JAMA ;— A formal diagnosis of alcoholism can have enormous personal implications for a patient, therefore assessment should be detailed Table 6. Alcohol abuse and dependence have a variable course characterized by periods of remission and relapse. There are three major hurdles to overcome in the treatment of alcoholism: a physiologic dependence symptoms of withdrawal , b psychologic dependence alcohol used as treatment for anxiety, depression, stress , and c habit the central part that alcohol occupies in the framework of daily living.
Alcohol dependence is treated in two stages: withdrawal and detoxification, followed by further interventions to maintain abstinence. The severity of withdrawal symptoms increases with each withdrawal episode. Severe withdrawal grand mal convulsions, delirium tremens occurs in 2 to 5 percent of heavy drinking, chronic alcoholics fewer than three days after stopping alcohol consumption, and may last for three to seven days.
With treatment, mortality is about 1 percent; death is usually caused by cardiovascular collapse or concurrent infection. Alcoholics should be admitted to the hospital for detoxification if they are likely to have severe, life-threatening symptoms or have serious medical conditions, suicidal or homicidal tendencies, disruptive family or job situations, or are unable to attend outpatient facilities. Considerable evidence shows that long-lasting neurobiologic changes in the brains of alcoholics contribute to the persistence of craving.
At any stage during recovery, relapse can be triggered by internal factors depression, anxiety, craving for alcohol or external factors environmental triggers, social pressures, negative life events. AA and similar self-help groups follow 12 steps that alcoholics should work through during recovery. This free program is particularly supportive for those who are poor, isolated, lonely, or who come from a heavy-drinking social background.
The aim of CBT is to teach patients, by role-play and rehearsal, to recognize and cope with high-risk situations for relapse, and to recognize and cope with craving. This counseling method is used to motivate patients to use their own resources to change their behavior. Thirty to 60 percent of alcoholics maintain at least one year of abstinence with psychosocial therapies alone.
The most promising of these medications are the opioid antagonist, naltrexone Revia , and acamprosate, a glutamate antagonist. These drugs, used separately and in combination, are likely to be the first of many pharmacotherapies targeting multiple neurotransmitters.
Several studies have shown that naltrexone 50 mg once daily reduces alcohol consumption in male and female alcoholics and is effective, when combined with psychosocial treatment, in reducing relapse rates. Disulfiram Antabuse, to mg daily , a drug with a moderate record of adverse effects 33 which has been available since the late s, blocks the metabolism of acet aldehyde and causes an unpleasant flushing reaction if taken with alcohol.
Outcomes of patients who take disulfiram are improved when the drug is taken under supervision. Depression and anxiety can precipitate heavy drinking but can also be a result of alcohol abuse. A careful history is required to identify the primary problem. Fluoxetine Prozac , a selective serotonin reuptake inhibitor, has been found to be effective in decreasing depressive symptoms and the level of alcohol consumption in depressed alcoholics. After a screening questionnaire has identified problem drinking, the physician may question the patient further to determine the severity of alcohol misuse.
The family physician should play a critical holistic role in treatment and prevention, working with the patient and family, even when other specialists may be involved. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Mary-Anne Enoch, M. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed.
Washington, D. NIAAA's epidemiologic bulletin no. Alcohol Health Res World. Alcohol abuse and dependence. Psychiatric disorders in America: the epidemiological catchment area study. New York: Maxwell Macmillan International, — Fleming MF. Strategies to increase alcohol screening in health care settings.
Enoch MA, Goldman D. Genetics of alcoholism and substance abuse. Psychiatr Clin North Am. Arch Gen Psychiatry. National Institute on Alcohol Abuse and Alcoholism.
Alcohol and tobacco. Alcohol alert no. Are women more vulnerable to alcohol's effects? Allebeck P, Olsen J. Alcohol and fetal damage. Alcohol Clin Exp Res. Drinking moderately and pregnancy.
Effects on child development. Alcohol Res Health. Alcoholism —30; NIH publication no. Cherpitel CJ. Brief screening instruments for Screening for alcohol problems in primary care: a systematic review. Arch Intern Med. There is also some evidence that medical evaluations can suggest effective treatments on an individual basis. As a consequence of a disease concept, it is viewed as a remitting and relapsing illness. Taking too much ethanol can harm the brain, heart, and liver.
If left unchecked, addiction can quickly intensify due to its loss of effects tolerance and increased neurological effects. Friendships can break down, careers may fall apart, and legal outcomes may emerge. It is also supported by the disease theory, in which the disease cause is viewed as a debilitating illness that can be treated. The best treatment is tailored precisely to the individual patient, and the presence of loved ones can greatly assist recovery. The third degree of addiction was commonly viewed as morally wrong and even shunned at the beginning of the 20th century by the general population as bad individuals.
These types of viewpoints led many medical professionals of the time to oppose the common perception and try to treat patients rather than dismiss them. Jellinek has contributed to greatly changing perceptions. In his theory, Jellinek detailed stages of alcoholism that drinkers pass through in stages. Due to its depressant effects on the central nervous system, alcohol has been shown to affect multiple parts of the brain simultaneously despite its relatively modest volume and cause alcohol use disorder.
However, if the chemical compounds are abused severely, they may start to deplete. The Disease Theory of Alcoholism is said to have the same problem. Baldwin Institute supports this assertion, stating there is an underlying assumption that alcohol use disorder requires medical treatment , which transfers the responsibility of alcoholism from the individual to the caretakers.
Individuals can receive counseling and be assessed for other underlying alcohol use disorders by professional clinicians to develop an individual treatment program. A comparison between alcohol dependence is provided by the National Council on Alcoholism and Drug Dependence. The nature of addiction is that it is determined by the absence of any control over the substance and the symptoms that show up as a result are managed by a professional, but this requires medical treatment as well.
One of the reasons why alcohol use disorder has been regarded as a physical disease is because of the withdrawal symptoms and physical cravings that often accompany the disease. As alcoholism is a disease of the brain, it can be seen as an addictive behavior.
The physical changes to the brain cause people who suffer from this addiction to behave differently and have uncontrollable desires for alcohol.
In turn, a genetic link was identified between addiction and hereditary predispositions to obsession. The causes of addiction are unclear. Any of these symptoms may be cause for concern. The more symptoms, the more urgent the need for change. Several evidence-based treatment approaches are available for AUD. One size does not fit all and a treatment approach that may work for one person may not work for another. Three medications are currently approved by the U. Food and Drug Administration to help people stop or reduce their drinking and prevent relapse: naltrexone oral and long-acting injectable , acamprosate, and disulfiram.
All these medications are non-addictive, and they may be used alone or combined with behavioral treatments or mutual-support groups. Examples of behavioral treatments are brief interventions and reinforcement approaches, treatments that build motivation and teach skills for coping and preventing relapse, and mindfulness-based therapies. Mutual-support groups provide peer support for stopping or reducing drinking.
Group meetings are available in most communities, at low or no cost, at convenient times and locations—including an increasing presence online. This means they can be especially helpful to individuals at risk for relapse to drinking.
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