1016/j.amepre.2009.11.005| pmid = 20117579 | pmc = 3735171 }}</ref>
Line 226:
[[File:Alcoholics Anonymous Regional Service Center by David Shankbone.jpg|thumb|A regional service center for [[Alcoholics Anonymous]]]]
Various forms of [[group therapy]] or [[psychotherapy]] are sometimes used to encourage and support abstinence from alcohol, or to reduce alcohol consumption to levels that are not associated with adverse outcomes. Mutual-aid group-counseling is an approach used to facilitate relapse prevention.<ref name="Morgan-Lopez-2006"/> [[Alcoholics Anonymous]] was one of the earliest organizations formed to provide mutual [[peer support]] and non-professional counseling, however [[Effectiveness of Alcoholics Anonymous|the effectiveness of Alcoholics Anonymous]] is disputed.<ref name="Cochrane2006">{{cite journal |last1=Ferri |first1=Marcia |last2=Amato |first2=Laura |last3=Davoli |first3=Marina |title=Alcoholics Anonymous and other twelve-step programmes for alcohol dependence |journal=Cochrane Database of Systematic Reviews |issue=3 |pages=CD005032 |date=19 July 2006 |pmid=16856072 |doi=10.1002/14651858.CD005032.pub2|quote=no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems}}</ref> A 2020 [[Cochrane Library#The Cochrane Database of Systematic Reviews|Cochrane review]] concluded that Twelve-Step Facilitation (TSF) probably achieves outcomes such as fewer drinks per drinking day, however evidence for such a conclusion comes from low to moderate certainty evidence "so should be regarded with caution".<ref name="Cochrane2020_p35">{{Cite journal |last1=Kelly
Manualized<ref>{{cite web|title=APA Dictionary of Psychology|url=https://dictionary.apa.org/|access-date=26 January 2022|website=dictionary.apa.org
===Moderate drinking===
Moderate drinking amongst people with alcohol dependence—often termed 'controlled drinking'—has been subject to significant controversy.<ref>{{cite web |last1=Ashton |first1=Mike |last2=Davies |first2=Natalie |title='Dangerous data': drinking after dependence |url=https://findings.org.uk/PHP/dl.php?file=cont_drink.hot |website=findings.org.uk |access-date=3 March 2023|archive-date=6 October 2022 |
Rationing and moderation programs such as [[Moderation Management]] and DrinkWise do not mandate complete abstinence. While most people with alcohol use disorders are unable to limit their drinking in this way, some return to moderate drinking. A 2002 US study by the [[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. This group, however, showed fewer initial symptoms of dependency.<ref name="DAWSON2005">{{cite journal | vauthors = Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ | s2cid = 19679025 | title = Recovery from DSM-IV alcohol dependence: United States, 2001–2002 | journal = Addiction | volume = 100 | issue = 3 | pages = 281–92 | date = March 2005 | pmid = 15733237 | doi = 10.1111/j.1360-0443.2004.00964.x | url = http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm | url-status = live | archive-url = https://web.archive.org/web/20110719104620/http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm
A follow-up study, using the same subjects that were judged to be in remission in 2001–2002, examined the rates of return to problem drinking in 2004–2005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics.<ref name="DAWSON2007">{{cite journal | vauthors = Dawson DA, Goldstein RB, Grant BF | title = Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up | journal = Alcoholism: Clinical and Experimental Research | volume = 31 | issue = 12 | pages = 2036–45 | date = December 2007 | pmid = 18034696 | doi = 10.1111/j.1530-0277.2007.00536.x | url = https://zenodo.org/record/1230663 | access-date = 1 July 2024 | archive-date = 25 July 2020 | archive-url = https://web.archive.org/web/20200725020723/https://zenodo.org/record/1230663 | url-status = live }}</ref> There was also a 1973 study showing chronic alcoholics drinking moderately again,<ref name=Sobell1973>{{cite journal|doi=10.1016/S0005-7894(73)80074-7|title=Individualized behavior therapy for alcoholics|journal=Behavior Therapy|volume=4|pages=49–72|year=1973|last1=Sobell|first1=Mark B.|last2=Sobell|first2=Linda C. }}</ref> but a 1982 follow-up showed that 95% of subjects were not able to maintain drinking in moderation over the long term.<ref name=Pendery1982>{{cite journal | vauthors = Pendery ML, Maltzman IM, West LJ | title = Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study | journal = Science | volume = 217 | issue = 4555 | pages = 169–75 | date = July 1982 | pmid = 7089552 | doi = 10.1126/science.7089552 | bibcode = 1982Sci...217..169P }}</ref><ref name=Pendery1982NYT>{{cite news|url=https://www.nytimes.com/1982/06/28/us/alcholism-study-under-new-attack.html|title=Alcoholism Study Under New Attack|work=
