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Alcoholism - Causes, Symptoms And Treatment

Causes of alcoholism

Numerous biological, psychological, and sociocultural factors appear to be involved in alcohol addiction. An off­spring of one alcoholic parent is seven to eight times more likely to become an alcoholic than is a peer without such a parent. Biological factors may include genetic or biochemical abnormalities, nutritional deficiencies, endocrine imbalances, and allergic responses.

Psychological factors may include the urge to drink alcohol to reduce anxiety or symptoms of mental illness; the desire to avoid responsibility in familial, social, and work relationships; and the need to bolster self-esteem.

Sociocultural factors include the availability of alcoholic beverages, group or peer pressure, an excessively

Signs and symptoms of alcoholism

Because people with alcohol dependence may hide or deny their addiction and may temporarily manage to maintain a functional life, assessing for alcoholism can be difficult.

Physical and psychosocial symptoms

• The patient's history may suggest a need for daily or episodic alcohol use to maintain adequate functioning, an inability to discontinue or reduce alcohol intake, episodes of anesthesia or amnesia (blackouts) during intoxication, episodes of violence during intoxication, and interference with social and familial relationships and occupational responsibilities.
• Many minor complaints may be alcohol-related. The patient may mention malaise, dyspepsia, mood swings or depression, and an increased incidence of infection. Observe the patient for poor personal hygiene and untreated injuries, such as cigarette burns, fractures, and bruises, that he can't fully explain. Note any evidence of an unusually high tolerance for sedatives and narcotics.
• Watch for secretive behavior. Suspect alcoholism if the patient uses inordinate amounts of aftershave lotion or mouthwash. When confronted, the patient may deny or rationalize the problem. Alternatively, he may be guarded or hostile in his response and may even sign out of the facility against medical advice. He also may project his anger or feelings of guilt or inadequacy onto others to avoid confronting his illness.
• Chronic alcohol abuse brings with it an array of physical complications, including malnutrition, cirrhosis of the liver, peripheral neuropathy, brain damage, and cardiomyopathy. Watch for these complications in a patient with an alcohol-related disorder.
• After abstinence or reduction of alcohol intake, signs and symptoms of withdrawal-which begin shortly after drinking has stopped and last for 5 to 7 days-may vary. The patient initially experiences anorexia, nausea, anxiety, fever, insomnia, diaphoresis, and tremor, progressing to severe tremulousness, agitation and, possibly, hallucinations and violent behavior. Major tonic-clonic seizures (known as "rum fits") can occur during withdrawal. Suspect alcoholism in any patient with unexplained seizures.

Treatment of alcoholism

Total abstinence from alcohol is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous (AA), may produce good long-term results.

Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering LV. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding.

Treatment of chronic alcoholism relies on medications to treat the effects of withdrawal; psychotherapy (consisting of behavior modification techniques, group therapy, and family therapy); and appropriate measures to relieve associted physical problems.

Aversion, or deterrent, therapy involves a daily oral dose of disulfiram to prevent compulsive drinking. Another form of aversion therapy attempts to induce aversion by administering alcohol with an emetic. Aversion therapy with disulfiram may only substitute one drug dependence for another, so it should be used prudently. For long-term success, the recovering individual must learn to fill the place alcohol once occupied in his life with something constructive.

Special considerations