Alcohol Abuse and Alcohol Dependence

Alcohol dependence is defined in the fourth Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association as “reeated alcohol related difficulties in at least three of the seven areas of functioning that cluster together over any 12 months period”. Special emphasis is given on tolerance and withdrawal, with psychological component. Alcohol dependence can occur to any man and woman and in all socioeconomic background or race. When any individual have problem in any one of the four areas of life that includes social, interpersonal, legal and occupational life is called alcohol abuse. It may include arrest due to driving under influence of alcohol.
In western countries alcohol dependence is as high as 10 to 15 % in men and 5 to 8% in women. Alcohol abuse is much higher than alcohol dependence. Contrary to the popular belief that a typical alcoholic is blue or white collar worker or a homemaker, not stereotypical homeless individual.
History of an alcoholic is same as that of normal individual, he starts consuming alcohol in teenage and continues throughout life. Normal individuals learn from minor mistakes and correct themselves. But for alcoholics, once established they are likely to have more problems in later life. But if treated properly alcoholics give encouraging results and up to two third maintain abstinence for years.
There is some influence of genetics. This is supported by studies where children of alcoholics were adopted at birth and raised without knowledge of their biological parents. They have four fold increase of alcohol abuse than normal persons. Alcohol abuse is also higher in monozygotic twins compare to dizygotic twins. About half of Asian men and women there is less chance of alcoholism due to presence of enzyme aldehyde dehydrogenese (ALDH). This enzyme is responsible for faster metabolism of alcohol.
Alcohol Withdrawal Syndrome: Once the brain has been repeatedly exposed to high dose of alcohol, any sudden decrease in alcohol consumption and subsequent reduction in blood can produce withdrawal symptoms. They are usually opposite to that of alcohol intoxication. These symptoms are tremor of hands, anxiety, agitation, high pulse rate, rise in body temperature, high respiratory rate, gastrointestinal upset, insomnia or sleeplessness (may be due to bad dreams) etc. Withdrawal symptoms generally start within 5 to 10 hours of reduced alcohol intake. Withdrawal symptoms become maximum in 2 to 3 days and reduce by fourth to fifth day. But anxiety, insomnia may last for more than 6 months and can contribute to returning to drinking alcohol.
Up to 5 % of alcoholics experience withdrawal seizure 48 hours after stopping consumption of alcohol.
In late stage of alcohol dependency delirium tremens (DT) occur, which is characterized by agitation, mental confusion, fluctuating levels of consciousness, tremor, high blood pressure, high pulse and respiratory rate. Delirium tremens occurs in persons who also have other medical problems. Fortunately this life threatening condition occurs in less than 5 % of the alcoholics.

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