===Medications===
In the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram.<ref>{{cite journal |title= Alcohol and Other Drugs|url=http://pubs.niaaa.nih.gov/publications/AA76/AA76.htm |url-status=live |publisher=National Institute on Alcohol Abuse and Alcoholism |archive-url=https://web.archive.org/web/20130728134244/http://pubs.niaaa.nih.gov/publications/aa76/aa76.htm |archive-date=28 July 2013 |access-date=11 July 2013 |number=76|date=July 2008|journal=Alcohol Alert}}</ref>
* [[Acamprosate]] may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of [[glutamate]], a [[neurotransmitter]] which is hyperactive in the [[post-withdrawal]] phase.<ref>{{cite journal | vauthors = Mason BJ, Heyser CJ | s2cid = 25810236 | title = The neurobiology, clinical efficacy and safety of acamprosate in the treatment of alcohol dependence | journal = Expert Opinion on Drug Safety | volume = 9 | issue = 1 | pages = 177–88 | date = January 2010 | pmid = 20021295 | doi = 10.1517/14740330903512943 }}</ref> By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity.<ref name="pmid20201812">{{cite journal | vauthors = Mason BJ, Heyser CJ | title = Acamprosate: a prototypic neuromodulator in the treatment of alcohol dependence | journal = CNS & Neurological Disorders Drug Targets | volume = 9 | issue = 1 | pages = 23–32 | date = March 2010 | pmid = 20201812 | pmc = 2853976 | doi = 10.2174/187152710790966641 }}</ref> Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.<ref>{{cite journal | vauthors = Rösner S, Hackl-Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M | title = Acamprosate for alcohol dependence | journal = The Cochrane Database of Systematic Reviews | volume = 128 | issue = 9 | pages = CD004332 | date = September 2010 | pmid = 20824837 | doi = 10.1002/14651858.CD004332.pub2 | url = http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802010000600014 | veditors = Rösner S | type = Submitted manuscript | access-date = 1 July 2024 | archive-date = 8 July 2020 | archive-url = https://web.archive.org/web/20200708231654/https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802010000600014 | url-status = live }}</ref><ref name=JAMA2014>{{cite journal | vauthors = Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC | title = Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis | journal = JAMA | volume = 311 | issue = 18 | pages = 1889–900 | date = May 2014 | pmid = 24825644 | doi = 10.1001/jama.2014.3628 | doi-access = free }}</ref>
* [[Naltrexone]] is a [[competitive antagonist]] for opioid receptors, effectively blocking the effects of [[endorphin]]s and [[opioid]]s. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body Naltrexone reduces the pleasurable effects from consuming alcohol.<ref>{{cite journal | vauthors = Soyka M, Rösner S | title = Opioid antagonists for pharmacological treatment of alcohol dependence – a critical review | journal = Current Drug Abuse Reviews | volume = 1 | issue = 3 | pages = 280–91 | date = November 2008 | pmid = 19630726 | doi = 10.2174/1874473710801030280 }}</ref> Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking.<ref name=JAMA2014/> [[Nalmefene]] also appears effective and works in a similar manner.<ref name=JAMA2014/>
* [[Disulfiram]] prevents the elimination of [[acetaldehyde]], a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many [[hangover]] symptoms from alcohol use. The overall effect is discomfort when alcohol is ingested: an extremely rapid and long-lasting, uncomfortable hangover.
Several other drugs are also used and many are under investigation.
