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FALLSEM2014-15_CP2721_30-Sep-2014_RM01_alcoholism-smoking-and-drug-abuse.docx

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Alcoholism Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing. It is medically considered a disease, specifically an addictive illness, and in psychiatry several other terms are used, specifically alcohol abuse and alcohol dependence, which have slightly different definitions.[1] In 1979 an expert World
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  Alcoholism Alcoholism  is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing. It is medically considered a disease, specifically an addictive illness, and in psychiatry several other terms are used, specifically alcohol abuse  and alcohol dependence, which have slightly different definitions. [1]  In 1979 an expert World Health Organization committee discouraged the use of alcoholism in medicine, preferring the category of alcohol dependence syndrome . [2]  In the 19th and early 20th centuries, alcohol dependence in general was called dipsomania, but that term now has a much more specific meaning. [3]  People suffering from alcoholism are often called alcoholics . Many other terms, some of them insulting or  informal, have been used throughout history. The World Health Organization estimates that there are 140 million people with alcoholism worldwide. [4][5]  The American Medical Association supports a dual classification of alcoholism to include both  physical and mental components. [6]  The biological mechanisms that cause alcoholism are not well understood. Social environment, stress, [7]  mental health, family history, age, ethnic group, and gender all influence the risk for the condition. [8][9]  Significant alcohol intake produces changes in the brain's structure and chemistry, though some alterations occur with minimal use of alcohol over a short term period, such as tolerance and physical dependence. These changes maintain the person with alcoholism's compulsive inability to stop drinking and result in alcohol withdrawal syndrome if the person stops. [10]  Alcohol damages almost every organ in the body, including the brain. The cumulative toxic effects of chronic alcohol abuse can cause both medical and psychiatric problems. [11]  Identifying alcoholism is difficult for the individual afflicted because of the social stigma associated with the disease that causes people with alcoholism to avoid diagnosis and treatment for fear of shame or social consequences. The evaluation responses to a group of standardized questioning is a common method for diagnosing alcoholism. These can be used to identify harmful drinking patterns, including alcoholism. [12]  In general, problem drinking is considered alcoholism when the person continues to drink despite experiencing social or health problems caused by drinking. [13]  Treatment of alcoholism takes several steps. Because of the medical problems that can be caused  by withdrawal, alcohol detoxification is carefully controlled and may involve medications such as benzodiazepines such as diazepam (Valium). [14]  People with alcoholism also sometimes have other addictions, including addictions to benzodiazepines, which may complicate this step. [15]  After detoxification, other support such as group therapy or self-help groups are used to help the  person remain sober . [16][17]  Thombs (1999) states according to behavioural sciences alcoholism is described as a “maladaptive behaviour”. He explains this must not be confused with “misbehaviour”. Behavioural scientists explain that addicts have a behaviour pattern that may lead to destructive consequences for themselves, their families and society. This does not label addicts as bad or irresponsible. [18]  Compared with men, women are more sensitive to alcohol's harmful physical, cerebral, and mental effects. [19]      Signs and symptoms Long-term misuse  Main article: Long-term effects of alcohol Some of the possible long-term effects of ethanol an individual may develop. Additionally, in  pregnant women, alcohol can cause fetal alcohol syndrome. Alcoholism is characterised by an increased tolerance of and  physical dependence on alcohol, affecting an individual's ability to control alcohol consumption safely. These characteristics are  believed to play a role in impeding an alcoholic's ability to stop drinking. [10]  Alcoholism can have adverse effects on mental health, causing psychiatric disorders and increasing the risk of suicide. The onset of depression is a common symptom. [20][21]   Physical Long-term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the liver,  pancreatitis, epilepsy,  polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers [22]  and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and cancer. Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption. [23][24]  A wide range of immunologic defects can result and there may be a generalized skeletal fragility, in addition to a recognized tendency to accidental injury, resulting a propensity to bone fractures. [25]    Women develop long-term complications of alcohol dependence more rapidly than do men. Additionally, women have a higher mortality rate from alcoholism than men. [26]  Examples of long-term complications include brain, heart, and liver damage [27]  and an 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. [26]  Alcoholic ketoacidosis can occur in individuals who chronically abuse alcohol and have a recent history of  binge drinking. [28][29]  Even though alcoholism can increase the risk of liver cancer, studies have shown that a moderate consumption of alcohol (1 serving/day for women and 2 servings/day for men) does not affect diabetes Type II greatly. Psychiatric Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive  problems are common; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia. [30]  Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time. [31]  Social skills are significantly impaired in people suffering from 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 abuse include impairments in perceiving facial emotions, prosody  perception problems and theory of mind deficits; the ability to understand humour is also impaired in alcohol abusers. [32]  Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe  psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence. [33]  Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia. [34]  Panic disorder can develop or worsen as a direct result of long-term alcohol misuse. [35][36]  The co-occurrence of major depressive disorder and alcoholism is well documented. [37][38][39]  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). [40][41][42]  Additional use of other drugs may increase the risk of depression. [43]  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 or antisocial  personality disorder,  bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder . [44]  Women with alcoholism are more likely to have a history of   physical or sexual assault, abuse and domestic violence than those in the general population, [44]  which can lead to higher instances of psychiatric disorders and greater dependence on alcohol. Social effects The social problems arising from alcoholism are serious, caused by the pathological changes in the brain and the intoxicating effects of alcohol. [30][45]  Alcohol abuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape,   burglary and assault. [46]  Alcoholism is associated with loss of employment, [47]  which can lead to financial problems. Drinking at inappropriate times, and behavior caused by reduced judgment, can lead to legal consequences, such as criminal charges for  drunk driving [48]  or public disorder, or civil penalties for  tortious  behavior, and may lead to a criminal sentence. An alcoholic's behavior and mental impairment, while drunk, can profoundly affect those surrounding them and lead to isolation from family and friends. This isolation can lead to marital conflict and divorce, or contribute to domestic violence. Alcoholism can also lead to child neglect, with subsequent lasting damage to the emotional development of the alcoholic's children. [49]  For this reason, children of alcoholic parents can develop a number of emotional  problems. For example, they can become afraid of their parents, because of their unstable mood  behaviors. In addition, they can develop considerable amount of shame over their inadequacy to liberate their parents from alcoholism. As a result of this failure, they develop wretched self-images, which can lead to depression. [50]   Alcohol withdrawal 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. [45][51]  Alcohol's primary effect is the increase in stimulation of the GABA A  receptor,  promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and  physical dependence. When alcohol consumption is stopped too abruptly, the person's nervous system suffers from uncontrolled synapse firing. This can result in symptoms that include anxiety, life threatening seizures, delirium tremens, hallucinations, shakes and possible heart failure. [52][53]  Other neurotransmitter systems are also involved, especially dopamine,  NMDA and glutamate. [10][54]  Severe acute withdrawal symptoms such as delerium tremens and seizures rarely occur after 1 week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one to three weeks. In the period of 3  –   6 weeks following cessation increased anxiety, depression as well as sleep disturbance is common; [55]  fatigue and tension can persist for up to 5 weeks as part of the post-acute withdrawal syndrome; about a quarter of alcoholics experience anxiety and depression for up to 2 years. These post-acute withdrawal symptoms have also been demonstrated in animal models of alcohol dependence and withdrawal. [56]  A kindling effect also occurs in alcoholics 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

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