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Alcoholism has multiple and conflicting definitions. In common and historic usage, alcoholism is any condition that results in the continued consumption of alcoholic beverages, despite health problems and negative social consequences. Modern medical definitions describe alcoholism as a disease and addiction which results in a persistent use of alcohol despite negative consequences. In the 19th and early 20th centuries, alcoholism, also referred to as dipsomania described a preoccupation with, or compulsion toward the consumption of, alcohol and/or an impaired ability to recognize the negative effects of excessive alcohol consumption.
Although not all of these definitions specify current and on-going use of alcohol as a qualifier for alcoholism, some do, as well as remarking on the long-term effects of consistent, heavy alcohol use, including dependence and symptoms of withdrawal.
While the ingestion of alcohol is, by definition, necessary to develop alcoholism, the use of alcohol does not predict the development of alcoholism. The quantity, frequency and regularity of alcohol consumption required to develop alcoholism varies greatly from person to person. In addition, although the biological mechanisms underpinning alcoholism are uncertain, some risk factors, including social environment, stress, mental health, genetic predisposition, age, ethnicity and gender have been identified. Also, studies indicate that the proportion of men with alcohol dependence is higher than the proportion of women, 7% and 2.5% respectively, although women are more vulnerable to long-term consequences of alcoholism. Around 90% of adults in United States consume alcohol, and more than 700,000 of them are treated daily for alcoholism. Professor David Zaridze, who led the international research team, calculated that alcohol had killed three million Russians since 1987.
Classification
The definitions of alcoholism and related terminology vary significantly between the medical community, treatment programs, and the general public.
Medical definitions
The National Council on Alcoholism and Drug Dependence and The American Society of Addiction Medicine define alcoholism as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking." The DSM-IV (the dominant diagnostic manual in psychiatry and psychology) defines alcohol abuse as repeated use despite recurrent adverse consequences. It further defines alcohol dependence as alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink. (See DSM diagnosis below.) Within psychology and psychiatry, alcoholism is the popular term for alcohol dependence . Note that there is debate whether dependence in this use is physical (characterised by withdrawal), psychological (based on reinforcement), or both.
Terminology
Many terms are applied to a drinker's relationship with alcohol. Use , misuse , heavy use , abuse , addiction , and dependence are all common labels used to describe drinking habits, but the actual meaning of these words can vary greatly depending upon the context in which they are used. Even within the medical field, the definition can vary between areas of specialization. Because alcoholism is often used in a derogatory sense in politics and religion, the meanings of the words surrounding it are often used imprecisely.
Use refers to simple use of a substance. An individual who drinks any alcoholic beverage is using alcohol. Misuse , problem use , abuse , and heavy use do not have standard definitions, but suggest consumption of alcohol to the point where it causes physical, social, or moral harm to the drinker. The definitions of social and moral harm are highly subjective and therefore differ from individual to individual.
Moderate Use is defined by The Dietary Guidelines for Americans as no more than two alcoholic beverages per day for men and no more than one alcoholic beverage per day for women.
Within politics, abuse is often used to refer to the illegal use of any substance. Within the broad field of medicine, abuse sometimes refers to use of prescription medications in excess of the prescribed dosage, sometimes refers to use of a prescription drug without a prescription, and sometimes refers to use that results in long-term health problems. Within religion, abuse can refer to any use of a poorly regarded substance. The term is often avoided because it can cause confusion with audiences that do not necessarily share a single definition.
Remission is often used to refer to a state where an alcoholic is no longer showing symptoms of alcoholism. The American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of alcoholism are no longer evident, regardless of whether or not the person is still drinking. They further subdivide those in remission into early or sustained , and partial or full .
The term dipsomania is used in medical and psychiatric circles to identify a condition which is characterized by the uncontrollable craving for alcohol or other intoxicants, which manifests for unknown reasons, and can be confused with alcoholism.
Risk factors
About 40 percent of those who begin drinking alcohol before age 14 develop alcohol dependence, whereas only 10 percent of those who did not begin drinking until 20 years or older developed an alcohol problem in later life. Alcohol abuse during adolescence may lead to long-term changes in the brain which leaves them at increased risk of alcoholism in later years; genetic factors also influence age of onset of alcohol abuse and risk of alcoholism.
The age of onset of drinking as well as genetic factors are associated with an increased risk of the development of alcoholism. Age and genetic factors influence the risk of developing alcohol related neurotoxicity. Recent research has found that alcohol use at an early age may itself directly influence the risk of developing alcoholism via influencing the expression of genes which increase the risk of alcohol dependence. This increased risk may be due to the highly sensitive developing adolescent brain which leads to modulating of the genetic state of the brain which in turn primes the adolescent for increased risk of alcohol dependence. Individuals who have a pre-existing vulnerability to alcoholism are also more likely to begin drinking earlier than average. Genetic traits which influence the risk of the development of alcoholism are associated with a family history of alcoholism. The risk taking behavior associated with adolescence promotes binge drinking. About 40 percent of alcoholics were drinking excessively by late adolescence. Most alcoholics develop alcoholism during adolescence or young adulthood. Severe childhood trauma is also associated with an increased risk of alcohol or other drug problems. There is evidence that a complex mixture of genetic factors as well as environmental factors, e.g. stressful childhood events, influence the risk of the development of alcoholism. Genes which influence the metabolism of alcohol also influence the risk of alcoholism. Good peer and family support reduce the risk of alcoholism developing.
Signs and symptoms
Effects of long term alcohol misuse
Main article: Long-term effects of alcoholThe primary effect of alcoholism is to encourage the sufferer to drink at times and in amounts that are damaging to physical health. The secondary damage caused by an inability to control one's drinking manifests in many ways. Alcoholism also has significant social costs to both the alcoholic and their family and friends. Alcoholism can have adverse effects on mental health causing psychiatric disorders to develop. Approximately 18 percent of alcoholics commit suicide. Research has found that over fifty percent of all suicides are associated with alcohol or drug dependence. In adolescents the figure is higher with alcohol or drug misuse playing a role in up to 70 percent of suicides. Alcoholism also has a significant adverse impact on mental health. The risk of suicide among alcoholics has been determined to be 5,080 times that of the general public.
It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption may include cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources. Severe cognitive problems are not uncommon in alcoholics. Approximately 10% of all dementia cases are alcohol related making alcohol the 2nd leading cause of dementia.
Long term misuse of alcohol can cause a wide range of mental health effects. Alcohol misuse is not only toxic to the body but also to brain function and thus psychological well being can be adversely affected by the long-term effects of misuse. Psychiatric disorders are common in alcoholics, especially anxiety and depression disorders, with as many as 25% of alcoholics presenting with severe psychiatric disturbances. Typical
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