* [[Benzodiazepines]], while useful in the management of acute alcohol withdrawal, if used long-term can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. This class of drugs is commonly prescribed to alcoholics for insomnia or anxiety management.<ref>{{cite book | veditors = Lindsay SK, Powell GE |title=The Handbook of Clinical Adult Psychology |url={{google books |plainurl=y |id=a6A9AAAAIAAJ|page=380}} |edition=2nd |date=28 July 1998 |publisher=Routledge |isbn=978-0-415-07215-1 |page=402 }}</ref> Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for alcohol use disorder relapse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.<ref>{{cite book |last1=Gitlow |first1=Stuart |title=Substance Use Disorders: A Practical Guide |url=
* [[Calcium carbimide]] works in the same way as disulfiram; it has an advantage in that the occasional adverse effects of disulfiram, [[hepatotoxicity]] and drowsiness, do not occur with calcium carbimide.<ref>{{cite journal | vauthors = Ogborne AC | title = Identifying and treating patients with alcohol-related problems | journal = CMAJ | volume = 162 | issue = 12 | pages = 1705–8 | date = June 2000 | pmid = 10870503 | pmc = 1232509 }}</ref>
* [[Ondansetron]] and [[topiramate]] are supported by tentative evidence in people with certain genetic patterns.<ref name=Soy2017/><ref name=Cs2017>{{cite journal | vauthors = Cservenka A, Yardley MM, Ray LA | title = Review: Pharmacogenetics of alcoholism treatment: Implications of ethnic diversity | journal = The American Journal on Addictions | volume = 26 | issue = 5 | pages = 516–525 | date = August 2017 | pmid = 28134463 | pmc = 5484746 | doi = 10.1111/ajad.12463 }}</ref> Evidence for ondansetron is stronger in people who have recently started to abuse alcohol.<ref name=Soy2017>{{cite journal | vauthors = Soyka M, Müller CA | title = Pharmacotherapy of alcoholism
Evidence does not support the use of [[selective serotonin reuptake inhibitors]] (SSRIs), [[tricyclic antidepressants]] (TCAs), [[antipsychotic]]s, or [[gabapentin]].<ref name=JAMA2014/>
Line 253:
[[Topiramate]], a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiveness of topiramate concluded that the results of published trials are promising, however as of 2008, data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence.<ref>{{cite journal|author=Olmsted CL, Kockler DR |title=Topiramate for alcohol dependence|journal=Ann Pharmacother |volume=42 |issue=10 |pages=1475–80 |date=October 2008 |pmid=18698008 |doi=10.1345/aph.1L157 |s2cid=27071889|issn=1060-0280}}</ref> A 2010 review found that topiramate may be superior to existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings.<ref>{{cite journal| last1 = Kenna | first1 = GA. | last2 = Lomastro | first2 = TL. |last3 = Schiesl | first3 = A. | last4 = Leggio | first4 = L. | last5 = Swift | first5 = RM. | title = Review of topiramate: an antiepileptic for the treatment of alcohol dependence | journal = Curr Drug Abuse Rev | volume = 2 | issue = 2 | pages = 135–42 |date=May 2009 | doi = 10.2174/1874473710902020135| pmid = 19630744 }}</ref>
[[Baclofen]], a [[GABAB receptor|GABA<sub>B</sub> receptor]] agonist, is under study for the treatment of alcoholism.<ref>{{cite journal|last=Leggio|first=L|author2=Garbutt, JC|author3= Addolorato, G|title=Effectiveness and safety of baclofen in the treatment of alcohol dependent patients.|journal=CNS & Neurological Disorders Drug Targets|date=March 2010|volume=9|issue=1|pages=33–44|pmid=20201813|doi=10.2174/187152710790966614}}</ref> According to a 2017 Cochrane Systematic Review, there is insufficient evidence to determine the effectiveness or safety for the use of baclofen for withdrawal symptoms in alcoholism.<ref>{{cite journal |last1=Liu |first1=Jia |last2=Wang |first2=Lu-Ning |date=20 August 2017 |title=Baclofen for alcohol withdrawal |journal=The Cochrane Database of Systematic Reviews |volume=8 |issue=8 |pages=CD008502 |doi=10.1002/14651858.CD008502.pub5 |issn=1469-493X |pmc=6483686 |pmid=28822350}}</ref> [[Psilocybin]]-assisted psychotherapy is under study for the treatment of patients with alcohol use disorder.<ref>{{cite web |last=Sullivan |first=Kaitlin |date=24 August 2022 |title=Does psilocybin change your brain? How the ingredient in magic mushrooms may ease addiction |url=https://www.nbcnews.com/health/mental-health/psilocybin-mushroom-help-people-alcohol-use-disorder-rcna44180 |access-date=7 September 2022 |publisher=NBC News|archive-date=6 September 2022 |
