Alcoholism is the excessive consumption of alcohol which causes serious health issues. Alcoholism is associated with social, psychological and physical problems that require immediate medical attention. The public health effects of alcoholism are exacerbated further by the fact that these disorders can be chronic and therefore require constant vigilance by patients and those around them, as well as repeated intervention.
The psychological dependence on alcohol causes “ alcohol withdrawal syndrome” which is a psychiatric disorder seen when a patient try to quit the behaviour.
What are the criteria for alcohol dependence?
1.Narrowing of the drinking repertoire.
2.Tolerance of effect of alcohol.
3.Priority of drinking over other activities.
4.Repeated withdrawal symptoms.
5.Relief of withdrawal symptoms after drinking.
6.Subjective compulsion to drink
7.Reinstatement of drinking behaviour after stopping.
What are the clinical features of alcoholism?
1.Social problems :
Common features include absenteeism from work, unemployment, financial difficulties and problems with the law such as violence.
2.Low mood :
Alcohol has direct depressant effect on brain. Attempted and completed suicide are associated with alcohol misuse.
Anxious people consume alcohol for relieving anxiety, but this can later develop dependence on alcohol.
Patient with alcohol dependence experience auditory hallucination.
5.Alcohol-related brain damage :
It is often used as a collective description of the many brain pathologies associated with alcohol misuse. Acute alcohol intoxication causes ataxia, slurred speech, emotional instability and aggression. Heavy drinkers may experience amnesia.
6.Other medical issues like :
•Neurological : cerebral degeneration, dementia, cerebral haemorrhage.
•Hepatic : fatty change and cirrhosis.
•Gastrointestinal : oesophagitis, gastritis, pancreatitis, malabsorption.
•Skin : spider naevi, palmar erythema.
•Cardiac : hypertension, cardiomyopathy.
How to diagnose alcoholism?
Diagnosis of alcoholism is mainly based on patients history, but many patients do not tell the truth about their alcohol intake. Alcohol dependence commonly presents with withdrawal in those admitted to hospital.
CAGE questions will be helpful in taking history :
C – does ever try to cut down the amount of alcohol?
A – does the patient’s behaviour annoyed anyone?
G – does the patient feel guilty on drinking behaviour?
E – eye-opener that is, in the morning when patient wakes up he thinks of quitting alcohol.
How do we manage patients with alcoholism?
First, the doctor has to give clear information about the harmful effects of alcohol and safe levels of consumption. In serious cases, patient’s are advised to alter leisure activities or change jobs.
Alcohol withdrawal syndrome can be treated once established, with long-acting benzodiazepines. Large doses may be required. Example diazepam 20mg 4 times daily. The risk of side effects of benzodiazepines includes respiratory depression.
Acamprosate ( 666 mg 3 times daily) helps to maintain absenteeism by reducing the carving for alcohol.
Disulfiram is one main drug used to resist people from drinking after abstinent. If one consumes alcohol during this drug therapy, it will cause a unpleasant reaction which follows, with headache, flushing, nausea and vomiting.
Antidepressants are given if patient suffer from severe depression disorder.
The prognosis of the alcoholism after treatment is good with 80% - 90% cure rate without any significant complications.