===Dual addictions and dependencies===
Alcoholics may also require treatment for other psychotropic [[drug addiction]]s and [[Substance dependence|drug dependencies]]. The most common dual dependence syndrome with alcohol dependence is [[benzodiazepine dependence]], with studies showing 10–20% of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as [[diazepam]] or [[clonazepam]]. These drugs are, like alcohol, [[depressant]]s. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as [[illegal drugs]]. Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers.<ref>{{cite journal | vauthors = Poulos CX, Zack M | s2cid = 23040302 | title = Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers | journal = Behavioural Pharmacology | volume = 15 | issue = 7 | pages = 503–12 | date = November 2004 | pmid = 15472572 | doi = 10.1097/00008877-200411000-00006 }}</ref> Benzodiazepine dependency requires careful reduction in dosage to avoid [[benzodiazepine withdrawal syndrome]] and other health consequences. Dependence on other sedative-hypnotics such as [[zolpidem]] and [[zopiclone]] as well as [[opiate]]s and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as [[barbiturate]]s, benzodiazepines and [[nonbenzodiazepine]]s. Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of [[psychosis]] or [[seizure]]s if not properly managed.<ref name="dolpdaa">{{cite journal | vauthors = Johansson BA, Berglund M, Hanson M, Pöhlén C, Persson I | title = Dependence on legal psychotropic drugs among alcoholics | journal = Alcohol and Alcoholism | volume = 38 | issue = 6 | pages = 613–8 | date = November 2003 | pmid = 14633651 | doi = 10.1093/alcalc/agg123
==Epidemiology==
Line 272:
{{legend|#d02010|9,122–25,165}}
{{div col end}}]]
[[File:Alcohol consumption per person, OWID.svg|thumb|upright=1.5|Alcohol consumption per person 2016<ref>{{cite web |title=Alcohol consumption per person |url=https://ourworldindata.org/grapher/total-alcohol-consumption-per-capita-litres-of-pure-alcohol |website=Our World in Data |access-date=5 March 2020 |archive-date=16 March 2020 |archive-url=https://web.archive.org/web/20200316145124/https://ourworldindata.org/grapher/total-alcohol-consumption-per-capita-litres-of-pure-alcohol |url-status=live }}</ref>]]
The [[World Health Organization]] estimates that {{as of|2016|lc=y}} there are about 380 million people with alcoholism worldwide (5.1% of the population over 15 years of age),<ref name=WHO2018 /><ref name=un2020 /> with it being most common among males and young adults.<ref name=DSM5/> Geographically, it is least common in Africa (1.1% of the population) and has the highest rates in [[Eastern Europe]] (11%).<ref name=DSM5/>
Line 278:
{{as of|2015}} in the United States, about 17 million (7%) of adults and 0.7 million (2.8%) of those age 12 to 17 years of age are affected.<ref name=NIH2015Stats>{{cite web|title=Alcohol Facts and Statistics|url=http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics|access-date=9 May 2015|url-status=live|archive-url=https://web.archive.org/web/20150518081638/http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics|archive-date=18 May 2015}}</ref> About 12% of American adults have had an alcohol dependence problem at some time in their life.<ref>{{cite journal |vauthors=Hasin DS, Stinson FS, Ogburn E, Grant BF |title=Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions |journal=Archives of General Psychiatry |volume=64 |issue=7 |pages=830–42 |date=July 2007 |pmid=17606817 |doi=10.1001/archpsyc.64.7.830 |doi-access=free}}</ref>
In the United States and Western Europe, 10–20% of men and 5–10% of women at some point in their lives will meet criteria for alcoholism.<ref>{{cite encyclopedia |url=https://www.britannica.com/EBchecked/topic/13448/alcoholism |title=alcoholism |year=2010 |encyclopedia=Encyclopædia Britannica |url-status=live |archive-url=https://web.archive.org/web/20101202043009/https://www.britannica.com/EBchecked/topic/13448/alcoholism |archive-date=2 December 2010}}</ref> In England, the number of "dependent drinkers" was calculated as over 600,000 in 2019.<ref name="cosu">{{cite web|url=https://www.gov.uk/government/publications/alcohol-dependence-prevalence-in-england|title=Alcohol dependence prevalence in England|date=18 March 2021|website=GOV.UK|access-date=1 July 2024|archive-date=1 May 2024|archive-url=https://web.archive.org/web/20240501215857/https://www.gov.uk/government/publications/alcohol-dependence-prevalence-in-england|url-status=live}}</ref> [[Estonia]] had the highest death rate from alcohol in Europe in 2015 at 8.8 per 100,000 population.<ref>{{cite book|vauthors=Ballas D, Dorling D, Hennig B|title=The Human Atlas of Europe|url={{google books |plainurl=y |id=z1ClDgAAQBAJThe}}|date=2017|publisher=Policy Press|location=Bristol|isbn=978-1-4473-1354-0|page=73}}{{dead link|date=May 2023 |bot=InternetArchiveBot |fix-attempted=yes}}</ref> In the United States, 30% of people admitted to hospital have a problem related to alcohol.<ref>{{cite journal |vauthors=Vonghia L, Leggio L, Ferrulli A, Bertini M, Gasbarrini G, Addolorato G |title=Acute alcohol intoxication |journal=European Journal of Internal Medicine |volume=19 |issue=8 |pages=561–7 |date=December 2008 |pmid=19046719 |doi=10.1016/j.ejim.2007.06.033}}</ref>
Within the medical and scientific communities, there is a broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."<ref name="autogenerated1">{{cite web|last=Volkow|first=Nora|title=Science of Addiction|url=http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf|url-status=live|archive-url=https://web.archive.org/web/20110629022654/http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf|archive-date=29 June 2011|publisher=American Medical Association}}</ref> Alcoholism has a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased.<ref name="Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al. 2003 253–268">{{cite journal |vauthors=Walter H, Gutierrez K, Ramskogler K, Hertling I, Dvorak A, Lesch OM |s2cid=6972064 |title=Gender-specific differences in alcoholism: implications for treatment |journal=Archives of Women's Mental Health |volume=6 |issue=4 |pages=253–8 |date=November 2003 |pmid=14628177 |doi=10.1007/s00737-003-0014-8}}</ref> Current evidence indicates that in both men and women, alcoholism is 50–60% genetically determined, leaving 40–50% for environmental influences.<ref>{{cite journal |vauthors=Dick DM, Bierut LJ |s2cid=10535003 |title=The genetics of alcohol dependence |journal=Current Psychiatry Reports |volume=8 |issue=2 |pages=151–7 |date=April 2006 |pmid=16539893 |doi=10.1007/s11920-006-0015-1 }}</ref> Most alcoholics develop alcoholism during adolescence or young adulthood.<ref name="Enoch-2006" />
Line 285:
[[File:Alcohol use disorders world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.3|Alcohol use disorders deaths per million persons in 2012
{{Div col|small=yes|colwidth=10em}}
{{legend|#ffff20|
{{legend|#ffc020|1–3}}
{{legend|#ffa020|4–6}}
Line 295:
{{div col end}}
]]
Alcoholism often reduces a person's life expectancy by around ten years.<ref name=Schu2014/> The most common cause of death in alcoholics is from cardiovascular complications.<ref name="Zuskin-2006">{{cite journal | vauthors = Zuskin E, Jukić V, Lipozencić J, Matosić A, Mustajbegović J, Turcić N, Poplasen-Orlovac D, Bubas M, Prohić A | title = [Alcoholism—how it affects health and working capacity] | journal = Arhiv Za Higijenu Rada I Toksikologiju | volume = 57 | issue = 4 | pages = 413–26 | date = December 2006 | pmid = 17265681 }}</ref> There is a high rate of [[suicide]] in chronic alcoholics, which increases the longer a person drinks. Approximately 3–15% of alcoholics die by suicide,<ref>{{cite book|title=American Psychiatric Association practice guidelines for the treatment of psychiatric disorders|date=2006|publisher=American Psychiatric Association|location=Arlington, VA|isbn=978-0-89042-385-1|page=1346|url={{google books |plainurl=y |id=zql0AqtRSrYC|page=1346}}|url-status=live|archive-url=https://web.archive.org/web/20160529103328/https://books.google.com/books?id=zql0AqtRSrYC&pg=PA1346|archive-date=29 May 2016}}</ref> and research has found that over 50% of all suicides are associated with alcohol or [[drug dependence]]. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also
Among those with [[alcohol dependence]] after one year, some met the criteria for low-risk drinking, even though only 26% of the group received any treatment, with the breakdown as follows: 25% were found to be still dependent, 27% were in partial remission (some symptoms persist), 12% asymptomatic drinkers (consumption increases chances of relapse) and 36% were fully recovered – made up of 18% low-risk drinkers plus 18% abstainers.<ref name="NIAAA2002">{{cite web|url=http://www.nih.gov/news/pr/jan2005/niaaa-18.htm |title=2001–2002 Survey Finds That Many Recover From Alcoholism |last1=The National Institute on Alcohol Abuse and Alcoholism |last2=U.S. Department of Health and Human Services, NIH News |date=18 January 2005 |publisher=National Institutes of Health |archive-url=https://web.archive.org/web/20060818230335/http://www.nih.gov/news/pr/jan2005/niaaa-18.htm |archive-date=18 August 2006 }}</ref> In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence....return-to-controlled drinking, as reported in short-term studies, is often a mirage."<ref name="VAILLANT2003"/> ==History==
[[File:Adriaen Brouwer - Inn with drunken peasants.jpg|thumb|[[Adriaen Brouwer]], ''Inn with Drunken Peasants'', 1620s]]
[[File:1904 Claim of Alcoholism Being Disease4.jpg|thumb|upright=0.7|right|1904 advertisement describing alcoholism as a disease]]
Historically the name ''[[dipsomania]]'' was coined by German physician [[Christoph Wilhelm Hufeland|C. W. Hufeland]] in 1819 before it was superseded by ''alcoholism''.<ref name="lexikon_psychiatrie_psychotherapie_medizinische_psychologie">{{cite book| last1 = Peters | first1 = Uwe Henrik | title = Lexikon Psychiatrie, Psychotherapie, Medizinische Psychologie|url={{google books |plainurl=y |id=qY6_DQAAQBAJ}} | year = 2007 | publisher = Urban Fischer bei Elsev | isbn = 978-3-437-15061-6 }}</ref><ref>{{cite book | last = Valverde | first = Mariana | title = Diseases of the Will | page = 48 | url =
Alcohol has a long history of use and misuse throughout recorded history. Biblical, Egyptian and Babylonian sources record the history of abuse and dependence on alcohol. In some ancient cultures alcohol was worshiped and in others, its misuse was condemned. Excessive alcohol misuse and drunkenness were recognized as causing social problems even thousands of years ago. However, the defining of habitual drunkenness as it was then known as and its adverse consequences were not well established medically until the 18th century. In 1647 a Greek monk named Agapios was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis, and internal bleeding. In the 1910s and 1920s, the effects of alcohol misuse and chronic drunkenness boosted membership of the [[temperance movement]] and led to the [[Prohibition|prohibition of alcohol]] in many countries in North America and the Nordic countries, nationwide bans on the production, importation, transportation, and sale of alcoholic beverages that generally remained in place until the late 1920s or early 1930s; these policies resulted in the decline of death rates from cirrhosis and alcoholism.<ref name="Blocker2006">{{cite journal | vauthors = Blocker JS | title = Did prohibition really work? Alcohol prohibition as a public health innovation | journal = American Journal of Public Health | volume = 96 | issue = 2 | pages = 233–43 | date = February 2006 | pmid = 16380559 | pmc = 1470475 | doi = 10.2105/AJPH.2005.065409 | quote = Nevertheless, once Prohibition became the law of the land, many citizens decided to obey it. Referendum results in the immediate post-Volstead period showed widespread support, and the Supreme Court quickly fended off challenges to the new law. Death rates from cirrhosis and alcoholism, alcoholic psychosis hospital admissions, and drunkenness arrests all declined steeply during the latter years of the 1910s, when both the cultural and the legal climate were increasingly inhospitable to drink, and in the early years after National Prohibition went into effect. }}</ref> In 2005, alcohol dependence and misuse was estimated to cost the US economy approximately 220 billion dollars per year, more than cancer and obesity.<ref name="soa2008">{{cite book|last1=Potter |first1= James V.|volume=2 |title=Substances of Abuse |url={{google books |plainurl=y |id=WU73eJAIDI4C|page=1}} |year= 2008 |publisher=AFS Publishing Co |isbn=978-1-930327-46-7 |pages=1–13 }}</ref>
Line 306 ⟶ 308:
==Society and culture==
{{see also|List of deaths through alcohol}}
The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society; for example, money due to lost labor-hours, medical costs due to injuries due to drunkenness and organ damage from long-term use, and secondary treatment costs, such as the costs of rehabilitation facilities and detoxification centers. Alcohol use is a major contributing factor for [[head injury|head injuries]], [[Whiplash (medicine)|motor vehicle injuries]] (27%), [[interpersonal violence]] (18%), [[suicides]] (18%), and [[epilepsy]] (13%).<ref>{{cite web |title=Alcohol and health |url=https://www.who.int/substance_abuse/infographic_alcohol_2018.pdf?ua=1 |
{{anchor|Hitting rock bottom}}The idea of '''hitting rock bottom''' refers to an experience of [[Psychological stress|stress]] that can be attributed to alcohol misuse.<ref>{{cite web |title=hit rock bottom |url=https://idioms.thefreedictionary.com/hit+rock+bottom |access-date=16 July 2022 |website=TheFreeDictionary.com |archive-date=16 July 2022 |archive-url=https://web.archive.org/web/20220716163516/https://idioms.thefreedictionary.com/hit+rock+bottom |url-status=live }}</ref> There is no single definition for this idea, and people may identify their own lowest points in terms of lost jobs, lost relationships, health problems, legal problems, or other consequences of alcohol misuse.<ref name=":0">{{cite journal | vauthors = Kirouac M, Witkiewitz K | title = Identifying 'Hitting Bottom' Among Individuals with Alcohol Problems: Development and Evaluation of the Noteworthy Aspects of Drinking Important to Recovery (NADIR) | journal = Substance Use & Misuse | volume = 52 | issue = 12 | pages = 1602–1615 | date = October 2017 | pmid = 28557550 | pmc = 6107067 | doi = 10.1080/10826084.2017.1293104 }}</ref> The concept is promoted by 12-step recovery groups and researchers using the [[transtheoretical model]] of motivation for behavior change.<ref name=":0" /> The first use of this slang phrase in the formal [[medical literature]] appeared in a 1965 [[Literature review|review]] in the ''British Medical Journal'',<ref name=":0" /> which said that some men refused treatment until they "hit rock bottom", but that treatment was generally more successful for "the alcohol addict who has friends and family to support him" than for impoverished and homeless addicts.<ref>{{cite journal | title = Treatment of Alcohol Addiction | journal = British Medical Journal | volume = 2 | issue = 5455 | pages = 184–5 | date = July 1965 | pmid = 20790596 | pmc = 1846501 | doi = 10.1136/bmj.2.5455.184 }}</ref>
[[Stereotype]]s of alcoholics are often found in [[fiction]] and [[popular culture]]. The "[[town drunk]]" is a [[stock character]] in Western popular culture. Stereotypes of drunkenness may be based on [[racism]] or [[xenophobia]], as in the fictional depiction of the [[Irish people|Irish]] as heavy drinkers.<ref>{{cite web | url=http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm | title=World/Global Alcohol/Drink Consumption | year=2009 | publisher=Finfacts Ireland | url-status=live | archive-url=https://web.archive.org/web/20150512161159/http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm | archive-date=12 May 2015
[[Peyote]], a psychoactive agent, has even shown promise in treating alcoholism. Alcohol had actually replaced peyote as [[Indigenous peoples of the Americas|Native Americans]]' psychoactive agent of choice in rituals when peyote was outlawed.<ref>{{cite journal | vauthors = French L | s2cid = 143549807 | year = 2008 | title = Psychoactive agents and Native American spirituality: Past and present | journal = Contemporary Justice Review | volume = 11 | issue = 2| pages = 155–63 | doi=10.1080/10282580802058270}}</ref>
Line 335 ⟶ 337:
==External links==
{{Sister project links|wikt=alcoholism|b=no|q=Alcoholism|s=no|commons=Category:Alcoholism|n=no|v=no|species=no|position=}}
{{Medical condition classification and resources
| DiseasesDB =
| |||